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Mouth Ulcers and Pus

Beapig

Mama Doe
Hi everyone, I hope that you're all well. I've been inactive on here for a while, and feel bad logging in just ask for advice. I could really do with your expert opinions though.

Mid last week, my little Lily was off her food. She had been completely fine the day before. The neighbour's have a new cat who is very nosy and gave her a fright in the morning (a completely harmless little goofball, but she didn't appreciate being approached by him) - I assumed that this is what caused the stasis. We took her to the vets and she had metacam and emeprid injections, but was no better overnight, so we took her to the vet hospital out of hours.

She was put on a drip and syringe fed, in the daytime the hospital is also an exotics vet (RWAF Gold), so the exotics day vet examined her first thing in the morning. Turns out she had some nasty spurs sticking into her cheek, which had caused ulcers, and he said he could see some pus in her mouth too :( She was already booked in for a dental the following week, but she had it performed that morning as an emergency.

She finally came home on Saturday afternoon, 2.5 days later. Finally some poops coming out. Tramadol twice daily, Ranitidine 3 x daily and critical care every 4 hours. We've been doing this round the clock and giving her a wide variety of forage free choice to try to get her appetite back too. I should mention that she is also moulting heavily, which did not help with the gut slowdown, so we've also been brushing her every time we syringe feed.

She was noticeably improving until yesterday morning, when she suddenly didn't want any greens for breakfast. We took her straight back to the vet and he was happy with her gut and said she was generally a lot more bright and alert, but she had also lost a bit more weight and had a lot of pus in her mouth, which was concerning. He said it could just be from the wound where the spurs were sticking into the cheek, or it could be worse if it was an infection in the tooth root. He did however say that his colleague who did the dental did not observe any loose teeth when performing the dental, which would have been the tell tale sign of a root infection.

He said the only way to know for sure would be to do a CT scan, which would cost £1100. I have already spent £2k+ on vet bills in the past week and unfortunately Lily isn't insured as she has a history of dental issues. To make matters worse, we're moving house 2 hours away on Monday. He said it would take 4 days to get the results of the CT scan. He did also question if it was worse than it seems, whether it would be fair to put her through another more extreme dental, as she is an older bunny. I would do anything for my pets, but I'm also scared of draining my emergency fund. I hope that people appreciate that and would not judge that there has to be a limit somewhere, although it's very hard to decide where that line should be drawn.

It was difficult to decide what to do, but for now she has been prescribed Baytril to see if that clears up the pus. I did wonder why she wasn't given antibiotics from the get go as the pus was observed pre-dental, but they're the experts and I trust their judgement. Apparently it takes 4 - 5 days for the antibiotics to start working, so we shouldn't expect overnight results.

I'm just wondering really if anyone else has been through a similar thing in the past with their bunny? Lily is reasonably bright today, she's moving around and has eaten some forage. She's happily eating her pellets too but still not interested in hay. Sometimes she is hunched and looking uncomfortable, other times she seems more relaxed and is grooming herself. We're still syringe feeding CC daily to make sure her gut keeps moving.

I'm just wondering if anyone has been through something similar with their rabbits before? Thank you so much as always.
 
Did she have skull radiographs taken when she had the emergency dental? That’s the only way to be certain that there isn’t a problem with the tooth roots. Also, infection might be in the jaw bones(osteomyelitis), not just soft tissue. Again, skull radiographs are needed to rule this out. Both tooth root elongation/infection and osteomyelitis can be extremely painful. The pain doesn’t go away after a dental, it is chronic and needs ongoing management.

IME Baytril alone is pretty useless when treating severe dental infections. But I guess a Gold * RWAF Vet must have good reason to only prescribe that :? Mind you, like you I question why abx were not prescribed straight away given that pus was seen :?

It is not at all unusual for a Rabbit with tooth root problems or osteomyelitis to stop eating hay. Chewing hay requires a rotational jaw action which can be very painful for a Rabbit with that extent of dental disease. Chewing pellets requires more of an up and down jaw action, which whilst not pain free is probably less painful than that caused when eating hay.

I would contact the Vet again to let them know that you still have concerns and perhaps they can suggest something to help. Some Rabbits can go off their food when on Baytril, it usually happens from day 4/5 of treatment.
 
Did she have skull radiographs taken when she had the emergency dental? That’s the only way to be certain that there isn’t a problem with the tooth roots. Also, infection might be in the jaw bones(osteomyelitis), not just soft tissue. Again, skull radiographs are needed to rule this out. Both tooth root elongation/infection and osteomyelitis can be extremely painful. The pain doesn’t go away after a dental, it is chronic and needs ongoing management.

IME Baytril alone is pretty useless when treating severe dental infections. But I guess a Gold * RWAF Vet must have good reason to only prescribe that :? Mind you, like you I question why abx were not prescribed straight away given that pus was seen :?

