# Antibiotics and Dental pains



## Cottonball (Apr 14, 2010)

Yesterday I took my rabbit to a vet to get his teeth trimmed. I assumed it would cost $105 like my other visit. But to my surprise the vet wanted me to pay $153. I did not understand what was going on until the vet explained that my baby bunny (he is only 3 or 4 years old) has a cracked tooth and he applied some antibiotics on it. The vet wanted me to take the medicine home and apply it on my bunny. He also told me my bunny needed his molars to be grinded.

I really care for my rabbit but I could not afford to buy the medicin orget his teeth grindedso all I could do is pay the $77 for his teeth to be trimed. 

What should I do? Should I buy the antibiotic from the vet? Should I try to take matters into my own hands? What should I do to help his teeth? He doesn't like chew toys that I brought for him and I am currently on welfare.


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## tonyshuman (Apr 14, 2010)

That's strange. I have not heard of a tooth being cracked, and if it were, I would assume that the vet would rather remove it than leave it in and apply antibiotics. 

Tooth issues in bunnies are very expensive and usually the best option is to remove the teeth. It will mean that you don't have to pay for tooth trims often, but a surgery to remove a tooth (and the opposite tooth because they grind each other down) runs at least in the $150 range.

So, the best option for the bunny is to have a different vet perform surgery to remove the cracked tooth and the one that is opposite it. He will probably need future tooth trims as well, for the rest of the molars. A dental issue bunny can be very expensive to take care of. Even providing chew toys doesn't really work--the only thing that can help is having him eat lots of hay, and that won't make tooth trims unnecessary, but rather increase the time between them.

There are options to help people pay for critical vet care for their animals, including IMOM (imom.org), CareCredit, and some rescues/shelters have low-cost vet services. Some rescues might be able to help with the vet care somewhat--check for some around you. However, if that's not going to work, it may just be that his medical issues are more expensive than you can afford, which I know is a very hard thing to think about, but it is something to remember.


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## Pipp (Apr 14, 2010)

A cracked tooth root and a potential infection is very possible. 



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## Pipp (Apr 14, 2010)

Sorry, couldn't get this text to show up on the page! 



http://www.theveterinarian.com.au/clinicalreview/article500.asp


_from: *Common problems in rabbits and ferrets*

Working with unusual pets brings with it a new set of challenges and opportunities for professional satisfaction.

MARK SIMPSON

Of all the gastroenteric problems we see in rabbits, dental disease is the most common. And while dental problems are occasionally due to congenital (possibly inherited) malocclusion, the vast majority of cases are a result of a progressive syndrome caused by poor diet.

Inappropriate levels of dietary protein, calcium, and vitamin D, coupled with inadequate dental wear are strongly implicated in the aetiology. The syndrome of acquired dental disease is characterised by an alteration in the orientation, then shape, and possibly structure of the teeth and the consequent development of malocclusion. It is my opinion that the altered wear (leading to altered pressure at the tooth roots) and generous supply of protein and calcium in inappropriate diets, permitting ready remodelling of the bones of the jaw, are causative factors in the majority of rabbit dental disease.

As a result of this re-orientation, sharp spurs can develop on the cheek teeth that penetrate surrounding soft tissues of the cheek or tongue. In particular I find lacerations and ulcerations of the tongue are intensely painful and affected rabbits do not eat or groom effectively.

Though the incisors are most commonly treated dental problem in rabbits, I believe they constitute only a small proportion of problems - most rabbit teeth problems are associated with the cheek teeth. I have seen several rabbits with bilateral, medially directed spurs of the cheek teeth of the lower jaw literally trapping or skewering the tongue in an immobile position.

Rabbits with spurs are often salivating, which gives rise to the lay term slobbers. Gut stasis is, for multiple reasons, a common sequelae. In some cases the appearance of the teeth in the mouth is normal, and the roots are the site of the pathology. In cases where the clinical sign indicate dental problem but oral examination is within normal limits, radiographs of the head, to assess the tooth roots, are indicated.

The tooth roots are significant as they are frequently the site of abscessation, which may be the first clinical sign the owners identify as a problem. These abscesses will lead to severe osteomyelitis, with draining sinuses on the face, and are an absolute disaster. While occasional anecdotal stories of resolution are told, the vast majority of these abscesses require intense and complicated debridement and the use specialised treatments such as antibiotic-impregnated methyl methacrylate pellets or ConsilÃ¢ to have even a hope of remission.

There is a constant risk of recurrence with these abscesses, and anything that can be done to avoid them is preferable to trying to treat them. One of the factors that we associate with these abscesses is the use of nail clippers to effect trimming, predominantly of the incisors. This technique has been associated with *longitudinal microfractures of the tooth, which provides an excellent avenue of access for bacteria of the mouth to enter the tooth apices and begin a problem.* For this reason we strongly recommend avoiding the use of nail clippers to trim the teeth.

