Stomatitis in Dogs and Cats
Stomatitis means “inflammation of the mouth” and is commonly known as chronic ulcerative paradental stomatitis (CUPS). It’s a widely recognized condition in cats, but it can affect dogs of any breed as well. Some breeds predisposed to the condition include the Maltese, Greyhound, Cavalier King Charles Spaniel and Scottish Terrier.
The clinical signs in dogs include foul-smelling breath, drooling with thick, ropey saliva and difficulty eating and opening their mouths. Sometimes the clinical signs can improve after a dental cleaning but return within a few weeks. Many dogs are in too much pain to allow anyone to examine their mouths, but if possible, one may see ulcers (canker sores) on the inside of the lips and inflamed gum tissue. The inflammation is not confined to the gums but affects the mucous membranes as well, particularly where the insides of the cheeks contact the teeth. These inflamed areas of contact also are called kissing ulcers. When teeth are involved, it could have associated periodontal disease (or bone loss around the tooth).
Some dogs exhibit so many signs of pain that they avoid opening their mouths to yawn or bark. Over time, the inflammation creates scar tissue in the lips and cheeks that may limit how far the dog can open his or her mouth.
The cause of this inflammation and pain is unknown. Veterinarians suspect that affected dogs are having an immune response to plaque, which is the soft white material that collects on teeth in between brushing. Plaque starts forming again shortly after brushing teeth, so it is almost always present. Aggressive plaque control with twice-daily teeth-brushing, medicated oral rinses and other home dental care products may decrease the clinical signs, but most dogs are in too much pain to allow this.
Adult dogs of any breed or age are at risk. Terriers and Maltese dogs may have a genetic disposition to this disease. There isn’t a blood test to diagnose the condition, but most dogs will have elevated globulins (a protein associated with chronic inflammation) and/or elevated white blood cells.
The first step in treatment is to have the teeth thoroughly cleaned under anesthesia. A biopsy may be collected to rule out other types of disease, such as cancer and autoimmune disease. Using dental radiographs and information collected during the oral exam, a veterinarian may recommend extracting some of the teeth. Most affected dogs have bone loss around their molars due to the severity of the inflammation in the mouth. Extraction of all of the teeth can result in complete resolution of clinical signs. Dogs can still eat without any teeth. There are some drug protocols aimed at decreasing the immune response that can help as well. If you suspect your dog has stomatitis, a soft diet and pain medication may help them feel better until a diagnosis is reached and a definitive treatment can begin.
MJ Redman, DVM, is a graduate of Washington State University who lives in San Antonio, Texas. Dr. Redman practices at MissionVet Specialty & Emergency and specializes in veterinary dentistry and oral surgery.