Friday, November 2, 2018

Gingival Hyperplasia and Radiosurgery No.29

Donald H DeForge, VMD
Silvers Sands Veterinary
Milford Veterinary Hospital-Urgent and General Care
17 Seemans Lane-Milford, CT-06460
P 203-877-3221
F-203-877-8301
E-Mail-DonDeForge100@gmail.com
Centers for Oral Care
Tri-State Advanced Oral Medicine and Oral Surgery
Fellow of the Academy of Veterinary Dentistry
No. 29






Topics in Companion Animal Dentistry:
Gingival Hyperplasia
and Radiosurgery
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Historical Background:
Gingival Hyperplasia is a common findings in Boxers, Bulldogs, Pit Bulls, and Cocker Spaniels
along with other breeds. Its etiology is not known but a genetic link to certain breeds is
suspected.  There is a proliferative and abnormal growth of gingival tissue with pseudopocket
formation. These pockets lead to attachment loss with food, hair, and debris entrapment.
This condition should never be ignored because it will lead to advanced periodontal pathology
and oral pain.
Diagnosis:
Diagnosis is with Incisional biopsy.  Gingival hyperplasia can mimic epulis; benign invasive
oral tumors; and oral malignancies.  It is essential to biopsy to rule out oral cancer.


Medicine Induced Gingival Hyperplasia:
Certain families of medicines can cause gingival hyperplasia.  Diphenylhydantoin;
Cyclosporine; and Calcium Channel Blockers can induce gingival hyperplasia.  
Not all patients on these drugs develop gingival hyperplasia. If a patient does have gingival
hyperplasia treatment alternatives for the condition under care must be scrutinized.


Treatment Choices:
The goal of treatment is the surgical removal of proliferative tissue restoring normal gingival
contour.  Cold steel; laser; and radiosurgery [4.0 MHz] are the surgical cutting choices. It is
my opinion that only radiosurgery should be utilized for the following reasons:
Radiosurgery~~~High Frequency 4.0 MHz*
  • Permits hemorrhage control with a clear surgical field of vision
  • It prevents seeding of bacteria into the incision site
  • It permits planing of soft tissue
  • It eliminates scar tissue formation
  • It minimizes post-operative discomfort and re-treatments
  • It has a pressureless cut with a “paint-brush”-like stroke
*If your patient has a pacemaker or an Implantable Cardioverter Defibillator [ICD] your
veterinary cardiologist must be consulted prior to the use of radiosurgery.


The Procedure:
Incisional Biopsy can be done before or during the procedure if the owner does not wish two
anesthesia visits.  Pre-Anesthesia testing is completed prior to anesthesia.
Gas Inhalation anesthesia only
Pre and post treatment oral photography is advised
Full mouth oral radiology must be completed prior to removal of hyperplastic gingiva to isolate
other co-existent oral pathology. Client consultation is compulsory with Informed Consent
before treating other pathologies.
Under general inhalation anesthesia periodontal Ligament Blocks are initiated~~~
[not regional] using Articaine/Septocaine-total dosage is weight dependent
A fully rectified 4.0 MHz waveform using a Vari-Tip 118 electrode for surgical removal of the
hyperplastic tissue, is initiated, with an inverse bevel gingivectomy followed by a ginigvoplasty
A complete Piezoelectric ultrasonic root planing is completed after gingivoplasty
Tincture of myrrh and benzoin is the recommended postoperative dressing


Follow-Up Care:
A soft diet is recommended for 30 days
All hard chew materials are removed from consideration
Plaque control is essential to assist in post care recovery
Rechecks are monthly for 6 months
Regrowth of gingival tissue is minimal with excellent periodontal care of the patient
professionally along with homecare anti-plaque topicals.
Questions about this blog?
Contact Dr. DeForge at: DonDeForge100@gmail.com

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