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Case study- Mucous-cystic gingivitis2015-11-14

Recently, two Boa constrictors have turned up with the same problem apparently in the praxis, that I will describe below in details...

Infectious, ulcerative stomatitis or "mouth-rot" occuring in reptiles has been well described in specific literatures. These recent two cases are considered special, because they both differ from classic cases mentioned in books.


The two boas being described in this study are both in good condition, having great feeding response and are kept in proper hygienic enviroment. Owners' attention was drawn to subtle swelling in the jaw region. At this stage, the swelling did not cause any complaints for the boas, nor food refusal by the way. 


Subtle swelling of gingiva in an Argentine boa (Boa c. occidentalis). Notice the subtle swelling below the right nostril and the not properly closed mouth.


Subtle swelling of gingiva below the left eye in a Peruvian redtail (Boa c. constrictor). Photo: Dudás Viktor


By opening the mouth, mucous membrane was pale, whitish, which is often the case with snakes and- in contrast with mammals -does not indicate anaemia and is not considered as pathological. The center of swelling was a certain area of the upper, outer denture; in one case it was close to snout, while in the other case it was located under the eye level. 
In both cases the center was surrounded by a transparent, mucous fluid-filled cyst, which caused the swelling itself. Therefore, hereby I refer to this pathological phenomenon as mucous-cystic gingivitis.


Peruvian redtail boa (Boa c. constrictor) with mucous-cystic gingivitis

 

Pathogenesis

Snakes kept in captivity are often rubbing their head to various parts/elements of the enclosure, especially when looking for food or being restless. Consequently, teeth -especially the ones close to snout -often get injured, damaged. Broken teeth remained in the gum can lead to inflammation, gingivitis, disorder of saliva diversion, creating fluid-filled cyst and in more severe cases snakes can end up with diffuse stomatitis


The first and most apparent symptom is the local swelling of gingiva (gum), that can worsen as far as the snake is no longer able to close the mouth. At this stage, a secondary bacterial infection has usually taken place as well, which can also affect to mandibula and maxilla bones to make it even worst. These developed stage, neglected cases are quite a challange to treat successfully even for a reptile specialist vet.


By opening the mouth, a cyst-like swelling is noticeable in the left upper, outer denture as it overlaps the forceps.




Treatment

By opening the cysts, dense and viscous mucus was removed. These cysts also contained several broken teeth, as well. Interestingly, affected areas did not show any apparent sign of bacterial infection at this stage. Opened cysts were flushed out by dilute iodine (Betadine-water 50-50%). This treatment was repated by owners every two days for 7 occasions altogether. In one case-, due to the larger size of the cyst and several broken teeth in it and in the mouth -a preventive antibiotic treatment was suggested and started by using enrofloxacin intramuscular.  
In the other case however-, where the cyst was considerably smaller and less losen teeth were present -wound-toilette with diluted Betadine a few times was just enough to recover properly. Here, the swelling practically disappeared by opening the cyst.


In one of the cases (the more severe one), we have started a cure of antibiotics, using enrofloxacin intramuscular


Successful treatment of those two cases were greatly achieved due to the early recognition by owners. As no secondery bacterial infection had taken place yet, both were relatively easy to cure and managed to recover quickly.

We are thankful for the pictures to the owner, Viktor Dudás. 

Dr. Botond Ádám

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