Mouth and Jaw problems and pain

What Dog breeds have black on their tongues

Question: Dr. Richards,

I volunteer for a no-kill animal shelter. We are often asked the breeds of the dogs we offer for adoption. Could you please clarify what breeds there are that might show black on their tongues? The only one I really know of is the Chow but I'm hearing form people that there may be others as well. We were given eight German Shepherd puppies recently and were told they were pure bred. Some of these puppies have black on their tongues. Is this indigenous to the German Shepherd breed? Thanks for your input.

Joan

Answer: Joan-

Totally black tongues and gums are typical of chow chows and shar peis. However, any dog breed that has black and tan, or predominantly black coloring can have black spots on the tongue. We see this occasionally in German shepherds that are black and tan and frequently in rottweilers and Labrador retrievers. I'm sure that there are other breeds in which the black tongue spots occur, but these are the ones that come to mind immediately.

Mike Richards, DVM 1/4/2001

Bad breath

Question: Dear Dr. Richards,

I recently (about 3 months ago) rescued an approximately 2 year old lab mix. He appears to be in good health overall now that we've had him fixed up and got some weight on him (he was starving and injured when we found him). However, he has VERY bad breath (kinda feces, garbage bad-dog breath smelling). Overall, his teeth and gums appear healthy and clean, although he had some black discolorations on his tooth enamel when we first found him (has disappeared since). He also has moderate to bad flatulence. We are feeding him eukanuba large breed formula. We switched to Nutro large breed formula for a few weeks, but it didn't help. His parasite tests have been negative, he has no diarrhea, but his stools are a little softer sometimes than my other two dogs. I use nolvadent dental gel on his teeth a couple of times a week and occasionally brush them with a pet toothpaste but his breath gets bad again soon after. His bad breath doesn't seem to be related to his eating anything in particular. We give our dogs very little besides dog food adn biscuits (Iams or Nutro usually) Can a sensitivity to his dogfood cause this along with his flatulance, or are there other possible problems to look out for?

Thanks, Erica

Answer: Erica-

The most common causes of bad breath are the dental disorders. If there is no obvious tartar or gum inflammation, this may be less likely. Some dogs that chew on themselves a lot have bad breath from getting hair wound around the tooth roots. If there is skin disease involving the lip folds, it can smell just like bad breath but actually be a dermatologic problem. Dogs that eat feces (theirs or other animals) can have bad oral odors as a result of this habit. In people, gas from the GI tract is supposed to be responsible for some cases of bad breath, so there could be a correlation between the soft stools, flatulence and oral odor. If deworming has not been attempted, even if there were no parasites found on fecal examination, that might be a good first step. If that doesn't help, in this case, I would lean towards trying a food trial with foods that are not likely to be involved in allergic reactions. Currently the simplest way to do this is to feed Purina's HA (tm) diet or Hill's z/d (tm) diet. The other approach is to pick a food with a novel protein (one the dog hasn't eaten before) such as duck, ostrich, alligator, tuna, salmon--just a protein source that your dog has not been exposed to. You have to feed these diets for at least 4 to 6 weeks to see if they help. Your vet may feel that another diagnostic test makes more sense first. These sorts of things are partly judgment calls based on experience. Since your vet practices in the area you live in, trusting his or her experience makes more sense. There may be other tests suggested now or in the future. I will be glad to try to help you sort through them if that happens.

It is good that you are brushing his teeth some. Keeping that up is worthwhile.

Mike Richards, DVM 12/26/2000

Enlarged salivary gland or duct and possible acute gastritis

Question: Hello Dr. Mike. I am a new subscriber. I have been enjoying the site for months and I thought I ought to become a subscriber. I am a RVT on leave to raise the kids--this site keeps me in touch with work. My questions concerns my 16 year old Doxie mix. She's got a lot of old age related problems--old kidneys, old liver, chronic back problems, cataracts. Despite everything, she's really doing well. She loves life and is still feisty (she's got a lot of terrier in her!) The latest thing to come us has me worried. For months now she has been doing this awful retching thing at night that the sound cannot even be described. After the episode she desperately needs to eat grass! Along with this came an exaggerated swallow.( she does this all day). After this went on for a while, I took her in and we scoped her. Nothing exciting, just what the doctor described as a "hyperplastic airway". Maybe caused by allergies. We did nothing for treatment (steroids are not an option with her weak kidneys).

