Changes

Clinical signs relate to the pain experienced and the inability of the rabbits to eat normally:  

Clinical signs relate to the pain experienced and the inability of the rabbits to eat normally:  

'''Lack of grooming''' leads to a poor coat, build-up of skin debris and ''Cheyletiella'' mite infestations.

'''Lack of grooming''' leads to a poor coat, build-up of skin debris and [[Mites - Rabbit#Cheyletiella parasitovorax|''Cheyletiella'' mite infestations]].

'''Digestive disorders''' are often seen: ileus, reduced number of droppings, intestinal obstruction from the ingestion of fur mats.

'''Digestive disorders''' are often seen: ileus, reduced number of droppings, intestinal obstruction from the ingestion of fur mats.

'''Uneaten caecotrophs''' due to a difficulty in reaching and ingesting the droppings. This leads to soiling of the perineal skin and can become fly strike if severe enough.

'''Uneaten caecotrophs''' due to a difficulty in reaching and ingesting the droppings. This leads to soiling of the perineal skin and can become a [[Cutaneous Blowfly Myiasis – Rabbit|fly strike]] if severe enough.

'''Epiphora and dacryocystitis''' due to impingement on the nasolacrimal duct by the elongated roots and the upper incisors, often with secondary bacterial infection.

'''Epiphora and dacryocystitis''' due to impingement on the nasolacrimal duct by the elongated roots and the upper incisors, often with secondary bacterial infection.

'''Abscesses''' seen as hard lumps along the ventral border of the mandible, or retrobulbar abscesses

'''Abscesses''' seen as hard lumps along the ventral border of the mandible, or retrobulbar abscesses.

'''Incisor malocclusion and overgrowth''' due to the lack of correct chewing motion due to cheek teeth malocclusion.

'''[[Incisor Overgrowth - Rabbit|Incisor malocclusion and overgrowth]]''' due to the lack of correct chewing motion due to cheek teeth malocclusion.

'''Pain and anorexia''' due to the spurs on the cheek teeth. There is often profuse salivation and staining of the fur under the chin and on the forelegs.

'''Pain and anorexia''' due to the spurs on the cheek teeth. There is often profuse salivation and staining of the fur under the chin and on the forelegs.

==Trimming Cheek Teeth==

==Trimming Cheek Teeth==

Corrective dentistry cannot restore normal occlusion to maloccluded cheek teeth because of the altered positon, shape and structure of the teeth. Changes in the direction of growth mean that malocclusion recurs and the spurs regrown, often in a matter of weeks. However acquired dental disease is progressive and eventually the germinal layer of the roots is destroyed and the teeth stop growing so trimming is no longer required.

Corrective dentistry cannot restore normal occlusion to maloccluded cheek teeth because of the altered position, shape and structure of the teeth. Changes in the direction of growth mean that malocclusion recurs and the spurs regrown, often in a matter of weeks. However acquired, dental disease is progressive and eventually the germinal layer of the roots is destroyed and the teeth stop growing so trimming is no longer required.

 

The number of times that the teeth require trimming is variable, but is usually every 6 weeks initially.

The number of times that the teeth require trimming is variable, but is usually every 6 weeks initially.

===Procedure===

===Procedure===

*General anaesthesia is required and a mouth gag and cheek dilators are extremely useful.

'''General anaesthesia''' is required and a mouth gag and cheek dilators are extremely useful. Hold the lip or tongue out of the way with a spatula. This protects the soft tissues. Dental burrs are the preferred instrument for removing spurs and reshaping cheek teeth, although molar clippers can be used if they are the only tool available.   

*Hold the lip or tongue out of the way with a spatula. This protects the soft tissues.

 

*Dental burrs are the preferred instrument for removing spurs and reshaping cheek teeth, although molar clippers can be used if they are the only tool available.   

Burring should not take more than a minute but, if it does, stop to cool the tooth frequently with a cotton bud soaked in cold water.

*Burring should not take more than a minute but, if it does, stop to cool the tooth frequently with a cotton bud soaked in cold water.

 

 

The nurse should hold the head (by the gag) and pull it forward extending the atlanto-axial joint or use a table-top gag. Rest your forearms on a sand bag, it makes your aim better! Keep the tongue pulled forward to prevent cyanosis.

Usual post-operative and post-anaesthetic procedures (fluids, analgesics, prokinetics) are useful.

 

Be extremely careful of the palatine vein. It will bleed badly if hit with the burr and may be very difficult to stop. If bleeding occurs, simple measure of pressing on the vein immediately with a dry cotton bud for five minutes may be more useful then trying diathermy, radiosurgery or other means of coagulation.

*Usual post-operative and post-anaesthetic procedures (fluids, analgesics, prokinetics).

*Be extremely careful of the palatine vein. It will bleed badly if you hit it with the burr and may be very difficult to stop. From experience, I recommend to use the simple measure of pressing on the vein immediately with a dry cotton bud for five minutes, and not to try diathermy, radiosurgery or other means of coagulation.

