What is Stomatitis in Dogs?

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Lymphocytic Plasmacytic Stomatitis ,

Chronic Ulcerative Plasmacytic Stomatitis-

or “CUPS”



photo of stomatitis in dogs


Recently our little rescue Maltese “Porkchop” has been diagnosed with this disease, he lost 12 more teeth to this disease plus 7 teeth a few days after we adopted him in Sept./2013.  It started out the reason why was he had a very bad foul odour from his mouth.

I have searched this out to the fullest and yes the Maltese Breed is susceptible to this disease as well as other breeds, although mostly common in Cats.


What is “CUPS” or Ulcerative Plasmacytic Stomatitis?


It is a very painful and often debilitating disease of the mouth involving the gums, mucous membranes, and the tongue.  This disease or inflammation can be causing your pet agonizing pain for a long period of time and you won’t even know it.


To understand this disease more clearer, as Dr. Fraser Hale DVM, FAVD, Dipl. AVDC, of the Hale Veterinary Clinic, states, Lymphocytic and plasmacytic adds nothing to our understanding of the condition and therefore should be dropped from the diagnostic vernacular.  These pets have a chronic inflammation and as any chronic inflammation will have lymphyocytes and plasmacytes which is blood cells, and so including the names of these cells in the name of the condition is redundant.  Of course blood has erythrocytes and leuhkcytes and of course chronically inflamed oral tissues will have a preponderance of lymphocytes and leukocytes.  There is no need to mention them when describing your pet’s condition.


“CUPS” has also been called idiopathic stomatitis, trench mouth, lypocytic-paradental stomatitis, ulcerative stomatitis, St. Vincent’s stomatitis, and necrotizing ulcerative stomatitis.



What Causes CUPS?

It’s unclear what specifically triggers it for each individual dog.  It has been said that trauma such as electric cord injuries or caustic substances can damage the oral tissues and lead to stomatitis conditions.  Due to overrepresentation in certain breeds such as Greyhounds, Cavalier King Charles Spaniels, Maltese, and Huskies, there may be a genetic component.

In the majority of cases it’s believed that the dogs’ immune system is overreacting to the bacteria in plaque.  The bacteria itself causes an antigenic response due to the chronic exposure of the pathogens to the immune system.  Normally their immune system keeps this in check, but in dogs with this disease the response is exaggerated.  Dogs with periodontal disease, the amount of plaque and calculus present can be very substantial.


What are other conditions looking like CUPS?

Its known that animals with this disease will often have periodontal disease, but having said that, the majority of dogs with periodontal disease don’t have “CUPS.” Severe gingivitis without inflammation in the other tissues doesn’t support a diagnosis of “CUPS.”

It’s also important to rule out other immune-mediated diseases such as pemphigus, which is a rare group of blistering autoimmune diseases that affects the skin and mucous membranes.

Uremia or kidney failure due to renal disease can often be present with oral ulcerations and halitosis, which colloquially is called bad breath.


What are the signs and symptoms of CUPS?

  • Inflammation and ulcerations to the inside lining of the cheeks-Buccal Mucosa.
  • Oral mucosa, the mucous membrane lining inside of the mouth.
  • Gingiva or gums, and the tongue.
  • The lymph nodes may be enlarged due to chronic activity due to the pain.
  • Excessive salivation.
  • Decrease in appetite.
  • Oral hemorrhaging at the slightest touch.
  • Bad breath.
  • Difficulty grabbing or chewing food, are common finding with “CUPS.”

Some animals will have a reduction of weight due to not wanting to eat because of the pain.  Cats will only lap up the liquid and leave the solid food due to the pain.


How is CUPS Treated?


The treatment plan will be and should be individualized based on the severity of the disease, the owner’s commitment to home care, the dog’s personality, and financial concerns.

Pets with this disease should have a comprehensive oral health assessment including scaling, polishing the teeth to remove the plaque and calculus (tartar), periodontal probing of each tooth, and x-rays while under anesthesia.

Many dogs like my Rescue Maltese, require some extractions if not all, due to periodontal disease.  If your pet is lucky enough to have some teeth remaining, it is very imperative that brushing is done each and every day.  Because after the cleaning or brushing of your dog’s teeth, bacteria starts forming a layer of plaque within hours, and since plaque is what is causing or contributing to the inflammation, the plaque needs to be eliminated as much as possible.  I can’t stress enough how important it is to brush your dog’s teeth every day in combination with pain relievers, oral rinses and even more may be needed with this disease.  Also frequent veterinary cleaning and evaluations are necessary to keep the inflammation at bay, if you will.

I understand that some pets just will not allow you to brush their teeth if not trained right form a very young age.  With this being said and this may sound drastic, but the veterinarian may extract all the teeth at this time, the dog is usually in so much pain that they actually feel better a day or so after the extractions.  It is said that some anorexic dogs with full mouth extractions starts eating ravenously after surgery that evening.

During surgery the goal is not only to remove the teeth, but also remove the ulcerations, inflamed and painful tissues.  All the alveoli, which is the sockets within the jawbone of the extracted tooth, is scraped with an dental instrument to free all the debris and is smoothed by odontoplasty to improve your pets comfort.


Today their are many premium soft foods available on the market to accommodate your pet that can be swallowed by your dog or cat.  It may take a little time to adjust to being toothless, but dogs tend to do very well since there is no longer any pain.


Porkchop has adapted very well, he still comes to the kitchen for his favorite veggie, which is cauliflower, and runs to his hiding spot and devours it. I have to admit though, I do give him very small pieces now in order for him to still enjoy.





May 2018
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