Introduction

• Cause: bacterial, viral and fungal infections, usually secondary to suboptimal husbandry.
• Signs: purulent discharge, caseous plaques, facial swellings, anorexia, lethargy.
• Diagnosis: clinical examination, radiography, cytology and culture.
• Treatment: topical and systemic antibiotics and antifungals, surgery, analgesia and assisted feeding alogside husbandry changes.
• Prognosis: variable depending on extent and chronicity of disease and whether underlying osteomyelitis is present.

Pathogenesis

Etiology

• Compromised oral mucosa due to:
  • Immunosuppresion.
  • Underlying viral infection, eg Herpesvirus.
  • Putrefaction of food during hibernation.
  • Oral, rostral and dental trauma.
  • Damage to dentition.
  • Damage caused by metabolic bone disease Metabolic bone disease/SNHP.
  • Hypovitaminosis A Hypovitaminosis A and squamous metaplasia.
  • Pentastomid infection (wild-caught animals).
• Secondary opportunistic infection:
  • Pseudomonas , Aeromonas, E. coli, Bacteriodes, Clostridia, Fusobacterium, Proteus, Devriesia, Mycobacteria, Mycoplasma.
  • Herpes and rana viruses (chelonians).
  • Candida, Aspergillus and other opportunist fungal infections.
• Progression to osteomyelitis Osteomyelitis and respiratory disease Lower respiratory tract disease.

Predisposing factors

General

• Suboptimal temperatures, humidity and ventilation.
• Poor calcium and vitamin D3 supplementation leading to metabolic bone disease/ SNHP.
• Hypovitaminosis A Hypovitaminosis A.
• Suboptimal UVB provision Chelonia husbandry Lizard husbandry Snake husbandry.
• Rostral trauma.
• Tooth damage and periodontal disease Periodontal disease often secondary to inappropriate diet.
• Latent herpes virus Herpes virus infection, ranavirus and mycoplasma infection in chelonia.
• Poorly implemented hibernation Hibernation / brumation, including lack of prehibernation management, lack of monitoring, excessive length  and no temperature control.
• Putrefaction of food during hibernation related to poor prehibernation management.
• Gout Gout which is often secondary to renal disease Renal disease.

Specific

• Lively or nervous species kept in unsuitable enclosures may be at risk of rostral trauma, eg Chinese water dragons.

Pathophysiology

• Compromise of oral mucosa.
• Invasion by bacteria, fungi and viruses.
• Severe inflammatory reaction.
• Progression to osteomyelitis.
• Spread to eyes and respiratory tract.
• Inability to eat and starvation.
• Septicemia may follow

Timecourse

• Often chronic but not noticed by owners.

Epidemiology

• Often husbandry related therefore may be clusters in animals kept in similar conditions Chelonia husbandry Lizard husbandry Snake husbandry.

Diagnosis

Treatment

Prevention

Outcomes