If patients do not tolerate prednisone, azathioprine can be used to control the inflammation. Start azathioprine at a dosage
of 1 to 2 mg/kg given once a day, and if effective, taper the dosage to 1 mg/kg given every other day after three weeks. Additional
monitoring for patients receiving azathioprine includes frequent CBCs. If evidence of bone marrow depression is observed,
discontinue the azathioprine, and explore other treatment options.
In patients in which medical therapy is not successful or not advisable, healthy teeth can be extracted to achieve beneficial
results.1,2 In some cases, extracting the caudal teeth (molars and premolars) will be enough. In patients in which caudal teeth extraction
fails to achieve clinical remission, extract the remaining teeth. In my experience, CUPS almost always resolves when all of
a dog's teeth have been removed. Dogs with no teeth can eat and live normal lives. But keep in mind that often, after all
the teeth are extracted, a dog's tongue will hang out of its mouth.
CUPS is a chronic condition that requires lifelong patient monitoring. Always stress to owners that this condition will most
likely require a lifetime of therapy. If owners run out of their dogs' medication, clinical signs of CUPS commonly recur.
A cure may be achieved, however, by extracting many or all of the teeth. Because of the potential side effects from the medications
used to treat CUPS, periodic physical and oral examinations should be accompanied by appropriate hematologic tests. Routine
dental prophylaxis (every four to six months) should be part of a complete oral hygiene program when the goal is to save teeth.
1. Harvey, C.E.; Emily, P.P.: Oral inflammatory and immune-mediated disease. Small Animal Dentistry. Mosby-Year Book, St. Louis, Mo., 1993; pp 145-155.
2. Wiggs, R.B.; Lobprise, H.B.: Clinical oral pathology. Veterinary Dentistry Principles and Practice. Lippincott Williams & Wilkins, Philadelphia, Pa., 1997; pp 104-139.
3. Smith, M.M.: Oral and salivary gland disorders. Textbook of Veterinary Internal Medicine, 4th Ed. (S.J. Ettinger; E.C. Feldman, eds.). W.B. Saunders, Philadelphia, Pa., 1995; pp 1084-1097.
"Dental Corner" was contributed by Daniel T. Carmichael, DVM, DAVDC, The Center For Specialized Veterinary Care, 609-5 Cantiague
Rock Road, Westbury, NY 11590.