Dry eye and dental disease

RE: Dry eye and dental disease

Hannah Wynne Richards — Wed, 09 Dec 2015 09:34:58 GMT

Martin I also hadn't heard of Sjorgren's syndrome. This forum is definitely worth CPD points!

Wynne

RE: Dry eye and dental disease

Rebecca Marchewka — Tue, 08 Dec 2015 17:08:34 GMT

[quote user="Andrew Kent"]

How high were the bile acids Rebecca?

[/quote]Bile acids were 213

RE: Dry eye and dental disease

Martin Atkinson — Tue, 08 Dec 2015 17:07:20 GMT

[quote user="Evelyn Barbour-Hill"]If the oral problem was really just periodontal disease and not part of Sjogren's syndrome....[/quote]I highlighted this from your post Evelyn as you are the person most able to answer on here but does Sjorgren's syndrome exist as such in animals? I have never considered it as a co-morbidity for keratitis sicca.

Indeed I'd never heard of Sjogren's syndrome until I started to suffer from a dry mouth to the point my lips stuck together at night, I had difficulty forming food boluses and swallowing and my tongue felt like a dry piece of felt! I've always had itchy eyes but attributed that to my contact lenses. Anyway Dr Google, the dentist, GP and specialist threw the word Sjogren's into the hat but offered nothing more that oral lubricants as a therapy although said specialist did say there are lots of things that can cause dry mouth (xerostomia to be medical), including diabetes, but it is often temporary. The dentist did warn me to be especially careful with my dental hygeine as tooth decay is very much accentuated by lack of saliva.

The long story is that it has gradually resolved and I think that there was an association with chlorhexidine mouth wash.

Bottom line is: is this something we should be looking for in dogs with KS especially as small brachycephalic dogs are over-represented and half of those have foul mouths at the best of times?

RE: Dry eye and dental disease

Andrew Kent — Tue, 08 Dec 2015 14:20:32 GMT

How high were the bile acids Rebecca?

RE: Dry eye and dental disease

Anthony Dennison — Tue, 08 Dec 2015 13:55:08 GMT

[quote user="Rebecca Marchewka"]

He has been losing weight and continues to be a quiet and old acting dog (he is 4) so I ran bloods and they have come back with high bile acids and normal liver enzymes. He has started on medical treatment treatment for a presumed portosystemic shunt and will see how he goes.

Not really sure how these things are linked, possibly a liver shunt has been the underlying issue all along.

[/quote]

You can get hepatocutaneous syndrome (disease? not sure of the exact name of it) where liver disease can cause crusting skin lesions around the muzzle.

RE: Dry eye and dental disease

Rebecca Marchewka — Tue, 08 Dec 2015 11:57:40 GMT

Hi, just thought people might be interested in what has happened with this dog.

I did skin biopsies which came back with demodex - some improvement with certifect but not great so have now started on aludex.

He has all his teeth apart from his canines extracted and his mouth is no longer a problem.

Not really sure how these things are linked, possibly a liver shunt has been the underlying issue all along.

Re: Dry eye and dental disease

Evelyn Barbour-Hill — Tue, 16 Dec 2014 18:55:48 GMT

Re: Dry eye and dental disease

Rebecca Marchewka — Tue, 16 Dec 2014 18:52:25 GMT

Just an update.

The dog came in 4 days ago with crusting and inflammation around lips and philtrum. Discussed biopsies with owner but cost becoming prohibitive. Started on prednisolone as looks suspicious of autoimmune disease. 4 days later (today) skin looks loads better.

Mouth so far so good. Being treated with maxi guard and aquadent at the moment with the hope of progressing to brushing.

Re: Dry eye and dental disease

Rebecca Marchewka — Tue, 09 Dec 2014 13:29:17 GMT

Thank you, yes that is the plan. He is coming in in a week or so so I will see how he is getting on.

Thanks again

Becky

Re: Dry eye and dental disease

Evelyn Barbour-Hill — Tue, 09 Dec 2014 13:12:25 GMT

[quote user="Rebecca Marchewka"]

The ANA test came back negative.

