gingival hyperplasia

Re: gingival hyperplasia

Anthony Dennison — Mon, 02 Mar 2015 16:56:41 GMT

[quote user="Martin Atkinson"]When they're 30 feet or more thats a lot of cutting back. Timber!!![/quote]

When I moved into my house just over 2 years ago there were about 8 30' leylandii along the back fence, they had grown outwards to the point where they were covering the hot tub in the back garden (main reason I liked the house...). I used some hedge trimmers to cut back the branches, but went too far back so it never regrew.

I managed to cut about 10' off the top of 3 of them myself, and obviously someone used to as well because after a certain height the trunks were splitting into smaller and smaller branches all over the place. Couldn't safely do the last 5, kept having a tree surgeon come round and off to sort it, held out until he offered to do it for £60 and leave the trunks for firewood.

Have barely scratched the surface of the amount of wood I got from it for my log burner!

Re: gingival hyperplasia

Martin Atkinson — Mon, 02 Mar 2015 16:30:14 GMT

[quote user="Anthony Dennison"]

[quote user="Martin Atkinson"]You clearly have slow growing Leylandi in your neck of the woods! Other than that I rest my case.[/quote]

Or do what I did, cut it back too far so it just dies and doesn't regrow...

[/quote]When they're 30 feet or more thats a lot of cutting back. Timber!!!

Re: gingival hyperplasia

Anthony Dennison — Mon, 02 Mar 2015 13:18:20 GMT

[quote user="Martin Atkinson"]You clearly have slow growing Leylandi in your neck of the woods! Other than that I rest my case.[/quote]

Or do what I did, cut it back too far so it just dies and doesn't regrow...

Re: gingival hyperplasia

Martin Atkinson — Mon, 02 Mar 2015 12:22:11 GMT

[quote user="Virginia Campbell"]It's like trimming a Leylandii hedge- you can knock four feet off it, and a year or two later you'll be back where you started.[/quote]You clearly have slow growing Leylandi in your neck of the woods! Other than that I rest my case.

Re: gingival hyperplasia

Evelyn Barbour-Hill — Sat, 28 Feb 2015 16:09:29 GMT

[quote user="Virginia Campbell"]It's like trimming a Leylandii hedge- you can knock four feet off it, and a year or two later you'll be back where you started.[/quote]

I like that. May I use it in the consulting room?

[quote user="Virginia Campbell"]I mean if you have one of those Boxer mouths where there is practically no normal gum. I trim back to as approximately normal as I can and maybe biopsy the biggest bit, one or two more representative looking bits and anything that doesn't look like the rest. But what should I do when it all grows back? Biopsy again? or just assume same as last time.[/quote]

It would be fair to assume nothing has changed.

But you should surely investigate fully the first time, for prognosis as much as anything.

Human dentists are pretty well obliged to take seriously even the teeniest of lesions – not obliged to biopsy necessarily, but obliged to take them seriously and monitor carefully.

Re: gingival hyperplasia

Virginia Campbell — Fri, 27 Feb 2015 23:01:07 GMT

I mean if you have one of those Boxer mouths where there is practically no normal gum. I trim back to as approximately normal as I can and maybe biopsy the biggest bit, one or two more representative looking bits and anything that doesn't look like the rest. But what should I do when it all grows back? Biopsy again? or just assume same as last time.

It's like trimming a Leylandii hedge- you can knock four feet off it, and a year or two later you'll be back where you started.

Re: gingival hyperplasia

Evelyn Barbour-Hill — Fri, 27 Feb 2015 22:53:11 GMT

[quote user="Virginia Campbell"]Suppose you find something nasty (I mean neoplastically nasty not dentigerous cysts) - what can you actually do about it?[/quote]

I dont really think that's an argument for not investigating.

[quote user="Virginia Campbell"]do you just keep on radiographing and biopsying multiple sites every few months forever? [/quote]

No, why would you? Sorry if I've missed something.

Re: gingival hyperplasia

Virginia Campbell — Fri, 27 Feb 2015 14:25:59 GMT

[quote user="Martin Atkinson"][quote user="Peter Southerden"]Typically in Boxers most of the enlargement is benign hyperplasia but because of the difficulty in distinguishing between these lesions based on appearance these lesions should be radiographed and biopsied.[/quote]Really? This condition is almost normal in Boxers IME. Surely X-raying and biopsying is a bit OTT unless they look really nasty and/or are causing the dog problems.[/quote]

Suppose you find something nasty (I mean neoplastically nasty not dentigerous cysts) - what can you actually do about it? The benign stuff grows back depressingly quickly and it all looks the same - do you just keep on radiographing and biopsying multiple sites every few months forever?

