Tooth root abscess prognosis

[Terra]

Hello, sorry to appear out of the woodwork just to ask a health question...

Martial is 6 1/2 years old. Last week I noticed a lump on his lower jaw, and on Friday we saw a new vet* with a reasonable amount of rabbit experience who confirmed it was a tooth root abscess. The vet started him on sulfatrim, which caused him to stop eating so he's no longer taking it, and he's booked in for surgery on Friday**. It's a small abscess that is (or at least was; difficult to tell when he's stopped eating for other reasons) asymptomatic so far, and I think the antibiotics did shrink it a bit before he stopped taking them.

My question is basically whether surgery is going to be worth it. I've seen from previous posts/other research that abscesses that don't have dental involvement can be held at bay by initial surgery and long-term antibiotic use for a good length of time, but I've not been able to find anything about those with dental involvement. He's had several dentals due to molar spurs previously (they're maloccluded; he eats a marvellous amount of hay when he's not ill). The previous vet he's seen have never mentioned that the roots look bad on X-rays (but they've also been terrible at communication).

He's not a brave rabbit. He refused to bond with another bunny (I think due to his pretty dire early life experiences) so he hasn't got any emotional support from other buns when he's travelling or at the vets. He finds vet visits incredibly stressful, and while I've got the hang of helping him recover from dentals, I don't think he'd choose to have surgery if it was only going to buy him a few extra weeks. Given that abscess wounds are usually left open, I also worry about whether I'd be able to drain and flush an open wound without causing him excessive stress.

I'm hopefully going to speak to the vet on the phone today to ask this question (and also whether he should have surgery while he's still unwell from the antibiotics), but I'd also appreciate hearing about any experience anyone here has had. I love this little creature more than words can say and dread losing him but I need to make the right decisions for him. If it's time to move to palliative care then I want to do that for him as best I can.

Thank you.


* His previous vets, despite supposedly being exotics specialists, have developed terrible communication skills, been prescribing low medication doses, and ignored my letter of complaint so I've ditched them. It's a shame because they used to be really good with buns. Now the nearest vet with an interest in rabbits is a good half hour motorway drive away, and Martial doesn't travel well at all. I've had three rabbit savvy vets disappear now.

** He's also on meloxicam and metaclopramide and being syringe fed; I asked a [different] vet who I spoke to on the phone for some ranitidine but she didn't think it was worth prescribing, hopefully I'm speaking to the original vet today and can get some.

 

[Shimmer]

The rabbits I had with jaw abscesses both had surgery to remove as much of the infected material as possible, then long term daily injectable penicillin (eg depocillin) and pain relief. If the wound is left open, it needs flushing out (couple of times a day?) with a 1ml syringe, and maybe packing with medical grade manuka honey so it heals from the inside outwards. Both of mine had over a year of good quality life afterwards, and they were fairly extreme cases. One was offered a partial jaw removal (I declined). Outdoor rabbits with open wounds need protecting from flystrike. I used F10 germicidal wound spray with insecticide, which was recommended by my vet nurse.

I would expect more skull x-rays to confirm any tooth / bone involvement, etc. prior to surgery. Aftercare can all be done at home once you have been shown what to do by the vet nurses.

However, he needs to be back to fully normal heath before he undergoes any more procedures, except in an emergency. I would defer Friday's procedure for at least a week, maybe two or more. A rabbit that is already in stasis isn't a good candidate for a GA. His body is already stressed, and rabbits don't cope well with that - so you don't want to make the situation worse. Get him eating normally first, feed him up in the meantime, and monitor his weight. He should be eating normally and back to his usual weight before you consider further procedures.

 

[Terra]

Thank you, Shimmer. He's an indoor bun so thankfully flystrike isn't a big risk. He will be having X-rays prior to surgery.

I have spoken to the vet this morning and her advice was that he should have surgery as long as he's still bright, active, and passing faeces (which he is) because his molar spurs have recurred and she's concerned that they may be contributing to the not eating at this point. I should clarify that he is nibbling a bit, especially when I hand feed him, and he's eating hay while he's using his litter tray - he's not been in complete stasis thankfully. A final decision can be made on Friday morning, of course.

The vet said that it's not a forgone conclusion that the abscess will recur and she thinks it's worth going ahead. However the practice isn't able to get injectable penicillin. I've seen that depocillin is available from online vet pharmacies with a prescription, so that's one option - has anyone used anything else (other than sulfatrim) with success?

Thanks again.

 

[InspectorMorse]

Thank you, Shimmer. He's an indoor bun so thankfully flystrike isn't a big risk. He will be having X-rays prior to surgery.

