Good afternoon everyone. My name is Charlotte and thank you for joining us today for our lunchtime webinar on dentistry, rabbits and rodents. Today's webinar has been kindly sponsored by IM 3, so big thank you to IM 3 for making today possible.

Our speaker today is the lovely Doctor Sophie Jenkins. Doctor Sophie Jenkins is an advanced practitioner in zoological medicine and is a veterinary surgeon based in South Wales. Sophie graduated from the Royal Veterinary College in 2008.

She went on to follow her passion for exotic animals and gained a general practitioner certificate in exotic animal practise in 2011. In 2016, Sophie completed a postgraduate certificate in exotic animal studies and was subsequently granted status as an advanced practitioner in zoological medicine. Sophie gives CPD talks and lectures to vets and nurses on exotic medicine and surgery.

Sophie is also a gold member of the Rabbit Welfare Association and fund, and she was recently awarded the Burgess XL winner of Rabbit bet of the Year in 2020. Sophie owns and runs Origin Vets clinic in South Wales and she offers 1st and 2nd veterinary opinion, as well as referrals for reptiles, rabbits, small animals, birds, amphibians, and fish. Sophie's exotic work covers a large variety of exotics.

Sophie has over 25 personal experience of keeping and breeding various reptiles as well, and has a big soft spot for rabbits and currently has 4 rescue lion heads. I wish to let you know that today's session will be recorded and available on playback, and you will all receive a certificate for today's attendance also. Please use the Q&A box for any questions you may have for Sophie.

Throughout the presentation, though due to the amount of information in this jam-packed session, we may run out of time with the questions submitted. Therefore, we will email out any responses to you in the next few days. Additionally, you'll be able to email us with any questions also, which will be in the chat box too.

So with no further ado, I'd like to hand over to Doctor Sophie to start today's session. Thank you, Sophie. Thank you, Charlotte.

Welcome everybody. Hopefully we'll enjoy this lunchtime salmon webinar. So we're on rabbits and rodents and dentistry.

We're gonna aim to understand normal anatomy for rabbits and rodents, understand why changes make there. We'll go through some interpretation of dental X-rays of some of the species, how to perform dental work on these species, and how to deal with dental abscessation. We really should be making dental checks part of our routine health check in any and these species.

It allows us to see the normal teeth, as, and also to examine the face as well, making sure that we're always checking them regardless of what they're coming in. We could be should be aware that there are congenital and acquired conditions of dental disease in in these species. Particularly rabbits, if they have incisor abnormalities noted, vaccines are neutering, it's normally because it's congenital.

They'll often present at less than 6 months within the size of abnormalities and less than 1 year with premotor and molar abnormalities when it's due to congenital conditions. This is worth knowing, particularly if you've got, breeders in the area that you're getting a lot of this, the same litters coming in, you can report back to the breeders, so it's, it's worth making note of that. You can also have acquired dental disease, this is for various reasons.

It's, it's often has relation to dietary impact. We often have underlaying diseases, particularly if there's pain elsewhere. For example, we could have dental disease because we're anorexic, because we are painful from a kidney stone.

It only takes about 4 or 5 days for spurs to develop on the molars if they're not eating properly. So within a week of not eating properly, then you can have dental disease develop. So it's worth noting it's not always primary.

So doing some basic exam exams, we want to use an otoscope. We want to be sure we're checking the teeth from the, the front and also from the sides. To do an 02 exam, we're sort of leaning down on the edge of the table or on the floor, and we're generally putting the otoscope in just the side of the inside, just the the the diastoma, which is the gap between the insiders and those first premolars.

It's worth making sure your nurses are aware how to do this. This is one of our nurses at, Victoria. And as part of the nursing checks as well, even if they come in for nail clips in this particular case, then, we still do dental exams.

It allows those nurses to have an idea of what's normal, and you can pick up therefore what's abnormal much earlier on. OK, so we have our laga morphs, which are rabbits and hares and peers. We've got herbivorous and rodents, which are caviorphs, so our chinchillas, des, guinea pigs, and these guys have teeth that continuously grow and erupt without an anatomical root.

This is because they have tough abrasive diets such as hay and grass and you've got that rapid tough we, which means they need to be replaced in that that turf as well. They're very similar to to horses if any to do horsework. This means that they have not only incisor issues, but they can have premolar and molar issues as well, depending on species.

Then we've got our omnivorous rodents, our myomorphs, things like our rats, our mouse, hamsters, gerbils. These guys have got incisors and they have got small, short crowned molars with, with anatomical roots. So they have these large incisors which grow continuously, allowing them to gnaw and it's of noting that the name rodent comes from the Latin word rode, which means to gnaw.

That literally is what they're doing. They're gnawing tough grasses, out of in their environment, and then they use the, the molars to chew them down. They have incisor issues, and they rarely have molar issues unless it's due to infection or tumour base.

They're not the same as our lagamos and herbivorous rodents. You mentioned that they askedtoma earlier and that literally is the gap that occurs between the incisors and those 3 molars or molars in your lupus rodents, and they do not have canines, OK? You often hear other people referring to them all as cheek teeth, which your premolars and molars in, in your rabbits.

They effectively function very similarly, but they are, they are a premolar and a molar. Not to get too bogged down on the numbers specifically right now, because you can follow this up, but it's worth noting that none of these guys have got canines that are lagomorphs have got 3 molars and molars and so our carriomorphs, but our myomorphs only have molars. If you're getting into doing dentistry work, whether you're doing rabbits or, or rodents, it's either worth getting copies of, of these systems or making your own, noting again that these guys do have numbers just like some cats and dogs, and it's always worth having these next to you when you're doing some dental work or being aware of, of what teeth, having to do work on, so you can keep an eye on the records as well.

