Treatment of dental problems: principles and options

Frances Harcourt-Brown

doi:10.22233/9781910443163.26

British Small Animal Veterinary Association , 349 (2013); https://doi.org/10.22233/9781910443163.26

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Treatment of dental problems: principles and options

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Author: Frances Harcourt-Brown
From: BSAVA Manual of Rabbit Surgery, Dentistry and Imaging
Item: Chapter 26, pp 349 - 369
DOI: 10.22233/9781910443163.26
Copyright: © 2013 British Small Animal Veterinary Association
Publication Date: January 2013

Abstract

Rabbit dentistry is a controversial topic and many types of treatment have been described. At the time of writing, there are no published comparative studies that evaluate the success or failure of any particular dental treatment for rabbits. This chapter looks at considerations for treatment; establishing a treatment plan; treatment of fractured teeth and jaws; treatment of incisor malocclusion; treatment of early signs of dental disease; treatment of spurs on the cheek teeth; and iatrogenic damage from dentistry. Operative Technique: Reshaping maloccluded incisors: an alternative method; Treatment of cheek tooth problems using handheld instruments; Treatment of cheek tooth problems using burrs; Pulpectomy.

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26.1

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26.1 Abnormalities detected during oral examination that require dental treatment.

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26.2

This 3-year-old male neutered rabbit was presented with acute anorexia. This longitudinal split in the crown of the 1st mandibular cheek tooth (arrow) was discovered during examination under anaesthesia. Only the exposed crown was affected, so the rabbit was treated with analgesia and nutritional support. He made a full recovery and the defect grew out over the following 6 weeks. © 2013 British Small Animal Veterinary Association

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26.2 This 3-year-old male neutered rabbit was presented with acute anorexia. This longitudinal split in the crown of the 1st mandibular cheek tooth (arrow) was discovered during examination under anaesthesia. Only the exposed crown was affected, so the rabbit was treated with analgesia and nutritional support. He made a full recovery and the defect grew out over the following 6 weeks.

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26.3

Owners sometimes trim their rabbit’s teeth with nail clippers. This procedure is not recommended. Transecting the crown in this way can shatter the tooth and leave sharp edges and exposed dentine, as in this rabbit’s left mandibular incisor. © 2013 British Small Animal Veterinary Association

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26.3 Owners sometimes trim their rabbit’s teeth with nail clippers. This procedure is not recommended. Transecting the crown in this way can shatter the tooth and leave sharp edges and exposed dentine, as in this rabbit’s left mandibular incisor.

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26.4

Although it is not acceptable to transect an enamelled crown with clippers, it is possible to remove slivers of tooth with handheld instruments. Molar cutters can be used without shattering the teeth. The long narrow section of the mandibular incisor shown here was clipped off. © 2013 British Small Animal Veterinary Association

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26.4 Although it is not acceptable to transect an enamelled crown with clippers, it is possible to remove slivers of tooth with handheld instruments. Molar cutters can be used without shattering the teeth. The long narrow section of the mandibular incisor shown here was clipped off.

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26.5

Cutting incisors with a cutting disc. Most rabbits will tolerate incisor shortening with power tools while they are conscious, although it is stressful for them. Some sort of gag is necessary to keep the mouth slightly open; a tongue depressor was used here but a 2 ml syringe is an alternative. The author prefers to make a deep groove in the teeth with a diamond cutting disc and then to snap the excess crown away by applying molar cutters across the groove. This reduces the risk of soft tissue damage from the disc as it goes through the tooth. The disc can also be used to smooth off any sharp edges that remain, although this is seldom necessary. Incisors can also be shortened with a dental burr. © 2013 British Small Animal Veterinary Association

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26.5 Cutting incisors with a cutting disc. Most rabbits will tolerate incisor shortening with power tools while they are conscious, although it is stressful for them. Some sort of gag is necessary to keep the mouth slightly open; a tongue depressor was used here but a 2 ml syringe is an alternative. The author prefers to make a deep groove in the teeth with a diamond cutting disc and then to snap the excess crown away by applying molar cutters across the groove. This reduces the risk of soft tissue damage from the disc as it goes through the tooth. The disc can also be used to smooth off any sharp edges that remain, although this is seldom necessary. Incisors can also be shortened with a dental burr.

