ALISON LAURIE-CHALMERS: Our Vet Speak correspondent says some breeds are more susceptible to Canine Chronic Ulcerative Stomatitis (CCUS), a painful and debilitating disease of the mouth
Fidget was a lovely, very wriggly, comical five-year-old Maltese Terrier.
He had been brought in regularly for dental treatment, as he had been constantly drooling and worrying at his mouth... and he had awful breath!
Fidget had previously received dental clean-up treatments at the clinic, which unfortunately had not made much difference to his symptoms.
As his problem was recurrent, he was referred to a dental specialist clinic where he was diagnosed with “CUPS”.
Chronic Ulcerative Paradental Stomatitis (CUPS), renamed recently as Canine Chronic Ulcerative Stomatitis (CCUS), is a very painful and often debilitating disease of the mouth.
It causes inflammation and ulceration in your pet’s mouth, involving the gums, mucous membranes of the cheek, palate, lip, tongue, and pharynx.
It is common to find significant ulcers on any oral tissue that meets or lies adjacent to the patient’s teeth.
Essentially, CUPS is mostly a “paradental” disease. This means that this disease does not usually affect tissues that connect the tooth but the tissues lying adjacent to and overlying the teeth.
These cases do experience severe oral pain, and they may scratch, rub, and paw at their mouths, and be reluctant to open their mouths for any exam.
They also have extremely bad breath, can be hesitant to eat and chew their food, and may drool excessively.
Although the exact cause of this condition is often unclear, in most cases it is believed that the immune system is overreacting to bacteria in any dental plaque present on the overlying or adjacent teeth.
Patients that suffer from CUPS have an immune response that is extreme and excessive, and local inflammatory reactions are then elevated in these individuals even to a small amount of dental plaque.
Often the condition is referred to as a plaque “intolerance”, or plaque “hypersensitivity”.
Dogs of any age can be affected, though it is rarely seen in dogs under a year old. Certain breeds such as Maltese Terriers, Cavalier King Charles Spaniels, Labrador Retrievers, German Shepherds, and Greyhounds are breeds more commonly affected.
Cases with CUPS will have oral pain, be reluctant to open their mouths, have bad breath, drool excessively and have a loss of appetite.
These patients may have mild to moderate plaque, advanced gum inflammation and classic typical cheek “kissing lesions,” which are ulcerations on the cheek tissue mucosa that lie adjacent to and touch the tooth surfaces.
These patients have developed severe ulcers on the inside of their cheeks, and some may also have lesions on their tongue.
Other severe autoimmune inflammatory disorders and immunosuppression due to other underling diseases can cause oral lesions and appear somewhat like CUPS. So, a complete physical exam and blood tests are also advised.
Initially cases require a complete dental prophylaxis, which involves a comprehensive oral health assessment and dental clean-up under carefully monitored anaesthesia.
This will include scaling and polishing the teeth to remove the plaque and calculus, full dental X-rays, periodontal probing of each tooth, and extraction of any diseased teeth or teeth in the worse affected inflamed tissue areas.
Biopsies of affected oral tissues may be taken for histological examination.
After dental treatment the owner must then carry out rigorous twice-daily oral hygiene and tooth brushing ongoing at home.
Often this plaque control is combined with some medical therapy to dampen the immune response.
These patients need to be re-examined regularly to assess them.When this is not successful, or the mouth ulcerations are long-standing or advanced, multiple tooth extractions are necessary as often the only treatment for CUPS, is the extraction of every tooth that is causing the inflammation.
In some cases, extracting the upper and lower back teeth (the premolars and molars) will be sufficient, while with others, unfortunately, full mouth dental extractions are required.
Pain medications and steroidal or non-steroidal anti-inflammatories give these cases some relief before and after dental surgery.
It’s important to note that CUPS requires life-long therapy and monitoring. Regular dental cleaning is advised, and a rigorous twice daily oral hygiene program is required when the goal is to save any remaining teeth.
Wee Fidget had to have his molars and some front incisors extracted. But he was much happier, and much more comfortable afterwards.
If you are concerned about your dog’s teeth, call your vet.
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*Alison Laurie-Chalmers is a senior consultant at Crown Vets.