There's a really good app called the Visible Bunny by I think it's Victoria University in America and they have this app there which you can basically take a rabbit into different levels of anatomy. So you can have a little look and you can see here that we've got, when the incisors are cluded, our cheek teeth have a little gap between them, and that is completely normal. So when they're cutting and slicing, those molars are not together.

When they're then chewing. In the back, those incisors are then apart, and if there's any abnormalities in the anatomy of any of this part, they don't function correctly. OK, so in regards to actually doing dentistry work, it's worth having a good selection of dental equipment.

These oops I've just got back there, sorry, these are the, new ones from IM 3. They're lovely, ergonomic design. They're very comfortable and just pick them up, back at the London vet show, and they're really, really comfortable to use.

These guys are also great to use. The, it's worth of these, you don't tend to use these for any of our . Rabbits and rodents work, but we do have them on board anyway for ferrets and hedgehogs, etc.

We've got, molar luxators, which are good to remove, and this, this is sort of tongue spatula. I don't tend to use this, these guys very much like mouth guides because I tend to use, dentistry tables. We use a straight nose comb, which is this guy over here, and we use a guard on it to protect the soft tissue, and we use it on low power so it replaces er the polisher head.

It's also worth noting that we sterilise our equipment between every dentist patient that we that we utilise. These guys do carry different bugs around. For example, a bordertal and rabbits, often carried but not susceptible to clinical disease, whereas guinea pigs are very susceptible to it.

Just to give you an idea of the angle then, so these are our incisor removers, and it just you can see how it follows the route of the incisor when we're removing them. OK, so signs of down to disease. This is our little hamster here, one that came in with incisor issues.

You can see we've got black spasm, we've got wetness around the nose. We get that out of focus there, but you can appreciate the, the sort of, soreness there and his eyes really sore. And this, this little guy had terrible, incisor disease.

So you get this drooling, wetness around the mouth, swelling or painful jaw underneath, often resistant to having mouth exams. You might have a change in food preference, so they may go off their palates because they've got lower jaw, problems, sorry, not lower jaw, reserved crown problems where they're chomping down and it's hard for them. So they prefer to eat the hay where they're more doing grinding work.

They might also have them but they're refusing to eat the hay because they've got spurs that are cutting into their cheek or their tongue. You might also get a change from harder to softer foods as well. It may show an interest in food, but not actually eating or difficulty eating.

It might get a bad odour from the mouth, it might be grinding their teeth. You can have dacrocystitis. We'll come on to that a bit later.

We've mentioned larospasm and euphori as well. You might have your eyes popping out, sort of bulges on the one side, optosis, we could have abscessation formation, we'll come on to that later. And then we can also have sycotrope accumulation because it could be painful for them to take the sycotropes away from the anus.

They might not be able to physically use their tongue properly, particularly things like guinea pigs, where the the teeth entrap the tongue. We could have a reduction in size or change in shape, colour, or number of faecal pellets being produced, and weight loss. We can also have reclusive or grumpy behaviour.

So we need to address the underlying cause of the dens disease. We need to try and work out is it primary, for example, because it's congenital, or because of dietary problems. Is it secondary or tertiary?

So is it secondary because they do have some gut stasis because they've got, a, a bladder stone or a kidney stone. It could be tertiary because we've got underlying E caniculi, which is causing granulomatous lesions, which is then causing stasis and therefore under dental disease, etc. They can be as often as every 4 to 8 weeks.

Bearing in mind the teeth grow, particularly the premolars and molars, around 11 millimetre every 4 days. You need to be honest with younger. It's obviously we've got dental costs, ongoing dental costs, and if you're having them done every sort of 1 to 2 months, it can be quite pricey.

For them, and not all insurances do cover that. Also, you've got the potential risks of long-term repeated dental GA work that you're doing, and we always have to come back to the quality of life. So if the patients are doing really well, they're bouncing back from anaesthetics, then great.

If they're getting weaker and weaker each time, it might be time to, to speak to their donors. So our normal incisors, they are chisel shaped. They, meet just in front to the top in front of the lower.

They have enamel on the front but nothing on the back. Then there's 4 main incisors in, the species we're talking about with regards to the rabbits and rodents, but there's also 2 smaller peg teeth in all the lagomorphs as well, which are on the upper side just behind those two front ones on the top. We need to be careful when re-examining these guys.

We need to avoid pinching the nose and make sure it's nice and open so they can still breathe, remember these guys are obligate nasal breathers, and they will panic if you block off their nose. So in relation to all abnormal incisors, just this is a little George, he's 11 months old, he'd been castrated 2 months prior, and he came in for weight loss. The owner noted he was eating less, dropping food on the floor, but neither the vet or the owner had noted prior to the referral that he had overgrown incisors.

And it's just a little case to think about while we're going through the incisor removal, and also to remind ourselves that more things are missed by not looking than by not knowing. So what could we do? We could clip them things like these guys, .

However, It causes sharp edges. It causes cracks longitudinally and it releases a lot of energy into that tooth which causes bruising right down at the pulp where the t's grown from at the juvenile layer, where you can get damaged periodontal tissue or periaal tissue, and you can also increase the risk of abscesses. So as a long term basis it's not an ideal situation to keep cliff in the teeth.

So we could work. This is a particular case of the guinea pig up here. You can see there's a lot of damage going on with the ts coming into there.

Now, many animals will tolerate furtherov incisors, some will need a little bit of talk or midazolam, but in the majority of cases this really is a temporary fix. Generally, if we leave them in these lager morphs and caviar morphs, they will cause, pressure to continue on the rest of the jaw and eventually worsen the dental disease and start to include things like premolar and molar issues there. It doesn't tend to be a problem leaving them so much in, myomorphs because they don't have these premolars or molars to worry about.

