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Chronic Ulcerative Paradental Stomatitis (Chronic Ulcerative Gingivitis) in Dogs

Occurrence: common
Location of illness: Head/Neck

Author: Dr. med. vet. Gisa Löwe | Last modified: 06.11.2025

ChronicChronic refers to a condition or disease that is long-lasting or permanent. Chronic diseases often develop slowly and can lead to persistent or recurring health problems over time. ulcerativeUlcerative refers to the condition or process that leads to the formation of ulcers. Ulcers are open Wounds or Lesions that can form on the skin or mucous membranes, are painful, and often heal slowly. paradental stomatitis (CUPS) is a painful inflammatory condition of the oralOral means "through the mouth" and refers to the intake of food, medication, or other substances through the mouth. In veterinary medicine, many treatments are administered orally. cavity in dogs, characterized by chronicChronic refers to a condition or disease that is long-lasting or permanent. Chronic diseases often develop slowly and can lead to persistent or recurring health problems over time. ulcers and inflammation of the gums, lips, and oralOral means "through the mouth" and refers to the intake of food, medication, or other substances through the mouth. In veterinary medicine, many treatments are administered orally. mucosaMucosa, also called mucous membrane, refers to the moist lining of body cavities that are connected to the outside world, such as the mouth, nose, lungs, and gastrointestinal tract. It serves to protect and facilitate the absorption of nutrients.. It is often associated with an overreaction of the immune systemThe immune system is the body's defense system against infectious agents such as bacteria, viruses, fungi, and parasites. It comprises a complex network of organs, cells, and molecules that work together to protect the body. to plaque.

The most important facts at a glance

Chronic ulcerative paradental stomatitis (CUPS) in dogs is an inflammatory condition of the oralOral means "through the mouth" and refers to the intake of food, medication, or other substances through the mouth. In veterinary medicine, many treatments are administered orally. cavity in which the immune systemThe immune system is the body's defense system against infectious agents such as bacteria, viruses, fungi, and parasites. It comprises a complex network of organs, cells, and molecules that work together to protect the body. overreacts to the bacteriaBacteria are microscopic, single-celled organisms that exist in almost every environment on Earth. Some types of bacteria are beneficial or even essential to life, while others can cause disease. in plaque. The exact cause of this reaction is unclear, but genetic factors may play a role, as certain breeds such as Cocker Spaniels are more susceptible. Symptoms include gingivitis, painful ulcers in the mouth, increased salivation, and bad breath. DiagnosisA diagnosis is the identification of a disease or condition by its symptoms and/or results from diagnostic tests. It is the first step in the management and treatment of patients. requires a thorough clinical examination, dental cleanings, and possibly biopsies to rule out other conditions. Treatment aims to relieve symptoms and control Inflammatory conditions, often through dental cleaning, antibiotics, and anti-inflammatory drugsAnti-inflammatory drugs are medications that reduce inflammation. They can be divided into nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids and are used in dogs and cats to reduce Inflammatory conditions and Pain.. In severe cases, Tooth loss may be necessary. The prognosisThe prognosis is the prediction of the likely course and outcome of a disease based on the general state of health, the nature of the disease, and the response to treatment. It can provide information on how a disease is expected to develop. depends on the treatment, and regular dental care and veterinary check-ups are crucial for preventionPrevention includes measures taken to prevent diseases or injuries. In veterinary medicine, this includes vaccinations, parasite control, and health monitoring.. Research focuses on genetic predispositions, the oralOral means "through the mouth" and refers to the intake of food, medication, or other substances through the mouth. In veterinary medicine, many treatments are administered orally. microbiome, and the development of new therapies to provide less invasiveInvasive describes medical procedures or pathogens that enter the body or penetrate tissue. In medicine, invasive procedures can range from minimally invasive techniques to open surgery. treatment options and improve the quality of life of affected dogs.

