16 Canine chronic gingivostomatitis
The dog was a retired racing greyhound. He had been with the owners for 3 months at the time of presentation to the referring veterinarian. The owners were concerned about halitosis and his eating habits. He was on a mixed dry kibble and moist canned food diet, but would only eat the moist food and would not eat every day, and never any large amounts. He had lost 2 kg in 3 months. The referring veterinarian diagnosed ‘severe periodontal disease’ and the dog received periodontal therapy (scaling and polishing), followed by a short course of antibiotics. This resulted in a reduction of the oral inflammation and increased appetite for a few weeks, after which both the halitosis and eating problems returned. The dog was then referred to us for investigation and treatment. Haematology and biochemistry screens were normal.
ORAL EXAMINATION – CONSCIOUS
Conscious oral examination was allowed, which revealed intense halitosis and gingivostomatitis (Fig. 16.1a). The mandibular lymph nodes were enlarged and seemed painful on palpation.
ORAL EXAMINATION – UNDER GENERAL ANAESTHETIC
A thorough oral examination, including investigating periodontal parameters, was performed and all findings were noted on the dental record.
In summary, examination under general anaesthesia identified the following:
All teeth were present and there were no clinical signs of periodontitis, so radiographs were not indicated at this stage.
Chronic gingivostomatitis (CGS) describes a clinical syndrome characterized by focal or diffuse inflammation of the gingivae and oral mucosa. While it is more common in cats, it also occurs in dogs.
It is thought to be an inappropriate response to oral antigens, namely bacterial plaque present on the tooth surfaces. While underlying vesiculo-bullous disease, e.g. pemphigus and pemphigoid or discoid lupus erythematosus (DLE), cannot be excluded, it is essential to have plaque control before these can be investigated.
In the dog, I approach CGS as follows: