Stomatitis

From Dog
Eosinophilic stomatitis in a Cavalier King Charles Spaniel[1]
Severe stomatitis and glossitis secondary to lymphoma in a dog[2]

Stomatitis is a general term for inflammation of the canine mouth.

Stomatitis is rarely a primary condition in dogs as is usually secondary to other diseases, including:

- Candida albicans[4] - creamy white plaques on the tongue or mucous membranes, often associated with long-term antimicrobials
- Nocardia spp - disseminated infections, often secondary to cyclosporin and ketoconazole therapy[5]
- Erythema multiforme
- Epitheliotropic T-cell lymphoma[6]
- Leishmania spp - ulcerative stomatitis[10]

Clinically affected dogs usually present with oral bleeding, oral pain (pawing at mouth, chattering jaw movements), anorexia, halitosis, dysphagia, ptyalism and submandibular lymphadenopathy. Oal examination usually reveals lip-fold dermatitis (intertrigo), gingivitis, periodontitis, glossitis and faucitis.

In cases of Stevens-Johnsons syndrome, severe hepatopathy, dyspnoea, pyrexia and cachexia may also be evident.

Blood tests are usually unrewarding, but in epitheliotrophic lymphoma, paraneoplastic hypercalcemia may be evident. In most cases of stomatitis, there is varying degrees of hyperglobulinemia and leucocytosis.

Diagnosis is one of exclusion and oral mucosal biopsy and bacterial and fungal are usually required to establish a definitive diagnosis. Histologically, oral lesions appear as erythematous, ulcerated, friable and proliferative ulcers which may contain a pseudomembranous layer. In ulcerative paradental stomatitis, there is usually visible areas of deep pocket formation, gingival recession, periodontal bone loss and furcation exposure.

In cases of mycotic stomatitis, there may be a history of prior long-term antimicrobial or immunosuppressive therapy.

In cases of severe bacterial stomatitis, dental descaling, tooth extractions, oral flushing with chlorhexidine solutions and broad-spectrum antimicrobial therapy such as clindamycin and metronidazole is required. With chronic ulcerative paradental stomatitis and drug reactions, immunosuppressive doses of prednisolone, azathioprine or cyclosporin are usually required in additional to above therapy[15].

In Stevens-Johnson syndrome, use of intravenous human immunoglobulin has also been reportedly efficacious.

References

  1. Cavalier Health
  2. Veterinary Dentistry
  3. Boutoille F & Hennet P (2011) Maxillary osteomyelitis in two Scottish terrier dogs with chronic ulcerative paradental stomatitis. J Vet Dent 28(2):96-100
  4. Jadhav VJ & Pal M (2006) Canine mycotic stomatitis due to Candida albicans. Rev Iberoam Micol 23(4):233-234
  5. Paul AE et al (2010) Presumptive Nocardia spp. infection in a dog treated with cyclosporin and ketoconazole. N Z Vet J 58(5):265-268
  6. Nemec A et al (2012) Erythema multiforme and epitheliotropic T-cell lymphoma in the oral cavity of dogs: 1989 to 2009. J Small Anim Pract 53(8):445-452
  7. Declercq J (2004) Suspected wood poisoning caused by Simarouba amara (marupá/caixeta) shavings in two dogs with erosive stomatitis and dermatitis. Vet Dermatol 15(3):188-193
  8. Nuttall TJ & Malham T (2004) Successful intravenous human immunoglobulin treatment of drug-induced Stevens-Johnson syndrome in a dog. J Small Anim Pract 45(7):357-361
  9. La Rocca PT et al (1985) Skin and mucous membrane ulceration in beagle dogs following oral dosing with an experimental aminoglycoside antibiotic. Fundam Appl Toxicol 5(5):986-990
  10. Koutinas AF et al (2001) A randomised, blinded, placebo-controlled clinical trial with allopurinol in canine leishmaniosis. Vet Parasitol 98(4):247-261
  11. German AJ et al (2002) Eosinophilic diseases in two Cavalier King Charles spaniels. J Small Anim Pract 43(12):533-538
  12. Joffe DJ & Allen AL (1995) Ulcerative eosinophilic stomatitis in three Cavalier King Charles spaniels. J Am Anim Hosp Assoc 31(1):34-37
  13. Dale DC & Hammond WP (1988) Cyclic neutropenia: a clinical review. Blood Rev 2(3):178-185
  14. Aĭrapetian GO & Kudrin VS (1987) Effect of anaprilin on the tyrosine hydroxylase activity of the oral mucosa in dogs with experimental stomatitis. Farmakol Toksikol 50(3):106-109
  15. Lyon KF et al (2005) Gingivostomatitis. Vet Clin North Am Small Anim Pract 35(4):891-911