However, they can still cause continued problems and often our little rats and hamsters with size of be every two weeks. So sometimes we need to work out what's best for them. We generally use a low or high speed boat or a diamond boat and again using a tissue guard as well.

So this is an example of a of a hamster. This one, it will be underneath a low dose tint with oxygen coming through. We've got a cotton bud here or you can use a syringe and to protect the soft tissue behind.

And you can see the sort of level taken. You've got the gingival layer just below here. And we go in at round about sort of 22 mills above that so we avoid hitting any soft tissue, but you can just see how much we're moving here.

This little guy had had trauma, he'd lost enough in sizesors, and the lower ones were continuing to overgrow. So he was, he comes in every sort of 3 weeks before this down to work. So if we're gonna actually do incisor removal, then ideally you want to be intubating these guys, have adrenaline to hand because they can bleed from here and sterile cotton buds.

We can use either lidocaine blocks or lidocaine and caine and, and take a note of what time we've given them. I normally would do the, the one lot, just 5 minutes before I would do the second lot just to allow me time to remove the upper ones until the, other local blocks don't, wear off. So we're using the, the dental, this is the, the one for IM 3.

This is another one I think from, instrumentation. They're very similar in how they work, but basically we're gently, working on the periodontal ligament, and it's all about patience, and just literally gently holding, twisting the ligaments, the, the, the instruments to to put pressure on the ligament and to stretch it. And we're holding, we're not wiggling back and forth, we're literally holding it.

And then we release, and then we go again and we hold and we release. And normally to remove all six and sizes in the rabbits, it takes me around about 15 minutes to do the whole lot. You can see here using our molar retractors here, that is to remove the incisor, how much of the actual reserved crown is in the mouth.

So this is what we see. And this is what's actually, in, in the, the jaw itself. And we need to remove all of this.

If there's anything that breaks in the bottom and you can't remove it, then be aware they will regrow. Also, prior to removal, generally, I put, bring the tooth out and push it back into the same, tract and destroy that germinal root, but it's always worth noting to the owners that they can regrow, and it does happen occasionally. So these are the removal of, of this, these particular teeth.

These ones with the black rabbit I just showed you there, and this is this particular rabbit here. But just to show you the difference in the length, again, the whiter section or creamier section is, is what you're seeing on the outside of the, of the mandible and maxilla. Everything that's pinker underneath is our reserved crown.

You can just appreciate how long these guys are, particularly the, the bottom ones. It's a bit hard to see here, but they are really twisted in this particular photo, and that can make it really difficult for removal. So again, just patience and time and slow stretching of the ligaments.

This is a guinea pig in size as you can see they're abnormal. And again, this is where it's worth noting about doing these guys under the GA rather than just bearing this down, because you can see in this photo on the right that the tongue is actually entrapped by the edges of these molars. They should be stopping here, and you can see the tongue is actually entrapped here.

So it, it, sometimes it's better to just go straight for GA especially the first one. This, was a little rabbit called Molly, Poppy, sorry, who I had actually fostered from a charity for a couple of months because she had a massive tumour here. We ended up having to remove her in sizesors because they were, putting pressure, from the tumour and moving out of place.

In order to save, the rest of the jaw, we, we did incisor removal and allowed her to to live her her days, but it's again, it's worth noting because under GA as we found the true extent of of this, mass. OK, so normal premolars and molars, we want to check them with the nooscope every consul as mentioned. Note that the guinea pigs are 30 degree angle.

Note that some animals do have what we call a step mouth, where they go up and down, so they should be a normal curvature. Now if it's is up, down, step mouth, it's normally cause it's infection in the germinal layer. We're gonna come on to X-rays, normal translucency at the base of the root is growth.

And also worth mentioning CT. We're not gonna discuss CT here, so I appreciate most people in general practise don't have access to CT, and also briefly endoscopy. It's really good if you've got an endoscope to utilise for these guys because you can just see the true extent here.

We've got buckle spurs down here, lingual spurs down here, and you can sort of have a comparison left and right. It just gives your nurses as well an option to see what's going on. This is where they've been burned back, so you can see the heights of where they should be.

And you can see again after you've taken the spurs back, how much soft tissue damage has actually caused on these gums here. So here you can see the nice spur which is causing laceration into the tongue. You can see here again in this rabbit, these horrendous spurs coming across, and how much damage it actually causes the tongue again, these guys are really long spurs, so they should be right back here as a normal anatomy.

This is an elongated lower premolar 2 on, in a rabbit on the right hand side. This guy had a danttal only a week before with the previous vets, and they hadn't noted this at the dental examination, despite it being under anaesthetic. And you can literally see it apologise for the quality, but you can see how long that tip is going.

It's growing out and under the tongue, it's not trapping on the tongue. And when I removed it, that, that, is what the tooth looked like, and that's just not a normal shape at all of a female or a rabbit. Again, these are spurs on the upper, you can appreciate the damage that it is causing here, cutting right into the, into the gums there.

These are lower elongation of the premolar 2 here. It's not spurred, but it certainly is going to cause problems as it grows into that cheek there. So this is gonna be one that would be considered removal.

And you can see again the soft tissue damage here from these spurs up here, and this one is a cheer. This is tongue entrapment in a guinea pig. So this little guinea pig here, you can see the left versus the right.

This is the same guinea pig. This is where the tongue's completely entrapped because they grow at a 30 degree angle. If they overgrow, that tongue literally can't move properly and they just can't eat at all.

So this is what they look like after you've actually removed them, but they can go back to looking like this within 6 to 8 weeks. And then this is another guinea pig again showing you how badly they can trap that tongue, they physically cannot move that tongue up and down because it's completely trapped there. And this is endoscopy of, the guinea pig after taking the the the length on those molars right back.