It is not at all unusual for a Rabbit with tooth root problems or osteomyelitis to stop eating hay. Chewing hay requires a rotational jaw action which can be very painful for a Rabbit with that extent of dental disease. Chewing pellets requires more of an up and down jaw action, which whilst not pain free is probably less painful than that caused when eating hay.

I would contact the Vet again to let them know that you still have concerns and perhaps they can suggest something to help. Some Rabbits can go off their food when on Baytril, it usually happens from day 4/5 of treatment.

Thank you so much Jane for your response. There were no radiographs done pre-dental as far as I'm aware, but I will ask. I assume that her mouth is still a bit sore in general, as she doesn't have a huge appetite but is enjoying some pellets and greens. As said it is terrible timing, we're moving house on Monday and meant to be packing (not complaining or anything about having to care for Lily but it adds a lot of stress to and already stressful situation)

Do you think it's feasible that the pus could just be from where the spurs were sticking in?
 
Yes, it’s possible.

It must be a very stressful time for you at the moment :( I really hope that Lily will feel more comfortable soon x

Thank you so much Jane, it is very stressful. We're just having to take it one day at a time at the moment...I really appreciate your help and advice.
 
I would also be querying the antibiotics..apart from the fact that pus should have been treated when initially seen (which I would certainly be mentioning...), I would ask about what other options are available (other than Baytril). I don't know if injectible penicillin would be appropriate in this case, but that's what my previous dental / jaw abscess rabbits have had. You can be shown how to do it at home to save travelling and additional stress. If it's being described as pus and was seen during the examination, I'm assuming it's more of the 'normal' free flowing stuff from an infection, rather than an abscess.

I think you need to get on top of the infection before considering anything else. Skull x-rays would be useful and can be looked at straight away. They should show any issues with the teeth / jaw, and would be significantly cheaper than a scan.
 
Hello :wave: I'm sorry that Lily is unwell. I'm also sorry that it's dreadful timing, but then doesn't this so often happen!

I have no experience with tooth root elongation/infection and no recent experience with dental issues of any sort. However, in addition to not treating the observation of pus from the outset with abx, I wonder also why, if she was already booked for a dental, dental pain was not considered straight away as a cause of her not eating, when she first went to the vets in the middle of last week. It seems that the spurs, ulcers and pus were not observed until the next morning by the exotics vet? What was meant by the suggestion of 'a more extreme dental'?

If it were me, I would contact the vet again this morning, as Jane suggested. If you don't feel satisfied with their response, I would seriously consider a second opinion, irrespective of RWAF Gold.
 
I would also be querying the antibiotics..apart from the fact that pus should have been treated when initially seen (which I would certainly be mentioning...), I would ask about what other options are available (other than Baytril). I don't know if injectible penicillin would be appropriate in this case, but that's what my previous dental / jaw abscess rabbits have had. You can be shown how to do it at home to save travelling and additional stress. If it's being described as pus and was seen during the examination, I'm assuming it's more of the 'normal' free flowing stuff from an infection, rather than an abscess.

I think you need to get on top of the infection before considering anything else. Skull x-rays would be useful and can be looked at straight away. They should show any issues with the teeth / jaw, and would be significantly cheaper than a scan.

Thank you, I've been wondering this too. I know that the vet who examined her and initially saw pus was not the same vet who performed the dental last Thursday, but presumably the notes are passed along, and any pus in the mouth would have been noticeable during the dental itself. The dental cost around £450, so I am assuming it was quite extensive.

I'm going to contact the vet again this morning and see if there is anything else to be considered. She's pooping well today at least, which is good. The fur all finally seems to be out of her system.
 
Hello :wave: I'm sorry that Lily is unwell. I'm also sorry that it's dreadful timing, but then doesn't this so often happen!

I have no experience with tooth root elongation/infection and no recent experience with dental issues of any sort. However, in addition to not treating the observation of pus from the outset with abx, I wonder also why, if she was already booked for a dental, dental pain was not considered straight away as a cause of her not eating, when she first went to the vets in the middle of last week. It seems that the spurs, ulcers and pus were not observed until the next morning by the exotics vet? What was meant by the suggestion of 'a more extreme dental'?

If it were me, I would contact the vet again this morning, as Jane suggested. If you don't feel satisfied with their response, I would seriously consider a second opinion, irrespective of RWAF Gold.

Hi Omi 🙂

To clarify, the vet I took her to initially on Thursday was our old 'regular' vet who we're still registered with. It's difficult to get a quick appointment with the exotic vet unless it is emergency/out of hours. The regular vet is the one who gave her injections and booked in a dental for the following week as they could see some spurs, we then went into the out of hours later as she was clearly still in stasis.

By more extreme dental, I mean if teeth needed to be removed. Apparently this is a riskier procedure, although it is all guesswork unless a CT scan is done.

I'm very much hoping the pus is 'just' from where the spurs were stuck in and not an abscess.
 