I have spoken to the vet this morning and her advice was that he should have surgery as long as he's still bright, active, and passing faeces (which he is) because his molar spurs have recurred and she's concerned that they may be contributing to the not eating at this point. I should clarify that he is nibbling a bit, especially when I hand feed him, and he's eating hay while he's using his litter tray - he's not been in complete stasis thankfully. A final decision can be made on Friday morning, of course.

The vet said that it's not a forgone conclusion that the abscess will recur and she thinks it's worth going ahead. However the practice isn't able to get injectable penicillin. I've seen that depocillin is available from online vet pharmacies with a prescription, so that's one option - has anyone used anything else (other than sulfatrim) with success?

Thanks again.

Azithromycin, but this can cause anorexia in some Rabbits


I have always had good results with Depocillin injections.

The choice of antibiotic should be made after MC+S Testing of a swab taken from the wall of the abscess capsule. A swab of just pus will not give a reliable result, Rabbit pus is often sterile.

 

[Terra]

Azithromycin, but this can cause anorexia in some Rabbits


I have always had good results with Depocillin injections.

The choice of antibiotic should be made after MC+S Testing of a swab taken from the wall of the abscess capsule. A swab of just pus will not give a reliable result, Rabbit pus is often sterile.

Thank you - very useful to know about the swab. I'd hope the vet knows that, but I didn't.

I've also found amoxicillin (injection) mentioned on past posts here. I'll pass all this info onto my vet this afternoon.

 

[a reader of books]

I'm so sorry Martial has a tooth root abscess and that he reacted badly to the sulfatrim. I know it's a difficult decision, whether to have surgery or not, especially when he's a stressy bun. My Tom had a tooth rooth abscess, and while I chose for surgery, it did not go well and in hindsight I wish I hadn't put him through that, but I can only say that in hindsight, since it's impossible, of course, to know beforehand what their recovery is going to be like. The specialist who treated Tom did these surgeries a lot, and the majority of bunnies did really well afterwards, so I'm not saying this to discourage you from going through with the surgery if that's what you think is best. I'm just sharing what happened since you asked for experiences. Tom was very unlucky, and his recovery from the surgery was very rough, the aftercare at home was very stressful for him, and a short time afterwards he needed a second surgery for the abscess, during which the vet concluded that nothing could be done to make Tom better, so he was put to sleep while he was still under GA. Every situation is different, though, and it sounds like you're really considering this from Martial's point of view, and how he would deal with things, what would be best for him. I'd say, see what the results of the x-rays are. That will tell you how bad it is, how many teeth are involved, and should give the vet a better idea of his prognosis and how easy or difficult his recovery will be. It's very hard to decide what to do when you don't have all the information yet. At the same time, I'd also listen to your instincts if you think Martial wouldn't cope well with being at the vets, the travelling, and the aftercare.

I'm also sorry you've been so unlucky with your vets.

 

[InspectorMorse]

Thank you - very useful to know about the swab. I'd hope the vet knows that, but I didn't.

I've also found amoxicillin (injection) mentioned on past posts here. I'll pass all this info onto my vet this afternoon.

Also, if there is any suggestion of using an antibiotic impregnated bead called ANTIROBE in the abscess capsule this SHOULD NOT be done if there is any risk of the abscess draining into the mouth. Antirobe contains the antibiotic CLINDAMYCIN which is highly toxic to Rabbits if ingested. It causes fatal enteritis.

 

[Shimmer]

Both of my rabbits were treated by FHB (The rabbit specialist vet in Harrogate). She did the operations and then the follow up treatment with depocillin, plus various pain meds. My wonderful local vet was happy to continue their care in consultation with her, and provided ongoing prescription meds. I got the needles, syringes and incinerator bins online from somewhere that Jane recommended, as it was a lot easier and cheaper than via my vet. The depocillin came in a bottle via my vet, and I dispensed from it for the daily injection.

You have to be careful with any of the penicillins - they must not be ingested orally by rabbits, so any leaks and spills must be wiped up immediately so there is no chance of accidental ingestion by either the patient or any other rabbits who may groom them. You soon get used to doing it, and it never bothered my rabbits. I actually found it easier than oral meds.

