Unexplained oral pain/inflammation in a WHWT

RE: Unexplained oral pain/inflammation in a WHWT

Bob Russell — Tue, 10 Nov 2015 09:46:14 GMT

[quote user="Anthony Todd"]

[quote user="Holly Lee"]I am a little bit stumped and concerned that we have not really found a source of the pain and discomfort[/quote]

Just sounds like discomfit from the gums to me?

Surely, with TMJ pain, you'd get a significant response if you opened the jaws real wide!!?

[/quote]

Not clear if anyone has tried! Yes I would expect a lot of resistance to attempts to open the mouth (or an inability to do so).

RE: Unexplained oral pain/inflammation in a WHWT

Richard Carter — Tue, 10 Nov 2015 09:44:41 GMT

[quote user="Anthony Todd"]That would be continuous, though[/quote] - no the running red eyes was transient and was related to food intake - as the food was digested/ processed, presumably the uraemia would deteriorate and various vagal innervations affected. Anyway Prof Williams at Cambridge got quite excited as there is a similar condition in humans apparently.

RE: Unexplained oral pain/inflammation in a WHWT

Holly Lee — Mon, 09 Nov 2015 17:20:32 GMT

I'm assured blood tests were all normal. The owner today told me that rubbing logic gel into the gums seems to have helped a little but given the fluctuation this may be coincidental.

Due to the owners location I have referred them back to the original vet for further work up, which to be honest is both a relief and a frustration.

I felt that if he was rubbing his face for another reason the redness could be secondary. Certainly getting photos or closer monitoring would have been useful and some type of allergic reaction is definitely a consideration given the fluctuation.

Apologies I may not be able to offer any follow-up for this case but I do greatly appreciate everyones replies.

Holly

RE: Unexplained oral pain/inflammation in a WHWT

Anthony Todd — Mon, 09 Nov 2015 17:18:23 GMT

[quote user="Evelyn Barbour-Hill"]

Yes, but we haven't found the source of it!

We aren't even certain that the "red gums" when they occur (if they occur) are the cause or the effect.

[/quote]

Doesn't the dog's discomfit coincide with the red gums? When the redness goes so does the discomfit?

I really doubt that the dog's rubbing it's cheeks on the ground could make the gums go red in the manner described?

Surely there would be redness on the inner lips rather than the gums?

Do an image search for allergic gingivitis in people, which is what it sounds like to me.

https://www.google.co.uk/search?q=allergic+gingivitis&espv=2&biw=1680&bih=949&source=lnms&tbm=isch&sa=X&ved=0CAYQ_AUoAWoVChMIj7OKl-yDyQIVx28UCh0f3ggI

All I'm suggesting is that it's something that the gums come in contact with but only in the morning.

Could be anything?

Sorry see this: https://en.wikipedia.org/wiki/Plasma_cell_gingivitis

RE: Unexplained oral pain/inflammation in a WHWT

Evelyn Barbour-Hill — Mon, 09 Nov 2015 16:36:17 GMT

[quote user="Anthony Todd"]

[quote user="Holly Lee"]I am a little bit stumped and concerned that we have not really found a source of the pain and discomfort[/quote]

Just sounds like discomfit from the gums to me?

[/quote]

Yes, but we haven't found the source of it!

We aren't even certain that the "red gums" when they occur (if they occur) are the cause or the effect.

RE: Unexplained oral pain/inflammation in a WHWT

Anthony Todd — Mon, 09 Nov 2015 15:34:46 GMT

[quote user="Holly Lee"]I am a little bit stumped and concerned that we have not really found a source of the pain and discomfort[/quote]

Just sounds like discomfit from the gums to me?

Surely, with TMJ pain, you'd get a significant response if you opened the jaws real wide!!?

RE: Unexplained oral pain/inflammation in a WHWT

Anthony Todd — Mon, 09 Nov 2015 14:22:07 GMT

[quote user="Richard Carter"]Had a GSD with red eyes and gums turned out to have renal problems[/quote]

That would be continuous, though, and this goes away during the day so I'd guess it is something that contacts the gum in the morning and passes off as the contact stops.

Contact allergies in the gums in humans are not unknown [eg toothpaste etc.]

As the reaction gets better during the day, unless, sorry again if you have the dog on continuous pred, or any steroid, you won't be able to do any sort of elimination trial.

[sorry, edited, got my "worse" and "better" wrong way round.... and the rest too!]