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26.6

Endoscopic images of the intraoral examination of a 4-year-old rabbit before (left) and after (right) clinical crown adjustment with a dental burr. Dust from dental burring is seen in the area of the right maxillary arcades and soft palate. (Courtesy of Vladimir Jekl) © 2013 British Small Animal Veterinary Association

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26.6 Endoscopic images of the intraoral examination of a 4-year-old rabbit before (left) and after (right) clinical crown adjustment with a dental burr. Dust from dental burring is seen in the area of the right maxillary arcades and soft palate. (Courtesy of Vladimir Jekl)

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26.8

Coronal reduction versus spur removal. X marks the part of the tooth that will regrow to form a spur. This site is the same whether coronal reduction or spur removal is performed. Taking the teeth out of occlusion allows them to grow faster, so the spurs may grow back more quickly if coronal reduction is performed. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2013 British Small Animal Veterinary Association

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26.8 Coronal reduction versus spur removal. X marks the part of the tooth that will regrow to form a spur. This site is the same whether coronal reduction or spur removal is performed. Taking the teeth out of occlusion allows them to grow faster, so the spurs may grow back more quickly if coronal reduction is performed. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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26.9

(a) Prepared skull of a rabbit with apical elongation of all the cheek teeth. The exposed apices and the pulp cavities can be seen in the orbit, lacrimal process and mandible. (b) The ventral aspect of a prepared mandible from a different rabbit shows the site of penetration of the 4th mandibular cheek tooth. Bulges at the apices of the 1st, 2nd and 3rd teeth could be palpated in the living rabbit along the ventral border of the mandible. (c) The ventral aspect of the prepared mandible shows the sites of penetration of the apices of the 1st, 2nd, 3rd and 5th mandibular cheek teeth on the medial aspect. Bulges at the apices of the 1st, 2nd and 3rd teeth could be palpated in the living rabbit along the ventral border of the mandible. © 2013 British Small Animal Veterinary Association

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26.9 (a) Prepared skull of a rabbit with apical elongation of all the cheek teeth. The exposed apices and the pulp cavities can be seen in the orbit, lacrimal process and mandible. (b) The ventral aspect of a prepared mandible from a different rabbit shows the site of penetration of the 4th mandibular cheek tooth. Bulges at the apices of the 1st, 2nd and 3rd teeth could be palpated in the living rabbit along the ventral border of the mandible. (c) The ventral aspect of the prepared mandible shows the sites of penetration of the apices of the 1st, 2nd, 3rd and 5th mandibular cheek teeth on the medial aspect. Bulges at the apices of the 1st, 2nd and 3rd teeth could be palpated in the living rabbit along the ventral border of the mandible.

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26.10

Oblique radiographic views of elongated apices to show the pulp cavities: (a) right and (b) left mandibular arcades of the same rabbit. The radiographs were taken with the rabbit on its back with its head extended and turned at approximately 45 degrees to the horizontal midline. On the right arcade there were spurs on the 3rd and 4th right mandibular cheek teeth. The pulp cavities can be seen as open structures on the right hemimandible. The pulp was removed from the 2nd, 3rd and 4th cheek teeth. On the left hemimandible the pulp cavities are smaller, indicating that tooth growth is slowing down. These teeth had been treated for spurs in the past but had none at the time of radiography, so the lingual edges were rasped and the apices left alone. © 2013 British Small Animal Veterinary Association

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26.10 Oblique radiographic views of elongated apices to show the pulp cavities: (a) right and (b) left mandibular arcades of the same rabbit. The radiographs were taken with the rabbit on its back with its head extended and turned at approximately 45 degrees to the horizontal midline. On the right arcade there were spurs on the 3rd and 4th right mandibular cheek teeth. The pulp cavities can be seen as open structures on the right hemimandible. The pulp was removed from the 2nd, 3rd and 4th cheek teeth. On the left hemimandible the pulp cavities are smaller, indicating that tooth growth is slowing down. These teeth had been treated for spurs in the past but had none at the time of radiography, so the lingual edges were rasped and the apices left alone.

