GINGIVITIS

Gingivitis is inflammation of the gum tissue resulting in redness and swelling. Gingivitis can lead to a more serious disorder, periodontitis, which in turn can lead to tooth loss.

DIAGNOSIS OF GINGIVITIS

ETIOLOGY AND RISK FACTORS

• Causes - Gingivitis is most commonly caused by the accumulation of dental plaque along the gum line. Plaque results when bacteria normally found in the mouth mix with proteins and starches found in saliva. Plaque eventually becomes tartar, a hard calculus that accumulates on the teeth. Local irritants and some diseases, such as plasmacytic gingivitis, spirochete infections (trench mouth), and certain immune-mediated diseases may also cause gingivitis.
• Risk factors
• Age - Generally associated with middle aged to elderly pets
• Breed/genetics - No statistical risk
• Sex - No statistical risk
• Geographic/environmental - No statistical risk
• Other medical disorders - Local irritants, xerostomia, and some diseases such as plasmacytic gingivitis and chronic bacterial oral infections may cause gingivitis.
• Prevention - Routine dental hygiene helps reduce the risk of developing gingivitis by decreasing the formation of plaque and tartar.

HISTORY AND CLINICAL SIGNS

• Species affected - Dogs and cats
• Presenting signs and historical problems - Red, swollen gums are common findings. In advanced cases, foul breath, drooling, difficulty eating or chewing, and poor appetite may be found.
  
  

PHYSICAL EXAMINATION FINDINGS

• General
• Attitude - Usually normal in most cases
• Body condition - Usually normal in most cases
• Vital signs - Usually normal in most cases
• Mucous membranes - Mucous membrane close to the gingiva may be affected by the inflammation and infection present, but capillary refill time and overall color are usually normal.
• Hydration status - Usually normal in most cases
  
  Red, swollen gums, foul odor to the breath, and dental tartar are common findings. Teeth may be discolored and loose. The sharp margins of the gingiva may be lost, and the gingiva may recede away from the tooth in some instances. The gingiva may bleed easily. Xerostomia may cause actual cavities or caries to develop in the tooth, with loss of adjacent gingiva. In severe cases, stomatitis and glossitis may also be present.

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  In some animals, cheilitis can accompany gingivitis. The regional lymph nodes of the head may be enlarged with marked or chronic gingivitis.
  
  The remainder of the physical examination is often unremarkable.

DIAGNOSTIC STUDIES

• Special examination techniques - Complete periodontal probing and dental charting are important in gauging the severity of the disease and following its progression or response to therapy. General anesthesia is required for this procedure. A plaque dye test may be performed, which consists of placing a red-colored liquid dye (plaque-disclosing solution) on the teeth. The dye is absorbed to reveal the extent of plaque accumulation.
• Clinical laboratory tests
• CBC - A complete blood is often normal, but leukocytosis may be detected with some oral infections.
• Serum biochemical tests - Usually normal
• Urinalysis - Usually normal
• Diagnostic imaging
• Radiographs (dental) - Full mouth radiographs are indicated, since 70 percent of the tooth structure is below the gum-line. These radiographs may also disclose more serious problems such as tooth root abscesses. With gingivitis alone, there is no loss of alveolar bone. In severe cases dental radiographs may be needed to examine the base of the teeth or lamina dura.
• Pathology
• Cytology and bacteriology - Cytology and culture of swabs of the mouth may be beneficialto identify the presence of spirochetes and other pathogenic bacteria.
• Biopsy/histopathology - A biopsy is indicated in animals with chronic non-responsive gingivitis.

DIAGNOSIS AND PROGNOSIS

• Differential diagnosis
• Chronic stomatitis
• Periodontitis
• Dental plaque or tartar without gingivitis
• Recommended tests - Oral exam and dental probing, possibly radiographs, cytology and bacterial culture.
• Summary of diagnostic criteria - An oral exam and dental probing reveals red, swollen gums and possibly, deep gingival pockets.
• Prognosis - The prognosis is good to excellent if treated early.

TREATMENT OF GINGIVITIS

TREATMENT PRINCIPLES

The goal of treatment is to reverse the gingivitis, eliminate any underlying causes, and treat any ancillary problems in the mouth.

INITIAL/HOSPITAL THERAPY

• Symptomatic therapy - Prior to dental work, it is recommended the animal be started on a broad-spectrum oral antibiotic with good activity against both aerobic and anaerobic bacteria. This therapy decreases the bacterial count in the mouth and lessens the chance of aerosolization of bacteria during dental procedures. Hand scaling with the animal awake may be considered if only one or two teeth are involved, and if the animal will tolerate the procedure.
• Specific therapy - Ultrasonic scaling and polishing of the teeth are indicated to arrest and reverse gingivitis. All plaque and tartar are removed. Loose and diseased teeth are extracted, or a root canal is performed whenever appropriate. Corrective procedures are performed if oronasal fistulas are present or if there is severe recession of the gums. The mouth may be rinsed with a diluted disinfectant at the end of the dental cleaning, and a prophy barrier sealant may be applied to the teeth.

LONG-TERM/HOME THERAPY

Daily oral hygiene that includes brushing of the teeth can be effective in reducing plaque. Dental care diets or treats can also help to maintain a healthy mouth. Chlorhexidine rinses or toothpastes effectively remove plaque above the gum-line and prevent the formation of new plaque. Swabbing of the gingiva with oral dental swabs may also be helpful.

FOLLOW-UP CARE

Follow-up examinations are recommended every 3 to 6 months. Semi-annual to annual dental cleaning by ultrasonic scaling also may also be recommended.