 

[Terra]

I'm so sorry Martial has a tooth root abscess and that he reacted badly to the sulfatrim. I know it's a difficult decision, whether to have surgery or not, especially when he's a stressy bun. My Tom had a tooth rooth abscess, and while I chose for surgery, it did not go well and in hindsight I wish I hadn't put him through that, but I can only say that in hindsight, since it's impossible, of course, to know beforehand what their recovery is going to be like. The specialist who treated Tom did these surgeries a lot, and the majority of bunnies did really well afterwards, so I'm not saying this to discourage you from going through with the surgery if that's what you think is best. I'm just sharing what happened since you asked for experiences. Tom was very unlucky, and his recovery from the surgery was very rough, the aftercare at home was very stressful for him, and a short time afterwards he needed a second surgery for the abscess, during which the vet concluded that nothing could be done to make Tom better, so he was put to sleep while he was still under GA. Every situation is different, though, and it sounds like you're really considering this from Martial's point of view, and how he would deal with things, what would be best for him. I'd say, see what the results of the x-rays are. That will tell you how bad it is, how many teeth are involved, and should give the vet a better idea of his prognosis and how easy or difficult his recovery will be. It's very hard to decide what to do when you don't have all the information yet. At the same time, I'd also listen to your instincts if you think Martial wouldn't cope well with being at the vets, the travelling, and the aftercare.

I'm also sorry you've been so unlucky with your vets.

Thank you for sharing. I've also had a bun, Mary, whose abscess surgery went badly, for several reasons (I can go into it if you like). With Mary, the surgeon actually phoned me while she was under GA to ask if they should let her go due to what they found on examination - I wasn't expecting to be faced with that decision and found myself unable to say to let her go, but she didn't recover properly and I decided to pts less than a week later, so with hindsight I made the wrong decision for her. But Mary had been ill for a long time with a condition we never properly diagnosed, and then her abscess developed as a result of spurs causing an injury in her mouth. Martial by comparison is fit and well (or was until the sulfatrim), so I'd expect better chances of a good outcome, though I know there's always risks and the chance of unexpected findings, especially with no scans beforehand.

I think on Friday I'll make sure to discuss the various likely findings from the X-rays with the vet beforehand, and if they find something unexpected I'll ask them to call me while he's under GA. Thankfully this new vet is only 10 minutes away on foot so he doesn't even have to go in the car to get there and back.

Also, if there is any suggestion of using an antibiotic impregnated bead called ANTIROBE in the abscess capsule this SHOULD NOT be done if there is any risk of the abscess draining into the mouth. Antirobe contains the antibiotic CLINDAMYCIN which is highly toxic to Rabbits if ingested. It causes fatal enteritis.

I've written that down on my list for when he has surgery, thank you.

Both of my rabbits were treated by FHB (The rabbit specialist vet in Harrogate). She did the operations and then the follow up treatment with depocillin, plus various pain meds. My wonderful local vet was happy to continue their care in consultation with her, and provided ongoing prescription meds. I got the needles, syringes and incinerator bins online from somewhere that Jane recommended, as it was a lot easier and cheaper than via my vet. The depocillin came in a bottle via my vet, and I dispensed from it for the daily injection.

You have to be careful with any of the penicillins - they must not be ingested orally by rabbits, so any leaks and spills must be wiped up immediately so there is no chance of accidental ingestion by either the patient or any other rabbits who may groom them. You soon get used to doing it, and it never bothered my rabbits. I actually found it easier than oral meds.

Knowing that FHB used depocillin gives me a huge amount of confidence that it's a good approach, so thank you. I have given buprenorphine by injection before but it was a while ago so I'd get a refresher, but yes - it seemed less hassle for the bunny than oral meds.

 

[Terra]

So yesterday Martial let me hand feed him a bit more than the day before, but this morning he's had pretty much nothing again. Not even enthusiastic about dandelion or parsley.

I'm taking him to see a different vet at the same practice shortly, they at least can prod his tummy more expertly than I can, and have another look in his mouth. At this rate I don't think he will be having surgery tomorrow. Though it seems like when I go with vets' advice it ends up being the wrong decision, and when I go against it, that's the wrong decision too. Sorry, I guess I'm not coping with this very well.

 

[a reader of books]

Thank you for sharing. I've also had a bun, Mary, whose abscess surgery went badly, for several reasons (I can go into it if you like). With Mary, the surgeon actually phoned me while she was under GA to ask if they should let her go due to what they found on examination - I wasn't expecting to be faced with that decision and found myself unable to say to let her go, but she didn't recover properly and I decided to pts less than a week later, so with hindsight I made the wrong decision for her. But Mary had been ill for a long time with a condition we never properly diagnosed, and then her abscess developed as a result of spurs causing an injury in her mouth. Martial by comparison is fit and well (or was until the sulfatrim), so I'd expect better chances of a good outcome, though I know there's always risks and the chance of unexpected findings, especially with no scans beforehand.

I think on Friday I'll make sure to discuss the various likely findings from the X-rays with the vet beforehand, and if they find something unexpected I'll ask them to call me while he's under GA. Thankfully this new vet is only 10 minutes away on foot so he doesn't even have to go in the car to get there and back.

