Management of Severe Periodontal Disease and Gingival Enlargement in a Dwarf Mongoose (Helogale parvula).

Development of gingival enlargement and periodontitis is described in a young dwarf mongoose. Repeated treatments resulted in gingival resection and histologic evaluation however gingival enlargement was ultimately responsive to extraction of associated teeth. In cases such as these, surgical extraction of teeth associated with severe recurrent gingival enlargement should be considered to avoid the stress and risk of repeated immobilizations.

Oral masses in African pygmy hedgehogs.

African pygmy hedgehogs (Atelerix albiventris) frequently develop oral neoplasms, and most of these neoplasms are malignant. We characterized oral masses detected in hedgehogs at clinical examination. During a 1-y period, we diagnosed oral cavity masses in 27 privately owned hedgehogs; 16 were female and 11 were male, with ages of 2-7 y (mean: 4.3 y). Eight masses were non-neoplastic and were diagnosed as gingival hyperplasia (GH). Nineteen masses were neoplastic, of which 17 were squamous cell carcinomas (SCCs) and 2 were mesenchymal tumors (1 spindle cell tumor of probable neural origin, and 1 hemangiosarcoma). The GHs were noninvasive, exophytic, and did not recur after surgical excision. The SCCs were highly invasive tumors that induced facial deformation and were located in the caudal portion of the oral cavity, with 12 of them arising from the right-caudal maxilla. Thus, clinical signs, growth pattern, and anatomic location can be used to suspect a diagnosis of SCC among the other possible diagnoses, such as GH, in this location. However, histopathology is necessary for confirmation. Also, hemangiosarcoma should be considered among the differential diagnoses.

Genome-wide expression analysis of hereditary hyperplastic gingivitis in silver foxes (Vulpes vulpes) using canine microarrays.

Hereditary hyperplastic gingivitis (HHG) is an autosomal recessive condition found predominantly in farmed silver foxes, first documented in Europe in the 1940s. Hereditary gingival fibromatosis (HGF) is an analogous condition occurring in humans. HGF has a heterogeneous aetiology with emphasis placed on the autosomal dominant forms of inheritance for which there are three known loci: HGF1, HGF2, and HGF3. Among these, only one causative mutation has been determined, in the Son of sevenless homolog 1 (SOS1) gene. The goal of this study was to explore potential molecular or cellular mechanisms underlying HHG by analysis of global gene expression patterns from Affymetrix Canine 2.0 microarrays cross-referenced against candidate genes within the human loci. We conclude that the SOS1 gene involved in HGF1 is not significantly up-regulated in HHG. However, the structurally and functionally similar SOS2 gene is up-regulated in affected foxes, and we propose this as a candidate gene for HHG. At HGF2 we identify RASA1 (rat sarcoma viral p21 protein activator 1) as a candidate gene for HHG, as it is up-regulated in affected foxes and is involved in MAPK signalling. From comparison to the genes within the HGF3 locus, we find evidence for a role of androgens in HHG phenotype severity by differential up-regulation of SRD5A2 in HHG-affected foxes. We hypothesize that the putative mutation occurs upstream of RAS in the extracellular signal-regulated kinase component of MAPK signalling.

Gingival overgrowth in a dog that received long-term cyclosporine for immune-mediated hemolytic anemia.

Gingival mass lesions developed when cyclosporine was administered for 600 days to a female, 7-year-old, longhaired dachshund diagnosed with intractable immune-mediated hemolytic anemia (IMHA). Histopathology indicated hyperplastic suppurative gingivitis. As the anemia improved, the dosage of cyclosporine A (CsA) was markedly decreased, and the mass lesions decreased in size and disappeared, thus suggesting that the mass lesions were an adverse reaction to CsA.

Amlodipine-induced gingival hyperplasia in a Great Dane.

A 3 yr old, 70 kg (154 lbs) female spayed Great Dane developed gingival hyperplasia after treatment of systemic hypertension with amlodipine 7.5 mg q 12 hr for 16 mo. Physical examination was unremarkable except for systemic hypertension and severe gingival hyperplasia. Amlodipine was replaced with hydralazine (0.72 mg/kg [0.32 mg/lb]). Nine months later, gingival hyperplasia was nearly resolved and hypertension was well controlled. Calcium channel blockers such as amlodipine are a rare cause of gingival hyperplasia in the canine patient. Recognition of this side effect is important because a full recovery can be achieved when the offending agent is removed.