This is a little day ago, had a little bit of bleeding from the incisors, but actually when we looked back on it, and this is under anaesthetic just before we, fully put onto a dental table, you can see this hugely overgrown molar premolar one there, it just needs to come right back down to here. OK, so coming on to dental X-rays. We want to ensure positioning is good.

Normally we, we need to be doing these under a full anaesthetic with some BA and pass oxygen. I don't tend to intubate these guys for X-rays. They're either heavily sedated or under anaesthetic, and we've got IV access on them, and we can flow by oxygen.

I'm not gonna go through positioning because that's quite a bit of extra work to do, but there's normal skull X-rays, you're looking at DBs, you're looking at obliques, and you're looking at laterals, and sort of was the coals as well. So this is our diastoma, and we know it's a bullet shape, so it sort of converges together. We note the plane of those premolars and molars, and we want that slight curve, so it's slightly higher at the front than they are at the back, but they do curve and drop in the middle.

That's completely normal. We want to note the base, of the, the jawline, the mandible there, make sure it's nice and smooth, and that there's no bumps that would indicate, root there so reserved crown issues. We can also check on our DV really nicely and on the laterals tympanic membrane area and the tympanic bullet sorry area, making sure there's no signs of any sort of inflammation going on there as well.

This is a great paper and I'm gonna sort of skim over a little bit, but if you want if you're interested in reading it, it helps you understand how to interpret dental, or head X-rays in rabbits, guinea pigs, and chinchillas. And let's discuss it very briefly. Basically, we're drawing a line from the tip of the nasal bone right across to the occipital proturbulence, and we should not have growth of these teeth above this line.

We then drawn a line down above a height and about 1/3 of the way up. We can join this line right through to the alveolar crest at the proximal end of a hard palette. And again, we should have a relatively smooth line between the upper and the lower premolar and molars here.

We note in the red line is our dental pain he, so as I said, it's slightly curved like this. We're noting the green line, which is that the as between the hard palate and the base, the man of the bone plates, and that converges slightly into that bullet shape. And then we've noted the the mandibular line at the bottom and it's even thickness.

On our DV views we're looking at the white lines here, which are the maxillary cheeky. The edges just here premolar 2 and 3 are normal to slip past here, OK? And then the blue lines which are just medial to these white lines are are mandible.

And again, we shouldn't have any growth coming back from there. OK, that's just highlighting the agencies of the 3 and 23. Guinea pigs slightly different, very slightly.

So, where we had previously the 3/4 3rd bullet height on the rabbit, we've actually got up to 3/4 in this one on a guinea pig, but otherwise, the general sort of, approach to this is, is very similar. Again, you should have the convergence of, of that, upper and lower jaw, creating that bullet shape rather than a sort of passing away from each other. So just a little bit of the skull anatomy in relation to this, these, lines here which are just poking out as the curved edges of primo 2 and 3.

OK, so that's normal and you can appreciate that 30 degree angle there. In dental disease, this is going back to a rabbit now, you could appreciate when you start putting these lines in, it actually becomes quite obvious. We've got this huge overgrowth up here, we've got a lot of proliferation of the tissue going on here.

You can see the incisor and the and the normal versus the abnormal. It's really starting to curve, almost like you could draw that circle, and it's coming right down and starting to put pressure on that hard palate. If we drew another line down here, you'd actually find this is now pretty much squared off with the asthma, rather than bullet shaped it.

We've got a lot of reaction going on here, which is causing mandibular bone loss, around the root of the, lower incisor. And when we're drawing this line across here, you can see that we've we've got the uppers are coming underneath, it's not meeting our normal anatomy. Going into a sort of a DV view then, again, you can see there's abnormalities.

There's all this here is causing abnormal growth tissue there. We've got this would be our mandibular line, this is poking out here. We've got mandibular, sort of growth coming out here from the lower premolars, and we've got maxillary M2 who's been displaced measly.

You can see that here as well. Just to note that lateral obliques are really, really good ways of looking for which took is actually affected. You can see here that this is causing a big pressure onto the lower mandible and this is a big risk of developing abscesses down here.

On the up and then you can see that this is elongated again. This will cause problems like, tachrocystitis or even retrovular eye abscesses as well. Moving on to the guinea pigs, so this is abnormal guinea pig here, and this is is the actual skull that was used for these, these X-rays.

And you can see here that we've got growth. These are not meeting properly, the abnormal in sizes of growth. We've got big bulges down here which is relation to here.

On the X-ray, where you've got this elongation of the reserved crowns. And we've got a lot of abnormalities, as noted, we've got this very big squared off, diastoma there and it's almost completely, starting to go out now rather than converging in. If you've got down to that machine, it's always useful, as well.

So you can see here that using it underneath the this is the premolars on the rabbit, you've got premolar 1 and 2 and molar 1 there. And you can see there that you've got this abnormal line of the mandible. We've also got reaction around here as well.

It's worth noting, they've got different grades, and I mean it, it, they are there. However, I have had rabbits which have got horrendous abscesses, huge osteomyelitis, and they seem as happy as ever. However, they are prey species, so they will not show signs of illness and disease until it is sort of.

On death's door really. Also, you know, most of these are dedicated owners with huge amounts, of time to be given lots of pain relief, so we are on huge amounts of pain relief long term, but it, it's worth noting because once we get into grade 4, grade 5, we, we really are having some hefty dental work being done on a regular basis. Go back to the visible bunny.

This is just showing you that those lacrimo glands, are sitting right above those pre, sort of premolar 2 here, molar 12, and 3 going on there, and any pressure you can see of growth here will put pressure on the tear duct. Also any changes in growth on the incisor will put pressure as that tear duct comes down over here as well. So it's worth monitoring with X-rays on that aspect as well.