Once there are spurs affecting the mucosa of the oral cavity the only successful treatment is removal of the spurs under general anaesthesia. It must be emphasised however that this is a temporary measure, and that trimming the teeth will need to be repeated once every six to 16 weeks for the rest of the rabbits life.

To anaesthetise these patients I use the protocol developed by Dr Ron Rees-Davies that I call rabbit DTK: DomitorÃ¢ (medetomidine 1mg/mL) at 30ug/kg, TorbugesicÃ¢ (butorphanol 10mg/mL) at 0.10mg/kg, and ketamine (100mg/mL) at 1mg/kg, which gives about 0.10mL DomitorÃ¢, 0.03mL TorbugesicÃ¢ and 0.03mL ketamine for a 3kg rabbit, which I inject intravenously as a single bolus. This usually allows enough anaesthesia for cheek tooth examination and burring.

I then intubate the rabbit and provide supply oxygen, and then I am in a position to provide additional gaseous anaesthesia if the need arises

My experience with local anaesthetic blocks in rabbits has not been as good as those used in cats and dogs. This is not totally surprising, as the sites, especially that for mandibular blocks, are much more difficult to access than in other species. I no longer attempt regional blocks for this purpose in rabbits.

Some specialised equipment is necessary to trim the cheek teeth of rabbits. There are many rabbit mouth gags, and some of these may be viewed at Dr David Clarkeâs web page at http://www.k9gums.com.au/page7.html. I find the concept of two-way action to be critical so that the jaws are opened and then the cheeks are effectively âdilatedâ one side at a time. I therefore have the jaws held open with a standard small animal gag.

I then have an assistant use wooden tongue depressors to expose each part of the cheek teeth. A DremelÃ¢ tool with a long bit is then used to burr all the cheek teeth to about a millimetre above the gum line. I find that if I slide off the tooth I do not damage the mucosa, (nor any expensive gags), but simply the wooden tongue depressor.

There is some controversy about how much to remove from the teeth. Some practitioners remove only the offending spur. It is not my aim to restore normal occlusion. By the time these procedures are required any return to normal occlusion is impossible as there have been irreversible changes to the tooth roots and dental disease will be permanent.

Some reports suggest burring will lead to heat necrosis of the tooth roots but I have seen no evidence in the many cases I deal with to support that contention. *However there is good evidence to suggest that occlusive pressure will drive affected teeth back into their sockets, and this disrupts the normal anatomy of the tooth apex. The gingival attachment and the periosteum are damaged.

Once again, as in the case of microfractures of the incisors, bacteria of the oral cavity can reach the tooth root and surrounding bone.

*By burring to within a millimetre of the gingival margin some of this occlusal pressure is relieved, and the likelihood of tooth root abscesses and associated osteomyelitis decreased. My clinical impression has been that rabbits that have their teeth shortened this way also return to eating more quickly, possibly because the root elongation has been painful.

Gastrointestinal hypomotility (also know variously as gut stasis, ileus, trichobezoars, or hairballs) is a secondary condition. It occurs frequently in rabbits in response to pain or stress and it is critical to identify and treat the underlying cause._


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## Pipp (Apr 14, 2010)

So he's getting his front teeth clipped and now the vet says he needs his molars trimmed? 

Clipping the front teeth shouldn't cost much. 

Is it a front tooth (incisors) or a molar tooth that is cracked? 

What does your bunny normally eat? You can try and control molar spurs with diet. 

The antibiotics are to prevent an infection, but he's not for sure going to get one. But if you're going to try and get his teeth down naturally, you'll have to really watch for signs of infection, and its hard to spot. Watch closely for any signs of chewing discomfort, a wet chin, a watery eye, any lethargy (depressed, tired or slow). Keep feeling his jaw and head for lumps. 

I'd talk to your vet about the prices, and check the prices from other vets. 


sas :clover:


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## Cottonball (Apr 14, 2010)

The vet clipped the front teeth. He said it was the bottom front tooth on the left. I think.


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## tonyshuman (Apr 14, 2010)

OK, I have heard of those getting cracked before. Typically when they get cracked, the vet will remove them. The reason is that the front teeth wear each other down--the top ones wear the bottom ones down, and vice versa. If a tooth is cracked, it can't wear the opposite one down. The vet can let the tooth grow more, so that it's back to a normal length, and that might be what he wants to do. The thing though is that while the bottom tooth is growing back (to grow the cracked part out), the top tooth will have to be manually clipped to keep it from getting too long.

The molar issue is a whole separate thing. Some people with dental bunnies have to have them sedated and have tooth trims every 3 months. It's not a cheap proposition, usually around $100/time. I am also in a financially tight situation (graduate school gives me a small living stipend) and I purposely chose to not adopt a dental issue bunny when I was looking for a girlfriend for Tony. Now, since you've had this guy for a while and you're very attached to him, you don't have that option of course. 

