Broken Bunny Teeth

Question
QUESTION: My bunny is nearly 2 years old. She has almost half of one of her top two teeth broken. Now her cheeks have these huge, hard lumps that feel like bone but it isn't. She also has conjunctivitis. WHAT SHOULD I DO???????

ANSWER: Hi Sasha,

Did you receive my reply to your question?  I sent it this earlier today but your question is still showing as be unanswered.  If you didn't receive my response, let me know and I will resend it.

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

QUESTION: No i didn't receive it. Could you please send it again because i am really worried about her.

Answer
Hi Sasha,

Sorry you didn't receive it...no idea why that happens sometimes.

I am assuming here that the "top two teeth" you mention are the upper incisors.  In reality, a rabbit is a lagomorph not a rodent.  The difference is rabbits have six incisors.  There are two small "peg" incisors directly behind the large visible incisors so you really have four incisors to deal with on the upper arcade.  Sometimes when a tooth breaks, it can cause either a problem in the roots of the teeth or a localized infection just below the gum line.  If this infection occurs and is not noticed (sometimes it is hard to see visually) the small localized infection continues to mature....and you get a jaw abscess.  The presentation of a jaw abscess usually manifests itself as a large lump on the face or underneath the jaw (if it affects the lower arcade), it can result in a drainage into the throat that causes a sound like coughing (rabbits can't technically cough), it might show itself as a pus discharge from either the nose or eyes or both and sometimes the rabbit will refuse to eat, it may pick up food and drop it, might refuse hard food like pellets and especially hay but might take greens and might have the "slobbers" which is marked droling.

An abscess is very serious and very painful.  It is often mistreated by vets....no flaming to them, but like so many issues with rabbits, in reality vets receive very little vet school training and have little experience in dealing with serious rabbit issues.  Dealing with these issues in a rabbit is much different than dogs or cats.

Just a few years ago, many vets would immediately suggest euthanizing a rabbit with a jaw abscess.  Then a surgery was developed in which antibiotic beads were surgically implanted.  While this looked good on paper, it doesn't work well but unfortunately is still performed by some vets.  The surgery is painful (even with the most aggressive narcotics and rabbits don't handle pain well), is very expensive and sometimes has to be repeated and it often resulted in serious conseqences due to the drug used.  The drug most often used was Clindamycin.  That drug tends to migrate to the GI tissue and kills nearly all the bacteria good or bad.  Without the good bacteria, food can't be digested.  And the one bacteria that the drug won't control is Clostridium and that bacteria is deadly in high numbers.

So, now we have a problem.  How do you treat this?  Most vets will culture and treat the bacteria on the exterior of the abscess.  The drugs used by most will not properly treat an abscess.  The problem is you have to reach the core of the abscess.  It is basically encapsulated and the pus is very thick.  This makes it very difficult for an effective drug(s) to reach the real problem.  I have had excellent results by using a combination of antibiotics....Pen G (a specific mix of Procaine and Benzathine) along with Zithromax.  WARNING:IT IS CRITICAL THAT THESE DRUGS BE PROPERLY DOSED AND BE ADMINISTERD BY PROPER PROTOCOLS.  IMPROPER USE OF THESE DRUGS WILL RESULT IN DEATH.  So while you may be able to acquire these drugs without consulting a vet....I would not suggest attempting to treat this yourself.  Penicillin is very safe and effective when used properly...but it is nearly always fatal if given by mouth.  It is also very important to offer pain management.  I usually offer a few days of a NSAID like Metacam (this class of drugs is stressful to the liver and kidneys and should be used only under the advice of a vet and the rabbit should be fully hydrated).  Especially early in the treatment, I prefer narcotics.  Buprenorphine (Buprenex) is the absolute best analgesic for rabbits.  Tramadol is also an acceptable pain med.  Suuplemental hydration using Lactated Ringers can be very useful and will make your rabbit feel better.  Modifications in husbandry might be required and might include assisted feeding or other measures to help maintain the digestive system if the pain causes loss of appetite.  I do not "lance", drain or otherwise invade an abscess surgically.  

If this is an abscess, and your question points me in that direction, this should be treated by a highly skilled rabbit savvy vet.  Not all vets are capable of treating this issue.  If you are in the US or Canada, if you have problems finding a vet that is willing to treat this, I might can assist you as I have an extensive listing of rabbit savvy vets.  Please keep in mind that I am not a vet.  My comments here are based on my many years of experience with "special needs" animals.  I do have the support of many of the best vets in my area and I live near a major vet school.  Several vets are using the drug protocol I developed and outlined for you here.  Good luck and keep me posted....and don't hesitate to contact me again if you need more info.