Subgingival hair: An embedded predicament

Hair in the oral cavity? How did it get there? Did it grow from hair follicles in the gingival sulcus? Is it a problem? If so, what can you do about it?
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Dec 19, 2012

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Often during an oral examination in dogs with short, coarse coats (e.g., bulldogs, Labrador retrievers and beagles), we notice coarse hairs extendinskin disease such as atopy, demodicosis or flea bite allergy, resulting in excessive self-grg from the canine, incisor or hard palate gingiva (Photos 1-3). Although it may appear as if the hair is growing ectopically, these dogs are usually affected by inflammatory ooming and guard hairs from the hair coat becoming embedded in the mouth.

Photo 1: A black Labrador retriever’s hair embedded in maxillary and mandibular gingival pockets.

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Photo 2: A bulldog’s maxillary first incisors showing periodontal disease and gingival recession secondary to periodontal disease that was caused by embedded hair.

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Photo 3: Hair extending from the hard palate in a bulldog.

Gingival disease may occur secondary to a foreign body reaction to the trapped hair in the gingival sulci. Even though hair composed of the dog’s own cells may appear to be innocently lying below the gingiva, it acts as an irritant in the gingival sulcus. Hair traps bacteria, provoking periodontal inflammation, infection, support loss and pain. The severity of periodontal disease secondary to hair lodged subgingivally varies from dog to dog. Some will have little to no response, while others will have destructive periodontal infection, gingival recession, clefts and alveolar dehiscence. The periodontium can change from normal to advanced disease in just a matter of weeks.

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Unfortunately, there’s no way to predetermine which dogs will react and which won’t. And hair located anywhere other than on the skin can cause inflammation and infection. So once hair is noted subgingivally, it needs to be removed and the damage assessed (Photos 4, 5A and 5B).

Photo 4: A periodontal probe extending apical to the mucogingival junction.

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Photo 5A: A 9-mm periodontal pocket at the mesial root after hair removal.

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Photo 5B: The hemisected mesial root extracted.

The pathophysiology of gingival recession
Normally, the dental alveolus completely surrounds the roots. The position of the gingival margin is determined by the height and thickness of underlying bone, thickness of the gingiva and tooth alignment.

Gingival recession is characterized by the displacement of the gingival margin apically from the cementoenamel junction following bone loss over the root. The loss of this attachment is the result of inflammatory processes in connective tissue. Recession can be localized (affecting one tooth) or generalized (involving multiple teeth or arches).

The height of the alveolar bone is normally maintained by an equilibrium between bone formation and bone resorption, which is regulated by local and systemic influences. When resorption exceeds formation, bone height is reduced.

Bone destruction in periodontal disease caused by hair foreign bodies is primarily a result of local factors that cause gingival inflammation. The incisor teeth have a thinner alveolar plate rostrally that predisposes the dog to mucogingival disease in this area. Gingival clefts resemble V-shaped notches in the marginal gingiva. If the gingival cleft is caused by loss of the underlying alveolar plate, then dehiscence may occur and extend from the free gingival margin, apically exposing the root through the alveolus.

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Treatment
Hair removal from the rostral gingiva in the examination room usually can be accomplished easily with a cotton-tipped applicator (Photos 6A and 6B). If inflammation or bleeding is present, further examination under anesthesia is indicated.


Photo 6A: Excess hair.

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Photo 6B: Using a long cotton-tipped applicator to remove excess hair.


Once the animal is anesthetized, its affected teeth and supporting structures (periodontal ligament, alveolar bone) can be examined thoroughly by probing and obtaining intraoral radiographs. Extraction of teeth with stage 3 mobility or advanced periodontal disease allows affected tissues to heal and not be further inflamed by coarse-hair foreign-body reaction. Often the incisors are difficult to extract without fracturing the long roots. Exposure with a full thickness mucogingival flap is most helpful.

Prevention
Address the underlying reason for the dog’s self-grooming to prevent further occurrence. Elimination of external parasites and treatment for atopy is indicated.

Advise the client that daily removal of subgingivally lodged hair by tooth brushing or removal with a cotton-tipped applicator will go far to eliminate further periodontal disease and tooth loss.

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Case Report: Advanced periodontal disease due to embedded hair in a bulldog

This bulldog’s maxillary incisors are affected by advanced periodontal disease secondary to a hair foreign body reaction.

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An intraoral radiograph reveals more than 50 percent bone loss surrounding the maxillary first and second incisors.

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A mucogingival flap revealing the loss of rostral alveolar bone coverage.

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An intraoral radiograph obtained after tooth extraction.

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The postsurgical appearance after gingival closure.

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Two weeks after surgery, the dog is healing well.