We won't go into Daro histograms here, as again it's another sort of topic, but. OK, so have a little look here. See if you can notice any abnormalities going on, .

OK, so we've got the first one. Does anybody notice this blocked tear duct? So this is, this is the drocystogram.

The something like omniaque has been used to go into the tear gland here and it comes down and it's not passing over those incisors there. This one, you hope you appreciate there, there's a very big abnormal soft tissue mass there, which is a big abscess. This one is all root reabsorption.

We've got, obviously root, it's more reserved crown, but you can see it's just sort of, it's just not there on this particular turf. We've lost our teeth here and, you know, the these are the uppers coming down and it sort of root absorption up there. And then this is root elongation coming down.

You can see how much it's broken down into the mandible here, and if we drew a line sort of coming across here, going down, you'd find that these are slightly above there as well, and you've got some reaction on the tissue up there. OK, so for molar removal, it's best to do or just the easiest to do if the t is really wobbly already. I generally use a Crosley molar laxator, which is this guy on the right here.

And lots and lots of patients, just like what their hand sizes. You can do intraoral removal, which is what I generally do. This is a mantidectomy, or, a maxillectomy, sinus opening.

You have to do an end GA and ideally you need to be intubating these guys. Dental table and light is really helpful, and if you've got endoscope, it helps as well. And these mole laxatives, are flattened at one angle on the one end and another angle on the other and it allows you to get.

To the act and medial planes and also you can go sort of rust and causal to the turf, but you wanna be careful how much pressure you put in rust and cadal because you've got adjacent teeth next to them as well. So generally work medial and lateral and then just the last sort of bit of rush and causal just to reset. You only remove that once that ligament is fully broken, OK?

So this is a little video of a chinchilla. You can see this huge amount of abscess and infection on the right hands, or it's left hand side, on the right of the video. You can see me there, just check on that test.

I'm looking to see how wobbly it is, OK. And then we wanna, when we remove this tur, we want to follow the curvature, and we also wanted to destroy the pulp by putting the tur sort of back in and, and destroying it. I've already destroyed it in this video, and you can see I'm just gently pulling it and we're just following the curvature out and then out it comes.

Information and that was the actual, that was that there, and this one was the one in front of it and this is the one behind it as well. We use Kalaser a lot. It does really help with the healing, aspect of things, and we are using it for our regular dental, rabbits as well when they come in for their dental checks as well.

But just to give you an idea of the size of some of these teeth and, and the difference in the curvatures of them as well. OK, so manectomy and maxillary sinuses, again, you want to do them under the GA and intubate them. You won't be doing high doses of morphine or methadone, X-rays to ensure that you're getting the corrector.

And more CT scan if you've got access to that. We want to watch the blood vessels. There's a lot of them around here.

You need to be really careful and also things like the facial nerves, etc. You can go dorsally or laterally. If you go in sort of ventrally on the, mandibula, then you can draw up to the drill up to the ventral mandible to locate the tough and remove the tough that way as well.

And we often do it in combination with abscess removal. Sometimes when you're removing the abscess, you can literally see the teeth underneath the abscess anyway, so that you just pull them out at that point then. Dental related abscesses are aggressive, capsule formation abscess.

They sometimes have vesti, visualous tracts, and the purse is generally really thick, and it, it does mean that abscessation and drainage is pretty much impossible and you should not really be attracted. Antibiotic therapy is often problematic and it might just cause, cause ward off abscesses if it's done alone without any, other surgical intervention. Osteomyelitis unfortunately is quite a common factor the with resulting of these abscesses and potentially ultravular involvement as well.

So there's a paper about Tyrrell in 2001 and noted that all the abscesses had all of the ones that have got stars on there. So pretty much all these anaerobic bacteria and then streptococcus, malaria is an aerobic one. However, it's worth noting when you're doing these culture sensitivity swabs because these guys are copper phagic, they can have normal gut flora in the mouth, such as enterobacteria, and I wouldn't worry about that because that is, that is normal.

So bear that in mind. And when you're culturing from these, abscesses, you wanna make sure you take the wall of the abscess, not the pus, because the pus is often sterile. This paper actually found that 100% of the bacteria was susceptible to clindamycin and felicol, and only 7% to things like TMPS, and about 54% to metronidazole.

It's a very good against anaerobic gramme negative facility but not so much against the gramme positive copy that was found in this study. However, clindamycin causes between 150 and 100% of fatal enteritis, so please don't use it. Generally, what I would use would be a combination of something like azithromycin and metronidazole.

If that's not getting, becoming really infective, then I would be justified in, in moving on to a tetracycline, like traceptcycline or on to penicillin. OK. You need to obviously remember what is licenced, what isn't licenced.

These penicillin and tetracycline must be given by injection simultaneously only. So you need to have compliant owners, either the ones that are able to effectively inject at home or they bring the rabbit in, but then they've got the stress of coming back and forth every 3 days. You need to really be justified in using these because if anything becomes ingested, it will cause a fatal enteritis.

OK, so abscess removals, it really isn't ethical or appropriate to be doing lancing and draining in these guys. The gold standard would be anaesthetic, dental X-rays and removal of the affected to. Where possible, we would remove the entire abscess, but it's some, some of them are very complicated, and some of them are multiple abscesses within abscesses.

So you end up doing a marsupialization. If there's any material left, it allows it to be drained away and it allows you to clean out the soft tissue, and, and remove any bone or, affected teeth as well. Again, I'm just reiterating to take a culture of the abscess wall and not a swab.