Shortly after the scoping, she started having a clear discharge from her left eye, left nostril and the left side of her mouth, especially after eating. The horrible sounds at night continue (about 3x monthly). Yet she continues to be perky and eat well. She has however gone from 16# to 12.8 in a little over a year. A few weeks ago she started having neurological signs-head tilt, limb weakness, walking into things. I took her to a neurologist, thinking maybe she had a tumor causing the drainage problems that was now causing neuro problems. While waiting to get an appointment, my vet suggested stopping a course of Cefadroxil she was on for a UTI in case it was related. Well, 3 days later when I was the neurologist, she was almost normal-just a mild head tilt and still the draining eye, nose and mouth. He ruled out Hepatic Encephalitis with an US and pretty much sent me on my way saying she's got a good quality of life for her age. I then took her to an ophthalmologist who discovered the enlarged Salivary gland (she gave it a name, but I don't remember which) that was probably responsible for the drainage problems. Now my question-at her age, is it most likely a tumor? Or could it be a blockage of some sort? The last few days the odor from her mouth has been bad and she is not eating as well. I don't think I'm interested in surgery, The scoping was very hard on her and took her some time to recover from that. Oh, by the way, we also cleaned her teeth then and didn't see anything unusual in her mouth at that time. She's also back on antibiotics for her UTI. I just want to keep her comfortable. Sorry for all the rambling, but I wanted to give you a bit of background. Thank you. Sara

Answer: Sara-

Was this a ranula? That is an enlarged salivary duct under the tongue. I have a patient with one of these who has had it all his life and had no discernible problems. But I have had other patients have problems with them, ranging from not eating to biting it and making it bleed.

An could be a salivary mucocele (sialocele), which is basically a leakage of saliva into the tissues around a ruptured salivary duct or salivary gland and the resulting inflammation. These can get abscessed at times and get pretty awful in a hurry. Opening them widely and placing drains usually will allow them to heal.

If a salivary mucocele occurs in the pharyngeal region it can lead to a harsh cough or retch and if it progresses it can lead to difficulty breathing. In the whole time I have been in practice I only remember one time in which I was able to do an emergency tracheostomy and save a patient in respiratory arrest --- and that dog had a pharyngeal mucocele that had abscessed.

Sometimes there are enlargements of salivary glands due to tumors or injury to the salivary gland itself, too. I have not had too much experience with salivary gland tumors but they are easy to get fine needle biopsies from and the pathologists have been able to work with these, so far, in our cases.

We have had a couple of dogs whose owners saw signs very similar to those that you are seeing, very loud, almost horrible sounding retching/gasping that has been related to laryngeal paralysis. Usually, though there are other signs, like loud respiratory sounds most of the time, tiring easily, or coughing.

I have a couple of patients who seem to have really painful acute gastritis that is unpredictable in its occurrence. They have had really loud retching/vomiting and seemed to have pretty severe abdominal pain based on body posture and response to pain medications. We have treated these guys with famotidine (Pepsid AC Rx) or cimetidine ( Tagamet Rx), metoclopramide (Reglan Rx) and pain relievers, usually mepheridine (Demerol Rx) and have had some success. I can't say that I know for sure what was happening or why the treatment worked, or even that it did work, since the episodes weren't occurring constantly. But the episodes did stop and we usually have continued the medications, except the mepheridine, for several months.

It does seem to me that it would be a good idea to get someone to look into the oral odor. If she will let you look around her mouth comfortably you could do that yourself. If she isn't comfortable enough to do that and if you think she would tolerate being masked down with isoflurane, perhaps after sedation with acepromazine or diazepam and a narcotic agent, like butorphenol or oxymorphone, it seems like it would be worth it to get a good look.

If she continues to have persistant urinary tract infections it would be a good idea to rule out hyperadrenocorticism as an underlying cause of that. It is definitely pretty common in older doxies. Treating with selegiline (Anipryl Rx) is much easier on older dogs than mitotane (Lysodren Rx), so it gives an option for treatment even in the dogs who might not be able to tolerate going through a whole lot of follow up testing during treatment.

Good luck with all of this. It is good that Bella has a good attitude. That helps a lot when multiple problems are present.

Please feel free to write back if you get more information on the salivary gland problem and need more specific information.

