Infected tooth extraction

Hey all, been a while since I've posted. Just wondering if anyone has any advice/experience to share.
A little over a week ago Snowflake went in for what I thought would be a routine dental (at 6yrs old I thought she'd done well to not need one up until now). I got a bit of a shock when the vet said she'd had to remove quite a lot of teeth. I got even more of a shock when I saw the photos of just how bad her teeth had been. I had no idea, every time a vet looked in the past they have always remarked how good her teeth looked.
Poor Snowflake now has nothing at all on the top left and is missing several other molars. The last couple of days she's had increasing pain and some light sneezing so I knew something wasn't quite right. Unfortunately taking her back to the vet today one of the areas where a tooth was extracted has become infected (or may already have been the vet said).

She's been on metronidazole, metacam and emeprid since extractions along with top up pain meds (a specific calpol paracetamol recommended by exotics vet). As of today she's started azithromycin and vetergesic as well.

Our vet has been really excellent as always and given her a thorough check, I have every confidence in her that she's giving her the very best care and that she couldnt' be in better hands.
I'm just wondering if there is anything at all I can do to improve her chances of beating this and from anyone who's had a rabbit with an infected extraction, what is the usual prognosis?
If the infection hasn't improved in 2 weeks with the antibiotics she's said she'll x-ray her but also said if it spreads up further many rabbits don't come back from it so I'm a bit scared to be honest

At the moment she's still finding solid foods quite difficult so she's mainly on supreme recovery and sometimes picking at a few other things.
I'm planning to buy some foods that might help, possibly, to boost her immune system such as coneflower. Any other recommendations? Or anything I should stay away from? I'm doing an order now from The Hay Experts as I can't seem to find coneflower anywhere else.

This is my first time with a rabbit having extractions and the first time having something as scary as an infection at the extraction point so I guess I'm just looking for what the likely outcome will be

Hello, sorry to hear of Snowflake’s advanced Dental disease. I would certainly want skull radiographs taken to assess the full extent of the infection. If osteomyelitis ( bone infection) has already occurred then sadly the prognosis is very poor. The teeth the Vet already removed were probably already lose. Removing molar teeth that are not yet lose is major surgery and if the jaw bone is infected it can easily fracture. Osteomyelitis is also extremely painful.

Systemic antibiotics might get the infection under control but not eradicated. Sometimes this can mean antibiotics for the Rabbits remaining time.It really does depend on the precise degree of infection and without skull radiographs this will not be known.

As previously mentioned, pain is the big factor to take into account. Personally I have had to make some difficult decisions for Rabbits with severe Dental disease that involves osteomyelitis.

All that said, if the infection is still confined to soft tissue then aggressive antibiotic treatment for a significant amount of time can bring about a more positive outcome.

Did the vet say why radiography was not done during the previous dental/ extractions ?

I don’t have any experience of this but I’m sending lots of vibes xx

Thanks Jane. Not really what I wanted to hear but I appreciate the honesty
She mentioned x-raying at the time of dentals but also mentioned the increased risk due to there being app another 20 mins of sedation. Because Snowflake is pretty badly underweight (the dental issues affected her eating and she lost weight) and also older (6ys so not old but also getting into the risk area) I said I don't mind either way but was hestitant about the extra risk. Bear in mind at the time I thought we were dealing with 'simple' dental issues, I thought it was just spurs that could be taken down. All of this has come as a shock.
Yes, the vet said one tooth was already loose. And she already had three missing which she said had probably been reabsorbed at some stage.

Do you think there would be greater benefit to taking her back for an x-ray before the 2 weeks? Or would it likely make little difference?
I did ask the vet yesterday about an x-ray but she seemed to be leaning to doing it in a few weeks time.
Is azithromycin not likely to be enough to hit the infection with?

Now this is all getting pretty terrifying. She's had a slow recovery from the procedure and clearly had pain but seemed to be making very very slow progress. It was only over the weekend that I noticed she seemed to be going downhill (i.e in more pain, drooling and her eye looking slightly inflamed)
Could that mean the infection has set in more recently perhaps? And maybe not had a chance to travel further?

Not sure what to do now.. It's not easy for me to get back and forth to the vets now as I'm having to take a taxi (£32 a time) due to not being able to drive. Without going into details as I know someone watches my account on here we've had an absolutely disastrous few months and have been left without transport as one of the many consquences.
With that said if there is benefit to having her x-rayed now I will take her straight back. If time is of benefit here then I would rather do that. Though I am concerned as the trip yesterday did stress her. She was eating before she left and stopped eating when she got home
Goodness I don't know what the right decision here is..

Edit: Sorry, quite tired so I probably didn't make my question very clear..
Would having an x-ray potentially change the course of treatment here, e.g would they put her on more aggressive treatment etc if they knew it had gone to the bone and it therefore be of benefit to have the x-ray sooner than later?
I know osteomyelitis has a poor prognosis generally.. But is treatment/management possible?
Snowflake has proven herself to be a fighter who enjoys life, I want to give her the best chance here whilst obviously being aware of what she's going through.
Hope that made some sense? :?

I would continue with the Azithromycin and other meds for the two weeks. Having Radiographs done right now wont really change what can be done, just give you a more informative picture of what is going on and thus how ethical it would be to continue treatment. It is possible that the infection is not yet involving bone. But if her eye is swollen it is indicative of possible tooth root elongation and infection which can progress to osteomyelitis.

