ULCERATIVE STOMATITIS (Mouthrot) IN REPTILES

Stomatitis-Mouthrot

      Mouth rot is the common name for stomatitis. It is a bacterial infection which settles into the gum tissue, palate or tongue.

     If left untreated, it can invade the jaw bone; advanced cases may require resectioning of the bone or tissue. One important fact often overlooked by pet owners is that mouthrot is not a disease itself - it is a secondary infection triggered by a systemic infection.

      Stomatitis presents as yellowish-whitish plaques, or irregular blotches on the gums. If poked, it is somewhat soft, rather like curds. In fact, iguana pus is referred to as caseous as it rather curdish or cheesy in nature, rather than what is produced by mammalian abscesses.

      Treatment is not something to be attempted by a child; many adults are too squeamish to try it themselves. A vet can show you how to work on it ... you should see a vet anyway. Systemic antibiotics are often indicated, and it may be quite painful and traumatic to dig out a plaque, requiring that the reptile be anesthetized and the work be done under sterile conditions.

The removal of the plaques and treatment of the site is as follows:

      Through the years, products such as hydrogen peroxide, mouthwash, even vaginal douches have been recommended for stomatitis. The problem is that these products are cytotoxic - they destroy the good tissue along with the bad. What is called for is a product which has antibacterial properties but which is gentle on healthy tissue. Vets will use a product called Novasolon (chlorhexidine diacetate) (available by mail order from animal suppliers, or from feed and grain stores, it is great to have on hand as a disinfectant; the stuff is expensive ($36/gal or about $10/qt) but you dilute it in water) or Betadine (Povidone-iodine, available at drug and grocery stores, it is great to have on hand as an antibacterial for cuts and scratches).

      The site is flushed with the dilute Novasolon or Betadine solution. A small bone curette or dulled dental pick (or, in a pinch, a broken cotton-tipped swab stick) is used to work out the plaques. The curette or pick is used to tease the plaque out of the pocket. If the plaque is not encapsulized, it may not come out easily, and there may be considerable bleeding. At this point, the vet may decided to stop and put the reptile on a 10 day course of enrofloxacin (Baytril), an antibiotic which devascularizes and encapsulates the plaque making for easier-- and less traumatic--removal.

      When the plaque(s) is out, the debris and blood is carefully washed out of the mouth to prevent any from being swallowed or aspirated (inhaled into the lungs which may cause a respiratory infection).

      This whole process may need to be repeated, weekly if not more frequently, until the plaques are finally all gone; as long as the infection is still in the body the plaques will keep forming. Thus the need for systemic antibiotics.

      Because stomatitis is a secondary infection, the reptile must be placed on a course of antibiotics. Broad-spectrum antibiotics are tried first. If the infection does not abate, a culture will have to be done to determine the best antibiotic to use. Because there are so many organisms running around a reptiles mouth, the best way to get a sample for culturing is by actually using a small piece of a plaque.

Things which are not stomatitis

      Sometimes food will get stuck between the "lip" and teeth. It may look crusty brown, sort of like a scab. It may also be whitish and crusty. Mouthrot is confined to inside the mouth and is never crusty (although excessive salivation or oozing from the plaque sites may cause a dried crust on the 'lip' area). Crusty sores may form at the rim of the "lip" area; if they do not heal and disappear, you may have a stubborn _Aeromonas_ infection - this requires a veterinary visit and systemic antibiotics. Abscesses may form around the upper or lower 'lip' on the outside of the face area. These, if left untreated, may, like untreated mouthrot, may destroy the bone and may work itself through deep enough to be seen in the mouth. Abscesses need to be excised and treated under sterile conditions and a course of antibiotics is generally prescribed.

Supportive Therapy

      Reptiles being treated for stomatitis are sick. They should be kept quite, and be kept warm. For the duration, the night time temperatures should be the same as the daytime temperatures in their enclosure. Some reptiles may be reluctant to eat or drink because of the discomfort. This may require that they be hand- or force-fed fluids and food. Pedialyte (R), a pediatric electrolyte solution, or a 1:1 mix of Gatorade(R) and water may be used for oral fluids. If force feeding is required, it is best if a slurry is administered by a tube attached to a large syringe; lizards may be encouraged to lap the slurry off the tip of the syringe itself.

Recommended slurry formulas are:

• Carnivore

  Hill's a/d thinned with Pedialyte®, 1:1 solution of Gatorade and water, or plain water.

• Omnivore

  1. Equal amounts of Hill's a/d and baby food vegetable, thinned with Pedialyte®, 1:1 solution of Gatorade® and water, or plain water.

  2. Herbivore slurry mixed with equal parts Hill's a/d, thinned with Pedialyte® or a 1:1 solution of Gatorade® and water, or plain water.

• Herbivore

  1. Soaked alfalfa pellets, pureed squash, pureed fruit, reptile multivitamin and reptile calcium supplement, thinned with Pedialyte® or a 1:1 solution of Gatorade® and water, or plain water.

  2. 1 can liquid Ensure, mixed with 1 banana and reptile multi-vitamin and calcium supplements.

      Note: a crushed Centrum® (human multivitamin) tablet may be used instead of the reptile vitamin supplements.

      Finally, you must take some time and evaluation the reptile and the reptile's environment. *Something* happened to make it sick in the first place. Temperatures may not have been calibrated correctly, a new animal may have been brought in without first being placed in quarantine, the enclosure and furnishings and equipment may have gone a little too long without being properly cleaned and disinfected, or the reptile has been under stress. Once you figure out the cause, and correct the situation, you will reduce the risk of continued infection or of reinfection.

References:

1. Frye, FL. 1992. Reptile Care: An Atlas of Diseases and Treatment. TFH Publications, Inc., Neptune City NJ. pp. 111, 116-117.

2. Boyer, TH. 1994. "Emergency Care of Reptiles." In Seminars in Avian and Exotic Pet Medicine, 3(4):210-216. AM Fudge DVM and J Jenkins DVM, eds. W.B. Saunders Company, Orlando FL.

3. Mader, DR. 1993. "Common Reptilian Bacteria: What are they and what is their significance." The Vivarium 4(6):27-29. 4. Stahl, SJ. 1995. "Bacterial Diseases." Journal of the League of Florida Herpetological Societies, May 1995, pp. 17-19. =====

Water Dragon Books

Green Water Dragons, Sailfin Lizards and Basilisks (General Care and Maintenance of Series) by Philippe De Vosjoli

      Basic but detailed information about the care, diet, and health of green water dragons, sailfin lizards and basilisks.

Anoles, Basilisks and Water Dragons : A Complete Pet Care Manual (More Complete Pet Owner's Manuals) by Richard D. Bartlett, Patricia P. Bartlett (Contributor)

     Discussion of the general care of many species of anole, basilisks and water dragons. Excellent information regarding enclosures, cage building, and insect care and breeding.

Eat This Bug : A Guide to Invertebrate Live Foods for Reptiles and Amphibians by Lynn Davis

      This book is a guide for owners of reptiles and amphibians who feed insects and other live foods to their pets. Advice is offered for selecting , ordering and raising your own supply of live invertebrate foods. More than a dozen species of live foods are discussed. The book includes instructions on keeping cultures of insects, and recipes & diets for insects.