Ulcerative Stomatitis (Mouthrot) in Reptiles
Melissa Kaplan and Robert Jereb DVM, Journal of Wildlife Rehabilitation 18(2):13. 1995
Note: This article was written for wildlife rehabilitators who, while they have specialized training in working with many types of birds and mammals, generally have little training or experience working with reptiles. Many are trained to perform certain levels of veterinary care on the animals they take in, and all work closely with veterinarians experienced in the care and clinical management of wildlife. This document is not meant to serve as a "do it yourself" manual for the herper who is not trained in the procedures described and who does not have access to appropriate veterinary care, antibiotics, etc.
Keywords: Stomatitis, mouthrot, bacterial infections, reptiles, ulcerative stomatitis
A variety of organisms have been associated with stomatitis, such as Aeromonas aerogenes, A. aerophila, A. hydrophila, Citrobacter freundii, Proteus sp., Pseudomonas aeruginosa and P. fluorescens, Staphylococcus sp., and Streptococcus. Other bacteria, such as Mycobacterium chelonie and the anaerobic Clostridium sp., have also been found in these lesions and exudates.
Dilute solutions of povidone-iodine (Betadine®) and chlorhexidine diacetate (Nolvasan®) are two products with low cytotoxicity. There are a variety of objects used to dislodge and remove the plaques from the mouth, including dulled dental curettes, small bone curettes, needle-nose serrated tweezers, and cotton-tipped swabs. In a pinch and when nothing else is at hand, the jagged end of a broken cotton-tipped swab shaft is useful.
Care must be taken to prevent accidental aspiration or ingestion of detritus when flushing the mouth. The reptilian glottis is high up in the mouth at the base of the extremely agile tongue; in snakes, it is close to the front of the mouth. To this end, the reptile should be laid on its side or held with the head tilted towards the ground.
Flush the mouth with the dilute solution of 1% povidone-iodine or a 0.25%-0.5% solution of chlorhexidine diacetate. Debride using the curettes or tweezer. The resultant cavity must be checked to ensure removal of all the material. Any loose detritus should be swabbed away with a swab dipped in the dilute solution. Once the plaques are removed, the mouth should be flushed again. The animal is then started on a course of antibiotics. (See Table 1.)
During the course of the antibiotic therapy, the mouth should be checked daily to watch for any recurrent plaques. It is not unusual for the above process to be repeated two or more times during recovery. Particularly severe cases may require more than a single treatment on the first day or two.
Most veterinarians and rehabilitators begin with a broad-spectrum antibiotic, but these may not be effective due to the causal organisms and the degree of patient debilitation. The standard culture sampling techniques of swabbing or washes may a yield a confusing mixture of natural and opportunistic buccal and environmental flora. A better method for obtaining a sample for culturing in resistant stomatitis cases is to make a incision into the infected gum and take a small sample of the infected tissue.
Simple stomatitis in chelonians may be treated by thorough washing of the buccal cavity with dilute povidone-iodine solution, finished by an application of topical antibiotics. Systemic antibiotic therapy is generally not required.
In severe or resistant stomatitis in chelonians, cultures should be done to identify the primary or any secondary organisms that may be at work and parenteral antibiotic therapy should be initiated.
If the patient has not eaten in some time and feeding is indicated, whole prey should not be given. Force feeding whole prey is stressful under the best of conditions; given the intensive curetting some patients require, additional stresses should be minimized as much as possible. Instead, puréed prey or a nutritional slurry should be administered by gastric tube. (See Table 2.)
The enclosure should be set up to reduce stress. Hide boxes work well for burrowing and cave-dwelling animals. Arboreal animals should be furnished with a secluded branch on which to lay. The enclosure should be screened from high levels of activity.
Water should be supplied in a form that can be utilized by the animal. Many small lizards require droplets to lap. A drip bottle can be set up over a clean plant or rock, or the sides of the tank may be misted with water at least once daily, taking care to not over-saturate the enclosure. Other lizards, snakes and chelonians do well with a shallow bowl of fresh water.
Frye, FL. 1992. Reptile Care: An Atlas of Diseases and Treatment. TFH Publications, Inc., Neptune City NJ. pp. 111, 116-117.
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.
Mader, DR. 1993. "Common Reptilian Bacteria: What are they and what is their significance." The Viviarium 4(6):27-29.
Stahl, SJ. 1995. "Bacterial Diseases." Journal of the League of Florida Herpetological Societies, May 1995, pp. 17-19.
Table 1. Parenteral Antibiotics
* = May cause tissue necrosis at injection site, especially if administered SQ; dilute with lactated Ringer's, sterile saline or bacteriosstatic water prior to injecting. Injectible enrofloxacin (Baytril) may be given orally.
Table 2. Nutritional Slurries Ingredients
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