INCIDENCE AND MANAGEMENT OF PERIEPICAL ABSCESS DUE TO CHRONIC INFECTION IN TEETH IN SLOTH BEARS Melu

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LESSONS LEARNED DENTAL TREATMENT OF RESCUED
DANCING SLOTH BEARS (Melursus ursinus) AND TIGERS
www.wildlifesos.org Dr.Arun A Sha, MVSc Lisa
Milella, Paul Cassar, Jonathan Cracknell, Alan
Knight
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Dancing Bears of IndiaPreliminary Study
1995-1997

• Practice prevalent for the past 300-400 years.
• 1200 Sloth Bears were being made to dance on
  the street by nomadic Kalandar Tribe.
• Sloth Bear cubs poached from the wild, mother
  bears killed.
• Protected under Schedule I of Indian Wildlife
  (Protection) Act, 1972
• IUCN Status- Vulnerable
• CITES-Listed in Appendix 1 .

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COMMON DENTAL DISEASES OF RESCUED DANCING BEARS

• STATUS OF TEETH IN DANCING BEARS
• Canines (fractured)
• Incisors (abrasion and fractured)
• Premolars (fractured, caries lesions)
• Molars (caries)
• ROOT CANAL PROBLEM OF CANINES
• GIGANTIFORM CEMENTOMA
• A benign fibro-cemento-osseous lesion around the
  apices of vital teeth causes severe disfigurement
  of the jaws.
• OSTEOBLASTOMA Giant osteoid osteoma
• DEVELOPMENTAL DENTAL DISORDERS

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SLOTH BEAR DENTAL FORMULA

• I 2/3 C 1/1 PM 4/4 M 2/3

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DENTAL RECORD
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ANAESTHESIA
XYLAZINE AND KETAMINE, HALOTHANE GAS VIA 18MM ET
TUBE
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ANAESTHESIA

• Intra-operative fluids given to all bears
• Vital Parameters are continuously monitored
  throughout the procedure
• Heart Rate
• Temperature
• Respiratory Rate
• Oxygen Saturation

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ET-INTUBATION
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AFTER ET-INTUBATION
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EXAMINATION
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DENTAL EQUIPMENTS
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PROBLEMS IN CANINE TEETH
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PROBLEMS IN CANINE TEETH
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MALOCCLUSIONS
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PROBLEMS IN CANINE TEETH
Draining sinus tracts
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INCISORS

• Many incisors had pulp exposure
• Some were fractured
• Most probably due to abrasion
• Therefore extracted

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MOLARS PREMOLARS

• Fractured premolars
• Caries lesions

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• Histopathological analysis showed gingival
  recession and calculus showed enamel dysplasia

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DENTAL RADIOGRAPHY
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DIAGNOSIS

• Decision to perform
• Extraction or
• Root Canal treatment based on clinical
  examination and radiographs

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Surgical Extraction of Upper Canine
EXTRACTIONS

• A muco-periosteal flap was raised from the medial
  aspect of 104 to distal 106.
• Buccal bone was removed using a no.8 high-speed
  round bur with sterile water for cooling.
• The tooth was luxated and then elevated using an
  8mm winged luxator and couplands no.3 elevator.
• The socket was debrided and then the flap sutured
  using monofilament absorbable 4/0 suture
  material.

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EXTRACTIONS
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EXTRACTIONS

• Dilacerated roots
• Resorbing roots

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EXTRACTIONS

• Debrided the sockets well
• Did not pack
• Sutured with monocryl 4/0
• Absolutely tension free due to suction force

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POST-EXTRACTION
HEALED TISSUE
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ROOT CANAL TREATMENT

• Most teeth had necrotic pulps
• All teeth with vital pulps had been fractured for
  a minimum of 3 yrs

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ROOT CANAL TREATMENT

• All except 3 teeth were less than 60 mm WL so
  standard veterinary length hedstrom files were
  used.
• Access was directly through fracture site

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ROOT CANAL TREATMENT

• Flushed with 5.25 NaOCl
• Dried with pipe-cleaners and paper points

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ROOT CANAL TREATMENT

• Filled with sealopex using a veterinary length
  lentulo.
• Paste syringed in initially due to volume

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ROOT CANAL TREATMENT

• Restored with glassionomer (chemical cure)
• Final restoration - amalgam

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MULTIPLE ENDO AND TIME CONSIDERATION
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RECOVERY

• The bears were carried back to the dens.
• Most bears were up within 30 minutes

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CASE STUDY 1
A 14 year old male bear weighing 115 kgs was
found having a large mass on the left upper jaw.

