Malocclusion and Infection

Nonagp

Post   » Thu Aug 30, 2018 1:42 am


Hello,

This is the first time I've had a guinea pig with malocclusion/infection. Tried to do as much research as I could before taking him to a vet, but there are still some things that I can't quite figure out. Have already read the malocclusion/antibiotics page on guinea lynx and looked through many threads trying to find similar situations/options. The vet I've chosen has really good reviews and is also one that my local guinea pig rescue uses as I know enough to choose one experienced with pigs. It's kind of a long story (1.5months), but I'll try to keep it short and detailed.

I have a 2.5 year old boar, no dental problems up until now, had him since he was young and provided the best possible (unlimited hay, chews, etc though I know sometimes he's a bit lazy). Mid July I noticed he was gagging a bit on hay. When it happened more than once, I knew it wasn't from eating too fast.

July 17 - Took him to the vet. They said he had some spurring on one side of his molars, just long enough to slightly cover the tongue, but not long enough to cause any abscesses. They palpated and found nothing. I also had them check his jaw alignment, they said it was fine. There were no visible abscesses and no foul smells from his mouth. After the procedure was done, took him home the same day and he was already enjoying solid food (pellets, hey, lettuce). They prescribed metacam and metoclopramide. He wasn't eating as fast as usual and didn't take to all his usual veggies yet, but I assume it was pain related. Over the week he continued to improve, but he started to wear his incisors unevenly - again I assume pain related.

July 24 - Follow up visit with a different doctor, they said he had some very minor spurring on one side, other side was fine. They said to stop metacam and to reduce metoclopramide. That evening I found him drooling. Immediately called the vet (follow up doctor had already left, got another on the phone) and she claimed he should be fine, that he was having an "off day." On a normal day I'd disagree, but I've never done this before...

July 25 - Drooling kind of subsided. Tried to encourage him to eat, but he didn't. Force fed him critical care. He really hates critical care and softened pellets.

July 26 - Took him to the vet first thing. Going forward, I take him to the first doctor that did the dentistry. Started back on metacam, continue metoclopramide, and now on bactrim. Pointed out he wore his incisors down at an angle, got brushed off. By the afternoon he already had more energy, playing with hay, back to eating veggies, avoids drinking/sips water from his bottle. Appetite was either same or increased. Had some soft poops. Each visit following they would palpate and check his molars, said they were fine, but apparently getting slightly more narrow in space.

July 30 - Revisit. Pointed out incisors again and asked them to take out the angle as I felt it was bothering him. She did, but she decided to take off more than that and took more off the bottom than the top. He was excited to try veggies that day. My heart broke watching him try desperately, but couldn't grab or tear anything. Noticed he was chasing his cage mate a lot for poop, but couldn't grab that either. Licked his lips a lot, not normal for him.

Aug 2 - Revisit. Told them it was trimmed too short. She and the lead vet insist that they were trimmed to "average guinea pig length" and that his molars were slightly more angled than the average guinea pig. They wanted to make more room in his mouth and suggested it was elongated roots making him unable to eat solid foods. I disagreed. They also blame him for being extra sensitive compared to other guinea pigs. That day he was able to start picking up, but couldn't tear through veggies. Each day he couldn't, he got bummed and gave up quickly. I've read assisting them by making match sticks and pushing them in, but he hates that and will pull them out if I even manage to get them in.

Aug 5 - Able to start grabbing better. Took chopped pieces of veggies. He made progress, needing less help as days went by. Still ate slow, but felt he was getting used to it. He'd ate some hay, but still not close to 100% eating. Sometimes he'd avoid his incisors and take in a bit too much veggies at once.

Aug 9 - Vet said it was OK to stop his antibiotic that night. Next say he gained weight, but 2 days following that he lost about 0.02kg each day. Put him back on bactrim. Next day, his weight stabilized. He was even able to gain a little weight over the next few days. Even though he lost weight he seemed active, alert, and no change in appetite (could be hiding it).

