Exotics (RABBITS) Flashcards
Why do rabbits get dental disease?
2 main aetiologies proposed:
Inadequate attrition and Metabolic bone
disease. In practice, both avoided with correct diet.
What are diagnostic techniques?
History
Clinical examination
Conscious oral examination
Conscious intra-oral examination
Oral endoscopy
EUA: good positioning and exposure
Describe the approach to the clinical exam of a rabbit?
Examine whole animal (esp rabbits) (Dental exam last!) Need to build a
general picture of the animals status before concentrating on teeth. Distant
examination should be performed, looking for the presence or absence of
epiphora, obvious incisor elongation, any grossly evident abscessation.
Examine the mouth and dewlap for signs of drooling.
Palpate ventral mandibular border and dorsolateral maxillary border for
swellings, asymmetry, pain. Examine incisors from front and sides.
Describe a conscious oral exam?
Run fingernail down and examine for horizontal grooves. Check peg teeth
as well. Check the soft tissues for horizontal incisor ribbing, usually upper
incisors first.
Discuss Conscious intraoral examination?
Limited view available with otoscope. Use plastic cones rather than metal but
watch for sharp edges developing on plastic ones. Good general overview of crown shape, and should spot obvious spurs, however, one WILL miss
lesions this way.
Discuss Oral endoscopic exam?
Superior view to otoscope, allows close up view of occlusal, lingual and
buccal surfaces. Must be done under good chemical restraint to avoid
damage to scope.
Discuss examination under GA of oral cavity?
Only way to fully examine the inside of the mouth as one will miss lesions
with conscious exam due to the inability to fully open mouth and to move
soft tissues (cheek and tongue) out of the way.
How should rabbits be positioned for oral exam under GA?
Positioning is vital to good evaluation of teeth. Positioning using a nurse is a waste of a good anaesthetist, potentially dangerous if using powered equipment and ergonomically bad practice. Positioning using a head clamp (VI) avoids awkward posture, keeps animal absolutely still. Can be used in rabbits or
cavies/chinchillas.
Why is radiography useful?
Radiography is a very useful adjunct to intra-oral exam. It allows
assessment of arcade shape, assessment of tooth pathology below the
gumline, and bony changes. May not affect treatment decision, but allows
some prognostication eg if severe tooth “root” pathology present, long term
prognosis is MUCH worse. It is essential in abscess cases or tooth removal
Skull radiographical changes with acquired dental disease include:
- Loss of a
distinguishable lamina dura. - Increased periapical radiolucency.
- Loss of the internal structure of the tooth.
- Elongation and distortion of the tooth roots.
- penetration of the ventral mandible or elsewhere.
6.Loss of the normal
occlusal pattern.
How can you grade rabbit dentition on radiographs?
Grade 1: is normal. Grade 2: is root elongation and deterioration in tooth
quality.
Grade 3: is acquired malocclusion.
Grade 4: is cessation of tooth
growth.
Grade 5: is endstage changes such as abscessation, osteomyelitis
and permanent calcification
How should incisor overgrowth be treated?
Incisor Overgrowth MUST NOT be treated by clipping with nail clippers:
this is painful and risks causing abscesses. Burring with a dental drill or
cutting disc is less painful with less risk of infection. Alternatively, removal
is appropriate in many cases.
Why is clipping the teeth so bad?
Clipping is dangerous due to the brittle poor quality enamel leading teeth to shatter unpredictably leaving sharp jagged edges and exposing pulp.
Considerable kinetic energy applied can lead to disruption of the apex.
Exposure of pulp is painful and allows infection. It is not justifiable in this
day and age, with very very few animals that cannot be restrained for powered cutting equipment.
How can incisor burring be carried out?
Incisor burring may be carried out using a high speed dental drill. This is
made easier by aiming the water away from the rabbit. It is easier, faster,
with less noise and stress than clipping or using a hobby drill/cutting disc.
There is the potential for soft tissue injuries.
What are the indications for incisor extraction?
Where permanent removal of teeth is
advantageous, particularly younger, stressier rabbits with rapidly growing
incisors. One needs to compare the
anaesthetic risk x1 vs multiple handling over lifetime.
Some top tips on incisor removal?
For incisor removal, good surgical anaesthesia and perioperative analgesia
is required. A clean surgical field, if not sterile. Appropriate equipment
includes a range of different sized needles and/or arossley luxator. More
delicate elevators are also useful, made by Docs Innovent. Patience and
time is required! Fingertip removal or instruments are both acceptable, but
whatever is used, avoid pulling in straight line, as the tooth is curved. Wait
until it is genuinely loose before applying traction.
Discuss dacrocystitis?
Dacryocystitis is a dental problem, not an ocular one (Primary
conjunctivitis relatively uncommon). Epiphora and purulent discharge from
nasolacrimal puncta is associated with blockage and infection of the duct.
