The Maltese: A Long-Lived Breed With Specific Vulnerabilities
Maltese dogs routinely live into their mid-teens, making them one of the longer-lived toy breeds. That longevity is a gift — but it also means health conditions that emerge in middle age can affect a dog for many years if undetected. Three conditions in particular deserve careful attention from every Maltese owner: dental disease, white dog shaker syndrome, and portosystemic liver shunts. Each is manageable when caught early and handled correctly.
Dental Disease: The Silent Epidemic in Small Breeds
Research consistently shows that periodontal disease affects over 80% of dogs by the age of three, and small breeds suffer disproportionately. The Maltese is especially vulnerable because its relatively large teeth are crowded into a small jaw, creating pockets where bacteria accumulate rapidly.
What Happens Without Intervention
Plaque mineralises into tartar within days. Tartar below the gumline triggers inflammation, bone loss, and eventually tooth loss. More seriously, chronic oral bacteria can seed into the bloodstream, contributing to heart valve disease — a concern given that small breeds already carry elevated cardiovascular risk as they age. Bad breath is usually the first owner-noticed sign, but by that point, significant disease may already be present.
Prevention and Treatment
Daily tooth brushing using a dog-appropriate toothpaste is the single most effective preventive measure available. Dental chews and water additives provide modest additional benefit. Professional scaling under anaesthesia, carried out by your vet, removes established tartar that brushing cannot touch. Many Maltese require this annually from around three years of age. Do not allow dental disease to go untreated on the basis of anaesthetic risk — modern veterinary anaesthesia protocols make the procedure far safer than the damage caused by chronic infection.
White Dog Shaker Syndrome
White dog shaker syndrome — also known as idiopathic steroid-responsive tremor syndrome or generalised tremor syndrome — was first described in small white-coated breeds, with the Maltese among the most commonly affected. The name is misleading: the condition has also been documented in dogs of other colours and larger breeds, but the Maltese remains a recognised high-risk group.
Clinical Signs
The defining feature is a full-body tremor that typically appears in young adult dogs, often between one and two years of age. The shaking can be mild and intermittent, or severe enough to affect walking and coordination. Affected dogs usually remain alert and are not in obvious pain. Rapid eye movements (nystagmus) and difficulty walking in a straight line may accompany the tremors in more pronounced cases.
Cause and Treatment
The underlying mechanism is believed to involve immune-mediated inflammation affecting the central nervous system, though the precise trigger remains under investigation. The condition responds well to corticosteroids, typically prednisolone, which are tapered gradually once tremors resolve. Most dogs achieve full remission, though a small proportion require ongoing low-dose treatment. If your Maltese begins shaking uncontrollably, seek veterinary attention the same day — several other conditions can cause tremors, and accurate diagnosis is essential before treatment begins.
Portosystemic Liver Shunts
A portosystemic shunt (PSS) is an abnormal blood vessel that diverts blood from the digestive tract away from the liver, bypassing the organ's detoxification function. The Maltese has one of the highest breed-specific rates of congenital liver shunts of any dog. Estimates suggest the condition affects approximately 1 in 100 Maltese, a prevalence substantially higher than in the general dog population.
Why It Matters
The liver filters toxins, metabolises nutrients, and produces proteins vital to normal physiology. When blood bypasses the liver, ammonia and other waste products accumulate in circulation, affecting the brain and other organs. This is referred to as hepatic encephalopathy.
Recognising the Signs
Symptoms often appear in puppyhood or young adulthood and can include stunted growth, disorientation, circling, pressing the head against walls, seizures, excessive salivation after eating, and unusual behaviour following meals. Some affected dogs are simply described as "not quite right" — quieter, less interactive, or intermittently confused.
Diagnosis and Management
Blood tests showing elevated bile acids before and after eating are the standard screening tool, followed by ultrasound or advanced imaging to locate the abnormal vessel. Treatment depends on shunt type and location. A single extrahepatic shunt — the most common form in the Maltese — is typically amenable to surgical correction with a good long-term prognosis. Medical management using dietary protein restriction and medications to reduce ammonia production can stabilise dogs prior to surgery or in cases where surgery is not possible. Consult a veterinary internal medicine specialist or surgeon experienced in hepatic conditions for the best outcome.
Additional Health Considerations
Beyond the three primary concerns above, Maltese owners should be aware of hypoglycaemia (low blood sugar) in puppies and very small adults, particularly during stress or illness. Collapsed trachea is also seen in the breed and should be evaluated if a persistent honking cough develops. Patent ductus arteriosus, a congenital heart defect, occurs at elevated rates and warrants cardiac screening in puppies.
Key Steps for Maltese Owners
- Begin tooth brushing from puppyhood to establish the habit early, and schedule professional dental cleanings as recommended by your vet.
- If your Maltese develops whole-body tremors, seek same-day veterinary assessment — white dog shaker syndrome is treatable but requires prompt, accurate diagnosis.
- Ask your vet to perform bile acid testing if your puppy shows any signs of neurological abnormality, poor growth, or behavioural oddities, particularly after meals.
- Monitor very small or young Maltese for signs of hypoglycaemia — lethargy, weakness, or wobbliness — especially after missed meals or stressful events.
- Attend routine health checks at least annually and ensure your vet listens to your dog's heart at every visit to catch any developing cardiac changes early.
With attentive ownership and a good veterinary relationship, the majority of Maltese health challenges are highly manageable. This is a breed that rewards care with years of devoted, spirited companionship.