And if there's any leakage at all, then when we are super late, what we do is we suture it in a capsule with something like a 40 or 3 non-cutting PDS. To the outer skin and it creates a sort of hole which I'll show you in a second. You must warn owners that this is what may happen and before they go and put the animal underneath surgery.

OK, otherwise it could be quite shocking to see the soft tissue afterwards. What we do is we use F10 for daily flushing, or if you haven't got that, then just saline. The F10 does help to kill off bacteria and it is safe if it is ingestibleable.

And then we use manuka honey or orobase to pack into the abscess afterwards, which helps again for healing. Manuka honey is really good for granulation, but sometimes it does mean it can granulate over the top too quickly, and then the abscess will build back up again, so just bear that in mind. You can suture in an antibiotic impregnated polymethy beads apologise, I can't pronounce that word ever, but you must ensure that there's no communication with the mouse because you can get fatal enterotoxemias, if there is anything that's ingested.

With the, the antibiotic powder you put it into the polymer and and the monomer as the resin is then mixed together, into a syringe, you push it out into little balls and you put it into the surgical wound. It's really good when you get high concentrations of local antibiotic, and it's very good in things like osteomyel. But it's higher cost, these guys, it's around about 80 pounds just to get this the stuff in, because you have to make them up in advance, you've got to get a culture in advance and sometimes by the time you get the culture back and the time you get these beads in, the abscess is actually a heck of a lot better and the granulation tissue has already taken good effect.

So just going back onto an X-ray, this is that of that particular rabbit there. And you can see how bad this extension is. When we looked in in the mouth, you can see the incisions are abnormal, but when we focus in on the motive, this, there actually wasn't a huge amount of, of sparing or elongation.

But when we remove the teeth, you can see the amount of damage that was actually going on there and how much soft tissue damage there was. These guys would come out relatively easily and not with all this soft tissue change going on. This is then marsupialization where we've sutured the inner capture wall to the outside of the skin and we use a laser here again to help with the tissue and to help with the dental abnormalities.

Finally, just going on to nutrition, not to be, missed, these guys, it's really important to have nutrition, both pre-anesthetic, and also post-anesthetic as well, OK? Making sure we know what we're giving to each species, whether it's a herbivore diet, an omnivore diet, we need to ensure we get the right amount, but not to be underestimated the value of nutrition. We have whizzed through a lot quicker than I actually thought we might have, so we've got time for questions.

just gonna quickly summarise, dental disease can be primary, secondary or tertiary. It's complex, and requires investigations. You must address the diet and husbandry in all cases.

Avoid clipping. It's painful, so we need to get analgesics on board and often long term. So it's worth doing blood work to make sure we're OK to be on things like non-steroidals.

You need plenty of patience, and steady stretching of the ligaments for tough removal. Dental abscesses normally always always require surgery and not to forget nutrition pre and post, dental work. And then there's that reference to the paper at the bottom again, OK.

Thank you for listening. I hope you've all been OK, having a nice lunch break, and then I'm here for any questions you may have. Thank you, Sophie.

So yeah, we have quite a few that have come through, so we'll see what we can get through. So the first one I've got is where can I find a long metal otoscope cone like the one in the photo that you had? That that one well they they come through like.

Heins do them, and I can't remember the other one, that particular one's from, but they do them in through, things like places like Burtons and stuff. It's just a standard long earpiece, attachment to an otoscope. It it comes normally in the packs.

Fab, thank you. The second one we've got is, is it necessary to use antibiotics after tooth extraction in rabbits or guinea pigs? If yes, which is the best choice?

No, it would only be if you've actually got infection on board. Sometimes we do dental work and, the tub is just wobbling in front of us, but there's no sign of any infection, so we just remove the turf, but no, it, it would only be if there's actual infection involved. Thank you.

Next one we've got is, do you have a dose rate for hamster, doing Dom Taubb at all? Anaesthetics the whole of the ball game. Generally we use a micro doses of DOM, so things like 0.05 mg per kilo andt between 0.3 and 0.8 mg per kilo as a maximum dose.

But that gives you. Sort of a decent plane just to do, to do the dental work, but it's not gonna give you a full anaesthetic thing. It's always though sort of species specific and well or the patient specific.

So we do like tweak all of our anaesthetics that we're doing. So I I can't say 100% that's what we do for every case. Thank you and I guess on the same line as anaesthesia, do you have any tips for intubating rabbits at all?

Routinely, I would use, an altoscope, either one, that's an open shafted altoscope, or you can use a, a complete, circular one, that we use a local anaesthetic at the back, of the larynx, and, I normally would hold the head myself, tilt it right back, put the otoscope in, visualise the glottis, and then I show, get my nurse to put the, something like a 4 French kind of urinary catheter down. We remove the otoscope and then we slide an an ET tube over the urinary catheter and remove the catheter and tie it in place. Thank you.

Next one we've got is, are you performing an infraorbital block for incisor extraction? Sometimes it depends on, on what we're doing and, and the case again. Sometimes if they're really wobbly, you don't have to do too much.

Often I'll put the kind of set it up using insulin needle to either side, medial and lateral, to, to the teeth, and that, that works really well as well. But we, we use multi-modal pain relief, as well. So we've got opioids on board, we've got non-steroids on board, we've got substance P blockers on board, as well as our local anaesthetics.

Thank you. Regarding trimming the abnormal incisors, is it possible to correct the abnormal growth but the angle, I'm by the angle of cutting trimming them? Is it possible to correct the abnormal growth, but I it would be by the angle of cutting trimming.

OK. Not, not easily, like you can improve the situation. I certainly have some, where they've had, dental work done, in the past that we've managed to lend them, but it all depends on, on how much dental work we're used to doing because.