Re: gingival hyperplasia

Martin Atkinson — Fri, 27 Feb 2015 11:09:23 GMT

[quote user="Peter Southerden"]Typically in Boxers most of the enlargement is benign hyperplasia but because of the difficulty in distinguishing between these lesions based on appearance these lesions should be radiographed and biopsied.[/quote]Really? This condition is almost normal in Boxers IME. Surely X-raying and biopsying is a bit OTT unless they look really nasty and/or are causing the dog problems.

Re: gingival hyperplasia

Bob Russell — Fri, 27 Feb 2015 09:10:33 GMT

Biopsy punch followed by a bit of cautery.

Re: gingival hyperplasia

Evelyn Barbour-Hill — Fri, 27 Feb 2015 00:43:37 GMT

For those Boxer things you need to take a wedge with a scalpel going right down to bone. Sometimes you can't because the tissue is so tough or even ossified, but at least if you're struggling you know you're sampling the right tissue.

Come to think of it you could possibly do it with a Jamshidi type device and take a core. I've not tried that.

Re: gingival hyperplasia

Virginia Campbell — Thu, 26 Feb 2015 22:08:01 GMT

[quote user="Evelyn Barbour-Hill"]if your biopsy is too shallow, as mine were in early days, it will be reported as hyperplasia. "Too shallow" would include cutting off one of the more prominent bulges, instead of cutting deeply into the main mass.[/quote]

That's my vetsurgeon lesson of the day learned I always send off the most pleasingly shaped sticky-outy bulgy bits cos when I get closer to where I guesstimate the real gingival margin should be, I'm usually scraping and picking inelegantly with a scalpel or prodding with the electrocautery, trying not to score or cook the crowns or take too much gum off and expose bone. From now on I will treat the biopsy like a proper neoplastic lesion and dig deep for it like I would a suspected SCC in a cat's mouth, and never mind if it looks a bit ragged.

Re: gingival hyperplasia

emerald — Thu, 26 Feb 2015 19:59:41 GMT

I've seen a couple of Irish Setter's with this too. Actually biopsied 1 on Monday. Is this a predisposed breed?

Re: gingival hyperplasia

Nicola Cole — Thu, 26 Feb 2015 19:25:58 GMT

You mentioned that 2 had major cardiac issues-were they on a calcium channel blocker? (as this can apparently cause gingival hyperplasia). I've only seen severe gingival hyperplasia once in a dog and it was on amlodipine.

Re: gingival hyperplasia

Bob Russell — Thu, 26 Feb 2015 15:11:37 GMT

I have started to book more of these in for biopsy. The article in the Journal of Veterinary Dentistry was a bit scary and has made me rethink the 'its OK its an epulis'!

Rather gave up on the classification bits, above my paygrade!!

Re: gingival hyperplasia

Evelyn Barbour-Hill — Thu, 26 Feb 2015 12:09:58 GMT

[quote user="Peter Southerden"]Typically in Boxers most of the enlargement is benign hyperplasia[/quote]

I have biopsied the classic Boxer lumpy gums for years and the reports have always been "fibromatous epulis"or "peripheral ossifying fibroma" with or without "odontogenic", or whatever the pathologist chose to call it.... I'm not sure that all pathologists can tell the difference – maybe it's hard to tell – maybe they are basically the same thing – but I reckon they would be able to distinguish pure hyperplasia. Of course if your biopsy is too shallow, as mine were in early days, it will be reported as hyperplasia. "Too shallow" would include cutting off one of the more prominent bulges, instead of cutting deeply into the main mass.

Anyway, always biopsy, assuming you can (as you probably cannot, in the face of severe cardiac disease and owner reluctance), because as Peter implies it could be something nastier and you can't tell by looking.

If anyone is interested, there's an interesting pair of articles in the latest Journal of Veterinary Dentistry (vol 31 no.4) but after a first reading of part 1 my brain hurt and I was more confused than ever.

Re: gingival hyperplasia

Rob Davis — Thu, 26 Feb 2015 10:01:54 GMT

[quote user="James Laidlaw"]I had on that went for gingival resection with a dentist who discovered a dentigerous cyst that had never been picked up almost at the point of a fractured jaw![/quote]

I have had this too with a boxer booked in for gingivectomy/gingivoplasty. It had bilateral dentigerous cysts which were both due to supernumary lower premolars (rather unfair of the dog as it appeared to have the correct number of visible teeth!). Needless to say my lunch break disappeared that day....

