Malocclusion

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alpayton

alpayton

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Copied from Chincare

MALOCCLUSION
Since 2001 we've treated eleven maloccluders in addition to many cases of only mild to moderate calcium deficiency. Our input in this section (where other sources are not cited) is based largely on our personal research and experience as well as feedback from others we've advised in the course of our rescue/ re-homing work.

Defining Malocclusion
Malocclusion, according to Dictionary. com, is defined as: "faulty occlusion; irregular contact of opposing teeth in the upper and lower jaws." Common usage in the pet chinchilla community differs somewhat from the actual definition of "malocclusion," being used to indicate a condition of overgrowth of the teeth, either root or crown elongation, in either the incisors or molars, regardless of misalignment but not excluding it.
In other words, the common usage focuses more on the problem of overgrowth than misalignment, probably because misalignment in itself isn't normally a significant problem, it's overgrowth that makes malocclusion fatal. Misalignment and overgrowth are actually very closely linked, overgrowth is often the precursor to misalignment. Our use of the term, "malocclusion" on this site leans more toward the common use of the word.

"Molar spurs," "burrs," or "points" are terms that all indicate the same thing- overgrowth, or elongation, of the back teeth above the tooth crown.

Malocclusion has three potential causes: genetic (hereditary), accidental (as with a chin who broke his upper incisors clean off as a kit, see photo) or environmental (brought on by calcium deficiency, inadequate tooth wear). Maloccluders of a genetic of environmental kind should NEVER be bred, they must be considered NFB.

Malocclusion Articles and Photos
ARTICLE BY DR. KEFFER, CHIN~VET Chinchillas are hypsodonts, meaning that they have continuously growing incisors and molars. If the teeth are not properly worn down by constant chewing of coarse material, they can overgrow. Instead of growing out of the mouth like we see with some rabbits and guinea pigs, the teeth actually reverse their direction and will grow from the roots. This means that you may not see the signs of tooth overgrowth until it is to late. The roots will grow up into the facial sinuses and even into the orbit (eye socket). Clinical signs such as runny eyes and protrusion of the eye will occur.

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EXCERPTS FROM: "DENTAL SURGERY TO CORRECT MALOCCLUSION" html/ .doc BY AZURE CHINCHILLAS
After a lengthy conversation with the vet (who is an acknowledged “exotics” expert) – that one of my chinchillas has been referred to for specialised dental work - I was told the following – which I think may be of interest. He explained that dental overgrowth (malocclusion) – as we all know – affects the grinding surfaces of the teeth, causing them to over-grow, misalign and form spurs and sharp edges that cause the chinchilla much discomfort and difficulty eating. This can affect any teeth, incisors, pre-molars and molars.

The usual treatment for the affected grinding surfaces is to have them filed or clipped down whilst the chinchilla is under anaesthetic. However, malocclusion can also affect the roots of the teeth too (this shows up well on X-rays). With the upper teeth – they over-grow upwards into the skull and towards the eye orbits - firstly occluding the lachrymal ducts and causing weepy eyes. With the lower teeth, they can over-grow downwards, into, and out of, the lower jaw. The lower tooth roots grow much faster than the upper ones. Understandably this root elongation causes the chinchilla to suffer from chronic “jaw-ache” which may prevent the chinchilla fully recovering, even though they may have had surgery to correct the grinding surfaces.

EXCERPT FROM "CLINICAL APPROACH TO THE CHINCHILLA"
BY HEIDI L. HOEFER, DVM, DABVP: ATLANTIC COAST VET CONFERENCE
Improper dental wear can result in overgrown teeth and sharp edges in both the incisors and cheek teeth. Clinical signs include weight loss, inappetance or anorexia, and drooling or "slobbers." Some chinchillas present with increased lacrimation (eye tearing) on the affected side.

Diagnosis is based on clinical signs and a thorough oral examination. An otoscope with a light source can be used to check the cheek teeth. Human nasal speculums are available with a light source that attaches to the otoscope handle for easier observation of the cheek teeth (Welch-Allyn bivalve nasal speculum #26030). Sedation may be needed to fully examine the cheek teeth. Skull radiographs are important to examine the occlusal (crown) surfaces as well as the roots.

Tooth root elongation and crown extension is a problem seen in some chinchillas on a low roughage diet. Pellets, grains, and most vegetation do not provide adequate chewing to wear down the cheek teeth properly and crown and root extension can occur. The roots form palpable "bumps" on the mandible and are readily seen on radiographs. Oral examination may show a somewhat normal occlusal surface and lack of points or ulcerations, although points can occur.

Treatment involves trimming of the sharp edges or overgrown teeth. A small bone rongeur (Lempert) or drill (dental or Dremel) can be used to file points. Tall crowns need to be burred down to the gum line and may be repeated every 6-8 weeks. Antibiotics are indicated for root abscesses and carries a very guarded prognosis for full return to function.

Owners should be aware of the likelihood of recurrence, the need for regular dental care, and the long term poor prognosis. This condition is irreversible and may result in chronic weight loss and painful mastications. These individuals are usually on syringe feedings indefinitely, which exacerabates the lack of wear on the crowns. Euthanasia is often recommended for these chronically painful individuals.

