You may have heard of kissing disease in people, caused by mononucleosis, but that does not cause your pet’s inflamed mouth. Another moniker that includes “kissing” is the culprit. Kissing lesions are often the main reason behind red, painful, inflamed gum, tongue, and oral tissue in pets. These lesions are known as chronic ulcerative paradental stomatitis (CUPS), which is a specific form of stomatitis, or oral inflammation. CUPS is more severe and encompassing than typical gingivitis, and can affect your pet’s entire mouth. Paradental tissues, which are soft tissues that often contact the tooth crowns when the mouth is closed, include the oral mucosa, the palatal mucosa, the buccal pouch lining, the lip margins, and the tongue epithelium. In many pets, these paradental tissues remain relatively healthy, despite the presence of moderate or severe periodontal disease. Other pets may have severe CUPS but relatively good periodontal health. Let’s take a closer look at this painful condition, so you can immediately recognize the signs and get your pet rapid relief.

What are chronic ulcerative paradental stomatitis signs in pets?

If your pet develops CUPS, the inflammation is not confined to the gums like gingivitis, and anywhere inside the mouth can be irritated, particularly where the cheeks contact the teeth—thus, the term, “kissing ulcers.” Clinical CUPS signs in pets can include:

  • Foul-smelling breath
  • Thick, ropey drool
  • Difficulty eating
  • Reluctance to open the mouth, yawn, or bark
  • Ulcers on the inside of the cheeks and lips
  • Pawing at the mouth
  • Refusing to allow an oral exam

Many pets are in too much pain to allow anyone to examine their mouth without sedation, but you may notice ulcers or inflamed tissue in areas other than the gums. Sometimes, the clinical signs improve after a dental cleaning, but will often return in a few weeks without proper follow-up care.

What causes chronic ulcerative paradental stomatitis in pets?

CUPS is called several other names— ulcerative stomatitis, idiopathic stomatitis, and lymphocytic-plasmacytic stomatitis—which reflects the lack of solid understanding of the condition. No cause has been established for CUPS, but plaque is suspected to be the trigger, since affected pets develop an immune response to plaque. Plaque starts forming almost immediately after toothbrushing, so pets almost always have plaque. 

Although CUPS has no definitive cause, this painful condition is widely recognized in cats, and can also affect all dog breeds. All adult pets are at risk, but some dog breeds seem predisposed, including:

  • Maltese
  • Cavalier King Charles spaniel
  • German shepherd dog
  • Greyhound
  • Scottish terrier

Remember, pets with moderate to severe dental disease may not display CUPS signs, and vice versa. This explains why Yorkshire terriers, Chihuahuas, and dachshunds, who tend to have severe dental disease, are not included in the CUPS breed predisposition list.

How is chronic ulcerative paradental stomatitis diagnosed in pets?

Diagnosing CUPS in an awake pet is a challenge, since these pets are often extremely painful and refuse to open their mouths, so we will likely recommend blood work and a biopsy to achieve an accurate diagnosis. These two diagnostic tests are needed to rule out similar conditions, such as autoimmune diseases, oral neoplasia, and infectious diseases. The biopsy has to be performed under anesthesia, so we will undertake additional dental diagnostic testing at the same time, which may include full-mouth dental X-rays, periodontal probing, and a thorough oral exam.

How is chronic ulcerative paradental stomatitis treated in pets?

CUPS management and treatment can be challenging and frustrating. The first step, after anesthetizing your pet to take a biopsy, is having your pet’s teeth thoroughly cleaned, above and below the gum line, to remove every trace of plaque. Depending on the inflammation’s severity, your pet may have developed bone loss around their teeth, in which case, based on your pet’s dental X-rays and oral exam, Dr. Weldon may recommend removing some or all of their teeth. Extraction of all teeth can reduce and occasionally completely resolve CUPS, because the primary source, plaque, has been removed. However, plaque can still develop on the mouth’s mucosal surfaces, including the cheeks and tongue, and ulcers may persist.

To combat your pet’s CUPS at home, twice-daily toothbrushing, medicated rinses, and other home dental care products may help. Unfortunately, your pet may be too painful to allow plaque-removing toothbrushing and rinsing, so at-home management can be difficult. Your pet may be a candidate for steroid therapy to decrease the immune response and reduce the inflammation and pain, but long-term steroid use comes with negative side effects.

The most effective way to keep pets with CUPS comfortable and inflammation-free is through a strict plaque-prevention protocol at home and at our Animal Dental Clinic. Your pet needs biannual or annual dental cleanings to remove plaque, no matter how thorough and diligent your at-home regimen, as only we can remove plaque that accumulates below the gum line. With our routine dental cleanings and your dedication to a well-rounded at-home care plan—and potentially full-mouth extractions—your pet with CUPS can live a happy, comfortable life.   

Does your pet show pain when yawning or barking? Reddened gums and thick saliva also can indicate painful chronic ulcerative paradental stomatitis in pets. CUPS requires prompt treatment, so contact our Animal Dental Clinic as soon as you recognize a painful periodontal problem in your pet.