Aug 13 - Revisit. Prescribed baytril to see if that would get rid of the infection. Asked them to readjust top incisors as I felt it was bothering him. They asked me where to trim this time and I gave them a modest suggestion as I didn't want to trim too much and set him back again. They suggested I consider getting his molars re-done. I refused. That same day he was very happy! Chewing away on his wood toy (that I didn't see him do since initial dentistry until now), drinking water from the bottle, purred like crazy while tearing into his veggies way more efficiently. Hay/pellet-wise still wasn't 100%, mostly wanted just poop (not his) and veggies.

Aug 15 - Seemed to be more dependent on me for calories so I increased the amount I was force feeding, but ability to eat veggies continued to improve.

Aug 17 - Finished first bottle of bactrim, continued with the rest. Appetite/activity stayed the same if not increased, minus less interest in eating poop (not his). He started to gain a more steady interest in pellets/hay.

Aug 20- Revisit. Cleared to stop baytril and continue with metacam/metaclopramide. I told them I wanted to hold off filing molars again. In the 2 days following he dropped 0.01kg then an alarming 0.03kg.

Aug 22 - Back on baytril. There were some minor fluctuations with his weight, but overall more stable. I had a crazy work schedule, but had been doing shorter hours since he got sick so that I could feed him better. Not sure if some of the fluctuations were work related, but it's been an uphill struggle maintaining his weight.

Aug 27 - Stopped working altogether to continue pushing his recovery. Pointed out that he was alert/active, but slightly puffy/not sleeping as comfortable over last couple days compared to being on both antibiotics. Got a refill and put him back on bactrim. Again, his weight fluctuated a bit, but overall went up a little. I noticed that he's obsessed with wooden chew and refuses to drink from a bottle (drinks from a dish instead) so I'm convinced his top front incisors are still not at perfect length despite his ability to eat veggies without issue.

Asked them if I would have to pay again should he need his molars re-done and they insist I do, which is not fair considering he didn't make a full recovery and the whole off day/bad incisor trim that set him back by at least 2 weeks. They (lead vet) tried to justify it by saying they "tried their best," charge less than others, requires 2 people, anesthetics, and oxygen. When I brought up his incisors are still bothering him and needs another readjustment he wants to charge me (at a discount) for that, too. Granted, I didn't pay for the first 2, but his suffering was prolonged. The most terrifying part was the lead vet suggesting he may need sedation for incisor work or to get both back and front done while under sedation. The doctor that did the first 2 did not use anesthetics. They also want me to tell them where it meets in the middle... All of this over one of the most minor malocclusion cases that have gone through their doors (they admitted to normally seeing much worse).

So my questions...

He might be slowly losing against the growth of his back teeth, but I can't find info on how long it takes for them to grow. He seems to be maintaining them to a degree where he can still eat hay relatively well and is taking in more pellets recently (and I think he'll want more hay if he resolves his incisor itch), but how long can I realistically delay and hope he resolves it himself? Interested to see how much more he'll potentially improve after tweaking his incisors.

Is it better to try and find his incisor length gradually instead of hoping I get the "middle" right? or should I continue to let him go crazy with chewing on wood for him to correct it himself?

Any idea why he drops weight while off antibiotics? I know the side effect is appetite loss while on it, but it's not the case for him.

Any advice how to handle the vet charging me to essentially fix their mistakes? Is this what normally happens? Feels like I'll only pay more if I change vets now and may run into one that's worse as my other options had not as good reviews/doesn't appear as guinea pig experienced.

Any other thoughts/advice are appreciated. I have an appointment booked this friday for his incisors. Sorry for the lengthy post...

User avatar
Lynx
RESIST

Post   » Thu Aug 30, 2018 12:08 pm


You need to look into the chin sling. Write Pinta (member here) who invented it. Should help if the jaw is "crooked". Have her look at this thread (send her a link)
www.guinealynx.info/chinsling.html

Look at one example of normal incisor length. Note tips if they are cut too long:
www.guinealynx.info/teeth_broken.html

Antibiotics can affect appetite:
www.guinealynx.info/antibiotic_advice.html

Nonagp

Post   » Thu Aug 30, 2018 1:21 pm


His jaw never used to hang slightly open until after the dental work. Do you think it became loose due to the surgery? My vet also manipulated his jaw and said it was fine. Otherwise it does sound similar

The antibiotics page says they may stop eating while on antibiotics, but he does not and the weight loss occurs while off antibiotics. This is the part that confuses me.

