Chronic Mouth Inflammation and Ulcers in Dogs

Canine Ulcerative Paradental Stomatitis (CUPS) is a chronic oral disorder characterized by painful lesions inside the mouth and on the tongue, caused by an intolerance to plaque.

Canine Ulcerative Paradental Stomatitis (CUPS), also referred to as Canine Chronic Ulcerative Stomatitis (CCUS), is an ulcerative disorder that affects the lining of the mouth in dogs. It is characterized by painful lesions of the lining of the mouth and connecting tissues. These lesions are caused by an excessive reaction to the plaque on the dog’s teeth, and are therefore more common on surfaces that are in direct contact with the teeth. It can be a daunting condition to treat and it has a tendency to reoccur.

This disease is considered to be a paradental disease, rather than a periodontal disease. The lesions are located on the oral mucosa, gingiva, tongue and pharynx instead of the alveolar bone, periodontal ligament or the structures at the root of the tooth.

• Blood in saliva
• Blood on toys
• Excessive drooling
• Lesions that are near teeth, painful or ulcerative
• Lethargy
• Reluctance to chew on toys
• Reluctance to eat
• Severe halitosis
• Swelling of lining of the mouth
• Swelling of the lip folds
• Thick, cloudy saliva 

Types

Scrupulous dental care at home is essential in preventing recurrences of the symptoms. Brushing your dog’s teeth with a toothbrush is the most common method for removing plaque from their teeth, but this is not a natural process for your dog and they may have to be trained to cooperate with the process. In order to get your dog used to having its teeth brushed, start by getting the dog used to the toothpaste, by letting it lick the toothpaste off your finger, followed by praise and rewards. (It is imperative that to find a toothpaste formulated for dogs, as human toothpaste can quickly prove deadly to dogs due to both fluoride and the possible inclusion of the sweetener xylitol.) 

The next step is to get the dog used to the feel of something being placed against the teeth by placing the toothpaste on their teeth with your finger and gently rubbing. Once your dog is comfortable with this process, the toothbrush can be introduced by putting the toothpaste on the brush and letting the dog lick it off the brush. Give your pet several days to get used to the feel of the brush on their tongue and gums before actually using it to brush their teeth. Use a soothing voice while brushing your dog’s teeth, and be sure to finish with lots of praise and rewards.

The painful inflammation and lesions of CUPS are caused by a severe reaction to the plaque found on the affected dog’s teeth. The oral ulcers are also called contact ulcers or “kissing ulcers” as they kiss the surface of the tooth. Breeds that may be predisposed to developing CUPS include:

• Dachshund
• German Shepherd
• Greyhound
• Labrador Retriever 
• Maltese

There is also some evidence to indicate that about five to ten percent of these stomatitis cases have a concurrent autoimmune disorder.

Initial diagnosis is based on the placement and appearance of the inflammation and the lesions. The ulcers form in the mouth mainly where the surface of the skin touches the teeth. The dog may exhibit reluctance to have its mouth examined due to pain. CUPS is similar in presentation to several other diseases, such as pemphigus vulgaris and epitheliotropic T-cell lymphoma, and additional testing will need to be done to exclude them from the diagnosis. A complete blood count, biochemistry profile, and urinalysis will be done, as well as an evaluation of thyroid function. 

Laboratory findings may show increased immunoglobulins and white blood cells, but any other unusual readings would need further analysis. A biopsy to rule out certain types of auto-immune disorders may also be recommended. Since the treatment for some auto-immune diseases is very different from the treatment for CUPS, it is essential to rule these out before finalizing any treatment plans.

The first course of action in treating CUPS is to remove as much plaque from the surface of the teeth as possible. The patient is likely to be anesthetized for the cleaning procedure, which will most likely include a more comprehensive assessment of oral health. X-rays of the dog’s mouth will be taken at this time and the teeth will be probed and charted to check for periodontal disease. Any teeth that are significantly affected by damage or disease may also be removed at this time. 

Your veterinarian will most likely prescribe pain management medication to help with pain from any extractions as well as the pain from the disorder itself. In some situations, additional medications such as antibiotics or corticosteroids may be recommended. If these measures combined with meticulous follow-up care are unable to bring relief a whole-mouth tooth extraction may be needed to control the disorder. In extreme cases, medication will continue to be required even after extraction.

This disorder requires vigilance on the part of the owner to resolve. Any buildup of plaque can result in new lesions forming, so steps must be taken to maintain the cleanliness of the canine’s mouth. Daily or twice-daily brushing of the dog’s teeth is a must in all cases where teeth are retained. Wax barriers, oral rinses or gels and even prescription dental diets may be employed to reduce the amount of plaque that forms in the mouth, and regular dental assessments and cleanings will be mandatory to maintain oral health. Dogs that require an entire mouth of teeth extraction generally respond well to the procedure, but soft food will be required for the remainder of their lives.

Conditions related to chronic mouth inflammation and ulcers can be expensive to treat. To avoid high vet care expenses, secure pet health insurance today. The sooner you insure your pet, the more protection you’ll have from unexpected vet costs.