Causes

A dog’s oral cavity is home to a variety of bacteriaBacteria are microscopic, single-celled organisms that exist in almost every environment on Earth. Some types of bacteria are beneficial or even essential to life, while others can cause disease. that normally exist in a healthy balance. However, in CUPS, the dog’s immune systemThe immune system is the body's defense system against infectious agents such as bacteria, viruses, fungi, and parasites. It comprises a complex network of organs, cells, and molecules that work together to protect the body. appears to be overreacting to the presence of these bacteriaBacteria are microscopic, single-celled organisms that exist in almost every environment on Earth. Some types of bacteria are beneficial or even essential to life, while others can cause disease.. The exact cause of this overreaction of the immune systemThe immune system is the body's defense system against infectious agents such as bacteria, viruses, fungi, and parasites. It comprises a complex network of organs, cells, and molecules that work together to protect the body. is not yet fully understood, but genetic factors are suspected to play a role.

Some dog breeds appear to be more susceptible to CUPS, including Cocker Spaniels, Cavalier King Charles Spaniels, and other smaller breeds. This suggests that certain genetic predispositions may increase the risk. It is believed that the immune systemThe immune system is the body's defense system against infectious agents such as bacteria, viruses, fungi, and parasites. It comprises a complex network of organs, cells, and molecules that work together to protect the body. of these dogs is more sensitive to the bacteriaBacteria are microscopic, single-celled organisms that exist in almost every environment on Earth. Some types of bacteria are beneficial or even essential to life, while others can cause disease. in plaque, leading to a chronicChronic refers to a condition or disease that is long-lasting or permanent. Chronic diseases often develop slowly and can lead to persistent or recurring health problems over time. inflammatory response.

The inflammation that occurs in CUPS is the result of an immune-mediated reaction to plaque and Tartar (calculus). These substances consist of bacteriaBacteria are microscopic, single-celled organisms that exist in almost every environment on Earth. Some types of bacteria are beneficial or even essential to life, while others can cause disease. and their metabolicMetabolic refers to metabolism, i.e. the entirety of chemical processes that take place in a living organism to enable life processes. Metabolic disorders can cause a variety of Diseases in Dogs and cats. products that accumulate on the teeth. In dogs with CUPS, the immune systemThe immune system is the body's defense system against infectious agents such as bacteria, viruses, fungi, and parasites. It comprises a complex network of organs, cells, and molecules that work together to protect the body. appears to recognize these substances as a threat and triggers an inflammatory response to combat them. However, this reaction can be excessively strong and lead to the painful ulcers that are characteristic of the disease.

Other possible causes that have been linked to the development of CUPS include systemic diseases such as diabetes mellitus or autoimmune diseasesAutoimmune diseases are conditions in which the immune system mistakenly attacks the body's own cells or tissues as if they were foreign substances. Examples in dogs and cats include autoimmune hemolytic anemia and systemic lupus erythematosus., which affect the immune systemThe immune system is the body's defense system against infectious agents such as bacteria, viruses, fungi, and parasites. It comprises a complex network of organs, cells, and molecules that work together to protect the body. as a whole and may increase the dog’s susceptibility to Inflammatory conditions.

Symptoms

Very common symptoms:

Common symptoms:

Rare symptoms:

The symptoms of CUPS are often very noticeable and painful for the affected dog. One of the most common symptoms is bad breath (halitosisHalitosis, or bad breath, is a condition characterized by unpleasant odors from the mouth. Causes can include dental problems, digestive system disorders, or respiratory issues.), which is caused by the bacterial infectionAn infection is the colonization and multiplication of pathogens such as bacteria, viruses, fungi, or parasites in an organism, which often, but not always, leads to a disease. and the breakdown of tissue. This bad breath is often very intense and unpleasant.

Another noticeable symptom is excessive drooling, which is caused by the Pain and Inflammatory conditions in the mouth. Dogs with CUPS may also show difficulty eating, as the Pain makes chewing and swallowing difficult. This can lead to a reduced appetite and Weight loss.

Red, inflamed, and ulcerated areas are often seen in the mouth of the affected dog, especially on the gum margins and oralOral means “through the mouth” and refers to the intake of food, medication, or other substances through the mouth. In veterinary medicine, many treatments are administered orally. mucosaMucosa, also called mucous membrane, refers to the moist lining of body cavities that are connected to the outside world, such as the mouth, nose, lungs, and gastrointestinal tract. It serves to protect and facilitate the absorption of nutrients.. These ulcers can bleed and are extremely painful when touched.

