Maltese Health Guide

How long do Maltese live — and what affects their lifespan?

Maltese health starts with one meaningful advantage: this is a long-lived breed. VCA Animal Hospitals puts the typical Maltese lifespan at 12–14 years, while the American Kennel Club cites a range of 12–15 years. Some individuals reach 16 or 17, though those numbers sit at the outer edge of what the data supports. The breed's small body, relatively low disease burden in early life, and genetically compact frame all contribute to that longevity — but sustaining it takes active management of the conditions that cluster in this breed.

The single biggest predictors of how long a Maltese lives are cardiac health after middle age and dental care throughout life. Both are within an owner's control. Understanding the full picture of breed-specific vulnerabilities — and the mechanisms behind each one — makes the difference between reactive veterinary visits and a proactive routine that preserves years.

For breed temperament and grooming context, see our guide on the 10 most common Maltese questions. If you're considering a related small breed, the Lhasa Apso guide covers a similarly long-lived companion with overlapping health considerations.

Hypoglycemia in Maltese puppies

Toy breed puppies, particularly Maltese under four months of age, face a metabolic vulnerability that larger dogs simply don't share. The mechanism is straightforward: toy puppies have minimal fat stores and immature livers that cannot synthesize glucose from stored glycogen efficiently. Between meals — or during any period of stress, cold, or unusual activity — blood sugar can drop quickly and steeply.

The symptoms escalate in a recognizable pattern. A puppy that seems tired and unsteady on its feet is already hypoglycemic. Left untreated, the wobbling gives way to muscle tremors and, in severe cases, seizures. The emergency first response is to rub a small amount of Karo corn syrup or honey directly onto the gums — absorption through the mucous membrane is rapid and does not require swallowing. Recovery should begin within five to fifteen minutes. That said, this is a bridge to veterinary care, not a substitute for it. A puppy that has crashed needs fluids, warming, and monitoring; call your vet immediately after administering the syrup.

Prevention is more straightforward than recovery. Feed Maltese puppies three to four small meals daily using a high-quality food with adequate protein and complex carbohydrates. Keep the puppy warm, minimize unnecessary stress during the first several months, and keep a high-calorie paste such as Nutri-Cal on hand as a preventive supplement if meals are missed. The risk drops significantly by six months, when liver function matures and the puppy carries more body mass relative to its energy needs.

Patellar luxation — grades, symptoms, and treatment

The kneecap (patella) sits in a groove at the bottom of the femur and should track smoothly as the leg extends and flexes. In many toy breeds, including the Maltese, that groove is too shallow or the leg's alignment is slightly off — so the patella slips sideways out of position. This is patellar luxation, and it ranges from an occasional, self-correcting nuisance to a condition that permanently disables the joint.

Veterinary orthopedists grade luxations on a scale of one to four. Grade 1 is the mildest: the kneecap can be manually pushed out of the groove but pops back immediately when released. The dog rarely shows lameness. Grade 2 involves intermittent spontaneous luxation; you may see the dog kick its hind leg outward to snap the patella back into place. Grade 3 means the kneecap sits outside the groove most of the time but can be manually repositioned; Grade 4 is permanent luxation that cannot be manually reduced at all.

Surgery is generally recommended from Grade 3 upward, though dogs showing significant lameness or compensation at Grade 2 are often candidates as well. The most common techniques include deepening the femoral groove (trochleoplasty), repositioning the attachment point of the patellar ligament on the tibia, and tightening stretched soft tissue. Recovery involves six to eight weeks of restricted activity. Left untreated, higher-grade luxation leads to chronic lameness, compensatory gait changes, and accelerated arthritis — making early diagnosis during routine vet visits genuinely valuable.

Mitral valve disease in Maltese

Mitral valve disease (MVD) is the most common cause of cardiac-related death in Maltese and in small-breed dogs generally. The condition involves the mitral valve — a two-leaflet structure between the heart's left atrium and left ventricle — gradually thickening and degenerating over years. As the valve leaflets change shape, they no longer close cleanly, allowing blood to leak backward with each heartbeat. The result is a heart murmur, and eventually, if untreated, congestive heart failure.

MVD accounts for approximately 80% of all diagnosed canine cardiac disease and affects an estimated 30–50% of small-breed dogs by age ten. In Maltese, a murmur is often detected during routine examination at age five or older — sometimes much earlier. The American College of Veterinary Internal Medicine (ACVIM) has published consensus guidelines that classify MVD into stages based on murmur grade, cardiac dimensions on echocardiography, and clinical signs. Dogs at Stage B2 — where the heart has begun to enlarge even without obvious symptoms — now qualify for medication under current guidelines, which has been shown to delay the onset of heart failure.

The practical implication for owners: any Maltese over five should receive a cardiac examination annually. A murmur of grade 3/6 or higher warrants echocardiography with a cardiologist to properly stage the disease. Catching MVD in its preclinical stage and initiating appropriate management is the single most effective intervention available for extending quality life in older Maltese.

