Maltese Dog Health Problems

Why Maltese Dogs Have Specific Health Risks

The Maltese is one of the oldest toy breeds in existence, with a documented lineage stretching back over two thousand years around the Mediterranean. Centuries of selective breeding for small size, a pure white coat, and a gentle companion temperament have produced a dog that is remarkably healthy for its size but carries specific genetic vulnerabilities that every owner should understand.

At four to seven pounds, the Maltese shares many toy-breed orthopedic and dental concerns with breeds like the Chihuahua and Havanese. However, two conditions set the Maltese apart. White Dog Shaker Syndrome, also called idiopathic cerebellitis, disproportionately affects small white-coated dogs, and the Maltese is the breed most commonly associated with it. Portosystemic liver shunts, a congenital vascular defect, also appear in Maltese at higher rates than in most other breeds, making early liver function screening an important step that many new owners overlook.

The good news is that Maltese dogs are resilient, often living 12 to 15 years or more with consistent care. Their small appetite makes weight management straightforward, their temperament supports low-impact exercise routines, and most breed-specific conditions respond well to treatment when detected early. The challenge is awareness: owners who do not know what to look for tend to miss early warning signs until conditions have progressed.

1) Patellar Luxation

Patellar luxation is one of the most frequently diagnosed orthopedic conditions in Maltese dogs. It occurs when the kneecap, or patella, slides out of the trochlear groove where it normally tracks during leg movement. In Maltese, this is almost always a medial luxation, meaning the kneecap slips toward the inside of the leg.

Veterinarians grade patellar luxation on a scale of one to four. Grade one means the kneecap can be manually displaced but returns to position on its own. Grade two means it occasionally slips during movement and may or may not return without manipulation. Grades three and four involve a kneecap that is displaced most or all of the time, often causing a persistent abnormal gait and progressive joint damage.

Many Maltese dogs with grade one or two luxation live comfortably for years with conservative management. You may notice occasional "skipping" on a back leg, where your dog lifts the affected limb for a few strides and then returns to normal. This intermittent lameness is characteristic and often the earliest sign owners notice. As the condition progresses, you may see reluctance to jump, stiffness after rest, or a bow-legged stance.

Prevention and management: Keep your Maltese at a lean body weight, as even a single extra pound on a five-pound dog represents a significant percentage increase in joint stress. Use ramps or pet steps for furniture access instead of allowing repeated jumping. Maintain short nails and consider traction aids on slippery floors. Low-impact exercise like controlled leash walks supports muscle tone around the knee without the jarring impact of free jumping.

When to call your vet: Seek evaluation if lameness persists for more than a day, if your dog stops using a leg entirely, if you hear clicking or popping sounds during movement, or if pain responses increase. Surgical correction is typically recommended for grade three and four cases or for lower grades that are progressing and affecting quality of life.

2) Dental Disease

Dental disease is arguably the most common and most consistently underestimated health problem in Maltese dogs. The combination of a tiny jaw, crowded teeth, and retained deciduous teeth creates an environment where plaque accumulates rapidly, tartar hardens along the gumline, and periodontal disease advances faster than owners expect.

By the age of three, the majority of Maltese dogs already show some degree of periodontal disease if dental care has not been a priority from puppyhood. The progression follows a predictable pattern: plaque buildup leads to gingivitis, which causes gum inflammation and bad breath. Left untreated, gingivitis progresses to periodontitis, where the supporting structures of the teeth begin to break down. This can result in tooth root abscesses, bone loss in the jaw, loose or lost teeth, and systemic bacterial spread that can affect the heart, kidneys, and liver.

Maltese dogs are also prone to retaining their baby teeth, particularly the upper canines. When deciduous teeth do not fall out as adult teeth grow in, the crowding worsens and creates additional pockets where bacteria thrive. Your veterinarian should check for retained deciduous teeth during early wellness visits, and extraction of retained teeth is a straightforward procedure that prevents significant problems down the line.

Prevention tips: Daily toothbrushing with an enzymatic canine toothpaste is the single most effective preventive measure. Start when your Maltese is a puppy to build tolerance. Schedule professional dental cleanings on the timeline your veterinarian recommends, which for many Maltese dogs means annually or more frequently. Avoid hard chew toys that can fracture small teeth, and choose treats that do not leave sticky residue on tooth surfaces.

When to call your vet: Persistent bad breath that does not improve with brushing, red or bleeding gums, visible tartar buildup, facial swelling near the jaw or below the eye, drooling, pawing at the mouth, dropping food during meals, or sudden reluctance to eat hard food.

If you are evaluating treats for dental impact, our Dog Treats hub compares options that minimize residue and support oral health between cleanings.

3) White Dog Shaker Syndrome (Idiopathic Cerebellitis)

White Dog Shaker Syndrome is a neurological condition that causes generalized, rhythmic tremors affecting the entire body. It was originally called "white shaker dog syndrome" because it was first described in small white-coated breeds, and the Maltese is the breed most closely associated with the condition. It is now understood that the disease can occur in dogs of any coat color, but it remains far more prevalent in white toy breeds.