Azithromycin is a good abx but it can cause quite severe anorexia in some Rabbits. My Rabbits have done better on Penicillin INJECTIONS.

At the moment as well as the abx insuring good pain control and that her gut function remains OK is the most important thing.

Ok.. Thanks Jane.
This is absolutely horrible. When I first took her in I thought it was 'just' spurs.
Would it be worth asking them if they'd try penicillin injections too (I know rabbits can't take it orally) or not going to make much difference at this stage? Could they culture the infection to see what antibiotic would be best? Or is that not possible/of benefit to do?
Poor girl. She's been so sweet through all this. She hates being held but she's tolerated it and even climbed up me to lick my face. She's just the most affectionate thing. I can't bear the thought of losing her.

I've just been down to see her, she seems to have bounced back from yesterday a little bit. She was showing stasis signs when she got home from vet but just took a crunchy treat off of me and has had some regular pellets + protexin pellets so hopefully she's feeling slightly better than last night. Still minimal amounts of solid foods but better than nothing.
She takes the liquid recovery food from a bowl well which is her main food at the moment but good to see her eating something more solid this morning.

Edit: Okay she is loving the selective meadow loops this morning :shock: snatching them right off of me-!
Not the sort of thing I'd normally allow more than one a day of but under the cirumstances I've given her a couple

I agree with Jane's last post. Give this treatment a chance to work, and take it from there. Taking a swab for culture may not give you any extra options as the antibiotics for rabbits are limited, but it's worth bearing in mind if she is sedated for xrays so that a decent sample can be taken. If they hve been on antibiotics, you don't always get a useful result, though, and it will take a week to get the results back (or more if the lab staff are off with Covid...as mine were)

I've had rabbits on long term depocillin injections due to jaw abscesses / teeth issues (about 18 months, as far as I remember). I had a bottle at home and a stack of syringes. They had whatever they could eat - softened pellets, recovery food in a bowl, grated carrot / apple etc, shredded greens, grass cut into 5mm pieces, apple or willow twigs with leaves hung at head height - normal things served in a way that made them easier to eat. Personally, I would try more recovery food to get her weight up a bit, if possible - then she's in a better position for whatever comes next.

I agree with Jane's last post. Give this treatment a chance to work, and take it from there. Taking a swab for culture may not give you any extra options as the antibiotics for rabbits are limited, but it's worth bearing in mind if she is sedated for xrays so that a decent sample can be taken. If they hve been on antibiotics, you don't always get a useful result, though, and it will take a week to get the results back (or more if the lab staff are off with Covid...as mine were)

I've had rabbits on long term depocillin injections due to jaw abscesses / teeth issues (about 18 months, as far as I remember). I had a bottle at home and a stack of syringes. They had whatever they could eat - softened pellets, recovery food in a bowl, grated carrot / apple etc, shredded greens, grass cut into 5mm pieces, apple or willow twigs with leaves hung at head height - normal things served in a way that made them easier to eat. Personally, I would try more recovery food to get her weight up a bit, if possible - then she's in a better position for whatever comes next.

Thank you Shimmer.
This is just so terrifying. I just want to give her her best chance
She's always been a little fighter. Being a stasis prone bun we've gone through some tough times. Including one time the vet was convinced she wouldn't make it through. But she fought on. I just want to support her and give her every chance. But it's hard seeing her in pain. If only they could talk and tell you what they want

I'll try to be patient then and give these meds a chance. I can take her back to the surgery at any time (it's a hospital so open 24/7) but the exotics specialist is only in on a tuesday.

I guess it's just that I want to do everything I can. I'm already kicking myself for not knowing she had any significant - let alone advanced - dental disease before. I just don't want to let her down.

Thank you all for the replies. Will keep you updated xx

Brko had two molars extracted. One root already startet to root and the other was defected and that was around that time, perhaps december in 2020. But the extraction was done ine the exotic vet clinic and they have plenty of experiences with even worse issues.

Can't offer any advice but sending lots of vibes for your bunny xx

Thank you all. She went for a recheck earlier this week. The infection is still present but it has gone down a lot from what it was. The vet said she seemed to be in less pain on examination as well.
She is eating better and able to eat vegetables now. She still won't touch hay but will have very small amounts of grass. She gained a little bit of weight. Not a lot but a little.
She's on a long course of amoxicillin along with metacam and buprenorphine for the pain. She is acting more like herself, following me around the house, binkying etc.
I'm being cautiously hopeful, she appears to be fighting it. Just hoping things stay in the right direction.

~ILoveMyBunny~ said:

Thank you all. She went for a recheck earlier this week. The infection is still present but it has gone down a lot from what it was. The vet said she seemed to be in less pain on examination as well.
She is eating better and able to eat vegetables now. She still won't touch hay but will have very small amounts of grass. She gained a little bit of weight. Not a lot but a little.
She's on a long course of amoxicillin along with metacam and buprenorphine for the pain. She is acting more like herself, following me around the house, binkying etc.
I'm being cautiously hopeful, she appears to be fighting it. Just hoping things stay in the right direction.

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Hopefully the antibiotic will keep on top of the infection even if it does not completely eradicate it.