Management of chronic dental problems

image of Management of chronic dental problems
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In all but a small number of cases, dental disease is an incurable and progressive condition. Once problems have started, the rabbit will never have perfect dentition so dental treatment can only be palliative. This chapter explains the commitment required from owners, the frequency of oral examination and dental treatment; the treatment of secondary problems associated with chronic dental disease; dietary modification; and managing secondary complications of dental disease.

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30.1 This 9-year-old rabbit has had dental problems all his life. He was born with incisor malocclusion and has had repeated treatment for spurs on the cheek teeth and recurrent abscesses. He has grooming difficulties. Despite these problems, he appears to have a good quality of life as a house rabbit and is a much loved part of the family.
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30.2 Endstage dental disease. This rabbit has no crowns at all on any of the cheek teeth; they have all broken off. Although this rabbit is free from oral discomfort, the inability to chew through fibrous foods has an impact on his health and welfare. This can be managed with dietary modification.
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30.3 Odontomas are not unusual in rabbits with endstage dental disease. They are usually slow-growing solid tumours that may or may not add to the rabbit’s existing dental problems. Surgery can be successful but is not always indicated.
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30.4 Hypertrophied mucosal flaps can develop in rabbits with short crowns on the cheek teeth. These flaps can catch on the teeth and become ulcerated and sore. Surgical removal is seldom successful on its own because the flaps quickly recur. Any sharp edges on the cheek teeth also need to be removed. In some cases, it is beneficial to reduce the height of the crowns so there is a bigger space between the upper and lower teeth, which prevents the flaps becoming compressed and damaged.
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30.5 A piece of hay that was retrieved from a rabbit’s mouth during a consultation. The rabbit had advanced dental disease and was presented with sudden-onset inappetence and profuse salivation. He made a complete recovery after the hay was removed. The stem was in the oesophagus and the seed head was caught around a deformed crown.
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30.6 Summary of dietary modification for rabbits with dental disease.
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30.7 This rabbit has an obstruction to the tear duct at the apex of the upper 1st incisor. The photograph was taken after the instillation of proxymetacaine eye drops to provide local anaesthesia. Pus from the punctum lacrimale is leaking into the conjunctival sac and overflowing down the face. The fur is wet, matted and soiled. There is a spastic entropion. There was a corneal ulcer close to the punctum, although it is hidden by the lower eyelid in this photograph. These changes are typical of many cases of endstage dental disease. Eye ointment alone will not resolve them. Critical examination of the eye and determination of the aetiology is necessary before embarking on further procedures, which are described in Chapters 17 and 28.
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30.8 Lateral radiographic view of the rostral section of a sagitally sectioned head of a rabbit that had recalcitrant dacryocystitis. Although the tear duct cannot be seen, the bony canal that encompasses it is seen as a dilated tubular structure that was filled with pus. The nasolacrimal canal was still blocked, even though the incisors had been removed. A remnant of a peg tooth remains in the jaw.
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30.9 Provision of bonded companions for any rabbit has much to recommend it. Grooming the body, face and ears is part of their social behaviour and can be very beneficial for rabbits with chronic dental problems.
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