I would look into vet insurance. Veterinary Pet Insurance (www.petinsurance.com) is the only one in the US that insures pets. It's about $12 a month, and they pay up to $50 per year for overgrown teeth. Now that isn't going to save you money, but if anything else comes up, like an abscessed tooth (infected tooth roots), or any other non-mouth-related issue, the plan will probably pay out more than you pay for it in a year. It won't save you a ton, but it may save you something.

This website:
http://www.petinsurance.com/forms.aspx
has the "Avian and Exotic Benefit Schedule", which lists what they will pay out for each condition per policy term (1 year).

This is IMOM: http://imom.org/

You may also want to contact New Jersey HRS because a rabbit rescue organization will be much happier to help pay for a bunny's medical treatment and keep him in your home than have him surrendered. That way, they know the bunny has a loving home, even if the parents need help paying for the medical care. It's easier and more cost-effective for them to help you pay for medical bills than to have you surrender him to a shelter, which then would have to pay all the bills and find him a new home.

http://www.njhrs.com/

I hope this doesn't sound callous--I really want him to stay with you and I'm just trying to help with some possible ways to pay for it.


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## hln917 (Apr 14, 2010)

Hi~ I use the Whitehouse Vet in Hunterdon County off of Rt 22. Dr. Barbara Guy is the only vet who is rabbit savvy there. Not sure which town you're in. Both my Baci and Shades have had molar issues now since last Oct. Baci had it more severe. Since Oct, both have already gone 2-3 times to have their molars filed down. Shades needs to go in every 4 weeks to get her front teeth clipped. As long as we maintain the front teeth, the molars are usually good for about 3 months. They charge me $10 to get the front teeth clipped and about $105. for any molar work. Most of the cost is from the anesthesia. Not all vets will perform rabbit dental work. If your bun need molar work, please do not wait till it's too late. Our first episode with Baci, we didn't know until he stopped eating and by then he was already in pain. The molar was growing into his inside cheeks causing him pain. Fortunately they were able to work on him asap. Good luck and keep us updated!


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## Cottonball (Apr 15, 2010)

I checked on my rabbit. He is eatting like a horse and shows no signs of pain or any kind of depression or watery discharge.

Should I give him a carrot to find out?


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## tonyshuman (Apr 15, 2010)

I would try to get a look at the front tooth myself, to see what it looks like.


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## Cottonball (Apr 15, 2010)

I am nervous. Idon't know how to open a rabbit's mouth, or touch his bottom jaw. The experience is similar to opening a liion's mouth.


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## jcottonl02 (Apr 15, 2010)

Lol I wouldn't quite liken it to looking into a lion's mouth!!! 

Just sit your bun down comfortably, in the best way for your bun. Place your fingers gently around the bun's top jaw kinda thing, and gently lift the lip back, and it should expose the upper and lower incisors. God that's so hard to explain lol!!!

I'm sure your bun won't bite you. I can put my finger inside my bun's mouth (to check for sharp edges) and all they will do is lick it lol.


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## Cottonball (Apr 17, 2010)

One quick question, what does a drool covered chin look like? And if a rabbit has a bad tooth ache would he/she/it flip the food bowl?


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## Pipp (Apr 17, 2010)

*Cottonball wrote: *


> One quick question, what does a drool covered chin look like? And if a rabbit has a bad tooth ache would he/she/it flip the food bowl?


Its usually just a damp or wet mouth, chin or chest, and not after a fresh drink from a crock of water. 

My bunnies will flip their food bowls when they stressed, angry, bored, hungry, not hungryÂ  and/or they think it's in their way.Â  Hard to tell!Â  

Is this unusual behavior for this particular rabbit?Â  

You can probably find a cheaper vet for the front teeth clipping/grinding, although they'll have to be careful given the crack. 

The molar spurs can often be controlled with diet.Â  I feed my guys stemmy carrot tops, kale, long strands of grass, broccoli, etc, going for as much variety as possible to make sure they're chewing using all surfaces.Â Â  I also give them several varieties of hay (1st cut, 2nd cut, local grass, etc) for the same reason. 

Fruit tree branches, especially apple and pear, with the bark intact (just throw them in the oven for an hour or so to kill off any bacteria and dry the sap) are another thing that will wear down teeth, including the incisors. 

I don't take my spurs bunny in to the Vet until I absolutely have to, because often they will break off or be ground down on their own, and there isn't a huge downside, it's not life-threatening as long as you're prepared to syringe feed for a few days when it does get to the point they stop eating, which usually means they have a spur rubbing on their cheek or tongue causing discomfort. .Â Â  




sas :bunnydance:


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## tonyshuman (Apr 17, 2010)

:yeahthat:
and
Sometimes bunnies do flip the bowl if they have tooth issues--their teeth may make it easier for the bunnies to eat their pellets and stuff off the floor rather than out of a bowl.


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