Dental Disease in Rabbits - Incisor Trimming vs Extraction
INTRODUCTION
Dental disease is a common condition in Rabbits due to their complex anatomy and physiology. They are what we call aradicular hyspodonts, which means the roots of their teeth are "open" and grow throughout their lives. When their teeth are perfectly aligned, they are on a proper diet, and barring any other complications, they will properly wear their teeth throughout their life. It is no surprise though, if their teeth are not aligned, if they're on an improper diet, or anything else interrupts this precise balance, they can quickly develop problems. And because their teeth continually grow throughout their life, often these problems become life-long.
One of the most common (and most noticeable) conditions that occurs is incisor overgrowth. These are the teeth at the front of their mouth. There are 4 primary incisors (2 upper and 2 lower) as well as smaller "peg" teeth behind them. When there is a problem, these will quickly begin to overgrow and can curve in, out, around, any which way. They will also occasionally break off on their own if/when they grow long enough.
THE CAUSE
As noted above, there are a variety of possible root causes. It can be as simple as a congenital malocclusion, meaning they were born so that that their teeth do not align properly (think a bulldog with an underbite), consequently they don't use them normally and thus they don't wear properly. It can also be caused by trauma or general dental disease elsewhere in the mouth.
THE PROBLEM
Plain and simply - their incisors don't wear and overgrow.
Rabbit incisors aren't involved in most of the chewing they do but they do use them to pick up food, collect cecotrophs, clean themselves, and a variety of other activities. Abnormal or missing incisors can inhibit their ability to do these things and can lead to significant secondary problems.
TREATMENT OPTIONS
The most common form of treatment is to trim the incisors as needed. Depending on the rabbit and the extent of the disease, this can be as often as once a month, or as little as every 4-6 months.
This procedure can be performed with the patient awake, is quick, does not cause any significant discomfort, and has a very low rate of complication. Even in the case where there is a "bad" trim - at an odd angle or the teeth split, rabbits recover promptly and without problems.
Granted, the prospect of having to have your rabbit's teeth trimmed as often as once a month for the rest of its life is daunting. So it is reasonable to consider a more permanent solution such as extraction of the incisors.
Due to their anatomy and physiology, the reason they end up in this situation in the first place, extracting rabbit teeth is a very complex proposition, not only the extractions themselves but surgery in general. First let's delve into rabbit surgeries in general and then our experience and recommendations for incisor extractions at the end.
GENERAL INFO ABOUT SURGERY IN RABBITS
We have many years of experience performing rabbit surgeries at Yarmouth Veterinary Center. One benefit of this experience is that we can provide a clear picture to our clients of what to expect when their rabbit will be having surgery.
Pet owners correctly understand that the risk of significant complications, including death during or after a procedure, with dog or cat surgery is very, very small. For example, veterinary studies show this risk with spay or neuter of a healthy dog or cat is well below 0.01%.
This same risk for rabbits is not as well known, but is understood to be significantly higher; veterinary studies place this risk at about 10% of all rabbit surgical procedures. Our experience at YVC is consistent with this. This risk is affected by the general health status of the pet - for young, healthy rabbits the risk is probably lower, for sick rabbits the risk is most certainly higher. The risk of complications is the same whether the surgery itself is simple or complicated.
A few additional important points:
The potential complications range from mild to severe. A complication can mean a prolonged recovery. Some rabbits will even pass away or be euthanized as a result of complications.
The complications can occur during or immediately after surgery, or may not appear for days or weeks after surgery. At YVC, we consider the post-op period for rabbits to be 2 to 3 weeks - if it is 2 to 3 weeks after surgery and the rabbit has shown no signs of problems, then it has completely recovered from the procedure.
The signs that a rabbit is having trouble recovering from its procedure are not always obvious, so it is important that owners observe their pet very carefully for 2 to 3 weeks after surgery, and call us if they suspect there are problems.
Post-operative care for rabbits can sometimes be more involved than it is for dogs and cats, requiring more time in our hospital and/or more time and effort at home.
And a few clerical but important points regarding rabbit surgery at YVC:
If a rabbit passes away during or shortly after surgery the client is responsible for the entire surgery fee.
If other complications occur at any time after surgery, additional exams, diagnostic tests, treatments, surgery, and supportive care are charged at regular YVC prices. We will discuss these treatments and their costs, and the pet's prognosis, before proceeding with them, so that clients have the opportunity to accept or decline the care.
SURGICAL EXTRACTION OF INCISORS
A physical exam and skull x-rays, which require anesthesia, are necessary before the procedure. We can do the exam and x-rays on the day of the procedure, or some other day before the extractions.
Our goal is to remove all the incisors in a way that prevents regrowth. This procedure is usually successful, but it is very important to consider the possible complications before deciding to have it done. (Based on our experience and the information in the veterinary literature, we estimate the potential for a significant complication is about 10% but closer to 50% or more of cases will experience of complication of some sort.) This is based on our experience and our assessment of the various sources of veterinary information on the topic, including the opinions of board-certified veterinary dentists who work with rabbits.
POTENTIAL IMMEDIATE COMPLICATIONS
Inability to remove the entire reserve crown (root) or germinal tissue (the soft tissue around the reserve crown that the tooth grows from). This can result in regrowth of the tooth.
Injury to the bones of the jaws including fractures that require surgical repair and extended nursing care for recovery.
Introduction of infection into the bones of the jaw
Death due to anesthetic complications or the overall trauma of the procedure.
POTENTIAL LONG-TERM COMPLICATIONS
Difficulty picking up food
Difficulties grooming which can lead to fur matting, urine scald, fecal matting
Difficulty collecting their cecotrophs, which are critical for normal digestion
Possibility of accelerating dental disease elsewhere in the mouth
Complications of examination of, and treatment for, dental disease involving the cheek teeth
THE LONG (IN THE TOOTH) AND SHORT OF IT
Dental disease is always progressive and rarely only involves the incisors alone. Rabbits are also prone to dental disease due to their anatomy and physiology.
When there is clear incisor overgrowth, incisor trims are easy, straightforward, and involve very little risk. Incisor extractions are complicated and present a lot of both short-term and long-term risks.
With this in mind, there are cases that we at YVC may recommend extractions on incisors, but these are few and far between. It is critical to consider every rabbit on a case by case basis and to have a thorough and informed discussion (or discussions) with our clients about the disease process and treatment options when presented with such a case.
