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It’s the corruption, stupid.

… riddled with inexplicable and elementary errors of law and fact

Republicans are the party of chaos and catastrophe.

My years-long effort to drive family and friends away has really paid off this year.

if you can’t see it, then you are useless in the fight to stop it.

I did not have telepathic declassification on my 2022 bingo card.

Let’s delete this post and never speak of this again.

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John Fetterman: Too Manly for Pennsylvania.  Paid for by the Oz for Senator campaign.

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Putting aside our relentless self-interest because the moral imperative is crystal clear.

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Too often we hand the biggest microphones to the cynics and the critics who delight in declaring failure.

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The republican caucus is already covering themselves with something, and it’s not glory.

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Do not shrug your shoulders and accept the normalization of untruths.

You are here: Home / Pet Blogging / Dog Blogging / CUPS Disease in Dogs

Reader Interactions

36Comments

  1. 1.

    SiubhanDuinne

    Never heard of it until now, but just looked it up and it sounds awful and painful. I hope your friend can get good veterinary dental care for her dog pronto.

  2. 2.

    SWMBO

    The article I read said it seems to be an allergy to the bacteria in the mouth. Have they tried Benadryl? And a low allergy diet?

  6. 6.

    RoonieRoo

    I have zero experience with CUPS so i have nothing to offer. It looks like a pretty awful disease. I am so sorry they are going through this.

  8. 8.

    debit

    Sounds a lot like stomatitus in cats. Our cat Max was diagnosed with that and had all his teeth removed and did very well for another 8 years. I would advise going to the vet clinic at your local vet university, if they have one, and if their local vet doesn’t know what to do (pull all the teeth).

    ETA: I just want to add that Max did great with no teeth, even ate dry food with no issues once his gums healed.

  9. 9.

    Alternative Fax, a hip hop artist from Idaho

    VA tech or Ohio State vet schools would be the best bet. It’s what I’d do for a dog w/ a pretty unusual disease.

  11. 11.

    debit

    @debit: The problem, of course, is that it’s horrifically expensive. Max’s treatment was at least $2500. I took Chloe to the U of M for multiple tooth extractions and it was a cool $2300 for 8 teeth. But like I said, it bought Max another 8 years and Chloe another 3.

    ETA: @MomSense: Hey yourself!

  12. 12.

    Steeplejack

    @debit:

    This is good to hear. The housecat is looking at some potentially serious dental work, and I have to admit I have been procrastinating on it.

  14. 14.

    Adam L Silverman

    http://veterinarymedicine.dvm360.com/dental-corner-diagnosing-and-treating-chronic-ulcerative-paradental-stomatitis?id=&sk=&date=&%09%09%09&pageID=2

    Treatment

    The initial treatment plan should include a complete dental prophylaxis: gross calculus removal and ultrasonic crown scaling, subgingival plaque and calculus removal, polishing, gingival sulcus irrigation with chlorhexidine solution, and a thorough oral examination including periodontal probing. It is difficult enough to save the healthy teeth in dogs with CUPS, but it is nearly impossible to treat the diseased teeth and keep the inflammatory disease in check. With this in mind, it is recommended to extract any teeth with advanced-stage periodontal disease at the time of the initial prophylaxis and oral biopsy. Patients with CUPS (or presumptive CUPS) are excellent candidates for OraVet (Merial), which is a waxy barrier applied to tooth surfaces after prophylaxis to retard plaque accumulation.

    The two main goals when treating CUPS are to provide immaculate oral hygiene and to achieve clinical resolution by using anti-inflammatory or immunosuppressive medications. The better the level of home care, the fewer drugs needed. Brushing a patient’s teeth and applying chlorhexidine daily, applying OraVet weekly, and instituting long-term intermittent antibiotic therapy (pulse therapy) are all home-care tools that can be combined to obtain maximal oral hygiene.