Clinicopathologic characterization of odontogenic tumors and focal fibrous hyperplasia in dogs: 152 cases (1995-2005).

OBJECTIVE: To characterize clinicopathologic features of the most common odontogenic tumors and focal fibrous hyperplasia (FFH) in dogs. DESIGN: Retrospective case series. ANIMALS: 152 dogs evaluated for oral tumors of possible odontogenic origin at the William R. Pritchard Veterinary Medical Teaching Hospital of the University of California-Davis between 1995 and 2005. PROCEDURES: Information was collected from records, including dog breed, age, reproductive status, and location of lesion in the oral cavity. Histologic slides pertaining to each dog were reviewed by 3 investigators. Data regarding clinicopathologic features of the 3 most common lesions (canine acanthomatous ameloblastoma [CAA], peripheral odontogenic fibroma [POF], and FFH) were summarized. RESULTS: 152 dogs with odontogenic tumors or FFH were identified. Sixty-eight (45%) dogs had CAA, 47 (31 %) had POF, 24 (16%) had FFH, and 13 (9%) had other odontogenic tumors. Canine acanthomatous ameloblastoma was present most commonly in the rostral aspect of the mandible, with POF and FFH more common in the rostral aspect of the maxilla. Males and females were equally represented among dogs with CAA and FFH. Castrated males were overrepresented among dogs with POF. Golden Retrievers, Akitas, Cocker Spaniels, and Shetland Sheepdogs were overrepresented among dogs with CAA. No breed predisposition was detected for FFH or POF. Dogs with FFH had a greater mean age at initial evaluation than did dogs with CAA or POF. CONCLUSIONS AND CLINICAL RELEVANCE: CAA, POF, and FFH have distinct clinical patterns that may help clinicians and pathologists identify such lesions more readily.

Gingival hyperplasia associated with the administration of amlodipine to dogs with degenerative valvular disease (2004-2008).

BACKGROUND: Calcium channel blocking drugs, usually nifedipine and less often amlodipine, have been reported to cause gingival hyperplasia (GH) in humans. HYPOTHESIS: Amlodipine, a dihydropyridine calcium channel blocking drug, can cause GH when administered chronically to older small dogs with degenerative valvular disease. ANIMALS STUDIED: From January 2004 to May 2008, 82 client-owned dogs with degenerative valvular disease and left atrial dilatation were treated with amlodipine in combination with spironolactone and enalapril and followed for >6 months. METHODS: Retrospective study. A chronological observation of GH in 2 dogs treated with amlodipine in 2004 and 2006 prompted the study. Patient histories and medical records of each dog treated with amlodipine for degenerative valvular disease from January 2004 to May 2008 were reviewed. RESULTS: GH was observed by clients and the authors in 7 of 82 (8.5%) dogs. Histologic confirmation of the diagnosis was made in 2 dogs. The minimum duration of treatment before diagnosis of GH was 5 months. GH began to resolve within 2 weeks of discontinuing amlodipine and resolution was complete within 6 months. Amlodipine administration was reinstituted in 1 dog in which GH had resolved, and GH reoccurred within 4 months. CONCLUSION AND CLINICAL IMPORTANCE: Long-term administration of amlodipine to dogs with degenerative valvular disease may cause GH in a small percentage of patients. GH resolves quickly after withdrawal of amlodipine treatment.

Gingival overgrowth in dogs associated with clinically relevant cyclosporine blood levels: observations in a canine renal transplantation model.

