Lizard and Snake Ulcerative Stomatitis

Careful examination of the mouth is necessary since lesions may not be extensive © RVC

Upper alimentary tract disease

Upper alimentary tract disease (UATD) is any pathological condition affecting the oral cavity, pharynx or oesophagus.

Stomatitis

Stomatitis (mouth rot) is the most common form of upper alimentary tract disease in reptiles. In snakes stomatitis is a very common multifactorial condition. Infectious agents generally are Gram-negative bacteria. However, stomatitis is usually secondary to stressors such as poor environmental conditions and malnutrition.

Examination

Clinical signs of stomatitis are excessive salivation, anorexia, weight loss and lethargy. Initial lesions are gingival petechiation which develop to oedema and ulceration with the presence of caseous material. Other associated problems include osteomyelitis around the teeth, haematogenous spread to other parts of the body, lower respiratory tract disease and a distended subspectacular space from blocked nasolacrimal ducts.

Ulcerative stomatitis in a Boa constrictor © RVC

Diagnosis

Stomatitis is usually not confused with other diseases in lizards and snakes and is diagnosed on physical examination. Diagnostic aids are necessary to ascertain the aetiology. The initial step is sampling of the affected area, preferably by biopsy, for bacteriology. This sample can also be submitted for fungal culture. All oral masses should be biopsied and cultured. Radiology is useful to determine bony involvement.

Therapy

Treatment of stomatitis needs to be aggressive since progression to systemic disease is not uncommon. Supportive treatment should be instigated immediately though care must be taken not to further traumatise the mouth. The application of topical antiseptics can be used in mild cases while surgical debridement under general anaesthetic may be indicated in severe cases. Secretions, necrotic tissue and debris should be removed by flushing with dilute povidone-iodine or chlorhexidene. Choice of antibiotics is dependent on sensitivity. Length of treatment may be from three weeks in mild cases to several months in more severe ones. If possible, the mouth should be cleaned twice daily during this time. Inadequate length of treatment is a common cause of therapeutic failure.

Prevention

Poor husbandry is usually the root cause of many problems with reptiles. The husbandry practices need to evaluated and corrected. One or several of the usual problems will most likely be present - incorrect temperatures and unhygienic conditions probably being the most common. Mild cases of stomatitis sometimes will resolve with only a change to the POTZ of the snake.