• Diagnostic imaging done.
• Extraction performed.
• Excised tissue subjected to histological
  examination and found to be a cementifying
  fibroma.
• Post-operative monitoring of bear done.

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Extraction of Lower Canine

• An incision was made from the medial aspect of
  the mass in a distal direction along the
  muco-gingival junction to the lower canine.
• The mass on the lower right rostral mandible was
  excised.
• Another incision was made on the lingual aspect
  of the mass.
• An osteotome and chisel was used to remove the
  calcified mass together with the lower incisors
• The flap was then extended to the distal canine.
• The lower canine was then extracted.
• The flap was sutured with monofilament absorbable
  4/0 suture material using a simple interrupted
  pattern.

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REMOVED FIBROUS MASS

• Dimensions of Incised bony mass
• 4 x 3 x 2.5 cm.
• On slicing a part of the canine teeth
• was also seen.

AFTER HEALING
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HISTOPATHOLOGY FINDINGS

• Chronic inflammation of hyperplastic squamous
  lining epithelial cells.

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HISTOPATHOLOGY FINDINGS

• Fibrocollagenous tissue showed
• Islands of irregular cementum formation
• Rimming of cells observed

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DISCUSSION FOR CASE STUDY 1

• The lesion
• may be solitary or
• occur in multiples.
• The initial lesion is a periapical proliferation
  of benign fibrous connective tissue in the
  periodontal ligament.
• There are no symptoms and x-ray shows a
  periapical radiolucency ordinarily not exceeding
  a centimeter.
• Cementum is slowly formed in the central area and
  the entire lesion becomes converted to a
  mineralized mass that appears radio-opaque on
  x-ray.
• Often a thin radiolucent halo persists around the
  circumference of the opaque lesion.

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PERIAPICAL ABSCESS
CASE STUDY 2

• An abscess is an abnormal cavity containing pus.
  
• The cavity is formed in tissues, due to local
  suppurative inflammation. Infection around the
  apex of a tooth leads to periepical abscess
  usually its secondary to periodontal or
  endodontic disease and its characterized by
  acute, sever painful swelling in the area of the
  affected tooth.

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Ventral aspect of the lower jaw of Tikku
Bear (Left) and Chotu Bear (Right)
The opening of Periapical abscess fistula from
the infected canine
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DENTAL RADIOGRAPHY
Radiograph showing Periapical Abscess of the
infected lower right canine of Tikku bear (left)
and Chotu Bear (right).
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• Infected Root Canal of Lower Right Canine(s) (Red
  Arrow) of
• Tikku Bear (Left) and
• Chotu Bear (Right)

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EXTRACTION PROCEDURE
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DENTAL ELEVATION
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DENTAL DRILLING

• The alveolar bone overlying the buccal surface of
  the tooth root was removed by using dental drill
  with the help of dental luxators and elevators.
• The attachment between tooth and periodontal
  ligament was detached by the way of gently
  working around the circumference of the canine.
• The canine was extracted out using extraction
  forceps by gentle pulling towards the direction
  of tooth curvature.
• The mucoperiosteal flap was replaced to close the
  extraction socket by simple interrupted sutures
  with absorbable polyglycemic acid mersuture, thus
  allowing primary healing.

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AFTER EXTRACTION
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POST OPERATIVE CARE

• Systemic administration of a broad-spectrum
  antibiotic injection Benzathine penicillin and
  non-steroidal anti-inflammatory injection
  Meloxicam given for five days.
• To reduce further complication and pain the bear
  was feed with only semisolid wheat porridge with
  boiled milk and multi vitamin supplement after
  cooling for five days.
• The animal made an uneventful recovery with out
  any complication and start consuming fruits and
  solid food after complete recovery.

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ETIOLOGY OF DENTAL DISORDERS IN BEARS

• When the canines teeth first erupt, many gypsies
  deliberately smash the teeth to disarm the bear
  and make them look less aggressive for tourists.
• It is not known at what age their teeth had been
  fractured, but mostly all four canines and most
  incisors were fractured and had necrotic pulps.
• The sloth bear was fed a combination of soft
  dietary ingredients that is taken in by a sucking
  action.
• Traumatic condition caused by the Kalandars by
  brutally breaking the teeth with iron chisels and
  stones in order to avoid biting while make them
  to perform.

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DENTAL SURGERYON TIGERSKarnataka, India
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DENTAL SURGERY-TIGERS
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Next day
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MOHAN POST-OP
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MANEKA POST-OP
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Thank You
Wildlife S.O.S
and
International Animal Rescue
www.wildlifesos.org
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Open for Discussion