Mike Richards, DVM 4/22/2000

Masticular myositis

Question: Dear Dr. Mike: My samoyed had a severe bout of masticular myositis last summer. The first sign I noticed was a slight yelp when she yawned. At the time I didn't know what that was about and when I brought her to the vet he thought that perhaps she had injured herself and was simply sore. Anyway, on to a terrible experience with locking jaw, severely swollen glands, weight loss... etc. She recovered with aggressive treatment and was weaned off her prednisone (started at 30mg daily to every other day dosings with decreases at 20mg - 10mg - 5mg) gradually over a couple of months. She has been fine for the last couple of months and then this morning I noticed that she let out a slight yelp when she yawned. Her yawn is also slightly restricted.... not the usual open gaping yawn. She is also making slightly noticeable grimaces with her lips. I fear it is returning and would like your sense on how to proceed. Yes, I will be calling my vet today but would like your opinion as well. Should I put her back on the pred? Start with 5mg and work up to disappearance of these slight symptoms... or start with ??? and work down. Thanks in advance for your input. P.

Answer: P.-

In a situation like this I would check for other potential causes of pain on opening the mouth, such as retrobulbar abscess, oral injuries or foreign bodies, swollen submandibular lymph nodes (or general lymph node swelling) and dental problems. If nothing like this was present then I would be inclined to restart prednisone and I'd probably start fairly aggressively --- the same sort of treatment regimen that worked the first time. It is possible that your vet may wish to try a different approach and since he or she can do an actual exam you have to put a lot more credence in their advice than mine.

I hope that that this is a passing thing. I'm glad you already have an exam scheduled, though.

If this is a return of the myositis it might be necessary to consider long term low dose corticosteroid use. That isn't an ideal situation but if you and your vet work together to keep the dose as low as possible and at the longest possible treatment intervals (hopefully at least every other day), it is possible to use prednisone long term without major side effects in most dogs.

Mike Richards, DVM 11/29/99

Spitting water while drinking

Question: Hi: I have a one year old female Beagle. About 90% of the time when she drinks water she spits some of it back up. This occurs whether she is staying still or playing. When she drinks after she has eaten, she still spits up some water, no food though. I called my Vet and I will be taking her in next week to get checked out. I am writing to you because I can never have enough information. :-) Thanks J. K.

Answer: J.K.-

Spitting up when drinking water can occur for a number of reasons. These include soft palate defects (cleft palate, palate fistulas, overly long soft palate, too short soft palate), laryngeal paralysis, myasthenia gravis, pharyngeal inflammation, tonsillitis, megaesophagus and probably other things that don't come to mind, right off.

In a young dog, soft palate abnormalities have to be the number one consideration since most of the other problems are more common as dogs age or are less common. It may be possible for your vet to determine if any of these conditions are present by an exam under anesthesia. If your vet isn't comfortable evaluating the soft palate problems he or she may be able to refer you to a specialist in your area who is comfortable making these evaluations. I have referred a couple of patients to veterinary schools when I just couldn't be sure whether the soft palate was causing problems or not. It is possible to evaluate the pharyngeal region and tonsils during the same examination.

If there is no evidence of that this is causing any significant problems, such as nasal discharge, pneumonia, weight loss, etc., then it may also be reasonable just to live with the condition and not try to make a definite diagnosis, or to put off trying to make a diagnosis until another condition makes anesthesia necessary. If you are more comfortable knowing what is happening or if there are signs that it might be causing problems, such as nasal discharge, weight loss, changes in the sound of barking, coughing or pneumonia, then it isn't a good idea to take a "wait and see" attitude.

If examination doesn't reveal a problem, then tests like barium swallow X-rays may help, if you wish to continue to pursue an answer.

Hopefully your vet will find something on the visit coming up. If a minor palate abnormality is present it may be possible to safely ignore this problem. That would be the best outcome, probably.

Mike Richards, DVM 12/10/99

Crying after eating - differential diagnoses

Question: hi - i got into the cybervet because i have a 13 year old westie who is now crying after she eats. she walks around with her pillow in her mouth wailing for @ 15 minutes, no matter how much food i give her (tsp or plate). she has been to the dog psychiartrist in the past for faking limping, but i would never forgive myself if she had a stomache problem and i dismissed it for that. also, she has a malignant tumor in her arm pit 1.5 years ago, so i wanted her checked out. my regular vet in on vacation until 8/11 so i took her to the associate who said she was faking for attention. i am not comfortable with this, so i am taking her to the regular doctor when he returns. do you think this is a real problem? please help!!!

Answer: L.-

You should watch very very carefully for signs of swelling around either eye with the symptoms you are seeing. There are a number of potential causes for pain around the time of eating but the most serious one is a retrobulbar abscess, or an abscess that forms in the space behind the eye. These can cause serious problems fairly quickly, including blindness and in severe cases, death. In most cases, dogs with retrobulbar abscesses are really pained by having their mouths opened -- some dogs refuse to allow this and others just scream when someone attempts to open the mouth beyond a certain point.