    The choice of antibiotics to treat oral infections is based on our knowledge of the common pathogens. Do not perform oral bacterial cultures because more than 200 species of microorganisms inhabit the oral cavity, and the results will only confuse the issue. Antibiotic selection should be based on each agent’s ability to affect gram-negative anaerobic bacteria. The short list includes amoxicillin trihydrate-clavulanate potassium, clindamycin, metronidazole, and the tetracyclines. These antibiotics differ in respect to their being bactericidal vs. bacteriostatic, their tendency to cause gastrointestinal side effects, and, in the case of the tetracyclines, their tendency to stain the teeth of actively growing dogs. Combination therapy, such as metronidazole and clindamycin, may be most effective in severe cases. Pulse therapy remains a controversial issue with no good scientific studies to document its effectiveness. However, there are many anecdotal reports of success. The risks of creating resistant bacterial organisms must be weighed against the benefits to a patient. If you choose pulse therapy, a common dosing regimen is 2.5 mg/lb (1.13 mg/kg) clindamycin given twice a day for five days every month.

    Prednisone is the drug of choice for suppressing the inflammation associated with CUPS. Start at an anti-inflammatory dosage of 1 mg/kg given twice a day, and taper the dose by cutting it in half every five days until the lowest every-other-day dose is achieved. When the prednisone dose is insufficient, the owners will report a recurrence of clinical signs, and the dose will need to be increased.

    If patients do not tolerate prednisone, azathioprine can be used to control the inflammation. Start azathioprine at a dosage of 1 to 2 mg/kg given once a day, and if effective, taper the dosage to 1 mg/kg given every other day after three weeks. Additional monitoring for patients receiving azathioprine includes frequent CBCs. If evidence of bone marrow depression is observed, discontinue the azathioprine, and explore other treatment options.

    In patients in which medical therapy is not successful or not advisable, healthy teeth can be extracted to achieve beneficial results.1,2 In some cases, extracting the caudal teeth (molars and premolars) will be enough. In patients in which caudal teeth extraction fails to achieve clinical remission, extract the remaining teeth. In my experience, CUPS almost always resolves when all of a dog’s teeth have been removed. Dogs with no teeth can eat and live normal lives. But keep in mind that often, after all the teeth are extracted, a dog’s tongue will hang out of its mouth.

    Conclusion

    CUPS is a chronic condition that requires lifelong patient monitoring. Always stress to owners that this condition will most likely require a lifetime of therapy. If owners run out of their dogs’ medication, clinical signs of CUPS commonly recur. A cure may be achieved, however, by extracting many or all of the teeth. Because of the potential side effects from the medications used to treat CUPS, periodic physical and oral examinations should be accompanied by appropriate hematologic tests. Routine dental prophylaxis (every four to six months) should be part of a complete oral hygiene program when the goal is to save teeth.

    REFERENCES

    1. Harvey, C.E.; Emily, P.P.: Oral inflammatory and immune-mediated disease. Small Animal Dentistry. Mosby-Year Book, St. Louis, Mo., 1993; pp 145-155.

    2. Wiggs, R.B.; Lobprise, H.B.: Clinical oral pathology. Veterinary Dentistry Principles and Practice. Lippincott Williams & Wilkins, Philadelphia, Pa., 1997; pp 104-139.

    3. Smith, M.M.: Oral and salivary gland disorders. Textbook of Veterinary Internal Medicine, 4th Ed. (S.J. Ettinger; E.C. Feldman, eds.). W.B. Saunders, Philadelphia, Pa., 1995; pp 1084-1097.

    “Dental Corner” was contributed by Daniel T. Carmichael, DVM, DAVDC, The Center For Specialized Veterinary Care, 609-5 Cantiague Rock Road, Westbury, NY 11590.

  15. 15.

    debit

    @Steeplejack: Obviously they need pain meds after surgery, but then they do great. I felt like shit when Max was diagnosed; he was a terrible garbage can diver and I resented him for it until I realized he was just looking for food that wouldn’t hurt him to eat. Poor kitty.

    Like I said, they do great on dry food, but wet food mixed with some warm water is really the best. Keeps ’em full and hydrated.