OBJECTIVE: To investigate the development of gingival hyperplasia in dogs after renal transplantation and administration of microemulsified cyclosporine A (MCsA). STUDY DESIGN: Experimental study. ANIMALS: Healthy adult mongrel dogs (n=5). METHODS: As part of study on renal transplantation, dogs administered MCsA (20 mg/kg/day), azathioprine, and prednisolone to prevent graft rejection were monitored for development of gingival changes. Prednisolone was discontinued after 3 months. MCsA dose was adjusted to maintain whole blood trough concentration of 400-700 ng/mL. Gingival change was evaluated by weekly examination and photodocumentation, and gingival biopsy for histopathology was performed at 28 weeks. RESULTS: One dog was lost because of acute graft rejection. Gingival hyperplasia developed in 3 of 4 dogs. The earliest gingival changes occurred in the interdental papillae at 20 weeks after transplantation. On histopathology, the underlying connective tissue was thickened and contained increase numbers of fibroblasts and inflammatory infiltrates. CONCLUSIONS: Long-term immunosuppression with an MCsA-based treatment likely induces substantial gingival hyperplasia when therapeutic, immunosuppressive blood levels of MCsA were maintained for 32 weeks. CLINICAL RELEVANCE: MCsA is used for immune-mediated diseases and preventing rejection after transplant in dogs. MCsA blood levels, and gingival hyperplasia should be monitored by routine examination of the interdental papilla in dogs administered MCsA for long periods.

Management of generalized gingival enlargement in a dog--case report and literature review.

The present report describes treatment of a dog with generalized gingival enlargement and serves as a review of etiology and treatment options for this condition. The combined use of scalpel blade, electrosurgical equipment, and a 12-fluted bur on a high-speed handpiece with water irrigation allowed for accurate excision of excess gingival tissue and contouring of remaining gingiva. Surgery coupled with professional dental cleaning/periodontal therapy can decrease the recurrence of this condition. In addition, home oral hygiene is an important component of the treatment plan. The history of patients with gingival enlargement should be reviewed carefully, including drug history and previous medical conditions, in an attempt to elucidate a specific cause and thus allow for greater long-term success.

Malignant tumor formation in dogs previously irradiated for acanthomatous epulis.

In this retrospective study of 57 dogs irradiated for oral acanthomatous epulis, 2 (3.5%) dogs developed a second tumor (sarcoma, osteosarcoma) in the radiation treatment field at 5.2 and 8.7 years after the end of radiation therapy. As opposed to previous reports, no second epithelial tumors developed in the radiation treatment field. There is a risk of radiation-induced carcinogenesis, but it appears that it is a relatively low risk and an event that occurs years after radiation therapy. Radiation-induced tumors are of more concern in younger dogs that undergo radiation therapy for tumors that are radioresponsive, such as acanthomatous epulis, where long-term survival is expected. The only statistically significant variable in the survival analysis was age, with dogs less than 8.3 years old having a significantly longer median overall survival (2322 days) than dogs older than 8.3 years (1106 days; P<0.0001).

Diagnostic value of magnetic resonance imaging and computed tomography for oral masses in dogs.

The purpose of this study was to determine the diagnostic value of magnetic resonance imaging (MRI) and computed tomography (CT) in oral masses of dogs. Nineteen dogs underwent clinical, MR and CT examinations. Eleven malignant and ten non-malignant masses were evaluated. Osteosarcoma was the most commonly found malignant oral mass and gingival hyperplasia was the most commonly found benign mass. The results showed that MRI provided more accurate information regarding the size of the masses and invasion of adjacent structures although MRI and CT show similar accuracy in assessment of bone invasion. Calcification and cortical bone erosion was better seen on CT images. Whereas contrast-MRI provided useful additional information, contrast-CT had no added benefit. In general, oral masses located in the caudal mandible, oropharynx and maxilla are better evaluated using MRI, once the histological type has been verified.

Simultaneous hyperplasia, metaplasia, and neoplasia in an 8 year-old boxer dog: a case report.

Generalized gingiva hyperplasia and multiple gingival masses were observed in an 8 year-old boxer dog. The masses were removed surgically. Three of them were biopsied. Microscopic examination was reported as fibrous gingival hyperplasia, fibrous epulis with osseous metaplasia, and mast cell tumor. Twenty-two months following surgery, moderate generalized gingival hyperplasia was present, with no clinical evidence of regrowth of the neoplasms.

Pathophysiology of acquired dental diseases of the horse.

Periodontitis, infundibular necrosis, and periapical infection are dental diseases commonly affecting adult horses. Routine dental examinations and care may help to prevent these diseases. Further investigation of the treatment of horses with these diseases using local antimicrobial therapy, restorative dentistry, and endodontic therapy is needed. An understanding of the pathogenesis of these diseases aids in diagnosis and treatment. Gingival hyperplasia and odontogenic tumors are uncommon but should remain in a list of differential diagnoses when examining a horse with pertinent clinical signs. Recognition of odontogenic tumors as early as possible may facilitate surgery. Examination of the oral cavity of foals beyond the neonatal period should allow identification of brachygnathia and timely treatment when indicated.