The exact cause is not fully understood, which is why it is also called idiopathic cerebellitis. The leading theory involves mild, non-suppurative inflammation of the cerebellum, the part of the brain responsible for coordinating movement. This inflammation may have an autoimmune component, though no definitive trigger has been identified. The condition typically appears in young adult dogs between one and three years of age, though onset outside this range is possible.

Symptoms usually develop over one to three days. Owners notice fine, diffuse tremors that affect the head, trunk, and limbs. The tremors are present at rest and worsen with excitement, handling, or stress. They typically decrease or stop during sleep. Affected dogs remain alert and responsive, which helps differentiate the condition from seizure activity. In more severe cases, dogs may also show head tilts, nystagmus (involuntary eye movement), or mild coordination problems when walking.

The good news is that White Dog Shaker Syndrome responds well to treatment in most cases. The standard protocol involves corticosteroids, typically prednisone, which are tapered gradually over several weeks to months. Most dogs show significant improvement within the first week of treatment. Some dogs require long-term low-dose maintenance therapy, while others can eventually be weaned off medication entirely. Relapses are possible but are usually manageable with a return to treatment.

Prevention and management: Because the cause is not fully understood, true prevention is not currently possible. However, owners who are aware of the condition can respond quickly when tremors appear, which shortens the period of discomfort and typically leads to faster resolution. Minimize stress during flare-ups, keep the environment calm, and follow your veterinarian's tapering schedule precisely, as stopping corticosteroids abruptly can trigger rebound symptoms.

When to call your vet: Any new-onset tremors in a Maltese warrant a veterinary visit within 24 hours. Seek same-day or emergency care if tremors are severe enough to prevent walking or eating, if your dog appears disoriented or unresponsive, if seizure activity occurs, or if tremors develop suddenly after possible toxin exposure, which must be ruled out.

4) Portosystemic Liver Shunt

A portosystemic shunt (PSS) is a vascular abnormality where blood from the digestive tract bypasses the liver through an abnormal vessel, flowing directly into the systemic circulation without being filtered and detoxified. The liver normally processes nutrients, metabolizes drugs, and removes toxins like ammonia from the blood. When a shunt diverts blood around the liver, these toxins accumulate and can affect brain function, kidney health, and overall development.

The Maltese is one of the breeds with the highest documented predisposition to congenital portosystemic shunts. Research has identified a genetic component, and responsible breeding programs screen for this condition. Most congenital shunts in Maltese are extrahepatic, meaning the abnormal vessel is located outside the liver, which is generally more amenable to surgical correction than intrahepatic shunts found in larger breeds.

Symptoms typically appear in puppies and young dogs, often before one year of age, though some dogs with smaller shunts may not show obvious signs until later. The hallmark presentation is hepatic encephalopathy, a constellation of neurological signs caused by toxin accumulation. You may notice intermittent disorientation, head pressing against walls, circling, staring into space, or unusual behavior after meals, when the toxin load is highest. Other signs include stunted growth compared to littermates, poor coat quality, excessive thirst and urination, vomiting, diarrhea, and the formation of ammonium biurate bladder stones.

Diagnosis involves a combination of blood work, bile acid testing, abdominal ultrasound, and sometimes advanced imaging such as CT angiography or nuclear scintigraphy to map the shunt vessel. Bile acid testing is a particularly useful screening tool and should be considered for all Maltese puppies, especially those showing any suggestive symptoms.

Treatment options: Surgical correction is the gold standard for extrahepatic shunts. The most common techniques involve placing an ameroid constrictor or cellophane band around the shunt vessel, which gradually narrows it over weeks, allowing the liver to adapt and develop proper portal blood flow. Success rates for surgical correction in dogs with extrahepatic shunts are generally good, with many dogs going on to live normal lives. Medical management with a low-protein prescription diet, lactulose to reduce ammonia absorption, and antibiotics to reduce ammonia-producing gut bacteria is used for dogs awaiting surgery or those who are not surgical candidates.

When to call your vet: Seek immediate veterinary care if your Maltese shows signs of hepatic encephalopathy such as disorientation, head pressing, seizures, or severe lethargy, especially after eating. Any Maltese puppy that seems unusually small, fails to thrive, or shows intermittent neurological signs should be evaluated for a liver shunt as a priority.

5) Progressive Retinal Atrophy

Progressive retinal atrophy (PRA) is a group of inherited degenerative eye diseases that cause the photoreceptor cells in the retina to deteriorate over time, eventually leading to blindness. In Maltese dogs, PRA is a recognized concern, though its prevalence is lower than dental disease or patellar luxation. The condition is inherited in an autosomal recessive pattern, meaning a dog must receive a defective gene from both parents to be affected.