I saw the broken teeth page. It covers broken and trimmed too short, but what about trimmed uneven? More was taken from the bottom vs the top. When i had them file the top a bit more after it grew back he can eat veggies with ease. It has been at least a week since and i was wondering if he would still correct the rest himself or file a bit more

Thanks for the quick response!

pinta

Post   » Thu Aug 30, 2018 3:19 pm


What infection were they treating - Flagyl(Metronidazole) is one of the best ABs for infections in the head area.

He needs xrays to rule out elongated roots and abscesses.

He should be sedated to have his molars properly trimmed. Trimming the incisors will do nothing to solve the problem as they are an indication the molars aren't grinding properly. If the incisors are trimmed to short the resulting gap could make him look like his mouth is hanging ajar.

From your description, he has an issue on one side of his jaw and he is avoiding proper molar contact. This will result in weakened jaw muscles on one side. He is young to have age related maloclussion. My guess would be he has an issue that hasn't been resolved on one side of his mouth. Brewing abscess or elongated roots.

You are probably screwed regarding payment to the vet. As much as I'd like to be reimbursed when a pig dies a couple of days after surgery, it ain't gonna happen. Just the way it is. And you don't want to make an enemy out of a vet in case they are your only option in the future.

Sounds like he just tolerates bactrim better than baytril - very common.

Hopefully the rescue vet will be better at dentistry. But he does need an xray and sedation to do a proper job. If he has elongated roots the tooth planing needs to be extreme (to the gums) and he will need another session in a few days(after the gums have receded to expose more tooth ) to ensure the teeth are planed to the gumline.

Nonagp

Post   » Thu Aug 30, 2018 5:48 pm


They didn't give me a clear answer when I asked how he got sick. Besides abscesses, how do I know it's a head infection? Do you recommend I ask about Flagyl and drop Baytril?

Yes, he was sedated to have his molars done. I just didn't agree with sedation for incisors. He didn't have any issues with his incisors until after the molar work. I knew enough that incisors should be left alone unless necessary. His response to the 45 degree angle being straightened out told me it was bothering him. Also, his mouth was hanging after molar work, but before the incisors were touched. After the incisors it just looked like he had no teeth

You are right about not making an enemy, which is why I kept it polite and didn't argue it much. Just seems wrong they can get away with not owning up to mistakes and he suffers more at the same time. They insisted it was elongated roots causing him to be unable to bite through veggies when I said it was too short (like I said he tears into veggies and he can bite through oxbow tabs after it grew back).

They said he tolerated the general anesthetic fine the first time (breathing/heart rate, etc) and besides his weight being only about 830g is in otherwise healthy condition. His initial molar work was done when he was 1070g. Trying my best to maintain and increase his weight. Is it currently still safe from your experience even though it's possible he still has some kind of infection on top of weight loss?

You've explained things so well, thank you! I will ask them for X-rays tomorrow on top of the slight incisor filing. I've read top and bottom grow at the same time so I'm just looking to balance the fact she took way more off the bottom than the top as I've given him time and it seems he's struggling to rebalance it himself.

pinta

Post   » Thu Aug 30, 2018 9:26 pm


I still don't know why he is on ABs? Are they just guessing he has an infection or do they actually know he has an infection?

If he has an abscess in the jaw area, it would be considered a head infection.

Is Baytril making a difference? Like humans it's best if he doesn't have to be on ABs at all. But if he does have an infection in his jaw, Flagyl is a great AB to use and it is very well tolerated by pigs.

You can file the incisors yourself with a glass nailfile. Glass is recommended over metal as it does a smoother job. But if you only file the incisors your are only treating the symptom, not the problem.