Portosystemic liver shunt

A portosystemic shunt (PSS) is an abnormal blood vessel that allows blood from the digestive tract to bypass the liver entirely. Under normal anatomy, the portal vein carries nutrient- and toxin-laden blood from the intestines directly to the liver for processing. When a shunt exists, that blood is diverted into systemic circulation before the liver can filter it — meaning ammonia, bile acids, and other metabolic waste reach the brain and organs unprocessed.

In Maltese, PSS is typically congenital: the abnormal vessel is present from birth, though signs may not appear until the puppy begins eating solid food. Characteristic signs include small body size relative to littermates, vomiting, excessive thirst and urination, and neurological symptoms after meals — disorientation, circling, and in severe cases, seizures. The post-meal timing is a clue: the digestive load spikes the ammonia reaching the brain.

Diagnosis involves measuring bile acid levels before and after a small meal — a pre/post bile acids test is the standard screening tool. A specific note for Maltese owners: research has shown that serum bile acid concentrations can run above reference range in clinically normal Maltese dogs, so results should be interpreted by a veterinarian familiar with this breed-specific quirk. Imaging (ultrasound or CT) confirms the vessel's location.

Surgical ligation — tying off or gradually occluding the shunt — is curative in many cases when the shunt is extrahepatic (outside the liver). Dogs that are not surgical candidates, or where multiple small shunts are present, can be managed medically with a low-protein prescription diet, lactulose (which traps ammonia in the colon), and antibiotics that reduce ammonia-producing gut bacteria. Medical management controls symptoms but does not correct the underlying anatomy.

Eye problems — tear staining and progressive retinal atrophy

Two distinct eye-related conditions appear in Maltese, and they operate through completely different mechanisms. Understanding which one you're dealing with determines the response.

Tear staining is the reddish-brown discoloration under the eyes that many Maltese owners find cosmetically frustrating. The primary cause is porphyrins — iron-containing molecules produced when the body breaks down red blood cells — that are excreted through tears. When porphyrin-laden tears sit on white facial hair, the iron compounds oxidize and stain. Sun exposure darkens the staining further. A secondary contributor is the yeast Pityrosporum (also called red yeast), which thrives in the persistently moist hair below the eyes and produces a noticeable odor when present.

The American Maltese Association recommends ruling out medical causes first — blocked tear ducts, entropion, ingrown eyelashes, or dental disease can all increase tear production. Once those are excluded, management involves keeping the area dry (blotting two to three times daily rather than wetting it), trimming the hair at the inner corner of the eye to reduce wicking, switching to stainless steel or glass bowls, and trying filtered water if your tap supply is high in minerals. A mixture of boric acid powder and cornstarch worked into the wet hair can gradually lighten existing staining. The antibiotic tylosin has historically been used to reduce tear staining, but cosmetic antibiotic use is now widely discouraged due to antimicrobial resistance concerns — most veterinary dermatologists reserve antibiotic treatment for confirmed secondary infections.

Progressive retinal atrophy (PRA) is a genetically inherited group of conditions causing gradual degeneration of the retina's photoreceptor cells. Night blindness appears first; the dog struggles to navigate in low light before losing daytime vision over months to years. There is no treatment, but many dogs adapt well to complete blindness using scent and memory. For breeders, genetic testing is the only prevention: the American Maltese Association recommends CAER (Canine Eye Registry Foundation) eye examinations and PRA-prcd DNA testing before any breeding dog is used. Owners acquiring a Maltese puppy should ask breeders for documentation of both tests on the parents.

Respiratory issues — collapsed trachea and reverse sneezing

The Maltese trachea is formed by a series of C-shaped cartilage rings that keep the airway open during breathing. In some small breeds, those rings weaken over time, causing the trachea to flatten — particularly during inhalation, when negative pressure inside the airway increases. The signature symptom is a harsh, honking cough that sounds like a goose; it tends to worsen with excitement, heat, or pulling on a collar. This is why every Maltese should wear a harness rather than a collar. A collar concentrates all leash pressure directly on the trachea; a harness distributes it across the chest and shoulders, removing that repeated mechanical stress from an already compromised airway.

Mild to moderate tracheal collapse is managed medically: cough suppressants reduce the frequency and severity of episodes, bronchodilators open the airway by relaxing the surrounding smooth muscle, and anti-inflammatory drugs address secondary irritation. Weight management matters enormously — even a few extra ounces on a four-pound dog increases the load on the respiratory system. For dogs that do not respond to medication and whose quality of life is significantly affected, intraluminal stenting (placing a mesh scaffold inside the trachea) is a surgical option performed by veterinary specialists.

Reverse sneezing is far less serious and often alarms owners unnecessarily. During a reverse sneezing episode, the soft palate is irritated — by a foreign particle, excitement, or a change in temperature — and the dog responds with rapid, forceful inhalations through the nose. The sound is dramatic. Episodes typically last less than thirty seconds, and the dog is otherwise completely normal before and after. Gently covering the nostrils briefly, or offering calm reassurance, usually shortens the episode. If episodes become very frequent or extend beyond a minute, a veterinary examination is reasonable, but in most Maltese reverse sneezing is a chronic quirk rather than a sign of underlying disease. For context on breathing in another small breed, see our Staffordshire Bull Terrier health guide.