  16. 16.

    debit

    Okay, one last PSA before I go to bed: if your pet’s breath stinks, I mean really stinks, it’s a sign they need to be seen by a vet ASAP. It’s not normal and it’s usually a sign of either gum or tooth disease. and needs to be addressed. We thought it was cute that Oliver had a fang that was always visible when his mouth was closed. Turns out it was an abscess in his canine that probably hurt like fuck until it was pulled. We should have been clued in when his breath turned rancid.

  17. 17.

    J R in WV

    Well, gross. But thanks for the education. None of our critters have even had dental problems, and we were complimented for their good oral health. But we weren’t doing anything other than snacks alleged to help oral health. Guess it worked. And Milk bonez for the dogs.

    Lucky, I guess.

  19. 19.

    StringOnAStick

    Basically this sounds like periodontal disease with a heightened systemic inflammatory component/response. Periodontal disease in any mammal, humans included, goes away once the environment required by the anaerobic bacteria that cause it is gone. You can get rid of the anaerobic “pocket” around the tooth by pulling the tooth; no anaerobic environment = no periodontal disease.

    Dogs can’t floss, but you can. If you want to avoid periodontal disease and the increased risk of stroke and heart attack (among other medical problems) that comes with it, floss, use a Waterpik, or have all your teeth pulled; your choice (can you tell I’m a dental hygienist yet?). Some people have a genetic variant that means their risk is higher and start showing symptoms very young, but that isn’t common. Being lazy about flossing is much, much more common. That AP story last year about no long term proof of flossing helping avoid periodontal disease was the worst kind of crap click bait, and utter bullshit. Don’t fall for it!

  21. 21.

    Zippity

    @debit: My 11 year old cat was diagnosed with Stomatitus in Feb. His breath wasn’t bad, but he wasn’t eating. Did a dental, and extracted a bunch of teeth. He kept losing weight. Tried laser treatments for several weeks. Gained a little, but hit a plateau and started losing again. Just tried a long acting steroid shot, and he gained more than a pound in 3 weeks. Hopefully, it gives him relief for a while.

  25. 25.

    RealityBites

    Have known several cats and one dog with this condition. All of them had bad cases that did not respond to antibiotics. They had ALL of their teeth removed, (I think a couple needed two or more surgeries to do this) They had antibiotics and painkillers while healing. Both cats and dogs can eat small kibble and some wet food without teeth. I have also heard of using steroids, cyclosporine, and laser treatment. I also knew someone who discussed antiviral medications (acyclovir) because one theory is that herpes and other viruses are involved. I do not remember if the antivirals were tried. But all the critters with the teeth removal have done well without additional treatment. There are a couple of moderate priced vets in my area who do very good dental work. We also have the Virginia Tech vet school nearby for consultation.
    Hope this helps. Please remember I am speaking from limited experience and I am not a vet.

  27. 27.

    Mnemosyne

    @debit:

    We know that Keaton needs the full cleaning under anesthesia, but he has had a bad reaction to general anesthesia in the past and almost didn’t make it. Ugh.

  29. 29.

    Mike J

    @Omnes Omnibus: Ok, my entertainment: I had to drive the rescue boat to actually conduct a rescue today. Had a guy who needed his 15kt sailing checkoff, but it was only blowing 12. Ok, he’s going to go out and practice, and if it comes up, we’ll do his check. Wind never came up, but his boat went over. I was on the dock, hopped in the rescue boat I had been using 10 minutes earlier, and pulled the starter. Nothing. Again. Nothing, Squeeze the ball, pull the choke, pull it. Nothing. Seemed like ten minutes went by, just pulling the starter over and over, but it was actually about one. Eventually Poseidon smiles on me and it starts.

    I motor out, and of course he’s fine. He’s got a PFD on, so he’s not in serious danger of drowning. The boat, however, is pointed downwind while on its side. He’s hanging on to the transom and just sort of moving down the lake, I grabbed the bow, spun it and stabilized, he grabbed the centerboard and it came right up.

