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CUPS – Chronic Ulcerative Paradental Stomatitis

Chronic Ulcerative Paradental Stomatitis (CUPS) in Dogs
Emily Edstrom, DVM, DAVDC

Most pet owners and veterinarians are aware of stomatitis in cats, but did you know this condition can also occur in dogs? Chronic ulcerative paradental stomatitis, or CUPS, refers to the inflammation of tissue in the oral cavity. Unlike periodontal disease, which affects the periodontal tissues (i.e. periodontal ligament, alveolar bone, cementum and gingiva), CUPS affects other structures in the oral cavity, including the buccal mucosa in contact with teeth, the palatal mucosa and even the tongue. Periodontal disease and CUPS do not always occur together; although, there is generally some degree of bone loss due to chronic inflammation.

Dogs with CUPS may present with severe halitosis, thick white plaque, and pain or difficulty eating. Contact ulcers most commonly occur on the mucosa overlying the maxillary canines and caudal dentition; these are sometimes referred to as “kissing ulcers.” Certain breeds, like Maltese and Cavalier King Charles, may be more prone to developing CUPS, but it can occur in any breed at any age.

Similar to stomatitis in cats, the cause of CUPS is believed to be an immune over-reaction to plaque and bacteria in the mouth. Plaque begins building up on the teeth within hours of a dental cleaning, so even the most diligent pet owner will be unable to prevent plaque from returning. Temporary remedies to alleviate pain and inflammation can include pain medications, antibiotics and occasionally immunomodulating drugs, like steroids. Unfortunately, once these medications are discontinued, the symptoms will quickly return. Extracting teeth in immediate contact with the contact ulcer can provide temporary relief, but the inflammation may shift to other parts of the mouth, once again causing pain and discomfort.

We believe that our pets deserve a pain-free mouth. Just like treating cats with stomatitis, the only potential for a cure may include multiple extractions. Following extractions, most owners are surprised at how much happier and energetic their dog feels, and they can finally stand to be in the same room with them!

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Fig. 1

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Figs. 1 & 2: A 12-year-old schnauzer with severe inflammation and ulceration of the maxillary buccal and vestibular mucosa. Note the thick, white plaque covering the caudal dentition and canine teeth.

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Fig. 3

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Figs. 3 & 4: Chronic inflammation can lead to horizontal and vertical bone loss, as noted in these radiographs.

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Fig. 5: Ulceration and proliferative inflammatory tissue of the caudal mucosa

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Fig. 6- Selective extractions can help to resolve inflammation locally; however, there is the potential for the inflammation to shift to other parts of the mouth over time.

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Fig. 7- Full mouth extractions can provide a cure for this painful condition.