[quote user="James Laidlaw"]Go to www.toothvet.ca and look under old cusp articles[/quote]

These articles are generally great - they cover a wide range of dental and oral issues and would recommend them to anyone who is interested in learning more about dentistry.

Re: gingival hyperplasia

Peter Southerden — Thu, 26 Feb 2015 09:36:19 GMT

Gingival enlargement is a difficult condition to deal with because it can encompass such a wide variety of conditions, some relatively benign such as gingival hyperplasia and peripheral ossifying fibroma where as Evelyn has said the main concern is periodontal disease and others more significant including benign odontogenic tumours (such as FEPO - fibromatous epulis of periodontal ligament origin, canine acanthomatous ameloblastoma) and other malignant non odontogenic tumours such as fibrosarcoma.

Typically in Boxers most of the enlargement is benign hyperplasia but because of the difficulty in distinguishing between these lesions based on appearance these lesions should be radiographed and biopsied.

Re: gingival hyperplasia

Evelyn Barbour-Hill — Thu, 26 Feb 2015 00:39:43 GMT

Boxers and certain related breeds. It's not gingival hyperplasia, in fact. It's peripheral odontogenic fibroma, and may or may not be ossifying (clinically it doesn't seem to make any difference). Some pathologists will insist on calling it fibromatous epulis.

It's a neoplasia arising from elements of periodontal ligament. Because of its nature, it is literally impossible to remove (unless you did a total gnathectomy..............). It is pretty difficult to even debulk or remove the obvious, because the fibrous tissue is very tough and often ossified. And of course if you debulk it grows again fairly quickly.

Despite its ugly appearance, its main significance to health is in the formation of "false pockets" –i.e. plaque traps – and the resultant secondary periodontal disease. Sometimes also I feel the smaller teeth, especially incisors, lose their bony support because of pressure, but they remain well supported by the neoplastic tissue.

I used to attempt heroic major debulking, but I rarely do that now. My approach is one of vigorous oral hygiene together with tactical debulking at certain points.

True gingival hyperplasia can be seen in any breed and can occasionally be dramatic. It seems to be one possible response by the gingiva to irritation. It is easy to excise and should be excised but this has to be done with competence lest the health of the gingiva be compromised.

Re: gingival hyperplasia

James Laidlaw — Thu, 26 Feb 2015 00:04:57 GMT

Excessive hyperplasia increases the depth of the gingival pocket or sulcus and so leads to usually and increased surface area of the crowns that can't be effectively cleaned. They're generally then more prone to plaque accumulation, tartar/calculus build up and periodontal disease. I had on that went for gingival resection with a dentist who discovered a dentigerous cyst that had never been picked up almost at the point of a fractured jaw! I think these are more of a problem than people suspect and treatment is a pain in the backside, bloody and a long operation where one needs to know what they are doing in order to treat properly. Go to www.toothvet.ca and look under old cusp articles link at top (after clicking the teeth to enter!) and there's a good article on it "gingival hyperplasia" and another called "focus on boxers" which is good too. Dentists might hopefully add their 2c as well soon enough.

Re: gingival hyperplasia

Stephen Courtney — Wed, 25 Feb 2015 21:19:52 GMT

Boxers get loads of blobby bits of hyperplastic gingiva that usually blend into epulides.

i had one dog on Atopica that got marked gingival hyperplasia - it is listed potential side effect - and she had the excess tissue removed surgically. Of course it grew back...she never minded it at all but it made her teeth look tiny, only little bits of the crowns were visible. i think hygeine would have been an issue but sadly she died of a GI tumour before any further dental procedures were needed.

Re: gingival hyperplasia

Martin Atkinson — Wed, 25 Feb 2015 19:00:19 GMT

[quote user="Alexa Bardell"]

I've done a quick trawl through previous posts and can't find any previous questions on this but I apologise if I've missed them

I have seen a few boxers and an irish setter recently with massive amounts of gingival hyperplasia- 1 of the boxers I could barely see any teeth in the mouth.

I was wandering if anyone knows what causes this and if it is possible to prevent it at all? I know I see it quite regularly in boxers but wandered what other people do to treat these? 2 of the cases I saw have major cardiac issues and owners are very reluctant to go for surgery at the moment. I have suggested chlorhexadine mouth rinses but couldn't really come up with anything else.

Any comments gratefully received

[/quote]Not seen it with any prevalence in Setters but it seems to be mandatory for Boxers. I've found surgery to be challenging as often they are very tough and fibrous, almost calcified on occasion. They don't seen to suffer too much increase in dental disease as a consequent of them IME so I would just advise dental prophylaxis in most cases.