Other symptoms may include Restlessness, Irritability, and a general deterioration in the dog’s well-being, as the constant source of Pain causes significant stressStress refers to the state of an organism reacting to external stimuli or demands. In veterinary medicine, stress can have physical or psychological effects on animals, impacting their health and well-being..

Diagnosis

The diagnosisA diagnosis is the identification of a disease or condition by its symptoms and/or results from diagnostic tests. It is the first step in the management and treatment of patients. of CUPS usually begins with a thorough clinical examination of the dog by a veterinarian. Particular attention is paid to the condition of the oralOral means "through the mouth" and refers to the intake of food, medication, or other substances through the mouth. In veterinary medicine, many treatments are administered orally. cavity in order to identify the characteristic ulcers and Inflammatory conditions. A complete dental examination in combination with a dental cleaning is often necessary to assess the condition of the teeth and remove plaque and Tartar (calculus).

In addition to visual inspection, the veterinarian may take samples of the affected mucous membrane to rule out other possible causes of the symptoms, such as bacterial or viralViral refers to viruses and their effects on the organism. Viral infections in dogs and cats can range from harmless colds to severe, life-threatening diseases. infections, tumors, or systemic diseases. Blood tests can also be performed to check for the presence of systemic diseases that may be contributing to CUPS.

In some cases, a biopsyA biopsy is a medical procedure in which a small amount of tissue is removed from the body to be examined under a microscope for signs of disease. Biopsies can help diagnose cancer and other conditions. of the oralOral means "through the mouth" and refers to the intake of food, medication, or other substances through the mouth. In veterinary medicine, many treatments are administered orally. mucosaMucosa, also called mucous membrane, refers to the moist lining of body cavities that are connected to the outside world, such as the mouth, nose, lungs, and gastrointestinal tract. It serves to protect and facilitate the absorption of nutrients. may be necessary to make a definitive diagnosisA diagnosis is the identification of a disease or condition by its symptoms and/or results from diagnostic tests. It is the first step in the management and treatment of patients.. HistopathologicalHistopathological refers to the microscopic examination of tissue samples for the diagnosis of diseases. This technique is used to identify the specific characteristics of diseases at the cellular level in dogs and cats. examination of the tissue can help identify the characteristic inflammatory changes associated with CUPS.

Therapy

The treatment of CUPS requires a multi-stage approach that aims to relieve symptoms and control the underlying inflammation. One of the first measures is thorough cleaning of the teeth to remove plaque and Tartar (calculus), as these are the main triggers of the inflammatory response.

Antibiotics may be prescribed to combat secondary bacterial infections that often occur with CUPS. In addition, anti-inflammatory drugsAnti-inflammatory drugs are medications that reduce inflammation. They can be divided into nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids and are used in dogs and cats to reduce Inflammatory conditions and Pain., such as corticosteroidsCorticosteroids are a class of steroid hormones that occur naturally in the body and can also be produced synthetically. They have anti-inflammatory and immunosuppressive properties and are used in veterinary medicine to treat a variety of conditions., can be used to reduce the inflammatory response and relieve Pain.

In severe cases, it may be necessary to extract some or all of the dog’s teeth to drastically reduce the bacterial load in the oral cavity and control the inflammation. This radical measure can often bring about a significant improvement in symptoms.

In addition to veterinary treatment, special diets and oralOral means "through the mouth" and refers to the intake of food, medication, or other substances through the mouth. In veterinary medicine, many treatments are administered orally. care products can be used to support dental health and minimize plaque formation.

Prognosis and follow-up care

The prognosis for dogs with CUPS varies depending on the severity of the disease and the effectiveness of the treatment. In many cases, the disease can be successfully controlled if diagnosed early and treatment is carried out consistently.

Dogs that require Tooth loss often show a dramatic improvement in quality of life as the source of Pain is removed and the inflammation subsides. However, removing many teeth can affect food intake, requiring dietary adjustments.

