dental problem?

Question
QUESTION: Dear Lee,
I wrote to you a couple of weeks ago when Ted (7-8 year old lop, weight 3.5kg.) was in hospital again. He had had a gastrotomy and a dental 6 weeks before that. Two weeks ago he had another dental (he had pretty much stopped eating hay again) and x-rays. One of his molar teeth is growing at a 90 degree angle apparently! He also has some elongated roots. He didn't eat pellets for a couple of days after the dental but we got him eating everything including grass and hay within a few days. However, only a week later he started eating less grass and hay again. And he is making chewing movements without food in his mouth. I guess his teeth are bothering him again? I don't know what to do. I can take him back to the vet but we can't have him undergo this procedure every two weeks surely? Any advice would be very much appreciated. Many thanks.
Best wishes,
Diane

ANSWER: Hi,

he has serious teeth problems, it sounds like you are saying.  If one is 90 degrees it isn't going to wear down with the other bottom or upper tooth it matches.  Rabbit teeth can grow 1/2 inch a month so yes, teeth problems can re-occur quickly under certain conditions.  These kind of teeth problems also can lead to problems in the teeth themselves, like cracked teeth, infections getting up into the teeth and bloodstream from the gums, etc.

If he also has elongated roots they can cause problems pushing up into the sinuses and possibly the eye, depending what roots are the problem(s).  They also can get infected easier.  In some cases the best thing is to pull them, but that is a good rabbit vets' determination, not mine.

So yes, get him back to a good rabbit vet (perhaps a better vet than currently seeing him).  Go here:

www.rabbit.org/vets/vets.html

and they have both US House Rabbit Society recommended rabbit vets and links to international pages of rabbit vets.

Get him back in, he's back in pain.

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

QUESTION: Dear Lee,
Thanks for your advice. I took Ted to the vet again this morning. She could see some inflammation on one side of his mouth and his teeth are not aligning properly on that side. Since he had a dental less than 2 weeks ago she didn't want to do another one today and just gave a Metacam injection. He did eat some hay and grass when we got home. I guess that means it must be mouth pain that is stopping him from eating hay and grass? I really don't know what to do and am worried sick. The link you gave me is out of date and I am finding it impossible to locate a vet near me (North London) who specialises in rabbit dentistry. I am a member of the Rabbit Welfare Association but they have stopped recommending vets. I am worried that my current vet did something wrong 2 weeks ago. Also, apart from the terrible stress for Ted I just cannot afford to spend over $400 (!) every couple of weeks. I am supposed to give him 1.1ml Metacam per day but that's not a solution in the longer term and I think today's shot has already worn off. I'm truly desperate. Any help you can give would be much appreciated.
Best wishes,
Diane

ANSWER: Hi,

I don't know what you mean "out of date" as I went there and went into the international vet listings link and found several UK rabbit vet sites.  RWA has a database of rabbit vets for members:

http://www.rabbitwelfare.co.uk/resources/?section=veterinary.html

If you can't get in for some reason, perhaps you an contact someone there "in the know" for the list as you said you are a member and you should have access to this.

In any case I don't know if you tried the following links:

http://www.rabbit-vet.co.uk/vet-list/find-a-rabbit-vet/

http://members.shaw.ca/cocoasun/Eurovets.htm#UnitedKingdom

http://www.rabbit-vet.co.uk/directory/Rabbit-Vets/England.php

http://www.cvsukltd.co.uk/practices.htm (recommended by rabbit owner)

http://www.poolhousevets.co.uk/  (recommended by several rabbit owners and RWA)

http://www.companioncare.co.uk/index.html (recommended by rabbit owner)

http://www.lecoeurrabbitrescue.co.uk/Vets.htm

Dr. Judith Brown at Firstvets:  http://www.firstvets.com/forest_hall.html

In London:
The Animal Clinic: Shooters Hill Road, Blackheath, London SE3. Tel. 0208 319 3033