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26.11

This 5-year-old neutered male Dutch rabbit was inappetent because food was caught round the elongated 6th maxillary cheek tooth, which was also impinging on the buccal mucosa inside the cheek (arrow). This tooth could be removed intraorally, although tooth fracture and haemorrhage are potential complications. An incidental finding was the absence of the crown of the 1st left maxillary cheek tooth, which had already broken off. © 2013 British Small Animal Veterinary Association

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26.11 This 5-year-old neutered male Dutch rabbit was inappetent because food was caught round the elongated 6th maxillary cheek tooth, which was also impinging on the buccal mucosa inside the cheek (arrow). This tooth could be removed intraorally, although tooth fracture and haemorrhage are potential complications. An incidental finding was the absence of the crown of the 1st left maxillary cheek tooth, which had already broken off.

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26.12

A feature of PSADD is loss of enamel and weakening of the teeth. The crowns often break just below the level of the alveolar bone where the tooth is no longer supported. On this prepared skull, two crowns on the left arcade (CT3 and CT4) had broken off in this way. The fractured occlusal section of tooth may be held in place by the gingiva but is mobile and can be a source of discomfort to the rabbit. The crown can be pulled off easily. © 2013 British Small Animal Veterinary Association

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26.12 A feature of PSADD is loss of enamel and weakening of the teeth. The crowns often break just below the level of the alveolar bone where the tooth is no longer supported. On this prepared skull, two crowns on the left arcade (CT3 and CT4) had broken off in this way. The fractured occlusal section of tooth may be held in place by the gingiva but is mobile and can be a source of discomfort to the rabbit. The crown can be pulled off easily.

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26.13

Tartar on the cheek teeth of a rabbit. This is the only case of tartar that the author has encountered in a rabbit. The tartar was easily removed with a dental scaler. © 2013 British Small Animal Veterinary Association

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26.13 Tartar on the cheek teeth of a rabbit. This is the only case of tartar that the author has encountered in a rabbit. The tartar was easily removed with a dental scaler.

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26.14

Damage due to inappropriate use of dental burrs. This rabbit was referred for treatment because he was undergoing dentistry every 3–4 weeks. He would only eat soaked nuggets and banana. Oral examination showed evidence of previous dentistry, including a deep groove along the right maxillary incisors that extended below the level of the gum. © 2013 British Small Animal Veterinary Association

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26.14 Damage due to inappropriate use of dental burrs. This rabbit was referred for treatment because he was undergoing dentistry every 3–4 weeks. He would only eat soaked nuggets and banana. Oral examination showed evidence of previous dentistry, including a deep groove along the right maxillary incisors that extended below the level of the gum.

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26.15

Penetrating burr injury. This rabbit was presented as a second-opinion case because it had not eaten since undergoing dentistry a week previously to remove a spur that was lacerating the tongue. After the procedure, the rabbit developed a flaccid swollen face extending across the cheek from the mandible to the zygoma. A probe inserted into the puncture wound in the angle of the jaw showed that the wound extended to a depth of 1.5 cm. The rabbit died. Wounds in this site, or lateral to the 1st upper cheek tooth, can be the result of a burr ‘walking off’ a tooth into the surrounding soft tissue. © 2013 British Small Animal Veterinary Association

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26.15 Penetrating burr injury. This rabbit was presented as a second-opinion case because it had not eaten since undergoing dentistry a week previously to remove a spur that was lacerating the tongue. After the procedure, the rabbit developed a flaccid swollen face extending across the cheek from the mandible to the zygoma. A probe inserted into the puncture wound in the angle of the jaw showed that the wound extended to a depth of 1.5 cm. The rabbit died. Wounds in this site, or lateral to the 1st upper cheek tooth, can be the result of a burr ‘walking off’ a tooth into the surrounding soft tissue.

