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Mouth Inflammation and Ulcers (Chronic) in Dogs

Oral Ulceration and Chronic Ulcerative Paradental Stomatitis in Dogs

Oral Ulceration and Chronic Ulcerative Paradental Stomatitis (CUPS) is a condition affecting dogs’ mouths, characterized by painful ulcers on the gums and mucosal lining. The root cause of this ailment is identified as an overly sensitive immune response to bacteria and plaque accumulated on tooth surfaces. Interestingly, signs of CUPS may manifest following a dental cleaning, as the manipulation can release these materials into the mouth.

While it’s observed that oral cavity manipulation and antigenic stimulation can trigger stomatitis, it’s also believed that affected animals would likely have developed the disease regardless. In severe cases, complete teeth removal might be the only solution to eliminate the bacteria normally residing on tooth surfaces from the mouth entirely.

Certain dog breeds have a higher susceptibility to this condition. Maltese, cavalier king charles spaniels, cocker spaniels, and Bouvier des Flandres are noted to have a heightened incidence. Among the complications associated with CUPS is idiopathic osteomyelitis, bone and marrow inflammation, which is particularly predisposed in cocker spaniels.

Symptoms and Types

  • Halitosis (Bad breath)
  • Gingivitis (Swollen gums)
  • Faucitis (Inflammation of the cavity at the back of the mouth – the fauces)
  • Pharyngitis (Inflammation of the back of the mouth, continuous into the larynx – the pharynx)
  • Buccitis/Buccal mucosal ulceration (Tissue of the inner cheeks)
  • Ptyalism (Thick, ropey saliva)
  • Pain
  • Anorexia (Loss of appetite)
  • Mucosal ulceration on the gums that meet the lips – also called “kissing ulcers”
  • Plaque on teeth
  • Exposed, necrotic bone (Alveolar osteitis and idiopathic osteomyelitis)
  • Scar formation on lateral margins of the tongue from prolonged inflammation and ulceration

Causes

Metabolic:

  • Diabetes mellitus
  • Hypoparathyroidism
  • Hypothyroidism
  • Uremia caused by renal disease

Nutritional:

  • Protein-calorie malnutrition
  • Riboflavin deficiency

Neoplastic:

  • Malignant melanoma
  • Squamous cell carcinoma
  • Fibrosarcoma

Immune-mediated:

  • Pemphigus vulgaris
  • Bullous pemphigoid
  • Systemic lupus erythematosus
  • Discoid lupus erythematosus
  • Drug-induced (toxic epidermal necrolysis)
  • Immune-mediated vasculitis

Infectious:

  • Leptospirosis
  • Periodontal disease

Traumatic:

  • Foreign body
  • Bone or wood fragments in the mouth
  • Electric cord shock
  • Malocclusion of teeth

Chemical/Toxic:

  • Acids
  • Thallium

Idiopathic:

  • Eosinophilic granuloma – Siberian Huskies, Samoyeds
  • Chronic Ulcerative Paradental Stomatitis (CUPS)
  • Osteomyelitis

Diagnosis

To diagnose your dog’s condition, you will need to provide a comprehensive history of its health, including when the symptoms began and any potential incidents that might have triggered the condition, such as chewing on cords or other objects, recent illnesses, and routine dental care practices. Your veterinarian will conduct a thorough examination of your dog’s oral cavity to assess the extent of inflammation and identify any teeth requiring attention.

Standard diagnostic tests will include a chemical blood profile, complete blood count, urinalysis, and electrolyte panel to detect any underlying diseases. Diagnostic imaging, such as X-rays, will also be performed to assess bone involvement and determine the extent of idiopathic osteomyelitis.

Chronic antigenic stimulation, often stemming from a chronic disease condition, can predispose an animal to the development of oral ulceration and stomatitis. (Antigens are substances that stimulate the production of antibodies in the body.)

Treatment

Treatment will focus on addressing underlying diseases if present. Dogs experiencing difficulty eating may require nutritional therapy to compensate. If your dog is anorexic, immediate measures such as a soft diet with fluid therapy and/or a feeding tube may be initiated, along with potential vitamin supplementation as recommended by your veterinarian. For pets with idiopathic osteomyelitis, removal of necrotic bone is crucial. Following removal, the gingival flap will be closed, and broad-spectrum antibiotics will be prescribed to prevent infection.

Antimicrobial agents may be utilized to manage primary and secondary bacterial infections. While they can offer therapeutic support between cleanings, prolonged or frequent use may contribute to antibiotic resistance. Anti-inflammatory or immunosuppressive drugs may be prescribed to alleviate inflammation and provide short-term relief, although potential long-term side effects of corticosteroid usage will be considered by your veterinarian when determining pain management strategies.

Topical therapies, such as chlorhexidine solution or antibacterial gel, may be applied directly to the gums and oral cavity. Your veterinarian may also recommend a topical pain medication to alleviate discomfort in the affected areas.

Living and Management

Dogs diagnosed with LPS and CUPS should undergo dental prophylaxis (preventive treatment) twice daily, or as frequently as feasible at home to mitigate plaque accumulation. Additionally, topical antimicrobials can be administered to the dog’s tooth and gingival surfaces as recommended.

Upon diagnosis, patients should undergo teeth cleaning, and regular veterinary dental appointments should be scheduled. During these appointments, dogs will receive periodontal therapy and extraction of diseased teeth as necessary to manage the condition effectively.

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