Gingivitis in a young labrador

Re: Gingivitis in a young labrador

Gerry Henry — Fri, 05 Jun 2015 08:39:36 GMT

[quote user="Rob Davis"]

[quote user="Gerry Henry"]

Saw a dog ages ago with similar that I referred to Norman Johnston. Seem to recall it had an abnormal reaction to very small amounts of plaque, CUPS rings a bell.

[/quote]

With CUPS you will have obvious inflammation including ulceration on the labial mucosa adjacent to the tooth surfaces.

[/quote]

Yes as I recall we did.

Re: Gingivitis in a young labrador

Evelyn Barbour-Hill — Thu, 04 Jun 2015 23:02:51 GMT

[quote user="Rebecca Benge"]

Saw her back today for a re-check - her mouth looks completely normal now! No odour and no inflammation. My plan is to implement teeth brushing and chlorhex rinses at home and see how she goes.

Just seems quite a severe reaction (drooling, smell, bit of bleeding) for really quite minimal tartar. I'm pleased she's much better anyway!

[/quote]

There you go see!

PS. Did you mean tartar? At the risk of boring everyone silly can't resist pointing out again that tartar is not pathogenic and the quanttity present has no relation to periodontal health.

Sorry! Sorry! Sorry!

Re: Gingivitis in a young labrador

Francisco Gomez — Thu, 04 Jun 2015 21:48:05 GMT

[quote user="Rob Davis"]

But would you expect to get a uraemic halitosis in the absence of uraemia?

[/quote]

Hmmm.. Good point. Difficult to interpret when you don't have the numbers in front of you.

[quote user="Rebecca Benge"]

Hmmmm no inflammation in the mucosa and no ulceration on the tongue.

I'm pleased she's much better anyway!

[/quote]

I'm glad your patient's better!

Re: Gingivitis in a young labrador

Rebecca MacMillan — Thu, 04 Jun 2015 21:43:19 GMT

Hmmmm no inflammation in the mucosa and no ulceration on the tongue.

Saw her back today for a re-check - her mouth looks completely normal now! No odour and no inflammation. My plan is to implement teeth brushing and chlorhex rinses at home and see how she goes.

Just seems quite a severe reaction (drooling, smell, bit of bleeding) for really quite minimal tartar. I'm pleased she's much better anyway!

Re: Gingivitis in a young labrador

Anthony Todd — Thu, 04 Jun 2015 17:58:08 GMT

[quote user="Francisco Gomez"]The other thing to consider is that I've seen many dogs with a rotten smell when they have a foreign body (just like when you suspected the dog might have something stuck in the mouth).[/quote]

Halitosis probably but a concurrent severe gingivitis??

Re: Gingivitis in a young labrador

Rob Davis — Thu, 04 Jun 2015 17:50:08 GMT

[quote user="Gerry Henry"]

Saw a dog ages ago with similar that I referred to Norman Johnston. Seem to recall it had an abnormal reaction to very small amounts of plaque, CUPS rings a bell.

[/quote]

With CUPS you will have obvious inflammation including ulceration on the labial mucosa adjacent to the tooth surfaces.

[quote user="Francisco Gomez"]I don't disagree with the other responses but if the case is still a bit of mystery, I would check a couple of things: Even with a biochemistry wnl, you'd still can suffer from renal disease.[/quote]

But would you expect to get a uraemic halitosis in the absence of uraemia?

Re: Gingivitis in a young labrador

Gerry Henry — Thu, 04 Jun 2015 08:15:32 GMT

Saw a dog ages ago with similar that I referred to Norman Johnston. Seem to recall it had an abnormal reaction to very small amounts of plaque, CUPS rings a bell.

Re: Gingivitis in a young labrador

Francisco Gomez — Thu, 04 Jun 2015 08:09:00 GMT

My opinion for what is worth:

I don't disagree with the other responses but if the case is still a bit of mystery, I would check a couple of things: Even with a biochemistry wnl, you'd still can suffer from renal disease. Would suggest checking an urine sample which is cheap and quick. How is creatinine? According to IRIS, >150mmol/l you can still suffer from renal issues, but according to our IDEXX machine, this is WNL. IRIS website page 5 CKD. I appreciate the patient is not old enough, but an undetected and resolved case of poisoning or a congenital deficiency could explain some of the signs. [All assuming the smell can be considered uremic, although I understand you can't post the smell in the forum, like Evelyn says ]

The other thing to consider is that I've seen many dogs with a rotten smell when they have a foreign body (just like when you suspected the dog might have something stuck in the mouth). I've met a few patients with a foreign body in the stomach that doesn't cause obstruction or vomiting for several days until the patient become ill or it eventually vomits it back. If costs and skills are not an issue, some of them can be found easily in the stomach by means of an ultrasound. Failing that, and if the patient needs another GA, perhaps endoscopy.

... or maybe I'm just clutching at straws...

Re: Gingivitis in a young labrador

Evelyn Barbour-Hill — Wed, 03 Jun 2015 23:34:00 GMT

[quote user="Rebecca Benge"]Probing was 1-2 mm in most locations, up to 3mm around the lower canines.[/quote]

Hmm, 3 on the canines counts as "normal", 1-2mm elsewhere could be showing a little loss..... 1mm could be normal, 2mm slightly abnormal....

Subgingival irrigation:

don't put chlorhexidine in the scaler water unless a) you know for certain that the scaler can stand it and you are sure you are using the correct solution; and b) you are using a scaler designed to work safely subgingivally, susch as the iM3/Odontoson.

Easier and safer: use an ordinary 2 to 10ml syringe, with a 25g needle on it if you are tightfisted but prepared to be careful, or a blue Portex "irrigating cannula" to be safe. Dilute chlorhexidine and, er, irrigate!

Could you post a sample of the odour on the forum?

Re: Gingivitis in a young labrador

Anthony Todd — Wed, 03 Jun 2015 22:37:01 GMT

[quote user="Rebecca Benge"]It's just bizarre quite how much this dogs breath smelt,[/quote]

This rings a vague bell with me and I seem to remember just changing the dog's diet or experimenting with change made a big difference in the dog I remember.

This is about my vintage....

.. While numbers were small, dogs on hard food retained essentially normal teeth and gums, and
those on soft food developed gingivitis, plaque and calculus. Krasse and Brill (1960) compared
a diet requiring mastication (biscuit plus boiled bovine trachea) with the same food ...

and may be relevant. [Googled "diet and gingivitis"]

Re: Gingivitis in a young labrador

Rebecca MacMillan — Wed, 03 Jun 2015 22:00:29 GMT

Thanks for your reply

Probing was 1-2 mm in most locations, up to 3mm around the lower canines.

The only thing I didn't do was the subgingival chlorhexidine irrigation? Sorry if it sounds daft, but how do you do that? Do you put a dilute chlorhex solution in the water container for the de-scaler?

It's just bizarre quite how much this dogs breath smelt, I was quite worried about what I would find under GA!

Re: Gingivitis in a young labrador

Evelyn Barbour-Hill — Tue, 02 Jun 2015 16:18:12 GMT

Pragmatic approach. You've covered everything so far and you've examined very carefully. I presume your scale and polish included probing (were there any significant probing depths?) and subgingival chlorhexidine irrigation.I do think you should initiate toothbrushing and/or chlorhexidine rinses. Then if there isn't a vast improvement in two or three weeks you can start hunting for mysterious metabolic or immunological causes, radiography, whatever.

I don't think gastric reflux would cause this, but if anyone knows differently I would be pleased to be corrected.