problem molars

Question
My 3 1/2 year old dwarf lop ear rabbit has a history of malalignment of the molars and has had two previous ops on her teeth.  I have been concerned about her eating habits over the past few months but the vet I saw on 3 separate occasions put this down to things other than her teeth - broody, anxious while we were on holiday, and a possible eye infection.  As I was increasingly anxious about her this week as she stopped eating I asked specifically for the vet who had seen her prior to this to examine her.  He saw her on Tuesday and she had surgery on her molars on Wednesday.  At discharge the Vet said that her molars were in very poor condition and had crumbled and split during the procedures to such an extent that her prognosis was very poor.  I have been feeding her with supreme science recovery 2 hourly since then, giving her prepulsid as prescribed, and she has been seen again by the vet yesterday.  He was very pessimistic about her outlook and although he gave her further pain killer and injection for her gut said that there was really nothing more he could do to help her.  She is still not eating (other than her syringe feeding) and is quite docile - she is happy to lie and be stroked and only has the occasional bounce around - she is not sitting hunched which would make me think she was in pain - but she is making no signs of recovery.  I am happy to continue force feeding if there is a chance that she will recover, but I don't want to make her last few days awful if there is no hope for her molars recovering.  The vet was very good one year ago when she was off her food following a tooth op when I had to force feed and inject medication for a couple of days, however he was quite positive then that if she started eating she would be fine - I am therefore dismayed at his pessimism this time and believe that he must think her can't recover.  Do you have any experience of this problem where the molars are in such a bad condition that they crumble and break - should we call it a day and have her put down peacefully or should we continue with aggressive treatment (force feeding).
She's a house rabbit but also runs around the garden, and has a large run outside for warm day use.
I look forward to you advice.
Cathleen

Answer
Dear Cathleen,

Did the vet say whether there was any sign of infection in the jaw (osteomyelitis)?  If so, this can be treated, but pain medication is a MUST.  You are correct in your assesssment that your bunny appears to be in pain, and she needs pain management, just as a human would in her condition.  But this doesn't necessarily mean it's time for euthanasia.  

Please ask the vet about giving her some metacam and tramadol, a combination which could completely change her outlook on life, and give her a will to live.  Banamine (flunixin meglumine) is even stronger than metacam, so banamine/tramadol could also be given.  (Metacam and Banamine should NOT be given together, as both are NSAIDs.)

Please ask if there is sign of infection for a culture and sensitivity test to be done:

www.bio.miami.edu/hare/culture.html

If the teeth are just crumbling, then it's possible that the bunny would be best off with the bad teeth just *removed entirely*.  Once the sockets heal up (with the help of antibiotics, most likely), she will still be able to eat soft food, and if she has even a few molars, she can probably even eat pellets and hay.  I know of more than one rabbit who lived long, happy lives with NO teeth.  But it will take some care and pain management to get your bunny to that stage.

If your vet has not suggested any of this, then I wonder if it might not be wise to seek a second opinion from a rabbit-savvy vet:

www.rabbit.org/vets

If you are in the UK, then the BEST rabbit vet for dental problems is Dr. Frances Harcourt-Brown:

http://www.any-uk-vet.co.uk/harcourt-brown/

But at this stage, unless the vet sees something he hasn't told you about, it doesn't sound as if this is a lost cause.  It just requires treatment that might be beyond the expertise of this particular vet.

I hope this helps!

Dana