If his mouth is hanging open it's because: overgrown molars are propping it open; his jaw has become weak from disuse and can no longer hold his mouth closed; or he is avoiding closing his mouth due to pain issues.

Elongated roots usually affect the molars, more so than the incisors. Incisors grow at a faster rate than molars. Almost twice as fast.

Nonagp

Post   » Thu Aug 30, 2018 11:04 pm


Originally he wasn't on antibiotics, but it was after his follow up visit that he started drooling and became lethargic. So, as far as I can tell they don't know what infection, but assume he has an infection of some kind. It was after he was on antibiotics that he bounced back and was in much better spirits.

Since he lost a bunch of weight off of Bactrim and was put back on Bactrim (then he stabilized in weight), they decided to try adding Baytril to see if that would resolve what might still be ailing him. When I ran out of Bactrim and he had only Baytril for a few days his weight was stable and also gained a bit. Shortly after they said I could try stopping Baytril and again he dropped in weight drastically and was a little puffed up until he was back on Baytril. This is why I'm so confused about what may or may not be making him sick still.

I guess he left his mouth open for pain issues. It's not hanging open as wide anymore after he was able to grab/eat solid food on his own again.

That's extremely helpful about the Flagyl and molar growth speed, thank you!

My plan for tomorrow morning is get the X-rays done first to see if there are root/abscess issues. Then adjust incisors if necessary and if elongated roots are confirmed then to have the molars done again. I'm hoping they can avoid sedation for the X-rays instead of sedating him twice in a day especially considering his current condition...

Would he still need it done to the gum line twice if he has elongated roots? The first time there may have been a gap as half way through recovery time he started grinding (not chattering) and I read a post you had that suggested it's the molars touching. I understand the first extreme planing would be to relieve pressure, but what about the 2nd time?

pinta

Post   » Thu Aug 30, 2018 11:52 pm


The first time the teeth are planed to the gum, they aren't really. This is because the gums swell in a reaction to pain. So you have to wait a few days until the swelling has gone down and the gums have receded exposing more crown to get the molars planed to the gumline. This is necessary for elongated roots as the idea is to relieve excessive pressure while still having the molars in contact.

If he's doing better on Baytril than on Bactrim, keep him on Baytril. It's a wide spectrum AB which means it can be effective against more kinds of bacteria than Bactrim. It's possible for a pig to have an infection that involves more than one bacteria necessitating more than one AB. This is the benefit of a lab test - It can tell you precisely what bacteria you are dealing with so you can be guaranteed you're using the right AB. But you need something to test to get that info.

Make sure he's getting fluids. Lethargy is often an indication of dehydration. If he's drooling heavily, he's losing fluids. A pig in pain can also be lethargic.

At his age I would suspect an injury in the mouth that is the root of the problems(perhaps a hay poke?). If he was a senior pig I would be concerned about his heart as pigs who have trouble breathing have trouble eating as they have to make a choice between breathing and eating. The less they eat, the weaker the jaw muscles become from disuse resulting in an inability to exert enough pressure while chewing, to self-grind the molars.

Nonagp

Post   » Fri Aug 31, 2018 2:33 am


I see. Hope it’s not too severe if this is the case.

I’m not sure which AB he’s doing better on. The 2nd time he went back on baytril he seemed stable, but not as perky. Could be that his tummy was getting used to it again (soft/weird poops)? Bactrim was added back on and he perked up more especially when his tummy settled more (firm poops). Something like a swab from an abcess to test?

Think part of my struggle to put weight on is him being extra active now.

Good news is he stopped drooling since the first time he started AB. Even when he stopped ABs he didn’t go back to drooling. I still offer various ways to hydrate (bottle, dish, syringe)

Fingers crossed it’s simply just a hay poke! Would be so nice if he didn’t need more molar work.

I can’t wait thank you enough for all this info. Very helpful. Thank you!

pinta

Post   » Fri Aug 31, 2018 6:41 am


Hay pokes inside the mouth/throat area are a common way for abscesses to start.

They lose weight very easily but it is very hard to put the weight back on. I aim for a 2 ounce gain with every feeding just to try and keep the status quo.

