July 2009
Dr Gerhard Steenkamp

This 7-year old Boxer is presented with a complaint of bad breath (halitosis).  On clinical examination you find these lesions affecting all four quadrants of the dog’s mouth.

1. What is the clinical differential diagnosis?
2. Is treatment indicated in this case, or not?  Defend your answer.
3. What is the correct management of a case like this?

Memo:

1. The only clinical diagnosis you can make is that of diffuse gingival hyperplasia (gingival overgrowth) affecting all four quadrants.  A number of pathological lesions can result in the gingiva having a clinically hyperplastic appearance and the true diagnosis can only be made on microscopic examination of all the hyperplastic gingiva.

2. Treatment, consisting of surgical resection (gingivectomy) is indicated as these hyperplastic gingiva forms pseudopockets (viz periodontal pockets, Vetnews-May 2009) which in turn increase the risk of periodontitis around these teeth.  More reasons for treatment are discussed in the next paragraph.

3a. All the hyperplastic gingiva should be surgically resected using the correct
surgical techniques to retain the normal gingival architecture. Resecting too much of the soft tissue around the teeth may result in gingival recession which will have an unacceptable appearance to the owner and also result in possible tooth sensitivity due to the exposure of root dentin.  Dentin has a much softer and porous nature than enamel and will also discolour very quickly and be more prone to caries, depending on the dog’s diet.  This area, devoid of the normal gingival architecture may also predispose the tooth to periodontal disease.

b.  Furthermore all the soft tissue removed should be sent for microscopic
examination, individually labelled.  Although gingival hyperplasia may only be a reaction of the gingival soft tissue to bad oral hygiene (plaque and calculus), it is our experience that a variety of neoplasms may actually also be present in the hyperplastic tissue.

We have seen cases where, apart from reactive inflammatory gingival hyperplasia associated with some teeth, the dog also had early acanthomatous epuli, peripheral odontogenic fibromas, peripheral ossifying fibromas and fibrous epuli associated with some of the other teeth in the same quadrant.  Although many of  these are small non-neoplastic hyperplastic conditions, neoplasms such as acanthomatous epuli may end up becoming large destructive masses which will result in the dog needing a partial or even complete jaw resection.  As the case is
for any neoplasm, the earlier it is detected the earlier it can be removed with little or no involvement of the underlying jaw bone.

c. Once the resection is complete, all the teeth should be scaled and polished and  dental pathology addressed as necessary.