Cora’s success story: a journey to a life without oral pain

Cora, an 8-year-old Australian Shepard mix came to us a few months ago for a consultation for her Canine Ulcerative Paradental Stomatitis (CUPS), now known as Canine Chronic Ulcerative Stomatitis (CCUS). This is a very painful condition and poor Cora was experiencing extreme pain. She would frequently cry out when something touched her mouth wrong, and she was avoidant anytime someone tried to touch her mouth.

You might remember that Cora was originally scheduled to have her COHAT procedure back in January of this year, but we had discovered during her pre-op workup that she had an arrhythmia. We called our friends from The Doppler Effect to do an echocardiogram as well as an abdominal ultrasound to determine the cause. In the end, her ultrasounds were normal, but in the process of pursuing diagnostics, we did discover that she was hypothyroid! Cora’s thyroid disease was treated with her regular veterinarian, at Sunray Animal Clinic, and once her thyroid disease was regulated, she returned to us at MVD for her procedure. Below is a picture of Cora in January when we discovered her arrhythmia. While Cora was very loving, she was clearly suffering with pain.

This time, Cora was in even more pain and the ulcerations in her mouth had worsened. We were able to get her on the schedule within days of her normal thyroid results. She was placed on an IV pain drip, and we did a full assessment of her oral cavity under anesthesia. The ulcers in her mouth were so severe and widespread that we decided that the best treatment for Cora was full mouth extractions. Cora had been in pain long enough, and it was time to resolve it.  Below are pictures of her severely inflamed mouth, including ulcerations on her tongue.

Dr. Keaten worked efficiently and removed all 37 of her remaining teeth in a 4-hour surgery. Cora did great through the procedure and woke up smoothly and comfortably. She went home with pain medications and instructions for a soft food diet. Cora returned the next day for a pain management assessment to make sure her pain was controlled and thankfully she was doing very well.

This is Cora within minutes of walking up from anesthesia with a pain free mouth with full mouth nerve blocks on-board.

Now, here’s the great part -just five days after her surgery, Cora’s parents called and told us that they FINALLY had their dog back! After four years of pain and many trips to the veterinarian, Cora was acting like a puppy only 5 days after surgery. They sent a video of Cora playing and running and doing things she had not done in years. She looked so happy! Below is the picture and note they sent as well as their testimonial- Look at that beautiful, happy smile!

“We haven’t seen Cora this happy and actually being playful in years. We are in tears watching her run around the house with the girls. Thank you so much. You’ve brought our girl back!!!!”

“We couldn’t be more appreciative for Dr. Keaten and her amazing, caring staff. Our dog, Cora, had been suffering with CUPS disease for about 5 years. We were constantly back and forth with vets and she had to undergo many surgeries for cleanings and tooth extractions. We were referred to Dr. Keaten as soon as she opened up her practice. Within a very short time, they got her in for a COHAT. Unfortunately, her pre-op showed some additional concerns and we had to cancel. Dr. Keaten made sure Cora got all the necessary evaluations and treatments before pursing her surgery. If it weren’t for these further evaluations, we would have never caught another disease she had. Finally, Cora received her COHAT where Dr. Keaten discovered all the reasons to why Cora was in terrible pain. She decided the best treatment was to pull all her teeth which she did in that one surgery. They thoroughly prepared us on how to take care of her post op. They also followed up with phone calls and appointments. Cora is now living as the happiest dog ever. She is pain free and acting like her old, puppy self which we have not seen in years. Thank you Mainely Veterinary for bringing our Cora back. We are forever grateful for you!!”

Cora returned for her 2-week recheck and was so happy to be at MVD. She went right to the consultation room where she is normally seen and scratched on the door! She was a little distraught that someone was in her room. She went around and gave her usual hugs and kisses, only this time, her kisses were pain and odor free! Mom reported that not only was Cora acting like a puppy again, but she was barking for the first time in years! Their young daughter was very confused by this because she had never heard Cora bark before.

Many tears of joy have been shed for this dog. Experiences like this truly remind us why we do what we do here at MVD; it’s for the love of pets and the impact we can have on the human-animal bond. We are so thankful to have been a part of Cora’s journey to a pain-free life.  We are also grateful for the support of her veterinarian at Sunray Animal Clinic and the collaboration with Dr. Lee Gregory at The Doppler Effect. Cora is such a wonderful dog with a loving, amazing family and we hope they get many more years with each other. Our only sadness is that now that Cora does not have any more teeth, we have no reason to see her again.

If you would like to learn more about this disease in dogs, read on below for more information.

Canine Chronic Ulcerative Stomatitis (CCUS), formerly known as CUPS, is a terrible, painful disease for dogs. CCUS is a condition where the mucosa of the mouth significantly overreacts to plaque and bacteria in the mouth and causes painful ulcerations.  Unlike periodontal disease, the gingiva around the teeth and bone are often unaffected.  This is a paradental disease that affects the tissues of the mouth that are not directly supporting the tooth, such as the tongue, cheeks, pharynx, lips, and mucous membranes.  Often, this is accompanied by a severe odor and a thick stringy cloudy saliva.

Since the problem is over-reaction to plaque and bacteria, some cases of CCUS can be managed with a very comprehensive homecare regimen and cleanings under anesthesia every 3-6 months.  The teeth need to be brushed at least daily at home and the use of water additives such as Healthy Mouth can be helpful as well. For more pets and their owners, the homecare schedule and frequent trips to the veterinarian can be hard to accomplish.  And for some pets, it isn’t enough to keep the pain and ulcers away.

In severe cases or if the above plan has already been attempted (or it is not possible), the best option is extraction of all teeth that are causing ulcerations.  This may mean a few teeth for some animals but for others it may mean all of their teeth, depending on severity.  It may sound like an extreme treatment but, consider this, CCUS patients are living in excruciating pain, and after the teeth are removed, they are able to live a pain-free life with over 90% of patients seeing full resolution of the disease.  Even if many or all their teeth are removed, these pets often eat better than before, because their mouth no longer hurts! These lucky pups also live in a home where they can be fed a soft food diet if necessary.

Unfortunately, this disease is often misdiagnosed or mismanaged, and some animals suffer with the condition for many years.  The mucosal ulcerations can become severely necrotic and can eventually begin to affect the underlying bone as well.  Below is a picture of a dog that was mismanaged for many years before he was seen at Mainely Veterinary Dentistry. The ulcerations on the gingiva are so chronic that they have become necrotic. In this extreme case, the infection and necrosis had progressed into the bone as well.

If this condition is recognized and diagnosed properly, steps can be taken towards proper treatment.  If the condition is not severe and the pet parent is committed to routine COHAT’s every 3-6 months as well as daily homecare, it may be manageable without significant extractions.  However, this can be a hard commitment for most pet parents.  In this case, extraction of the teeth associated with mucosal lesions, even though there is usually no periodontal disease of the tooth, is the best treatment to ensure a pain-free happy life for the dog.

If you think your pet may have this condition or is experiencing oral pain, we encourage you to seek advice from a trained veterinary dental professional. Mainely Veterinary Dentistry’s mission is to improve and maintain the overall health and well-being of pets and the human-animal bond by addressing the oral health of cat and dogs. MVD provides high quality and compassionate veterinary dentistry services and education to small animal pet owners as well as training and education to general practitioners and their support staff in New England. Mainely Veterinary Dentistry provides preventive dental cleanings, oral exams, full mouth x-rays and oral surgery services. If you would like to learn more about your pet’s oral health or if they are an anesthesia candidate, fill out our referral form to schedule your consultation today.