Becky

[/quote]

I guess you treat this as straightforward periodontal disease then.

Re: Dry eye and dental disease

Rebecca Marchewka — Tue, 09 Dec 2014 09:28:28 GMT

The ANA test came back negative.

Becky

Re: Dry eye and dental disease

Andrew Kent — Thu, 27 Nov 2014 21:03:26 GMT

I can't say Ive ever seen a case but have seen Biotene Gel suggested elsewhere

Andy

Re: Dry eye and dental disease

Rebecca Marchewka — Thu, 27 Nov 2014 20:02:40 GMT

No results yet. The side which i removed all the teeth from was really bad, I would say beyond 'normal' dental disease. The good side is,at the moment relatively normal. I will try and post pictures when I am at a computer.

Thank you for your help.

Becky

Re: Dry eye and dental disease

Evelyn Barbour-Hill — Thu, 27 Nov 2014 14:52:21 GMT

[quote user="Nicola Lawlor"]

Toothbrushing is going to be essential here for the remaining teeth or you will likely be back to square one with this side within a short period of time.

[/quote]

Yes but the OP seems to suggest the dog had started to resent brushing. Work very very gradually back toward brushing.

If the oral problem was really just periodontal disease and not part of Sjogren's syndrome, the edentulous areas are going to be the healthiest sites of all from now on. The other side had only "low grade gingivitis" and may never progress to worse than that.

Any test results yet?

Re: Dry eye and dental disease

Nicola Lawlor — Wed, 26 Nov 2014 22:53:53 GMT

Toothbrushing is going to be essential here for the remaining teeth or you will likely be back to square one with this side within a short period of time.

Re: Dry eye and dental disease

Rebecca Marchewka — Wed, 26 Nov 2014 21:10:22 GMT

One side of the mouth was awful - I extracted all of the teeth leaving only the canines and some incisors. The other side only had low grade gingivitis and some tartar. Sorry I can't work out how to upload the photos. I descaled and polished these teeth

I am hoping that with good management we will be able to preserve the remaining teeth as the dog is only 3 years old.

Thank you

Becky

Re: Dry eye and dental disease

Evelyn Barbour-Hill — Tue, 25 Nov 2014 23:09:22 GMT

[quote user="Rebecca Marchewka"]

Well, I have taken bloods for ANA antibodies and removed all the worst affected teeth. 4 days post dental treatment the dog is much happier and the mouth looks great. I would really appreciate any tips on how to maintain oral health in the longer term.

thank you

[/quote]

Good news!

[quote user="Rebecca Marchewka"] I would really appreciate any tips on how to maintain oral health in the longer term.[/quote]

Clearly, any of the "mouthwashes", probably one of the gels rather than actual liquid, would be good from the saliva deficiency point of view as well as the direct oral hygiene. There are various chlorhexidine ones, and another called Maxi-Guard (I think) which is based on zinc ascorbate. The owner can perhaps slobber this around with a finger, and eventually come to gentle brushing.

What did you do with the teeth that were not the worst affected but were not perfectly healthy either?

Re: Dry eye and dental disease

Rebecca Marchewka — Tue, 25 Nov 2014 08:55:24 GMT

thank you

Re: Dry eye and dental disease

Evelyn Barbour-Hill — Tue, 18 Nov 2014 23:02:56 GMT

Well, to me that gives you every reason for pursuing all the diagnostic tests.

Re: Dry eye and dental disease

Rebecca Marchewka — Tue, 18 Nov 2014 18:55:41 GMT

I appreciate that. I was just thinking that if he is going to lose all of his teeth anyway (which by the look of his mouth is likely) will he need long term medication.

Re: Dry eye and dental disease

Evelyn Barbour-Hill — Tue, 18 Nov 2014 18:16:45 GMT

[quote user="Rebecca Marchewka"] I don't really know whether chasing the diagnosis will change the management.[/quote]

Well, if you confirm a diagnosis of autoimmune disease you'll feel confident about starting immunosuppressive drugs, I guess.