Our dog had a retrobulbar tumor and had similar signs -- but she would open her mouth part way before it hurt. She continued to eat but sometimes acted as if she was in pain afterwards. So this would be a concern, too.

Dogs that have periodontal disease will sometimes have pain but I can't recall a patient having severe pain for fifteen minutes after eating.

Dogs with marginal liver function can have behavioral changes associated with the period immediately after eating. In severe cases this can cause severe neurologic signs, including stupor or seizures.

Older dogs get a condition known as canine cognitive dysfunction that can cause odd behavioral signs. We have one patient in our practice who wailed for ten to fifteen minutes at a time, several times a day who responded well to selegiline (Anipryl Rx), the medication approved to treat this condition.

Gastic problems are conceivable, as well.

Westies are prone to craniomandibular osteopathy. If she had difficulty with this as a puppy, there is some chance that she has arthritis in the mandibular joints now. This can happen without having the craniomandibular osteopathy, too. Recognizing TMJ in dogs isn't easy, since they can't complain effectively.

I think that it is worth continuing to look for a medical cause of this problem, personally. I am sorry that the list of differential diagnoses for the symptoms is long enough to make it difficult to search through. Please keep checking to be sure she can comfortably open her mouth and that there is no visible swelling around one eye. If these signs develop, don't wait for your regular vet.

Mike Richards, DVM 12/20/99

Response: what are you taking about!!!??? IF she has all these problems? i asked you a guestion. i guess i appreciate the care you took in that but aren't we getting a little carried away?!

Answer: L-

The only way to really figure out what is wrong is to consider all of the possible problems --- I don't think that all of them are likely to occur in a single patient but the big risk is not to think about one of them and to miss it because of that. Once a list of the potential causes can be constructed then it is possible to eliminate individual potential problems by the lack of supportive signs for that condition.

To give you an example, using the list that I constructed of possible differentials:

1) retrobulbar abscess or retrobulbar tumor

is there swelling around the eye? pain on opening her mouth?

if not, then these are less likely

2) periodontal disease

does she have excessive tartar? mouth odor? bleeding from her gums? loose teeth?

if not, then this isn't too likely

3) liver disease

do blood chemistry values support this diagnosis? is she jaundiced? if not, then this isn't too likely

4) canine cognitive dysfunction

has she forgotten she is supposed to go outside to urinate and defecate? does she stand at the door and go out and then come right back in? does she forget about mealtimes? have other odd behaviors that are new? does she act confused or vocalize for unexplained reasons?

if not, this diagnosis is less likely

5) temporomandibular joint arthritis

this one is pretty hard to eliminate without taking X-rays -- and even then it can be hard. it would be easier if dogs could talk, sometimes if there is the perception that pain exists, it may be beneficial to use a pain relief medication just to see if it helps.

6) gastrointestinal disease

are there any other signs, such as regurgitation, vomiting, diarrhea weight loss?

if not, this is less likely, too

It is likely that I have not thought of all possible problems --- but the point is that it is necessary to consider all of the problems that could lead to a particular clinical sign and then to eliminate them based on the presence or absence of other clinical signs.

I didn't mean to worry you --- just to tell you that I supported your perception that there really could be a medical cause that may have been overlooked because your vet wasn't thinking about all of the possibilities.

It is hard in practice because we have to deal with a lot of variability in both the pet's ability to mimic illness and the owner's perception of when their pet is ill, which can vary widely. I have some owners who worry easily and bring their pets in when they are just a little off -- and other owners who if they call me I know that their pet is already in the midst of a medical crisis. If your vet knows you well and thinks you are in the first category, then he or she is going to put less weight on your perception of the illness and look for obvious clinical signs. The problem is that once in a while, your perception is going to be right when the clinical signs are slight ---- so you have to be willing to schedule more rechecks than the person who waits until their pet is actually bleeding or actually comatose prior to coming to the vet.

The thought process outlined above doesn't take very much time after making the list -- it is usually easy to eliminate many of the possible problems. So I don't look at it as getting carried away but as being careful.

Sometimes when one of my clients has paid for X-rays and lab work and a couple of rechecks and I tell them I really think their dog is normal, they think I got carried away, though. Deciding how far to go in looking for problems is one of the things that makes veterinary medicine challenging and difficult.

Mike Richards, DVM 12/20/99