Epulides in the dog: a review.

This article is based on a review of the literature and the study of pathology sections obtained from various veterinary pathology laboratories. Epulis is a non-specific, clinical designation for a localized, exophytic growth on the gingiva. Four reactive epulides occur in human beings, namely focal fibrous hyperplasia (fibrous epulis), pyogenic granuloma, peripheral giant cell granuloma (giant cell epulis), and peripheral ossifying fibroma (calcifying fibrous epulis). The first three also occur in dogs but only focal fibrous hyperplasia appears to be common. The peripheral ossifying fibroma has not yet been reported in dogs. Odontogenic tumors occurring on the gingiva (i.e., as epulides) are referred to as peripheral odontogenic tumors. Three types have been reported in dogs. One, the common fibromatous epulis, is equivalent to the rare peripheral odontogenic fibroma in human beings. Another, the acanthomatous epulis, appears to be a form of ameloblastoma but differs from the peripheral ameloblastoma in human beings in that it invades bone; its biological behavior is therefore that of the human intraosseous ameloblastoma. The third, a rare lesion, has been referred to in the veterinary literature as a calcifying epithelial odontogenic tumor, although it is not the canine counterpart of the human CEOT. The term, amyloid-producing odontogenic tumor, has been suggested as being appropriate for this lesion.

Focal gingival hyperplasia in a horse.

A diagnosis of gingival hyperplasia in a 22-year-old Quarter Horse gelding was confirmed by histologic examination. Clinical signs included difficulty eating hay, and a large, intraoral soft tissue mass measuring 13 x 8 x 4.5 cm. The mass was located in the mucosa on the lingual aspect of the caudal left portion of the mandible, ventral to the base of the tongue, and covered the second and third lower molars, extending rostrally along the buccal mucosa to the premolars. The left maxillary second and third molars were overgrown with sharp edges. Lateral radiography of the mandible revealed absence of the left third molar, with associated bony irregularity and sclerosis. The horse was positioned in right lateral recumbency under general anesthesia, and the entire mass was resected. It was speculated that the lesion developed secondary to chronic irritation from opposing teeth and food-packing after loss of the lower third molar; this would not be an unexpected development in a species with continuously advancing molars.

Epulides in dogs.

Eighty-one cases of canine epulides are described clinically and histologically; 73 cases were diagnosed as inflammatory, fibrous hyperplasias of which 37% showed metaplastic bone formation and 22% demonstrated so-called plexiform epithelial hyperplasia which seems to have no human counterpart. There is no indication that metaplastic bone formation or plexiform epithelial hyperplasia influences the biologic behavior of the lesion. A distinction between these two histologic variants carries no prognostic significance. Six cases of epulides proved to be pyogenic granulomas and two were malignant tumors. It is stressed that the term epulis is non-specific giving no indication as to the true nature of the lesion.

Surgical treatment of epulides in dogs: 25 cases (1974-1984).

Epulides were diagnosed and surgically removed in 25 dogs. Histologic examination of the epulides indicated that 40% (10/25) were acanthomatous, 32% (8/25) were ossifying, and 28% (7/25) were fibromatous. Recurrence of the tumor directly resulted in the death of 2 dogs. One of these dogs died of malnutrition 13 months after removal of an ossifying epulis, and regrowth of an acanthomatous epulis that was not resected completely resulted in malnutrition and death in another dog 6 months after surgery. Malignant transformation was observed in a third dog 6 months after removal of an ossifying epulis when an osteosarcoma developed where the epulis had been removed. The range of survival was 6 to 134 months, mean survival time was 43.1 months, median survival time was 49 months, and 1-year survival rate was 92%. Satisfactory long-term tumor control was achieved by aggressive surgical treatment of epulides.

Gingival hyperplasia induced by diphenylhydantoin in a gorilla.

An adult male lowland gorilla had been treated with diphenylhydantoin for 6 months following several acute convulsive episodes. The gorilla remained clinically normal during that period. Then, for no apparent reason, it refused its usual diet. Physical examination revealed acute inflammatory gingival hyperplasia. Full mouth gingivectomy and antibiotic and analgesic therapy resolved the oral inflammation and the anorexia.