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26.16

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26.16 Guards are available to protect the surrounding soft tissue when using burrs during dentistry. (Courtesy of Evert-Jan de Boer)

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26.17

Post-mortem specimen showing the lateral aspect of a longitudinally sectioned hemimandible of a wild rabbit. It shows the relationship of pulp cavity to exposed crown after coronal reduction. The cheek teeth were burred nearly to the gum before the specimen was prepared. The rostral extension of the pulp cavity of the 2nd cheek tooth has been exposed to its extremity close to the occlusal surface. Nerve fibres will extend into the dentine from this site. (Reproduced from In Practice, with permission) © 2013 British Small Animal Veterinary Association

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26.17 Post-mortem specimen showing the lateral aspect of a longitudinally sectioned hemimandible of a wild rabbit. It shows the relationship of pulp cavity to exposed crown after coronal reduction. The cheek teeth were burred nearly to the gum before the specimen was prepared. The rostral extension of the pulp cavity of the 2nd cheek tooth has been exposed to its extremity close to the occlusal surface. Nerve fibres will extend into the dentine from this site. (Reproduced from In Practice, with permission)

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26.18

This rabbit had undergone generalized coronal reduction in the late stages of dental disease. The photograph only shows the left maxillary teeth but all four arcades were similar. No teeth were in occlusion. The rabbit was only able to eat softened, grated or shredded food. © 2013 British Small Animal Veterinary Association

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26.18 This rabbit had undergone generalized coronal reduction in the late stages of dental disease. The photograph only shows the left maxillary teeth but all four arcades were similar. No teeth were in occlusion. The rabbit was only able to eat softened, grated or shredded food.

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26.19

Iatrogenic abscess from use of clippers.(a) Lateral view of the skull of a rabbit that was presented as a second-opinion case because he had not eaten since dentistry was performed 3 days previously. The rabbit had a history of fast-growing recurrent dental spurs so the veterinary surgeon had attempted to increase the interval between dental procedures by removing all the crowns of the left arcade down to the gum. Molar clippers were used for the procedure. (b) Despite antibiotics, analgesia and other supportive care, a large gangrenous abscess developed under the jaw over the next 3 days and the rabbit died. This case emphasizes the need for consideration of the effects of dentistry. Removing spurs from the edges of one or two teeth with molar cutters is completely different from cutting off the whole exposed crown, especially in teeth that are growing and have an open pulp cavity. © 2013 British Small Animal Veterinary Association

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26.19 Iatrogenic abscess from use of clippers.(a) Lateral view of the skull of a rabbit that was presented as a second-opinion case because he had not eaten since dentistry was performed 3 days previously. The rabbit had a history of fast-growing recurrent dental spurs so the veterinary surgeon had attempted to increase the interval between dental procedures by removing all the crowns of the left arcade down to the gum. Molar clippers were used for the procedure. (b) Despite antibiotics, analgesia and other supportive care, a large gangrenous abscess developed under the jaw over the next 3 days and the rabbit died. This case emphasizes the need for consideration of the effects of dentistry. Removing spurs from the edges of one or two teeth with molar cutters is completely different from cutting off the whole exposed crown, especially in teeth that are growing and have an open pulp cavity.

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The most useful instruments: short-handled crocodile forceps (top) can be used to remove tooth fragments; long-handled molar cutters (middle) and a diamond rasp (bottom) are used to trim and rasp the teeth.

The most useful instruments: short-handled crocodile forceps (top) can be used to remove tooth fragments; long-handled molar cutters (middle) and a diamond rasp (bottom) are used to trim and rasp the teeth. © 2013 British Small Animal Veterinary Association

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The most useful instruments: short-handled crocodile forceps (top) can be used to remove tooth fragments; long-handled molar cutters (middle) and a diamond rasp (bottom) are used to trim and rasp the teeth. The most useful instruments: short-handled crocodile forceps (top) can be used to remove tooth fragments; long-handled molar cutters (middle) and a diamond rasp (bottom) are used to trim and rasp the teeth.