Tooting Broadways Vets. Near Tooting Broadway
station. 107 Garratt Lane london SW170LN. 0208 672 4710

CANONBURY VETS,Essex Rd London n1

GREAT WESTERN EXOTIC VETS
Unit 10 Berkshire House,
County Park,
Shrivenham Road,
Swindon SN1 2NR
Tel: 01793 603 800 Fax: 01793 603 801
Email: swindonreferralexotics@vets-now.com
Website: www.gwexotics.com


Hopefully the above info can give you some other places to investigate.  As far as what needs to be done, best bet (not being a vet, not seeing your bunny) I would guess would be to remove the offending teeth.  And probably the corresponding upper or lower tooth it is supposed to grind against (with nothing there that tooth would overgrow and cut into the gums).  This will also probably result in some diet changes.  If he still has molars that are okay he will be able to eat hay.  If these are front teeth he will still be able to do generally okay with foods as his molars will crush and grind most things.  A vet that would be doing the surgery would discuss any changes to diet that were necessary.  

In the long run, I think he'll be happier, won't have pain or repeat visits to get anethestized and have his teeth ground down every two weeks, he'll be healthier as his eating won't be interrupted and his jaw and mouth won't develop sores nad possible infections, and you won't go broke (an obvious benefit for him and you).

If he starts grinding hard again I'd just give him an additional metacam dose (not more than one extra a day).

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

QUESTION: Dear Lee,
Thanks very much for your response. I have spent lots of time looking for rabbit vets near me but it's an impossible task. I looked (again) at the links you sent me and unfortunately couldn't find anyone close enough. Given London traffic even short distances by North American standards can mean hours of extremely stressful driving.
After a lot of agonising I switched back to my local vet for yet another dental tomorrow. Fortunately Ted is not in a terrible state, he eats pellets and veg but I want to avoid him having another blockage due to lack of fibre. I have also asked an expert to look at the x-rays and give an opinion on whether Ted's problem can be kept under control with regular dentals or whether as you suggest we need to consider extraction. It seems expert opinion is divided on this with some saying it should only be done when there is an abscess, loose teeth, etc. Also, I am very concerned about putting him through another serious operation. Do you have experience with rabbits who have had this procedure? Has it solved the problem? How long was the recovery period?
Best wishes,
Diane

Answer
Hi,

well, unless there's a problem with the tooth roots affecting the sinuses or the eyes, or getting infected, tooth grinding is the only other option.  I don't have first-hand experience with chronic teeth problems in my own rabbits.  

I have second-hand experience from others that I've talked/read about their experiences and it does solve the problems that malocclusions bring.  I'd personally expect them being on post-op antibiotics and pain meds for at least the week after, maybe longer on the antibiotics, especially if their gums are cut up or have abscesses.

I think one thing you need to bring up with the vets is the fact that he can't make it two weeks before the teeth are affecting his eating.  Such a frequency means him being put under anesthetic 26 times a year to trim his teeth.  Consider the stress factor on the rabbit form all this.  Also factor in this may increase him having to be on antibiotics and pain meds because of the mouth or tongue being cut up from the tooth spurs.  Removing the problme teeth eliminates all this potentially unnecessary and stressful procedures and travel and long-term expenses for anesthetics, vet time, pain meds, and antibiotics.  You did not say it affects all his teeth so I am assuming he'll be left with enough teeth to still be able to eat hay and grind it in his remaining molars.

I think in the long run, my personal opinion, again, not knowing your rabbit like you do, would be to remove the teeth, and save the little guy from 26 trips a year to the vet to be put under and have his problem teeth ground down.  Also save him from 26 potential gut slowdowns because his eating starts to decrease due to gum pain.

Good rabbit vets who do surgery and have high records of success are the first stating place.  Then discussing their tooth extraction history and experience.  They have to make sure to get the entire tooth out.  That's the most important thing.  All of it.  Molars may be easier to extract because their roots don't curve like the front incisors and they aren't quite as long.