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molar extraction?

22 9:46:20

Question
QUESTION: Dear Dana,
Ted, lop, 8-9 years old, has seen the vet about every 3 weeks for the last year. He gets spurs and stops eating hay which affects his digestion - few and hard, small droppings. (He has never been a good hay eater and he has been getting worse over time.) Usually there is a small improvement after the vet visit but one or two weeks later we're in the same situation. I have asked the vet for an x-ray so we might know what's going on but he feels he would want to do any operation right away to avoid anaesthetising twice.
I have read about extractions and I am terrified. As far as I know it is not always the same tooth that develops spurs.
Apart from the refusal to eat hay, Ted seems quite comfortable. He eats veg (although he slows down  a lot and becomes selective when his teeth are bad), he is keen on willow leaves and he loves soaked pellets (I only give him a few so I can mix pain killer and any other medication in them).
I read that extraction is only recommended if there is an abscess or the teeth are loose.
My current vet is considered rabbit savvy - he is on your recommended list. He is the only vet I know of who files off spurs without anaesthetic.
My question is - should I go ahead with the x-ray and trust my vet to do whatever he feels is best? I just can't bear the thought of inflicting so much stress and pain on Ted when he may not even survive the operation and if he does it may not help much if at all. I have been constantly worried for the last year and would really appreciate any help you could give me.
Many thanks!
Diane

ANSWER: Dear Diane,

This is a tough one, since I can't see your bunny to judge how he's dealing with the constant molar filings. But if the filings are doing the trick to keep him happy, then...well...if it ain't broke, don't fix it.

I very much doubt that he'd be better off with NO molars than with molars needing an occasional filing.  The only problem is that the vet may not be able to really get any significant improvement without anesthesia.  These days, extraction is not the only way to deal with this problem, and sometimes simply filing the molars to the gumline (no lower!) can help restore a normal occlusion.  But that would require anesthesia.

Radiographs are a must for any serious dental procedure, since the vet needs to know what he's dealing with.

I'm not sure where you are in the UK, but if you want to get a second opinion, then there would be none better than Frances Harcourt-Brown in Harrogate, Yorkshire.  Just something to think about.

For now, though, if he's eating and acting happy, I would not be too aggressive.  Head radiographs would help, and there is a very interesting article with radiographs that shows the vet what to look for in terms of angles of occlusion on the pictures.  If your vet would like a copy, let me know and I'll send one.

Hope this helps.

Dana

---------- FOLLOW-UP ----------

QUESTION: Dear Dana,
Thank you so much for your prompt reply.
Ted is not too bothered by spur removals as they don't involve an anaesthetic. It is a bit of a trip to the vet and he does sulk for about 15 minutes when we get back but this is nothing compared to how dreadful he used to be when I used to have his teeth filed under anaesthetic and he would be miserable for at least two days after.
BUT
a) it seems the spur removal only helps a bit for about a week or so, and
b) he has been getting worse over the last year so that even on good days he hardly eats any proper hay (he nibbles alfalfa leaves and might have a bit of dried grass)
I think my vet is planning to extract one molar, not ALL molars! Of course I guess he will decide what to do when he sees the x-ray. My worry is that Ted's teeth are generally bad and the extraction won't help much if at all. Is there anything else that can be done? Is there any way I could keep Ted comfortable by changing his diet if he does not or cannot eat hay?
I discussed the 'filing down to the gum line' approach with the vet on my first visit a year ago but he said that in his experience it does not work.
Could you email me the article you referred to or send me the reference? I expect my vet will say that once the teeth are bad you can't ever get them back into alignment with filing...
I am terribly sorry to go on - I suppose it is an insoluble problem really. I just want to do what's best for Ted and I have been struggling for a year now to figure out what that is.
Thank you so much for your advice, I really appreciate it.
Diane

Answer
Dear Diane,

Your vet might be right about the teeth never being normal again once there is misalignment.  But sometimes the "down to the gums" treatment does help, as long as the bunny is fed long fiber hay while the teeth grow back.

Removing one molar probably won't hurt, but unless it's infected there seems little point in it.  :(

I wonder if the vet might be able to do a really good trim-down--with or without anesthesia--so Ted can go a bit longer than a week.  But there's no easy solution here.

I don't have access to the .pdf of the dental radiography article here.  But if you can write to me at:  hunhare@gmail.com  I'll be able to send it from there.

Dana