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Symptom Progression of Malocclusion

While incisor elongation can be readily observed without veterinary equipment, molar spurs are at the back of the mouth (WAY back) and require the use of a veterinary otoscope, which reveals protrusions that are sometimes pointed or growing at an angle toward the inner cheek. If allowed unchecked overgrowth, incisors will grow in a curved and tusk-like fashion, eventually piercing the sides or roof of the mouth and molars will likewise overgrow until they eventually pierce the inner cheek. Molar root elongation in the lower jaw can sometimes be felt protruding from the lower jawbone, but it takes an experienced touch to know what's "normal" and what isn't.

All symptoms are NOT equal! They are ordered here to show that malocclusion is a progressive problem that occurs IN STAGES. Malocclusion is not always a "death sentence," it may be reversible in the initial and mid stages with intensive calcium supplementing among other things, see Supplementing Calcium and Implementing Environmental Changes. If you think you see one of the final symptoms of malocclusion, like watery or discharging eyes and there have been no preceeding symptoms, then you may not be dealing with a case of malocclusion at all, your chin may simply have an eye irritation.

The FIRST thing you should do if you suspect a case of malocclusion is to GET A HEAD X-RAY!

Don't wait for your exotics specialist vet to suggest one! They may not think to mention it and a head-x-ray is the ONLY WAY to be certain that malocclusion is indeed what you're dealing with and to discover how far it has progressed, and whether the chin may benefit from immediate treatment or require euthanasia.

For instance, it's not uncommon for a vet to treat the immediate and obvious, like clipping incisor overgrowth or a molar spur, when if he had done a head x-ray and seen that the chin's malocclusion had already advanced to the point where euthanasia was required, it would have spared both the chin and the chinparent a lot of agony and expense in the long run. DON'T resign yourself and your chin to a sentence of irreversible doom if you suspect malocclusion, DO get a head x-ray to know how to proceed in the best interests of your pet!

If a chin with malocclusion is physically able to feed himself he should be allowed to do so for the sake of getting proper tooth wear! If he can't, he'll require handfeeding.

INITIAL SYMPTOMS INCLUDE:
At the very earliest stage there are NO externally manifest symptoms and only a yearly or bi-annual head x-ray will be able to detect if the tooth roots are just beginning to overgrow or become misaligned. When initial symptoms become evident they include: Crumbled pellets, eats less hay (pellets are soft food, hay requires more biting and grinding effort) pawing at the mouth, disinterest in gnawing, difficulty using the water bottle that results in a wet front, tooth elongation of crown in either the incisors or back teeth (molar spurs), incisors with clear, white or yellow tooth enamel (indicating calcium deficiency).

Get a head x-ray, this will serve as a reference point for follow-up head x-rays to determine if treatment was effective. If the chin has only initial symptoms, chances are very good that after an incisor trim or molar clipping he'll be on the road to recovery because when caught early, malocclusion can be receptive to treatment and even reversible.

If the chin's teeth are a bit sore as a result of having his overgrowth removed he may benefit from some handfeeding or supplementing for a few days following his vet visit. As soon as a maloccluder can eat on his own, though, it's important that he be allowed to so because his teeth need proper wear to prevent overgrowth and more malocclusion.

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MILD TO ADVANCED SYMPTOMS INCLUDE:
Weight loss due to inability to eat normally, pain during eating, possessiveness of food dish, selective eating (prefers soft food like a grains mix to pellets), pawing at mouth with fur worn away from paws and chin as a result, will not gnaw chew toys and eats little to no hay, hunched painfully or huddling with cagemates for warmth (due to loss of weight and body fat), small droppings (from inadequate food intake or selective eating), some whitish discharge around eyes (stress reaction), soiled or damp paws, mouth and chest from drooling or "slobbers" (drool and soiled fur may smell; chins may also drool from other dental disease that is not malocclusion) and desperate, often futile attempts to eat. Molar root elongation in the lower jaw may be present, and although it takes an experienced touch to know what's "normal" and what isn't, the overgrowth is evidenced by small, spikey bumps at the very back of the jawline.
At the mid to advanced stage the malocclusion is causing some pain and interfering with the chin's quality of life, his ability to eat and behave normally. A head x-ray is IMPERATIVE, without that it's impossible to know for certain whether there is still a chance for treatment or if the final symptoms are present and euthanasia is the only merciful option.

What determines whether malocclusion requires euthanasia is how far the roots of the teeth in the UPPER jaw have progressed toward the ocular or sinus cavities. If the roots are already invading those areas, there is nothing more that can be done to treat or relieve the suffering and euthanasia prevents the chin from lingering in horrible pain and hunger until imminent death.

FINAL SYMPTOMS ARE:
A very distinct, palpable protrusion under the lower jaw that indicates that molar root elongation in the lower jaw has grown substantially past the jaw line, watery or discharging nose or eyes that indicate that the roots of the teeth in the upper jaw have overgrown right into the ocular or sinus cavities- please note that MOST of the time when a chin has ONLY watery or discharging eyes WITHOUT the other preceding symptoms of malocclusion, that he's merely experiencing an eye irritation.

Once root overgrowth in the UPPER jaw has progressed into the occular and sinus cavities, euthanasia is unfortunately unavoidable. But there is no way to be CERTAIN that this has happened without a head x-ray! Even the root overgrowth in the lower jaw doesn't bode the same problems that occur when the tooth roots of the upper jaw are pressing into the ocular and sinus cavities, although overgrowth in the lower jaw is usually an indication that the upper jaw roots have also extended considerably.
 
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