I'm so sorry Mary's abscess surgery went badly. It's so understandable that you weren't able to tell the surgeon to let her go when they called you. They called me while Tom was under GA, too, and I know it's such a shock. You don't get any time to properly think about it. It's so difficult to make a decision right away, and you did what you could at that time. With Martial normally being fit and well in comparison to Mary, I would expect he has a better chance of getting through the surgery, too, but him being poorly right now is far from ideal for surgery, of course, so I understand why you don't think he won't be having surgery tomorrow after all. I'm really sorry he's barely eating today. Taking him back to the vet sounds like the best idea, and I hope they can help you make a decision. When my bunnies have had to have surgery while they weren't eating (dental surgery while they weren't eating because of the dental problems), we've given them a few days of really good syringe feeding and pain meds and gut stimulants so their guts are working nicely and they're in good shape before we had them go through with the surgery. Would that be an option?

 

[Shimmer]

When my bunnies have had to have surgery while they weren't eating (dental surgery while they weren't eating because of the dental problems), we've given them a few days of really good syringe feeding and pain meds and gut stimulants so their guts are working nicely and they're in good shape before we had them go through with the surgery. Would that be an option?

That would also be my recommendation. I wouldn't put an anorexic rabbit through an anaesthetic unless it was an emergency and really couldn't wait a few days. They really need to be in as good a shape as possible beforehand, so they can deal with recovering from the op. They are much more delicate than other pets. If you can't deal with the gut issues now, then it's going to be so much harder to keep going after an anaesthetic. It's also harder to get veterinary help over a weekend, so if he doesn't pick up, it is down to the out of hours vet who may not be rabbit savvy.

Another option is to admit him for treatment / feeding up before his op. Does your vet have nurses in overight who could do this?

 

[Terra]

Just to update on Martial....

The (assumed) abscess was shrinking all last week and by Friday it was gone. I took him in for his appointment anyway as he still wasn't eating but the vet still couldn't find anything that might be causing him not to eat.

Martial ate a little more over the weekend but not enough to convince me he was recovering, so yesterday morning I took him back to the old vets specifically to see the remaining exotics specialist, who looked in his mouth and saw sharp spurs (the other vet on Friday said she couldn't see any bad spurs...I know it's hard to see in a bun's mouth but why did one see nothing and the other immediately saw they were sharp?). Martial was admitted for a dental, plus X-rays and blood tests. The X-rays and blood tests were all normal (no sign of the supposed abscess on them either). Martial's recovering at home quite well for someone who wasn't eating properly for ten days before having surgery. Thankfully he only lost 100g during the ordeal. I'm still syringe feeding him but he is picking at his hay and greens quite regularly, so fingers crossed he'll be better soon. He's also back at his usual position, sitting on my feet under my desk

The working hypothesis now is that he had a bad reaction to the antibiotics that was the initial cause of him stopping eating, which allowed his usual spurs to grow away very quickly, and by the time the antibiotics were out of his system his teeth were making it painful to eat. (Either that or it's complete coincidence that it happened at the same time.) Regarding the lump, if it was an abscess then some kind of bunny miracle has occurred, but it's also quite possible it was a random lymph node swelling that went down once I started him on meloxicam.

 

[joey&boo]

That's a great update (apart from the mystery of the "abscess"). I hope Martial continues to do well & his appetite improves more & more

 

[Shimmer]

Thanks for the update. I had been wondering what was happening. It is always worth getting a specialist opinion if you can and you are not entirely happy with the first opinion. It can make a big difference to the outcome. I'm glad he is now recovering after appropriate treatment. Spurs can develop quite quickly is a rabbit isn't eating properly. One of mine had to have his incisors checked and burred every 2 weeks.

 

[AnjaSanja]

Hi there! I will borrow this topic for small input-update on my dental bun. His first problems were noticed in oktober/november 2020, eating less hay, followed by transceluent eye discharge and slightly bulged one eye. Aaaaand diagnose-all the roots are badly elongated, abscess in periorbital area. He had 2 teeth extracted and abscess drained, 4 weeks of two antibiotics, 2 pain meds and 3 days of gut medicine. After that he had ON/OFF spurs or too long crowns, often checkups....And well here we go again. Around 14 days ago the same symptoms, and x-rays did show abscess, one root pressing too much to the eye. So 4 days ago he had one more teeth extracted, abscess drained and another 4 weeks of the same meds.

He is a good boy with will to eat and live. He eats veggies on his own, pellets and I still do give him 2 meals of CC. Breakfast and dinner. He started to play and nibble with his hay ball. Pain meds at their finest. He will turn 7 in july.