I've had my share of dental bunnies, attending lecture by FHB on rabbit teeth & it still confuses the hell out of me. That is a really expensive dental bill IME. I think its reasonable to ask your vet to reconsider the abx, ask opinions about the pus & for an itemised copy of your receipt. My vets always offer this & its so useful for seeing what has been done & what each thing costs. Personally I wouldn't go for the scan (at least not yet), xrays are a lot cheaper & skilled vets can often do them without sedation. In this situation I think my priority would be good pain relief that suits her & better abx.

Lots of vibes for Lily & you, it must be really stressful & terrible timing with your pending house move too.
 
I am sorry you are going through this with Lily and it is adding to your stress of moving.
She is lucky to have you giving her excellent care.
My dental bunny had ulcers on both cheeks during his dental last week, yet no pus; still he was not eating much hay though he enjoys his greens and pellets. He is still on critical care to supplement his eating. He also has a possible ear infection so is on Sulfatrim abx. He is also on Metacam.

Sending positive vibes for you and your beautiful girl.
Is she still getting pain relief?
 
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I've had my share of dental bunnies, attending lecture by FHB on rabbit teeth & it still confuses the hell out of me. That is a really expensive dental bill IME. I think its reasonable to ask your vet to reconsider the abx, ask opinions about the pus & for an itemised copy of your receipt. My vets always offer this & its so useful for seeing what has been done & what each thing costs. Personally I wouldn't go for the scan (at least not yet), xrays are a lot cheaper & skilled vets can often do them without sedation. In this situation I think my priority would be good pain relief that suits her & better abx.

Lots of vibes for Lily & you, it must be really stressful & terrible timing with your pending house move too.

Hi joey&boo! :wave:

Thank you for saying this, it is certainly overwhelming and I feel in over my head a little. I spoke to the vet today and he said a culture could be done if they can work out where the pus is coming from to check which antibiotics would be most appropriate. He said a skull x-ray would be possible but a CT scan would give much more detail. He said x-ray would be £500 - £600 or CT £1100...this is only the second day of the Baytril and I'm hoping it will work.
 
I am sorry you are going through this with Lily and it is adding to your stress of moving.
She is lucky to have you giving her excellent care.
My dental bunny had ulcers on both cheeks during his dental last week, yet no pus; still he was not eating much hay though he enjoys his greens and pellets. He is still on critical care to supplement his eating. He also has a possible ear infection so is on Sulfatrim abx. He is also on Metacam.

Sending positive vibes for you and your beautiful girl.
Is she still getting pain relief?

Thank you bunny momma, it is a very tricky time. I hope that your dental bun goes back to eating hay soon too, it's such a worry when they're off their hay :( I'm worried about Lily continuing to lose weight, so letting her eat more or less whatever she feels like at the moment (within reason!)
 
Thank you bunny momma, it is a very tricky time. I hope that your dental bun goes back to eating hay soon too, it's such a worry when they're off their hay :( I'm worried about Lily continuing to lose weight, so letting her eat more or less whatever she feels like at the moment (within reason!)

Thank you. My dental bunny is a little dwarf with molars that slant. He wears his teeth almost to the gums and needle like points still grow toward his cheeks. Vet says very unusual. He is not a candidate for invasive procedures, so we keep him comfortable and eating.
You are wise to let her eat greens and pellets so her gut continues to move while her mouth heals. You mention syringe feeds and my boy accepts them without much stress so I give him a syringe feeding each day to add some extra fiber and keep him from losing weight.
In regards to getting a cat scan, I cannot see putting a bunny through one unless it would likely change the treatment plan, keeping in mind that some treatments involve extensive aftercare which may not be in the best interest of some bunnies.
Sending vibes her pain meds will keep her comfortable until the abx begin to work.
I hope your move goes smoothly too.
 
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Thank you. My dental bunny is a little dwarf with molars that slant. He wears his teeth almost to the gums and needle like points still grow toward his cheeks. Vet says very unusual. He is not a candidate for invasive procedures, so we keep him comfortable and eating.
You are wise to let her eat greens and pellets so her gut continues to move while her mouth heals. You mention syringe feeds and my boy accepts them without much stress so I give him a syringe feeding each day to add some extra fiber and keep him from losing weight.
In regards to getting a cat scan, I cannot see putting a bunny through one unless it would likely change the treatment plan, keeping in mind that some treatments involve extensive aftercare which may not be in the best interest of some bunnies.
Sending vibes her pain meds will keep her comfortable until the abx begin to work.
I hope your move goes smoothly too.

Thank you so much for your kind words. This whole situation has truly made me reflect on how much of a bad 'design' a rabbit's mouth seems to be, with these horrible little spurs coming out even if they're grinding them down eating hay!
 
Chewing hay requires a rotational jaw action which can be very painful for a Rabbit with that extent of dental disease.

Is the rotational jaw action the same for grass as it is for hay? Lily is finally picking at some grass today, which is so nice to see. She's generally in much better spirits today too :love:
 
Is the rotational jaw action the same for grass as it is for hay? Lily is finally picking at some grass today, which is so nice to see. She's generally in much better spirits today too :love:

Yes, but grass is much softer so less likely to be as sore on any soft tissue damage.
 
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