Chronic Ulcerative Paradental Stomatitis in Dogs

The tissues involved in paradental stomatitis (oral mucosa, the palatal mucosa, the lining of the buccal pouch which is the area in the mouth that lies between the cheek and the teeth, the margins of the lips and the epithelium of the tongue) are not the same ones affected by periodontal disease in dogs (gingiva, alveolar bone, periodontal ligament and cementum on the root). Both paradental stomatitis and periodontal disease can exist in the same host but one is not dependent nor is either a response to the other. They are separate conditions which can cohabitate in the canine mouth.

Chronic ulcerative paradental stomatitis in dogs can be defined as an inflammatory condition of tissues in the mouth, located adjacent to the teeth, in which ulcerative lesions have formed.

The symptoms of chronic ulcerative paradental stomatitis (CUPS) are these:

• Fetid or foul halitosis (bad breath)
• Drooling (thick, cloudy, stringy and sometimes bloody)
• Lack of appetite or anorexia
• Pain ranging from mild to severe as the condition progresses
• Severe gingivitis (red or very pink, puffy gums)
• Multiple places in which the gingiva is noted to be pulling away and/or tearing away from the teeth
• Ulcerations in the mucosa of the lips and buccal pouch adjacent to the large teeth

Types  

Chronic Ulcerative Paradental Stomatitis (CUPS), also called Canine Chronic Ulcerative Paradental Stomatitis (CCUPS), is among several other diseases and conditions which exhibit similar symptoms but there is only one type of chronic ulcerative paradental stomatitis which can be diagnosed as a mild, moderate or severe stage of development.  The degree to which it has progressed will determine the intensity and the success of  treatment.

The cause of chronic ulcerative paradental stomatitis in dogs is believed to be intolerance to plaque, which forms and builds up freely without appropriate cleaning and removal.  This is how the scenario plays out:

• Bacterial activity in the canine mouth is normal for certain bacterium; however, when the bad bacteria begin to battle for dominance over the good bacteria, signals are sent to the immune system
• Once the immune system is triggered by the inflammation caused by the battle of the bacterial organisms, it mounts a formidable attack on the “bacterial invaders” and the plaque normally associated with periodontal disease   
• Just like in the human mouth, this attack in the canine mouth by the immune system on the bacterial invaders begins a process which creates more inflammation which stimulates more response from the immune system
• The inflammation begins to eat away at the tissues of the mouth, causing damage to primarily the various types of tissue noted above; those tissues are not necessarily the same ones generally associated with periodontal disease, though this condition is sometimes considered a form of periodontal disease because inflammation is at its root

Diagnosing this condition requires an approach which consists of ruling out similar diseases.  There are several other oral disease conditions which can exhibit similar symptoms but are not treated in the same manner as CUPS.  Your veterinary professional will need to rule out those other potential diagnoses before he can initiate appropriate treatment for CUPS.  Your vet will need as complete a history from you as possible.  This should include dietary regimens which include the treats offered and the duration of the current regimen.  Be sure to note the specific symptoms you’ve noticed in your canine family member, including the severity of them as well as the duration. Also be sure to include whatever your normal oral hygiene regimen is for your pet.  

Your vet will need to do a physical examination and will likely need blood work for lab evaluation and tissue samples for microscopic review.  Your vet will be looking for the characteristic “kissing ulcers” or “kissing lesions” in the areas of the mouth in which the lips “kiss” the teeth which are known to accompany CUPS.  Some of the samples required for diagnosis may need to be obtained while your pet is under some degree of anesthesia as the area where the veterinary profession will be probing and checking will likely be painful for your pet. Radiography (x-ray) may also be needed for further clarification of symptoms, clinical signs and other test results.   Your may vet feel it is necessary to refer you to a vet who specializes in veterinary dental medicine, especially for more severe cases.

At least part of the treatment plan will be pretty much what your dental professional would recommend under similar circumstances: a thorough professional dental cleaning and scaling with at least twice daily meticulous teeth cleaning at home to reduce the plaque formation and the reaction it is causing.  If there is a problem or a reluctance on the part of the pet parent to clean the areas which are ulcerated, which won’t be easy due to the pain your pet is experiencing, a decision may be necessary to extract the teeth where the ulcerated lesions have formed to reduce the plaque.  

While this may be an immediate solution to the problem, it is only temporary because the plaque is still forming and causing inflammation on those paradental areas of the canine’s mouth.  Frequently, when tooth extractions are done to ease the pain and reduce the ulcerations, plaque still forms, fueled by a hyperimmune response to the plaque.  Antibiotic and anti inflammatory treatments may also be initiated to manage the bacterial aspect and suppress the immune response in an attempt to allow you to perform the at home oral hygiene regimen which is being recommended.

When appropriate treatment is provided in a timely manner and appropriate meticulous oral hygiene measures are initiated and continued at home, the prognosis is good for your canine family member.  The oral hygiene regimen required at home will likely be a change for you as the pet parent, but, in view of the fact that the bacterial inflammation which is at the root of chronic ulcerative paradental stomatitis in dogs can cause major and life threatening health problems for your beloved family member, all attempts to do your part at home will protect your pet from further disease down the road.  Of course, copious doses of the three A’s (affirmation, affection and attention) will also go a long way toward full recuperation of your beloved doggy family member.