You become quite quick at how to do things and really dental shouldn't be taking longer than about 15 minutes, otherwise you start getting problems with the jaw. And where I've had some in where they've been like taking a long time to do the dental work, the jaw's been open a while, then those incisors don't meet and then they start to overgrow, particularly in guinea pigs. And with time, that can come back, you just have to give them time and you have to be booing them if they're getting too long.

Ah. And do you use a particular dental table at all, one of the vets is saying they struggle and find it awkward. My dental table I've had for about 10 years now, I can't can't even remember where it came from, veteranstrumentation I think.

Which digital X-ray do you use for optimal, infra oral pictures? I don't know. I don't know what.

Sorry, it's all right. What do you suggest for postoperative nutrition? Is there anything in particular?

What do I suggest for what, sorry? Post-operative nutrition. Depends on the species, you can use any of the ones that are suitable for that particular species.

We like Emirate, herbivore, and Omnivore care for our patients, but you can use Obo fine grind, you can use supreme recovery, you know, it's just getting nutrition into them. Even things like having, dandelions, you know, local to your practise, you know, in, in little baskets in, out the back or something like that, and you can literally like postbos affect them into the mouth. Yes.

Could you elaborate on using F10 to clean, marsupialization? Is this the concentrate diluted particular factor and flushed in? So I use F10 SC.

Not 1 mL in, 100 mLs, and we use that to, to clean the, abscess out and then, we just, we, we can, we normally would like, either get the owners to do it with just cool boiled water and then they buy F10, or, we can make up things like a bag of saline and teach the owners how to draw the saline out with the F10 in it, and then they flush it that way. does bearing require an analgesia? I think you need to just be aware that that burning is, consciously, is a risk of potentially causing burns because if you over rev the Dremel, then you can cause, burns.

So I think ideally you should be doing it fully consciously, having something on board, and just being very aware of the machine pressures. Then things like Tubb can work quite well, and normally these guys are, you know, maybe on some long term pain relief anyway. She is.

Someone's asked about, could you explain exactly what you do with the laser? That K laser is a Q4K laser, and we basically use it in the different settings. It helps to, the blood supply to flow to the area, it creates a lot of heat to bring the soft tissues blood supply back, helps to heat it's a.

Very complex way of working, but it's, it's very good and we utilise it as a soft tissue setting for the abscess work. We'll utilise in the dental setting through the cheek or if it, if it's the mouth, and the dental table still, we'll use it in already on an intraoral setting. So, And we've got how to prevent dental disease in rabbits except accepted hay-based diet.

Does calcium metabolic bone disease play a role and will sunlight prevent that? Oh sorry, I miss, oh, how to prevent a dental disease as well except a hay-based diet. I, I mean.

I haven't touched on diet in this, because it's pretty much an hour in itself just talking about, rabbit diet. What you have to remember is that hay based on its own will not provide all of the nutrients that a rabbit would need if they're not having access to. Origin in the wild.

You know, rabbits don't just eat sort of grasses and haze in the wild. They do eat different types of flowers, and weeds that have all different types of minerals in them. So if you only do hay-based diet and a rabbit, you potentially make it deficient in other areas, you need to be controlled.

So Sort of 85% to sort of hay based, around about 5% being pallets, about 25 grammes per kilo of rabbit for 24 hours. Plenty of foraging foods, so things like weeds and flowers and dry foraging as well. In regards to keeping them indoors, outdoors hard ground did do a lovely paper on all this, and there does seem to be some cor correlation.

Rabbits that are never exposed to direct sunlight, having lower vitamin D levels and potentially, having issues there. But you've got to remember that rabbit bone density is only about 8% at best anyway. And so, you know, I think allowing them access to outdoors is, is always a really, vital part of any rabbit husband you're keeping and, you know, keeping it in away obviously from predators, but allowing them access, you know, is, that's what they would have in the wild.

Thank you. We've got another one is, would you use penicillin in rabbits for dental abscesses? We've mentioned about penicillin in this, and I think you need to be very careful from a, from a veterinary licencing point of view and with the RCBS and BMD involved.

It's, it's, you need to be justified. So again, culturing your abscesses, not using it as a routine base. And if you're not getting a response to it, then remember it's not 100% effective.

So, you know, compared to things, clindamycin, but of course clindamycin we can't be using. So, you know, I would be looking at azithromycin was 86% effective, and then metronidazole works quite well. So using them combined together.

If that's not working effectively, then I think you can, you know, use penicillin with, with, a problem, just being aware of the situation. She is. So we've got, in all cases, grades of dental disease, should we remove the teeth, prophylactically, and also would you recommend trimming of the front teeth, for example, every 1 to 2 months, or removing them in case of malocclusion.

Sorry, I missed the very, very first. So, in all cases of grades of dental disease, would, should we remove the teeth prophylactically? And also another question would be, would you recommend trimming of the front teeth, for example, every 1 to 2 months, or removing them in case of malocclusion?

OK, so the second part in regards to removing them, generally I recommend removing the incisors as soon as I notice there's a problem with them, just because they cause, so much problems on the back. Sometimes you don't always need to remove all the incisors, sometimes it could just be one that's affected, if you're doing like glaocystograms and I just remove the one, and we monitor the others. If they start having problems, we remove them.

In regards to all cases in grade of dental disease, then I mean removing teeth proactically no, is not what I would suggest we do because you can bring dental disease under some form of control. You can't take it back to be nonexistent, but we've had dentals on rabbits chinchillas, etc. Where previous practises they were having dental work done like a lot.

But, and the animals are struggling within 2 or 3 weeks again. But when we started doing them more effectively, then they're actually going on months between. But it all depends because some, some cases it really is literally every 2 months.