==Extraction of cheek teeth==

==Extraction of cheek teeth==

This is often requested by owners to prevent regrowth of spurs that require regular trimming. However the extraction of cheek teeth is inadvisable and often unnecessary, unless periapical abscesses due to the dental disease are present.

This is often requested by owners to prevent regrowth of spurs that require regular trimming. However the extraction of cheek teeth is inadvisable and often unnecessary, unless periapical abscesses due to the dental disease are present.

Extraction of cheek teeth follows the same principles as incisor extraction – special sharp elevators or bent hypodermic needles are used to cut the periodontal ligaments around these box-shaped structures.

Extraction of cheek teeth follows the same principles as [[Incisor Overgrowth - Rabbit#Extraction of incisors|incisor extraction]] – special sharp elevators or bent hypodermic needles are used to cut the periodontal ligaments around these box-shaped structures.

It is not necessary to remove the opposing cheek tooth as an upper tooth occludes with two lower teeth and vice versa. Also, adjacent teeth tend to tip towards any gap that is left.

It is not necessary to remove the opposing cheek tooth as an upper tooth occludes with two lower teeth and vice versa. Also, adjacent teeth tend to tip towards any gap that is left.

===Procedure===

===Procedure===

*pre-operative radiography to assess root morphology.

Start with pre-operative radiography to assess root morphology. Follow-up must be maintained as the opposing teeth will need occasional occlusal adjustment to prevent overgrowth and interlocking into the space left after extraction.

*Follow-up must be maintained as the opposing teeth will need occasional occlusal adjustment to prevent overgrowth and interlocking into the space left after extraction

 

*Intra-oral approach:  

'''Intra-oral approach''': <br>

**Used when there is no gross apical ankylosis

This technique is used when there is no gross apical ankylosis. The procedure is essentially the same as that for [[Incisor Overgrowth - Rabbit#Extraction of incisors|incisor extraction]] except that forceps are used for the final extraction after the tooth has been fully mobilised in its “socket”.

**The procedure is essentially the same as that for incisor extraction (see above) except that a forceps is used for the final extraction after the tooth has been fully mobilised in its “socket”.

 

**Luxators are used to loosen the periodontal membrane especially on the mesial (palatal/lingual) and lateral (buccal) aspects of the tooth.

Luxators are used to loosen the periodontal membrane especially on the mesial (palatal/lingual) and lateral (buccal) aspects of the tooth. Careful elevation with horizontal sectioning and removal of successive portions is generally effective when the root is too long to remove in one piece.  

**Careful elevation with horizontal sectioning and removal of successive portions is generally effective when the root is too long to remove in one piece.  

 

*Extra-oral approach  

'''Extra-oral approach ''':<br>

**Buccotomy is advocated to approach maxillary teeth in some texts but is traumatic - avoid if possible.  

Buccotomy is advocated to approach maxillary teeth in some texts but is traumatic - avoid if possible.  

**Osteotomy is preferred via the ventral mandible or through the maxillary bone. Use a slow speed bur to cut away any bone (much may have been lost due to the original disease processes).

 

**“Transabscess” approach may be required but if so flush copiously with povidone iodine solution  

Osteotomy is preferred via the ventral mandible or through the maxillary bone. Use a slow speed bur to cut away any bone (much may have been lost due to the original disease processes). “Transabscess” approach may be required but if so, flush copiously with povidone iodine solution. Elevate or repulse the tooth into the oral cavity and remove via the surgical access. Luxators may have to be used to sever the remains of the periodontal ligaments.

*elevate or repulse tooth into the oral cavity  

*remove via the surgical access.  

*You may have to use luxators to sever the remains of the periodontal ligaments

===Postoperative care===

===Postoperative care===

Hillyer (1994) points out that after extraction the socket of a tooth should be cultured and appropriate antibiosis carried out.  

Hillyer (1994) points out that after extraction the socket of a tooth should be cultured and appropriate antibiosis carried out.  

Packing the socket with calcium hydroxide fills the dead space and has antiseptic properties – do not use calcium hydroxide powder or a paste made from the powder – the polymerised product (Life®; Kerr) is superior and doesn’t seem to cause thermal necrosis.   

Packing the socket with calcium hydroxide fills the dead space and has antiseptic properties – do not use calcium hydroxide powder or a paste made from the powder, the polymerised product is superior and doesn’t seem to cause thermal necrosis.   

Suturing or gluing an empty socket is advised if several teeth have been extracted (prevents impaction with foodstuffs) but is not possible if only one tooth has been removed.

Suturing or gluing an empty socket is advised if several teeth have been extracted (prevents impaction with foodstuffs) but is not possible if only one tooth has been removed.

Harcourt-Brown, F. (2002) '''Textbook of Rabbit Medicine''', ''Elsevier Health Sciences''

Harcourt-Brown, F. (2002) '''Textbook of Rabbit Medicine''', ''Elsevier Health Sciences''

[[Category:To Do - Review]]

[[Category:Rabbit Dentition]]

[[Category:Expert Review - Exotics]]