Will the owners follow any sort of elimination trial but?

I think the retained roots are a red herring.

RE: Unexplained oral pain/inflammation in a WHWT

David Mills — Mon, 09 Nov 2015 13:17:15 GMT

Does sound odd. Depends on how veracious the owner is being (which if its a new client you may not be able to judge). You could always offer to have the dog in for the day (FOC) to see if what happens actually happens. That, or trial preds.

RE: Unexplained oral pain/inflammation in a WHWT

Richard Carter — Mon, 09 Nov 2015 12:34:05 GMT

Calcium/phos levels/ renal parameters/ post prandial inflammation if hepatic?

Had a GSD with red eyes and gums turned out to have renal problems

RE: Unexplained oral pain/inflammation in a WHWT

Lucy Fleming — Mon, 09 Nov 2015 12:26:31 GMT

[quote user="Holly Lee"]The owner is a long way out from us and grumbles about coming in so not sure we're going to get to see it at it's worst - it is difficult to assess exactly what it looks like when bad.[/quote]

Would they maybe be able to take some photographs during an episode then? Might not give much more information, but possibly worth a try?

RE: Unexplained oral pain/inflammation in a WHWT

Bob Russell — Mon, 09 Nov 2015 11:50:38 GMT

If the original practice has done any investigation and or scale and polish then this might be two indirectly linked and temperomandibular joint pain would be high up my list. Prolonged use of a gag could aggravate the joints.

Possible that the gingivitis and dental problems are not related at all to the site of pain. If only they could talk!!!

RE: Unexplained oral pain/inflammation in a WHWT

Hannah Wynne Richards — Mon, 09 Nov 2015 11:20:37 GMT

You can only do what an owner allows you to do.

Wynne

RE: Unexplained oral pain/inflammation in a WHWT

Holly Lee — Mon, 09 Nov 2015 11:13:28 GMT

Thank you both very much for your replies.

I don't unfortunately have access to the full records however the owner assures me the dog has not had extractions at the back. The gum is completely healed and smooth overlying the site with no outward sign of a problem.

Allergy is definitely a consideration - not something I'd considered.

The owner is a long way out from us and grumbles about coming in so not sure we're going to get to see it at it's worst - it is difficult to assess exactly what it looks like when bad.

Thanks again for the replies,

Holly

RE: Unexplained oral pain/inflammation in a WHWT

Lindsey Edwards — Mon, 09 Nov 2015 01:01:16 GMT

Are the signs associated with food or any other routines in the house such as cleaning? Could it be a contact/inhalant allergen inciting a hypersensitivity reaction?

RE: Unexplained oral pain/inflammation in a WHWT

Evelyn Barbour-Hill — Sun, 08 Nov 2015 23:33:25 GMT

Hmm, a bit challenging.

[quote user="Holly Lee"]Whenever I have examined the dog his gums appear normal but the owner describes all of his gums on both sides of the mouth becoming bright red and inflammed and him being sore and rubbing at his face, predominantly at the back of the mouth,[/quote]

I know it can be difficult, but see if you can get the owner to bring the dog when he is in such an episode. It may not be quite as the owner describes it.....

[quote user="Holly Lee"]could it be TMJ pain? neuropathic? [/quote]

Yes, perhaps, but why would that make his gums bright red?

[quote user="Holly Lee"]Should we try antibiotics for gingivitis but then why would it not be red all the time, and cleaning the teeth hasn't helped?[/quote]

Well, hang on a minute, he hasn't got gingivitis; and if he did, antibiotic drugs would not be the treatment.

[quote user="Holly Lee"] could those tooth roots explain the whole thing?[/quote]

I'm at a loss as to how they could be responsible for the whole thing, but you never know. Do you happen to know if they were left behind after an "extraction", or was the rest of the tooth lost to caries, or something else? Is the overlying gum healed and firm, or is there any suspicion, even slight, of a persistent sinus? If the latter, best to get them out, but the owner must understand that this may not cure the main problem.

If the gums really do get bright red and inflamed both sides.... and I confess I'm a little sceptical here.... and it comes and goes so quickly, perhaps there is an immunological problem. Some appropriate blood tests would do no harm. If the owner is ready to spend some money, maybe a CT scan: it might pick up some undetected TMJ problem or some soft tissue lesion.

Facial pain is difficult to investigate sometimes, even in humans who can describe and localise the pain!