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The rasp on the left is a diamond rasp that is extremely useful for smoothing off sharp edges quickly and atraumatically. The rasp on the right is a heavy, cumbersome, solid-ridged instrument that is ineffective and can cause trauma to the teeth and surrounding tissues, and is therefore not recommended.

The rasp on the left is a diamond rasp that is extremely useful for smoothing off sharp edges quickly and atraumatically. The rasp on the right is a heavy, cumbersome, solid-ridged instrument that is ineffective and can cause trauma to the teeth and surrounding tissues, and is therefore not recommended. © 2013 British Small Animal Veterinary Association

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The rasp on the left is a diamond rasp that is extremely useful for smoothing off sharp edges quickly and atraumatically. The rasp on the right is a heavy, cumbersome, solid-ridged instrument that is ineffective and can cause trauma to the teeth and surrounding tissues, and is therefore not recommended. The rasp on the left is a diamond rasp that is extremely useful for smoothing off sharp edges quickly and atraumatically. The rasp on the right is a heavy, cumbersome, solid-ridged instrument that is ineffective and can cause trauma to the teeth and surrounding tissues, and is therefore not recommended.

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(Image reproduced from In Practice, with permission)

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(Image reproduced from In Practice, with permission) (Image reproduced from In Practice, with permission)

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Using molar extraction forceps to remove a loose crown. (Image reproduced from In Practice, with permission)

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Using molar extraction forceps to remove a loose crown. (Image reproduced from In Practice, with permission) Using molar extraction forceps to remove a loose crown. (Image reproduced from In Practice, with permission)

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Mobile 5th mandibular cheek tooth. (Image reproduced from In Practice, with permission)

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Mobile 5th mandibular cheek tooth. (Image reproduced from In Practice, with permission) Mobile 5th mandibular cheek tooth. (Image reproduced from In Practice, with permission)

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Rose-head burr ideal for rabbit dental work. (© John Chitty) Rose-head burr ideal for rabbit dental work. (© John Chitty)

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Gag in place with good view of the molar teeth. (© John Chitty) Gag in place with good view of the molar teeth. (© John Chitty)

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A rabbit on a dental table with its mouth open. (© John Chitty) A rabbit on a dental table with its mouth open. (© John Chitty)

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The large hole in this mouth gag can be placed over the gums where the incisors were. (© John Chitty) The large hole in this mouth gag can be placed over the gums where the incisors were. (© John Chitty)

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Palpation of the ventral border of the mandible to locate the swellings over the elongated apices of the teeth.

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Palpation of the ventral border of the mandible to locate the swellings over the elongated apices of the teeth. Palpation of the ventral border of the mandible to locate the swellings over the elongated apices of the teeth.

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Soft tissues over the ventral border of the mandible.

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Soft tissues over the ventral border of the mandible. Soft tissues over the ventral border of the mandible.

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Elongated apex that has penetrated the ventral border. In many cases, the enamel on the circumference of the tooth and in the central enamel fold can be identified.

Elongated apex that has penetrated the ventral border. In many cases, the enamel on the circumference of the tooth and in the central enamel fold can be identified. © 2013 British Small Animal Veterinary Association

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Elongated apex that has penetrated the ventral border. In many cases, the enamel on the circumference of the tooth and in the central enamel fold can be identified. Elongated apex that has penetrated the ventral border. In many cases, the enamel on the circumference of the tooth and in the central enamel fold can be identified.

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Any residual bone that is covering all or part of the apex of the tooth can be carefully removed.

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Any residual bone that is covering all or part of the apex of the tooth can be carefully removed. Any residual bone that is covering all or part of the apex of the tooth can be carefully removed.

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Postsurgical appearance of the apex of the tooth after the pulp has been removed.

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Postsurgical appearance of the apex of the tooth after the pulp has been removed. Postsurgical appearance of the apex of the tooth after the pulp has been removed.