    He would have eventually gotten it fixed and back up, but he was kind of happy I was there to help. Today was the second or third 70° day we’ve had this year, and the lake was 49°. I was in the water just last month for my instructor training and it is no fun when it’s that cold.

  30. 30.

    CaseyL

    Poor doggie! Pulling all the teeth sounds pretty traumatic all by itself, but if he’s in that much pain… best of luck with him!

    @Mike J: Good on ya – and good thing you were there. Was he wearing a drysuit along with the waterwings? If not, he could’ve gone hypothermic.

  32. 32.

    Anne Laurie

    First I’d heard of this, too. However, I can attest that small dogs in general tend to have ‘problem’ teeth — that’s why there are so many ‘adorable’ pics of chihuahuas/pugs/maltese with their tongues hanging out the side of their mouths.

    I’ve known a great many dogs of all sizes who’ve lost all or most of their teeth as they aged. Usually they recover very quickly, and have no trouble whatever eating kibble, much less soft food. So it won’t be cheap for your friend, but (barring other health issues) it *should* be resolvable!

    Also, here’s my every-so-often PSA for doggie dental cleanings, especially for older dogs. I know it’s terrifying to contemplate putting a beloved companion with geriatric issues under general anesthesia, but I’ve also known many many dogs who gained extra years of pain-free life afterwards. Watching a gimpy, cranky old dog suddenly revert to dancing around the yard and gulping their dinner rather than picking at it is magical. It even convinced me to start getting my teeth professionally cleaned more often, and I’m severely dental-phobic!

  33. 33.

    Dr. Ronnie James, D.O.

    @Alternative Fax, a hip hop artist from Idaho: If you’re in the NE, I can’t recommend UPenn’s vet school in Philly enough. They have done an amazing job with our dog’s Cushing’s Disease (missed by a half-dozen vets over 10 years of symptoms), and my in-laws’ cat’s cancer a few years ago.

    One caveat: it probably goes without saying, what with it being an Ivy League school and all, but the bills can be somewhat staggering (though not for routine measures).

  34. 34.

    Nan

    The important thing about removing a dog or cat’s teeth is that it is not simple. Pre-anesthesia work-up, general anesthesia, availability of dental radiology (in case of broken-off root tips), serious dental expertise – all essential, and costly. That said, I agree that these animals are much happier after partial or full dental extraction. They don’t care that they have no teeth, just that they don’t hurt. Personally, I do not have the patience for daily work on the mouth of a cat or dog – particularly as they can become “bitey” after a bit. And I am a veterinarian, so there.

  35. 35.

    InternetDragons

    John – Just sharing a little info based on having been raised in a family of veterinarians and working through undergrad and grad school as a vet tech.

    CUPS is a miserable condition (obviously) with a guarded prognosis and limited chance of cure. Any dog can get it (cats too), though it is more prevalent in certain breeds – I want to say German Shepherds, Greyhounds, and Dachshunds, but my memory on that detail may be shaky.

    There’s been other good advice in the thread, so I won’t repeat that. Just a couple of other points that may or may not be useful:

    For any chance of success, the care given at home has to be absolutely meticulous. The home care necessary for CUPS is, frankly, an absolute pain in the ass for both the owner and the pet, and over time (as pointed out above) the pet may get increasingly stressed by it and get nippy/generally unhappy.

    In addition to the ongoing home care, some dogs see improvements with the use of wax barrier sealants on the remaining teeth. Check with your vet about that possibility.

    The “dental diet” foods by Hills, Purina, or Royal Canin can help a bit, but less so in advanced cases.

    I’ll be honest here – I’ve seen the best results come from full or nearly full dental extraction. While doing this is a major surgical procedure – not risk-free, and not cheap – the pets always seem so much happier and more comfortable afterwards, and do just fine on a soft diet.

    I hope this helps a bit. The news about CUPS usually doesn’t provide much cause for optimism if a family is hoping that the initial veterinary intervention plus home care will result in a cure.

  36. 36.

    Eadgyth

    It might well be too late, but a full meat diet generally helps dogs reduce inflammation and oral problems.

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