This is very common. It is important to investigate the teeth, esp maxillary
incisors and UPM1
How are the nasolacrimal glands flushed?
GA/sedation is not usually required: local anaesthetic applied, and instilled,
and the process is well tolerated, if the fluid is warmed, and apart from the
initial feel of the fluid going in, which may cause them to pull away, off it,
it seems to be tolerated.
Purpose made cannulae exist, but 20-24g IV catheters work well: tapered
ends easier to introduce, cheaper, readily available. Can always start things
off with 24-26g and progress to larger if difficult to enter puncta. Flushing
with sterile fluid is useful but there may be merit in instilling therapeutics.
What do overlong cheek teeth do?
Over-long cheek teeth prevent proper grinding of food, bring the incisors
out of occlusion (making them overgrow), and cause deeper pain at “root”
nerve level. These respond variably to shortening of the teeth, depending
on chronicity.
What is the main
source of acute pain in these animals?
Traumatic occlusion of tongue is the main
source of acute pain in these animals, and removal of spurs is curative.
What is the aim of cheek teeth treatment?
To take teeth out of traumatic occlusion with soft tissues and to allow normal anatomical closure of mouth. To remove any teeth, or clinical
crowns, which are loose or associated with abscessation.
What do clients need to be aware of with cheek teeth treatment?
Remember that this is not a one-off treatment. Treatment intervals vary
with age of rabbit, stage of dental disease and diet from 4 weeks to 6
months. It is management of the condition rather than a cure.
When may clipping of teeth be employed?
Clipping may be employed, but not for general crown reduction ie where
entire thickness of tooth “leans” as there is a high risk of shattering the
entire tooth, even below the gumline. It is for removal of angled spurs only,
being quicker, and resuling in less risk of “slippage” of burrs on spurs.
Why is filing with manual files so dangerous?
Filing using manual files is, in my opinion, EXTREMELY dangerous. It
jars the teeth in their sockets, loosening them (note that if the intent is to
remove such loose crowns, thats one thing, but if its not noticed, and one
leaves loosened teeth, this is going to make that rabbit very uncomfortable
post-dental). It is an inefficient, slow method, but the main problem is the
massive risk of hitting the large, relatively unprotected blood vessel at the
angle of the jaw. THIS CAN BE RAPIDLY FATAL.
What is the
method of choice for crown reduction and shaping teeth?
Burring using either a low speed handpiece in a purpose made dental
machine, or attached to a flex-shaft for a hobby tool, is, in my opinion, the
www.improveinternational.com | 5
method of choice for crown reduction and shaping teeth. Ie as a sole
method for overlong crowns and after clipping spurs to lower crowns.
However, it is not without risks. It involves using a sharp high speed
rotating piece of metal in a confined space with limited visibility and the
potential for patient movement. This is why lighting, positioning and
anaesthesia are all vital
What are the considerations for case selection for anaesthetics?
Do we need to anaesthetise this animal for diagnostics and
treatment? Is it fit for a GA? Weigh all patients! Pre-anaesthetic
stabilisation is vital and can be simple. This animals may not be eating or
drinking well if at all.
Key safety points in anaesthesia include?
An open vein and an open airway.
What is helpful prior to intubation?
Preoxygenation is helpful prior
to intubation.
How is blind intubation done?
The blind technique is simple,
when it works! This carries risks of introducing foreign bodies into the
trachea, and laryngeal trauma with repeated attempts, as one cannot see
what is happening. Place the rabbit in a position (extreme head up, or
dorsal recumbency) where the soft palate is disengaged from the epiglottis
and slip the tube in on inspiration.
What are AIPMMA beads?
- Antibiotic impregnated
polymethylmethacrylate beads - Permanently implanted or removed later as
necessary
How is marsupialisation done?
- Debulk abscess to greatest extent possible
- Remove appropriate amount of skin to be able to tack skin to deeper tissues with no dead
space or tension - Monofilament material preferred to avoid
tracking infection through tissues - Start at 4 points of compass to avoid
unevenness
Give some examples of osmotic agents?
- Concentrated dextrose
- Honey
–Ordinary honey
–Manuka/tea tree honey - Antibacterial
- Mystical effects of bee ingredients?
What are the indications for cheek tooth extraction?
- Indications
–Already loose
–Involvement with abscessation
–Or both! - Not a minor undertaking
- Effect on apposing teeth less than would be imagined
What is another possible treatment option?
Laser ablative surgery
Show grade 1 rabbit dentition?
–Grade 1 is normal.
Show grade 2 rabbit dentition?
–Grade 2 is root elongation and deterioration in
tooth quality.
Show grade 2-3 rabbit dentition?
–Grade 3 is acquired malocclusion.
Show grade 4-5 rabbit dentition?
–Grade 4 is cessation of tooth growth.
Show grade 5 rabbit dentition?
–Grade 5 is endstage changes such as abscessation,
osteomyelitis and permanent calcification.
