Best Practices for Pocket Pet Dentistry

According to the 2022 Pet Ownership report published by the Animal Medicines Australia Organisation, approximately 4% of households keep small mammals. That is around 900K nationally. Pocket pets such as guinea pigs, rabbits, mice, and rats have continuously growing teeth and thus tend to suffer from many dental conditions that veterinary teams see in practice on a regular basis. These may include congenital dental issues that are present at birth (i.e. size & shape of the skull), or acquired issues that result from trauma, systemic disease, neoplasia, and improper nutrition. It has been estimated that around 90% of domestic rabbits will suffer from dental problems.

Diets lacking in fibre and nutrition can facilitate the progression of dental disease. Pets with dental disease are usually more reluctant to eat (due to discomfort, physical restrictions etc.) and have digestive tract issues. This only further exacerbates the problem, highlighting the importance of monitoring and maintaining good dental health in pocket pets.

Here are 10 best practices when it comes to pocket pet dentistry.

• Examine the patient for signs of dental disease during the consultation.

Signs to look out for in your pocket pet include nasal discharge, an inability to close their mouth properly, facial masses or swelling, protruding front teeth, and excessive drooling. Changes in their behaviour may include reluctance to eat, chew, or swallow food properly or they stopped grooming themselves.

Clients are also a great resource for providing any history regarding behavioural changes.

• Sedation is necessary for a thorough dental examination.

As pocket pets have small oral openings, anaesthesia is a common practice. Even under anaesthesia, a complete evaluation is still difficult as an intubation tube can further restrict this area. Therefore, a combination of both injectable and inhalation anaesthesia is preferred over intubation. This combination allows for access to the oral cavity and rapid adjustment of anaesthetic depth. Other options that may assist with anaesthesia include custom mouth gags, retractors, bivalve nasal speculums, and an otoscope cone. 

Patients with dental disease tend to also have other diseases or health concerns simultaneously. A comprehensive evaluation should be conducted to determine whether they need additional supportive care. Hydration state, body temperature, GI tract function, nutritional status, and pain management should be considered before inducing anaesthesia, and body temperature, heart rate and respiratory rate should be monitored throughout.

Examination of the mouth for any cracked/fractured teeth, misalignment, swelling, bleeding, or anything else abnormal should be routine for all patients. Teeth and gums can be exposed by peeling back the lower lips with a thumb and index finger with one hand and the upper lip with the other. An oral speculum can be used to open the oral cavity, and a small dental explorer can be used to assess tooth mobility.

• Scan to examine what you cannot see during the dental examination.

Radiology should be performed on all patients as most teeth and supporting structures are not visible and below the gum line. It is the only way to examine the tooth roots, jawbone, periodontium, nasolacrimal canal, and intra-alveolar portion. This is especially important as 80% of dental diseases arise from these areas.

The ‘laterolateral view’ often provides the most useful information, but others may include the dorsoventral/ventrodorsal skull view and the left & right 40-degree oblique skull views.

• Other diagnostics tests can help determine the root cause of the issues.

Endoscopic oral examinations can be very useful for viewing small details such as lesions and taking pictures. However, the equipment can easily be damaged if it is chewed on, so it is usually conducted under sedation.

Blood tests may be conducted if the cause of the dental issues is suspected to be the result of systemic disease.

• File or trim down overgrown teeth.

Dental issues such as malocclusion of incisors and overgrowth of incisors & cheek teeth may require procedural intervention such as an odontoplasty and crown height reduction.

Trim down teeth with dental burrs or file them down with dental drills. Guillotine-blade nail trimmers are not recommended as they can damage the teeth and gums. Floating cheek teeth can be worked on with a small file or rasps, burs on a handpiece, or rongeurs. Surfaces should be smoothed with lateral excursion, and the patient should be evaluated for adequate motion. Soft tissue around the working area should be protected from these instruments with a tongue spatula or a regular dental cement spatula. Repeat this process every 3-6 weeks or as required.

