Removing complex teeth safely and with minimal impact.
This chronic and painful oral disease is characterised by severe, debilitating and protracted oral inflammation and ulceration in dogs. CCUS is one of the most frequently misdiagnosed oral conditions we see. Unfortunately, many patients are managed for an extended period of time as if they have periodontal disease.
CCUS is an immune-mediated condition where the immune system in affected dogs overreacts to bacteria in plaque. Even minimal plaque formation can trigger an exaggerated local inflammatory response, leading to heightened symptoms.
Understanding CCUS
While the exact cause of CCUS is unknown, dogs with the condition often experience moderate to severe oral pain, reduced appetite or a preference for softer foods. They may resist handling, especially around the mouth, paw at their face, drool excessively, have trouble swallowing and exhibit irritability or weight loss. Severe halitosis is also common.
CCUS is distinguished from gingivitis and periodontitis by inflammation affecting not only the gums and periodontal tissues but also the buccal mucosa, paradental tissues and other areas. Affected tissues are friable and bleed easily, with visible grey/white plaques and smelly, soft plaque on the teeth.
CCUS tends to be more common in certain breeds like Maltese Terriers, Cavalier King Charles Spaniels, Greyhounds and Cocker Spaniels, though any breed can be affected.
Treatment
Strict plaque control is essential, involving regular professional dental treatment, including periodontal therapy and the extraction of diseased teeth, alongside diligent home care. Home care should include daily brushing with or without an antibacterial oral rinse.
Alternatively, extracting all teeth or those in contact with ulcerated mucosal surfaces can be considered, as full-mouth extractions usually resolve mucosal ulceration. If teeth remain, meticulous home care and ongoing professional intervention are crucial.
Medications are usually reserved for non-responders or acute flare-ups before or alongside dental intervention. Doxycycline may be recommended short-term following or during a dental procedure. Pain management typically includes NSAIDs (if appropriate), paracetamol and possibly opiates.
Treatment
Oral ulceration may resolve several weeks after dental treatment or extractions. To ensure inflammation has subsided, a recheck is typically recommended two weeks after the procedure and again eight weeks later (in cases of extractions). If not already done, a biopsy may also be performed to rule out other causes of oral ulceration, including other immune-mediated conditions and epitheliotropic lymphoma.
Supportive care is crucial for patients with CCUS, as many experience moderate to severe oral pain. Providing adequate pain control, nutritional support, assistance with grooming, and specific antibiotic therapy can help manage patients pre-and post-operatively, especially for those undergoing extractions.
Fortunately, unlike a similar condition in cats, treatment in dogs with selective to full-mouth extractions is almost always successful in relieving inflammation and clinical signs.
Prevention
Until the cause of CCUS is clearly understood, no prevention is possible. Research is ongoing into potential causes and alternative management options.