As I said though, removing the sort of pre-molars and molars, if they're not already a little bit wobbly, they're not the easiest to remove. So it's worth just bearing that in mind. Particularly, In things like chinchillas and Diego's, you know, it's very hard to, you've got very little space to work in there compared to a rabbit, and so unless it's particularly wobbly, you've got to watch because you can fracture the jaw.

Thank you. Is there actually a, like a length per se of how short and normal rabbit teeth should be, as, one of our, diss have said they've seen rabbits in perfect condition with no problems eating, but they seem quite long, as in 5 millimetres long. What, what the the incisors or the motors?

. I haven't actually specified. I I've just put normal rabbit teeth cheek cheek rabbit cheek teeth. Yeah, I'm assuming maybe more.

Yeah, I mean, you're looking at, you're looking at the shape of them again, doing things, if you've got any doubts, doing x-rays and, and, analysing those x-rays will really help you knowing if there's any sort of clinical problem involved and things, you know, generally if it doesn't look quite right, it's normally not quite right. She is. And I think, for pain relief, there was a couple of questions, sort of what would you use for pain relief, is it in sort of NSAIDs?

I think there was a couple of questions in regards to that. So I guess for dental pain but also chronic pain. So for like long term pain, again, I was just saying about running bloods first, check everything's sort of OK on that aspect of things.

Normally we do something like meloxicam, species dependent on the doses and that. We may include things like, buprenorphine, sublingually, gabapentin medication, . Paracetamol, I mean, again, those are off licence meds, but we work, we titrate it all to our individual patients, so, you know, it's not something that I'd go for for saying exactly what everything, every dose is always this dose sort of thing for this patient because it always depends on what the patient actually how it's doing and and things.

So. Got it, do you have to remove a molar in arcade opposite if removing a a molar? Do I have to what, sorry?

Or remove a molar in arcade opposite if removing a molar. No. Oh, they can't they rarely do I ever have to go back and remove one opposite.

Perfect. Another one we've got in regards to dentistry, can you take off lateral mandibular bone? Bone if tooth fractured during removal, I think, is what they're trying to say.

What's so it's can you take off the lateral mandibular bone. If a tooth fractures during removal, I think is what they're trying to say. If it if it's the tough scratches, can you, can you do a mandectomy?

I think that's what they're, I think that's what they're trying to say. You, you could do and to remove the remaining bit, you can also take x-rays, make a note on it, and then reexamine in about sort of 8 weeks' time and normally the test's grown up enough and then you can remove it at a later date, but requiring good pain relief in between. Have you ever used CRI Linocaine for any dental procedures?

I don't, I don't routinely in regards to dental work, but I do for other stuff. Perfect, . Would you attempt an incisor instruction in a rat?

Yeah, we, we have done incision instructors and rodents. You've got to be really careful with the, with things like the myomorphs. The, incisor actually encompafies quite a bit of the jaw.

And so when you're removing these incisor, there is a big risk of jaw fracture. Sometimes if we're worried about it, we'll just remove one test and then a couple of weeks later do the other test. again, if these.

Because these guys don't tend to have molar issues, related to sort of incisor dental problems compared to like your rabbits and, and, and cavios, then, often they will do fine with just doing light sedation and, and sort of adrenaline on, on the incisors, versus the risk of potential causing fracture, to the jaw. I mean, it's not happened to me, as, as yet on that aspect, but we did have one, with the rodents, but I have had one, rabbit where I, removed the premolar one and it, and the jaw was so weak around there, it just fractured. It healed really well with time, but it, you know, it is just to be very aware of it and let the owners be informed.

Cheers. We've got, what are your thoughts on long-term antibiotics in stage 45 dental disease cases? I think again, this is where we need to, where, you know, we need to be ensuring that we've got a .

A culture of, of what we, we're using antibiotics for to ensure that it's the right antibiotic if we're gonna be doing long term. I mean, often these abscesses may well need sort of 3 to 4 months of our antibiotics, we need to ensure we're on the correct ones. Thank you.

And that also brings actually to another question is saying if you haven't got, haven't got the opportunity to do a bacter bacterial culture, is there sort of a main antibiotic that would tend to sort of draw to first if you aren't able to, to do that culture? I think this sort of goes back to that Tyrrell paper again and, probably saying that we're gonna go for azithromycin and metronize our combination together. So And what local anaesthetic nerve block is used for incisor removal?

You can use like the mandibular, Fox, and, maxillary sinus blocks. So, the intraorbital block, and some, as I say, also just go on either side and some sizes and and and doing some local tissue around there as well. And do you use anything in particular to open the mouth for lateral X-rays?

No, no, the mouth to mouth is, is closed, for x-rays. Perfect. And with, the talk of the plastic otoscopes, would you use that as, opposed to the metal ones?

Is there a preference? I use the metal ones, purely because they destroyed the plastic ones so quickly when they chomp down on them. I also know people who won't use the metal ones in case it causes soft tissue trauma.

I've never had that actually happen, in 15 years. Maybe it's a possibility. But my concern on metal ones we can clean and disinfect very easily between patients.

Once a rabbit chomps down on a, a plastic one, you've got, you know, very difficult in cleaning them and, and sharp edges from the plastic as well. Thank you. So unfortunately, we are drawing to an end now, as we do have quite a few questions still, so we'll obviously get, those answers back to everyone.

But I'd like to obviously say thank you so much, Sophie, for presenting today's webinar. It was a very informative session and you managed to squeeze a lot of information into that time. Also, we'd just like to say thank you again to Imre for sponsoring today's session.

Obviously we've got, any questions, Sophie's got her detail, the email there as well, but obviously any questions that we've got today left over, we will get back to you, and you will receive your certificate and recording of this, will be available in the next few days. So we hope you all enjoyed today's webinar and thank you all for joining us. Thank you.

Bye.