Stomatitis has many definitions and presentations. It is essentially a chronic bacterial infection, debilitating and inflammation of the oral tissues that generally originates in the periodontium, or the soft tissue that surrounds the teeth (gums), or in the facial region (oropharyngeal region).
Although viruses and immune system disorders have been implicated as causes of stomatitis, this pathological complex appears to be a progressive oral bacterial infection leading to a prevalence of gram negative anaerobic bacteria. The granulation tissue that is formed following the presence of this condition favors a bacterial accumulation impenetrable to antimicrobials (drugs that kill bacteria).
Stomatitis can result in a severe oral infection that causes pain in the mouth, weight loss, behavioral changes and rough hair.
There are other pathologies that may appear similar to stomatitis, such as a serious periodontal pathology, or a deep infection of the gums and surrounding tissues that can lead to loss of teeth and bone mass.
- Blood leaking from the mouth
- Behavioral changes (the dog tends to hide)
Diagnostic tests are necessary to recognize stomatitis and exclude other pathologies. Such tests can include:
- Medical history and complete physical examination, in particular a thorough examination of the oral cavity. To reach a correct diagnosis, the latter must be carried out under general anesthesia.
- Complete periodontal survey (with the aid of a periodontal probe for the evaluation of the tooth-gingiva interface) and dental charting to follow the course of the disease. General anesthesia is required for a thorough examination of the oral cavity and in case of periodontal probing.
- Complete oral radiographs. They are important for the evaluation of dog teeth. 70% of the tooth structure is located below the gingival margin. X-rays can show bone loss due to periodontal disease and help determine if teeth can be saved or, in cases of severe bone loss of 90%, extracted. Radiographs may need to be repeated every 3-6 months depending on the course of this pathological process.
- Blood chemistry tests, complete blood count and urinalysis. They can be recommended to determine the general health of the dog. Typically, these tests are also recommended before subjecting the dog to anesthesia.
On an individual basis and depending on each specific case, additional diagnostic tests may be recommended, including:
- Biopsies of pigmented tissues that invariably contain lymphocytes, a specific type of white blood cell. This is the oral response observable in infected oral tissues. So, unless there is a suspicion of neoplasm, the biopsy is of little benefit.
- Anaerobic culture (bacteria that live without oxygen) and antibiogram of infected oral tissues to analyze bacteria. These are expensive diagnostic procedures that are not commonly available from veterinarians.
- Immunological tests at specialized veterinary hospitals.
The patient is prepared for anesthesia by fasting at least 3 hours before the procedure. Treatment includes:
- Intravenous combination of antimicrobials (antibiotics) and liquids (if needed in sick or dehydrated patients). Antibiotics are often administered for 5-7 days before the procedure, but have a limited effect.
- Descaling should be done with ultrasound instruments and root planing (cleaning of the teeth under the gums). Anesthesia is required for these procedures.
- Dental extractions or coronal amputations can be performed depending on the radiographic outcomes. Coronal amputation is a procedure in which the visible portion of the tooth (the crown) is removed leaving the root (the part of the tooth under the gums). The root acts as a bone graft which helps reduce healing time and pain. The gum is usually sutured on the root.
- Vaporization with carbon dioxide-CO laser2 granulomas and infected regions. Vaporization by CO laser2 is a procedure in which the CO2 it causes the rapid transformation of fabric, debris, bacteria and water into steam which is subsequently sucked into a filtration system. This breaks the bacterial protective coating and kills the bacteria. It is important that the veterinarian is expert in the use of the laser in case of stomatitis.
- Pain should be treated as needed.
What to do at home
- Administer antibiotics as recommended by the vet.
- In the same way as humans, daily brushing of teeth is important for good oral health of the dog. In general, the use of a specific soft bristle toothbrush is recommended.
- The use of food lines (for example Hill’s Prescription Diet T / D®) or specific snacks can be useful to preserve a healthy mouth. Rinse with chlorhexidine or specific toothpastes (e.g. CET® toothpaste, CET® enzyme toothpaste) are excellent means of counteracting plaque formation under the gingival border. We recommend that you always ask your veterinarian for advice on how to use these products.
- Follow up (often every 3-6 months) as recommended by the veterinarian for a reassessment. It is recommended that you contact a veterinarian who specializes in dentistry. Cleaning of the teeth on a half-yearly or yearly basis by scaling with ultrasound instruments may be recommended.