Because CUPS is a chronicChronic refers to a condition or disease that is long-lasting or permanent. Chronic diseases often develop slowly and can lead to persistent or recurring health problems over time. disease, lifelong monitoring and care are required to prevent relapses and ensure the dog’s well-being.

Prevention

The most important measure for preventing CUPS is consistent dental hygiene. Regular brushing and the use of special oral care products can help prevent the accumulation of plaque and Tartar (calculus), which are the main triggers of the disease.

Regular veterinary check-ups and professional dental cleanings are also important to monitor the condition of the teeth and gums and to intervene early if signs of Inflammatory conditions or other problems appear.

For dogs with a genetic predispositionA predisposition is an innate inclination or susceptibility of an organism to certain diseases or conditions. In dogs and cats, there may be a genetic predisposition to certain conditions such as hip dysplasia or certain heart diseases. to CUPS, it may be helpful to consider special dietary measures that promote oral health and support the immune responseAn immune response is the immune system's reaction to foreign substances (antigens), such as microorganisms or proteins. It involves a series of processes aimed at recognizing, fighting, and eliminating these antigens..

Outlook on current research

Chronic ulcerative paradental stomatitis (CUPS) in dogs is a complex and challenging disease that is still the subject of intensive research. Scientists and veterinarians are working to better understand the exact causes and mechanisms of this inflammatory disease. Currently, CUPS is believed to be an overreaction of the immune systemThe immune system is the body's defense system against infectious agents such as bacteria, viruses, fungi, and parasites. It comprises a complex network of organs, cells, and molecules that work together to protect the body. to the normal bacterial flora in the dog’s mouth. Current research focuses include investigating the genetic predispositionA predisposition is an innate inclination or susceptibility of an organism to certain diseases or conditions. In dogs and cats, there may be a genetic predisposition to certain conditions such as hip dysplasia or certain heart diseases. that may make some dog breeds more susceptible to this disease.

Another area of research focuses on the role of the microbiome in the oralOral means "through the mouth" and refers to the intake of food, medication, or other substances through the mouth. In veterinary medicine, many treatments are administered orally. cavity. Scientists are investigating how the balance of bacteriaBacteria are microscopic, single-celled organisms that exist in almost every environment on Earth. Some types of bacteria are beneficial or even essential to life, while others can cause disease. in the mouth can affect the occurrence and severity of CUPS. This research could provide new approaches to preventive treatment or to alleviate symptoms by specifically altering the microbiome.

In addition, the development of new therapies is being explored. While removing the affected teeth is often the most effective treatment method, researchers are looking for less invasiveInvasive describes medical procedures or pathogens that enter the body or penetrate tissue. In medicine, invasive procedures can range from minimally invasive techniques to open surgery. alternatives. These include immunomodulatorsImmunomodulators are substances that affect the immune system by increasing or decreasing its activity. They are used in dogs and cats to treat autoimmune diseases, allergies, or as cancer therapy. that are designed to regulate the response of the immune systemThe immune system is the body's defense system against infectious agents such as bacteria, viruses, fungi, and parasites. It comprises a complex network of organs, cells, and molecules that work together to protect the body., as well as new anti-inflammatory drugsAnti-inflammatory drugs are medications that reduce inflammation. They can be divided into nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids and are used in dogs and cats to reduce Inflammatory conditions and Pain.. These could help improve the quality of life of affected dogs without the need for extensive Tooth loss.

There are also studies looking at nutrition and its impact on CUPS. Researchers are investigating whether certain diets can reduce inflammation or whether dietary supplements are beneficial. These studies are still in an early stage, but could provide valuable insights in the long term.

Collaboration between veterinarians, dentists, and immunologists is crucial to fully understand the mechanisms of CUPS and develop better treatment strategies. By sharing knowledge and applying the latest scientific methods, researchers hope to sustainably improve the quality of life of dogs with CUPS.