White Shaker Syndrome

White Shaker Syndrome — more precisely called Idiopathic Tremor Syndrome — produces whole-body tremors in young adult dogs, typically between one and two years of age. The name reflects its original association with white-coated breeds: Maltese, West Highland White Terriers, Bichons Frises, and Poodles are the most commonly affected, though dogs of any color or size can develop it. The tremors are generalized, meaning the entire body shakes rather than an isolated limb, and they worsen with excitement or stress.

The cause is not fully established, but the condition is believed to be immune-mediated — an inflammatory process targeting the central nervous system. This explains why it responds so well to corticosteroids. Prednisolone at an initial dose of 1–2 mg/kg daily typically produces visible improvement within one to two weeks. Once tremors resolve, the dose is tapered gradually to the lowest level that maintains remission. Some dogs require lifelong low-dose therapy; others can eventually discontinue treatment. The prognosis, once diagnosis is confirmed and treatment started, is generally very good.

Dental health, ear care, and preventive routine

Small breeds accumulate dental disease faster than large breeds for a structural reason: the teeth are sized for a much larger jaw. The Maltese mouth is small enough that teeth crowd together, creating tight spaces where plaque mineralizes into tartar rapidly. Periodontal disease — infection of the tissues supporting the teeth — is not just a mouth problem. Chronic oral bacteria enter the bloodstream and have been associated with cardiovascular and kidney disease in dogs. Daily toothbrushing with a canine-formulated toothpaste is the most effective intervention available, and it costs almost nothing compared to professional dental procedures under anesthesia.

Ear infections follow a similar logic. The Maltese ear canal tends to retain moisture, and the breed's hair grows into the canal. Regular cleaning with a veterinarian-recommended solution prevents the warm, moist environment that allows yeast and bacteria to take hold. Check ears weekly; if you notice a dark discharge, odor, or the dog is shaking its head or scratching at an ear, a vet visit is warranted promptly.

The preventive routine that gives a Maltese the best chance at the long end of its lifespan comes down to a few non-negotiable habits: annual veterinary examinations, dental care starting in puppyhood, a harness for all leash walks, cardiac evaluation from age five onward, and prompt attention to any sudden behavior change. For comparison on preventive approaches across toy and small breeds, the Miniature Schnauzer guide covers a breed with similar longevity expectations and overlapping health priorities.

Frequently Asked Questions

What is the average lifespan of a Maltese?

VCA Animal Hospitals puts the typical range at 12–14 years; the AKC cites 12–15 years. With attentive care — particularly dental hygiene and cardiac monitoring after age five — many Maltese reach the upper end of that range. Individual outliers reaching 16 or 17 years are documented but not the statistical norm.

How do I know if my Maltese puppy has hypoglycemia?

Signs appear in stages: lethargy and weakness first, then unsteady walking or wobbling, followed by muscle tremors or seizures in severe cases. If your puppy seems unusually tired or uncoordinated, rub a small amount of honey or Karo syrup onto the gums immediately and contact your veterinarian. Prevention involves four small meals daily and keeping the puppy warm and calm.

At what grade does patellar luxation require surgery?

Grade 3 and Grade 4 luxations generally warrant surgical repair, as the kneecap cannot stay in the groove without structural correction. Grade 2 may also be a candidate for surgery if the dog is showing significant lameness or compensation in its gait. Grade 1 can often be monitored without intervention. Your veterinarian or a veterinary orthopedic specialist will assess the individual dog's degree of lameness and quality of life alongside the grade.

When should a Maltese start having cardiac evaluations?

Annual cardiac examinations — specifically listening for a murmur — are advisable from age five. If a murmur is detected at grade 3/6 or higher, echocardiography with a veterinary cardiologist is the next step to stage the disease properly and determine whether medication is indicated. Early intervention at the preclinical stage, before heart failure develops, can meaningfully extend both lifespan and quality of life.

Is tear staining in Maltese a health problem or just cosmetic?

Primarily cosmetic, but it can signal an underlying medical issue. Excessive tearing caused by blocked tear ducts, entropion, dental disease, or eye infection will produce staining, and those conditions need treatment. Once a veterinarian has cleared any medical cause, tear staining is cosmetic — manageable with daily drying of the facial hair, dietary adjustments, and clean water, rather than antibiotics.

What causes White Shaker Syndrome and can it be cured?

The cause is not fully established, but it appears to be an immune-mediated inflammatory process affecting the central nervous system. It is not caused by the dog's white coat color specifically — any dog can be affected, though white-coated breeds are over-represented in reported cases. Treatment with corticosteroids (prednisolone) typically produces rapid improvement within one to two weeks. Many dogs achieve full remission; some require ongoing low-dose maintenance. The prognosis with treatment is very good.

Chiara Bradshaw

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