Pale gums are when the normal pink color of the gums turns pale or white, usually due to a serious underlying health problem.
• Any change in color can indicate the presence of a life-threatening underlying condition and must be treated as an emergency
• The most common cause of pale gums in dogs is anemia: the reduction of red blood cells through numerous mechanisms, such as blood loss, red blood cell destruction, or inadequate production of red blood cells
• Anemia has many potential causes, which are frequently life-threatening
• Dogs presenting with pale gums require stabilization via supplemental oxygen, IV fluids, or blood transfusions before diagnostics begin
• Diagnostics to identify the underlying condition include physical examination, blood work, diagnostic imaging, and urinalysis
• Treatment and prognosis vary widely depending on the underlying condition
Healthy dogs have pink to light red gums; normal pigmentation can cause gums to appear darker in certain spots. Examination of the mouth and gum color while dogs are healthy provides owners a visual baseline to help identify any changes in the future. In some cases, comparing to another pet in the household can also provide a useful baseline.
Pale gums are confirmed by lifting the upper lip, applying pressure to the gum, releasing pressure, the observing how long it takes for color to return, which should take no longer than 1 or 2 seconds.
Pale or white gums can be caused by a number of underlying conditions.
Anemia the most common cause of pale gums in dogs. Anemia is a state of inadequate red blood cells in the bloodstream, and can be caused by blood loss, breakdown of red blood cells, or decreased production of red blood cells.
Blood loss can be caused by
• Traumatic injuries causing persistent bleeding • Heavy parasite infestation (e.g. ticks, fleas, hookworms)
• Gastric ulcers • Hemorrhagic gastroenteritis • Blood clotting disorders
• Cancers, including intestinal tract cancers, urinary tract cancers and hemangiosarcomas
Destruction of red blood cells (hemolysis) can be caused by
• Autoimmune conditions such as immune-mediated hemolytic anemia or immune-mediated thrombocytopenia
• Blood parasites such as babesiosis or ehrlichiosis • Cancer • Crotalid snake envenomation
• Toxicosis (e.g. mushroom, rat poison, mothball, NSAID, onion, or zinc)
Decreased production of red blood cells can be caused by
• Chronic kidney disease • Severe nutritional imbalances • Autoimmune conditions • Hypothyroidism
• Reaction to drugs • Cancers, such as lymphoma
Other causes of pale gums include:
• Shock (circulatory failure) • Severe pain • Liver disease • Inflammatory bowel disease
• Heart conditions such as dilated cardiomyopathy or congestive heart failure
• Conditions affecting hormone levels, such as diabetes mellitus and hypoadrenocorticism
The paleness of the gums is not always representative of the severity of the underlying condition. Most conditions that result in pale gums are emergencies so urgent veterinary care is required in any dog with pale gums.
A dog who exhibits pale gums needs immediate emergency care as it is a symptom of a number of life-threatening conditions. If the animal is presenting other symptoms such as lethargy, difficulty breathing, collapse, or is visibly bleeding, a veterinarian should be contacted immediately.
The first step in the treatment of pale gums is the stabilization of the dog’s condition through supportive treatments such as:
• Supplemental oxygen • Supplemental heat • IV fluids• Blood transfusion
Once stabilized, a dog presenting with pale gums usually undergoes the following diagnostics:
• Physical examination • Blood work • Diagnostic imaging • Urine analysis • Fecal analysis
Treatment of pale gums varies greatly and is dependent on the underlying cause.
Broad treatments for the underlying causes of pale gums may include:
• Specific medications • Surgery • Nutritional therapy • Palliative care • Euthanasia
Prognosis is extremely variable and depends on the underlying condition.
Pale gums can be mistaken for cyanosis. With cyanosis, the gums are pale blue, reflecting poor oxygen delivery to the tissues. Blue gums are also an emergency.
Dogs suffering from pale or white gums may present a number of additional symptoms, including but not limited to:
• Lethargy • Rapid breathing • Appetite loss • Vomiting • Diarrhea • Swollen lymph nodes • Collapse
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