Frequently asked questions (FAQs)

What is ChronicChronic refers to a condition or disease that is long-lasting or permanent. Chronic diseases often develop slowly and can lead to persistent or recurring health problems over time. ulcerativeUlcerative refers to the condition or process that leads to the formation of ulcers. Ulcers are open Wounds or Lesions that can form on the skin or mucous membranes, are painful, and often heal slowly. paradental stomatitis (CUPS) in dogs? CUPS is a severe inflammatory condition of the gums and oral mucosaMucosa, also called mucous membrane, refers to the moist lining of body cavities that are connected to the outside world, such as the mouth, nose, lungs, and gastrointestinal tract. It serves to protect and facilitate the absorption of nutrients. in dogs. It is characterized by painful ulcers and Inflammatory conditions caused by an excessive immune responseAn immune response is the immune system's reaction to foreign substances (antigens), such as microorganisms or proteins. It involves a series of processes aimed at recognizing, fighting, and eliminating these antigens. to the dog’s oralOral means "through the mouth" and refers to the intake of food, medication, or other substances through the mouth. In veterinary medicine, many treatments are administered orally. flora.
What symptoms occur in dogs with CUPS? The most common symptoms include bad breath, excessive salivation, difficulty eating, Weight loss, bleeding gums, and visible ulcers in the mouth. Dogs may also show signs of Pain and change their behavior by appearing less active or withdrawn.
Which dog breeds are most commonly affected by CUPS? Although CUPS can theoretically occur in any dog breed, some breeds such as Greyhounds, Cavalier King Charles Spaniels, and Cocker Spaniels are more susceptible. This suggests that a genetic component may play a role in susceptibility to the disease.
How is CUPS diagnosed? The diagnosisA diagnosis is the identification of a disease or condition by its symptoms and/or results from diagnostic tests. It is the first step in the management and treatment of patients. of CUPS is usually made by a thorough clinical examination of the mouth, supplemented by a medical history of the dog. In some cases, blood tests and biopsies of the affected tissues may be necessary to confirm the diagnosisA diagnosis is the identification of a disease or condition by its symptoms and/or results from diagnostic tests. It is the first step in the management and treatment of patients. and rule out other conditions.
What treatment options are available for dogs with CUPS? The most common treatment is the removal of the affected teeth, which often results in a significant improvement in symptoms. In addition, anti-inflammatory drugsAnti-inflammatory drugs are medications that reduce inflammation. They can be divided into nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids and are used in dogs and cats to reduce Inflammatory conditions and Pain. and antibiotics can be used to relieve the inflammation and prevent infections. Regular dental cleaning and oralOral means "through the mouth" and refers to the intake of food, medication, or other substances through the mouth. In veterinary medicine, many treatments are administered orally. hygiene are also important.
Can CUPS be cured? CUPS cannot currently be cured, but the symptoms can be significantly alleviated with appropriate treatments and care. The removal of the affected teeth is often the most effective method to improve the dog’s quality of life.
What role does nutrition play in the treatment of CUPS? A balanced diet can help support the dog’s overall health, but there is currently no specific diet that has been shown to prevent or cure CUPS. However, some veterinarians recommend special diets or supplements that may help reduce the inflammatory response.
Are regular follow-up appointments with the veterinarian necessary? Yes, regular follow-up appointments are important to monitor the progress of the disease and adjust treatment. The veterinarian can also perform professional dental cleanings at these appointments to promote the dog’s oralOral means "through the mouth" and refers to the intake of food, medication, or other substances through the mouth. In veterinary medicine, many treatments are administered orally. health.
Can home remedies help in the treatment of CUPS? While home remedies cannot replace professional treatment, some measures, such as brushing teeth with a pet-friendly toothpaste, can help improve oralOral means "through the mouth" and refers to the intake of food, medication, or other substances through the mouth. In veterinary medicine, many treatments are administered orally. hygiene. However, it is important to discuss all home remedies with a veterinarian to ensure that they are safe and effective.
How can I help my dog live with CUPS? In addition to following veterinary recommendations, you can help your dog by maintaining good oralOral means "through the mouth" and refers to the intake of food, medication, or other substances through the mouth. In veterinary medicine, many treatments are administered orally. hygiene, supporting him with an appropriate diet, and attending regular veterinary check-ups. Watch your dog for signs of Pain or discomfort and adjust his care accordingly.