Nonagp

Post   » Fri Aug 31, 2018 3:49 pm


Back with some very good news! Got the x-ray done and ruled out both elongated roots and head abscesses. My gut told me he didn't have elongated roots, but you're right to get confirmation. She also said other parts of his head looked good, no spurring of teeth still (he's maintaining). The only part that might be slightly questionable is one part of his jaw might be slightly thinner than normal, but no root issues of any concern.

As for the infection, I asked if it was possible for them to figure out what it was and she said she couldn't. Thinking maybe he recovered from the infection of a hay poke after all this time on ABs? They also mentioned the possibility of being on AB for a long time/life long due to how the gut responds to it. Is this a thing? He didn't need ABs up until he got sick and now his body's addicted?

For now I'm in no rush to take him off of it though. I want to focus more on getting that healthy weight back before I toy with it again. I'm thinking his metoclopramide will be the first to go as decreasing dosages have no ill effect on him (seems like he does even better with less actually!). She said we can still try reducing ABs later.

Also wondering how I could purchase the chin sling template from you?

Thank you!

pinta

Post   » Fri Aug 31, 2018 4:34 pm


Metoclopramide can be a life long thing. It isn't an AB - it helps move the gut. It's the first line of defense when stasis(gut stops moving) happens. Pain meds can be a lifelong thing.

Not aware of ABs being a lifelong thing. Problem is they kill off the good bacteria which can result is Stasis, necessitating the need for metoclopramide. When I had pigs on ABs longterm for "chronic" URIs it turned out the problem was a weak heart which can create the symptoms of a URI. Heart meds were the answer.

The most reliable visual sign of illness in a pig is puffing up(trying to stay warm) and snout in the corner(feels to crappy to interact).

Lethargy could be dehydration, weakness from heart issues, arthritis(hurts to move), inability to eat.....

Were they treating with ABs just in case the pig had an infection?

Nonagp

Post   » Fri Aug 31, 2018 8:40 pm


I only thought of motility drugs for not eating properly and didn't think about the affects of AB in that way. Good to know.

Every time he had a physical they didn't find anything that would link to an abscess. When he first showed illness he drooled (off/on), was puffed, avoided interaction/just sat there and did nothing, almost lost all appetite. It was a sudden change from being alert in the morning before/during his first follow up visit then suddenly that in the afternoon/evening. They suspected an infection of some kind for those symptoms and prescribed Bactrim. Hours later he really perked up.

Admittedly, I've been somewhat bad/inconsistent with hydration. Mainly, when I thought he was good/didn't care for it I took the dish of water out. Drinking from a dish is not normal for him and I never saw him use it that way until more recently. I thought that maybe he was getting enough from other ways like syringe and had been dipping some hay in water. On top of the fact it was risky as I know his cagemate loves to flip bowls

Perhaps it's moreso related to hydration now that you mention it...

However, when Bactrim was stopped the first time I didn't notice symptoms of illness, just weight loss. Then he went back on and the weight loss stopped. Then when he ran out of Bactrim - did good for a few days on just Baytril. Then stopped the Baytril, he seemed a bit puffy and lost weight, but otherwise alert/active. When he went back on, his weight stabilized. Maybe this is just water weight?

I kind of panic with how low his weight is already. Definitely going to keep a closer eye on how he wants to drink. I was far more focused on his teeth before. So far he's back to drinking from the bottle after his top incisor adjustment! He can still eat solid foods as well so I haven't messed that up at least

pinta

Post   » Fri Aug 31, 2018 10:57 pm


An average pig needs 60ccs of water daily(I think that's the right number - someone chime in if I'm wrong). A pig that isn't eating will also need fluids as well as food. I subcue in 20ccs at least once a day if all the nutrition is coming from handfeeding. Subcuing fluids is a lot easier that syringing and removes the risk of the pig aspirating if the fluids go in too fast orally. The hardest thing about subcuing is getting a needle into the skin. Rabbits and cats are like butter compared to pigs who can bend a needle their skin is so tough. Once the needle is in the hydrating is done within a minute. Your vet can show you how to do it. Make sure you get a 20cc syringe and a tube to attach to the syringe with the other end attaching to the needle. This will allow the pig some wiggling room while you are injecting. Impossible to hydrate a pig easily using the method used for cats and dogs where they are injected with fluid directly from the bag.