The early stage of PRA affects the rod photoreceptors, which are responsible for vision in low light. Owners often notice that their dog becomes hesitant or clumsy in dim environments, bumps into furniture when lights are low, or shows reluctance to navigate stairs or unfamiliar spaces at night. This night blindness can be subtle at first and is easy to attribute to other causes. As the disease progresses, the cone photoreceptors degenerate as well, leading to vision loss in daylight and eventually complete blindness.

The rate of progression varies. Some dogs lose functional vision over several months, while others decline gradually over several years. There is currently no cure or treatment that can halt or reverse PRA. However, because the condition is painless and progresses gradually, most affected dogs adapt remarkably well, especially when owners make environmental accommodations.

Prevention and management: The most effective prevention strategy operates at the breeding level. DNA tests are available for some forms of PRA, and responsible Maltese breeders screen their breeding stock. When purchasing a Maltese puppy, ask for documentation of PRA testing. For dogs already diagnosed, management focuses on maintaining a consistent home environment, using verbal cues and scent markers to help navigation, keeping furniture placement stable, blocking access to hazards like pools and staircases, and continuing mental stimulation through scent-based games and interactive toys.

When to call your vet: Schedule an ophthalmologic evaluation if you notice any changes in your dog's confidence in dim lighting, if eyes appear more reflective than normal (a sign of retinal changes), if your dog bumps into objects in familiar settings, or if you notice any cloudiness, redness, or discharge from the eyes. Early diagnosis through electroretinography (ERG) can confirm PRA before visible symptoms become obvious.

6) Collapsed Trachea

Tracheal collapse is a progressive condition in which the cartilage rings that hold the trachea open weaken and flatten, causing the airway to narrow. This is a common issue across toy breeds, and the Maltese is no exception. The weakened cartilage allows the tracheal membrane to sag into the airway during breathing, creating turbulence, irritation, and the characteristic honking cough that owners often describe as sounding like a goose.

The condition can affect any part of the trachea, from the neck (cervical trachea) to the chest (intrathoracic trachea), and the location influences when symptoms are worst. Cervical collapse tends to cause coughing during inhalation, while intrathoracic collapse is more pronounced during exhalation or coughing. Many dogs have collapse in multiple segments.

Triggers that worsen symptoms include obesity, excitement, pulling against a collar, exposure to respiratory irritants like cigarette smoke or strong chemicals, high heat and humidity, and respiratory infections. Episodes can range from mild intermittent coughing to severe respiratory distress with cyanosis, where the gums and tongue turn blue from lack of oxygen.

Diagnosis typically involves a combination of physical examination, radiographs (which may show tracheal narrowing, though the dynamic nature of the condition means static images can be normal), and fluoroscopy or bronchoscopy for definitive assessment. Fluoroscopy is particularly useful because it allows real-time visualization of tracheal movement during breathing.

Prevention and management: Use a chest harness for all walks and leash activities rather than a neck collar, which places direct pressure on the trachea. Maintain a lean body weight, as excess fat around the neck and chest compresses the airway. Avoid exposure to smoke, aerosol sprays, and strong fumes. Manage excitement and exertion in hot weather. Medical management includes cough suppressants, bronchodilators, anti-inflammatory medications, and sedatives for severe episodes. Surgical options, including tracheal stent placement, are reserved for severe cases that do not respond to medical management.

When to call your vet: Seek same-day care for coughing episodes that do not resolve within a few minutes, any episode where gums or tongue appear blue or pale, labored breathing with visible effort, collapse or extreme lethargy following a coughing fit, or any breathing pattern that appears panicked or distressed.

Expected Cost Ranges for Common Maltese Conditions

Treatment costs for Maltese health conditions vary by geographic region, severity at diagnosis, and whether specialist referral is required. The ranges below reflect typical U.S. costs and are intended to support financial planning rather than replace specific veterinary estimates.

Building a dedicated veterinary fund or investing in pet insurance early in your Maltese's life can prevent treatment delays driven by financial uncertainty. For broader annual cost planning, see our Pet Costs hub.

When to See a Vet Immediately

Maltese dogs are small enough that serious conditions can escalate rapidly. Call or visit emergency care without delay if your Maltese shows any of the following:

• Labored breathing, blue or pale gums, or persistent honking cough that does not resolve.
• Generalized tremors accompanied by disorientation, inability to walk, or seizure activity.
• Head pressing against walls, circling, staring blankly, or other signs of hepatic encephalopathy.
• Collapse, fainting, or sudden inability to stand or maintain balance.
• Repeated vomiting combined with lethargy, abdominal pain, or refusal to drink.
• Sudden vision loss, severe eye redness, or signs of acute eye pain such as squinting and pawing.
• Facial swelling, particularly below the eyes, which may indicate a tooth root abscess requiring urgent treatment.

Toy breeds have less physiological reserve than larger dogs, meaning they dehydrate faster, lose body heat more quickly, and can deteriorate from stable to critical in a shorter window. When in doubt, contact your veterinarian or an emergency clinic rather than waiting to see if symptoms resolve on their own.