Young pets that already have slight malocclusions need their teeth trimmed every 6-8 weeks to prevent issues associated with caudal tooth overgrowth. For example, they may be prevented from closing their mouth properly, which can lead to inadequate wearing down of teeth.

• Extract problematic teeth.

Removing troublesome teeth entirely to prevent the future need for repeated filing is the best long-term solution for chronic issues. This procedure is done under general anaesthesia, either intraorally or extraorally. 

Equipment may include spatulas, cheek dilators, tabletop mouth-gag positioners, oral speculums, a dental handpiece with a cheek guard, dental burs, and Crossley incisor & molar luxators.

• Remove and treat abscesses.

Tooth abscesses can lead to facial swelling, odour, appetite loss, and loose or painful teeth.

Abscesses are usually only detected through radiography or CT scans. The infected teeth are removed before further treatment such as repeated lancing & flushing of the area, complete surgical excision, antibiotic bead impregnation, and systemic antibiotics.

• Use digital dental charts for good record keeping

Dental charts are an extremely useful tool for vet staff to follow checklists, and record and store patient information. VetCheck offers a dental chart patient file in which information such as dental procedures, periodontal disease stage, radiograph findings, skeletal malocclusions, nerve blocks, treatment lists, and medications can all be recorded. This is extremely important for future reference and monitoring, given the problematic nature of pocket pet teeth. These reports push straight back to the patient file in the practice management system and can be shared with the client as a dental report to add value.

• Obtain and record an in-depth patient history.

After dental procedures, the patient should eat ASAP to wear down existing teeth and promote proper GI tract function. Additionally, for patients who had a tooth extracted or an abscess removed, analgesia and nutritional support are required. All this information should be recorded in the patient’s file. Treatment for potential secondary infections should also be considered depending on the type of dental issues and the results of diagnostic testing.

Additional information on the patient’s weight, personality, normal eating habits, and faeces monitoring can be useful when analysing their clinical signs or post-treatment progress.

• Advice for pet owners about home care.

Proper care and maintenance at home can help prevent exacerbating the dental issue or even from it arising entirely. It is important to balance tooth growth with attrition (reducing strength through sustained pressure).

The pocket pet’s diet is an extremely important factor in their dental health. Fibre is strongly recommended to help with the regular wearing of the molars. For most species, their diet should consist of around 80% hay or grass. Small quantities of fresh pellets and fresh produce can be provided but it is not necessary. Adequate amounts of calcium are crucial in preventing reduced jaw mobility and sufficient mineralisation of teeth. Calcium can be found in dark, leafy vegetables, grass, hay, and pellets. Vitamin D is also important for aiding in calcium absorption. For those struggling to eat due to tooth pain, etc., syringing powdered formulas mixed with water directly into their mouth is suggested.

Providing pocket pets with items to chew on, such as toys or sticks, is essential for keeping their teeth and gums strong. It will also simultaneously work on filing down teeth and preventing overgrowth. Many pet products are even fortified with extra supplements and minerals for additional nutritional benefits. However, some may cause more harm than good, especially if the pocket pets are ingesting whatever they are chewing. 

Further reading

Osofsky A & Verstraete FJM. 2006. Dentistry in Pet Rodents. Compendium on Continuing Education for the Practising Veterinarian. 28. 

Hamlin J. 2013. Causes, examination and treatment of dental disease in rabbits. The Veterinary Nurse. URL:

https://www.theveterinarynurse.com/review/article/causes-examination-and-treatment-of-dental-disease-in-rabbits

DeCubellis J & Graham J. 2013. Gastrointestinal Disease in Guinea Pigs and Rabbits. Vet Clin North Am Exot Anim Pract. 16(2):421-435. 

Bohmer C & Bohmer E. 2017. Shape Variation in the Craniomandibular System and Prevalence of Dental Problems in Domestic Rabbits: A Case Study in Evolutionary Veterinary Science. 4(1):5.