One thing some vets forget to do is warm the fluids in hot water to baby bottle temp before injecting(probably because they don't need to when hydrating cats and dogs). Room temp fluid will result in the pig spasming. I just hold the full syringe under hot running water until warmed sufficiently. The only thing a pig should feel when being subcued is the needle going in. If they react to the fluids the fluids are too cold or too hot. Oh and don't subcue in the same spot each time or you will build up scar tissue. You can inject the needle anywhere you can tent the skin(pulling it away from the body to insert the needle).

Nonagp

Post   » Fri Aug 31, 2018 11:37 pm


Thankfully he hasn't been completely dependent on me for food and water. Minus the initial illness he always had some kind of appetite. Even while on antibiotics he didn't lose appetite and actually continued to eat more. I've been generally intimidated with using a syringe to force anything in general, but I'm really glad I don't have to force him to drink water from a syringe. He tends to just lap it up on free will. The syringe I use for water is thinner than the bottle so it made it easier for him.

Based on my previous post does it sound like he had an infection in the beginning?

pinta

Post   » Sat Sep 01, 2018 6:11 am


I really couldn't say. His reaction to pain in his mouth could have looked like he was ill. The fact he's kept eating throughout everything does make me wonder if he did ever have an infection. Sick pigs usually don't have an appetite. Generally my vets will put a pig on ABs if there is an obvious sign of an infection such as blood in the pee, a temperature, crusty eyes, snotty snout, abscess (which is cleaned out as well as treated with ABs), puffed up and lethargic and not eating.

If dental work is done they'll be put on painkillers and ABs only if an infection was discovered.

A pig that is losing weight while still eating will have the teeth checked first and the heart listened to second. If the teeth are fine and the heart sounds iffy, heart meds will make all the difference in eating and weight gain. If it's not the heart or the teeth(and it could be both at the same time), an ultrasound could reveal an internal problem.

Blood tests at the start can also be helpful, pointing towards which organ might be having issues or even diagnosing diabetes. Diabetes causes weight loss while the pig still eats. Excessive drinking and weight loss are an indication of diabetes. Easy to maintain diabetic pigs with glyburide.

User avatar
Lynx
RESIST

Post   » Sat Sep 01, 2018 9:06 am



Nonagp

Post   » Sat Sep 01, 2018 11:09 am


Starting to think it was just pain related? I’m thinking he was still sore from the dental work and the scope in his mouth only exasperated the pain considering he had no indication of an infected site and he only started showing signs of possible illness after that. Looking back, when he started AB he also went back on metacam where drooling came to a halt.

She listened to his heart before and after and found no issues.

He doesn’t drink excessively. I’ve monitored him and the bottle water level. They don’t exceed the amount you described above.

Early on she felt a blood test wouldn’t help as he didn’t have issues with weight loss (minus when i stop ABs, but starting to think that was more my fault). He conveniently made a urine sample and his test result was perfect (no blood).

He is currently still gaining weight. I’m looking forward to stopping ABs with your insight. Thanks again!

pinta

Post   » Sat Sep 01, 2018 2:52 pm


Just a heads up - I'm going to be off the grid til Monday night so won't be checking emails.

Nonagp

Post   » Sat Sep 08, 2018 11:55 pm


Updating to say that he is doing very well. He is officially off both antibiotics and is gradually gaining weight while hand feeding is being reduced. Thank you again for the brainstorm - it really helped!

Only thing I can't seem to wrap my head around is the cause. My vet has cleared heart, teeth (now still maintained), jaw alignment/muscle, abscess, and even checked his ears. He does have a cagemate that enjoys picking up and flipping the ceramic food bowl though. So, thinking some soreness related trauma or perhaps a slight vitamin C deficiency that I need to give him more of?

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