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

“Dancing Bears of India”

Preliminary 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 .

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

COMMON DENTAL DISEASES OF RESCUED DANCING BEARS

SLOTH BEAR DENTAL FORMULA

I 2/3 C 1/1 PM 4/4 M 2/3I 2/3 C 1/1 PM 4/4 M 2/3

DENTAL RECORD

ANAESTHESIA

XYLAZINE AND KETAMINE, HALOTHANE GAS VIA 18MM ET TUBE

ANAESTHESIA

Intra-operative fluids given to all bears

Vital Parameters are continuously monitored throughout the procedure

– Heart Rate– Temperature– Respiratory Rate– Oxygen Saturation

ET-INTUBATION

AFTER ET-INTUBATION

EXAMINATION

DENTAL EQUIPMENTS

PROBLEMS IN CANINE TEETH

PROBLEMS IN CANINE TEETH

MALOCCLUSIONS

Draining sinus tracts

PROBLEMS IN CANINE TEETH

INCISORS

Many incisors had pulp exposure

Some were fractured Most probably due to abrasion Therefore extracted

MOLARS & PREMOLARS

Fractured premolars

Caries lesions

Histopathological analysis showed gingival recession and calculus showed enamel dysplasia

DENTAL RADIOGRAPHY

DIAGNOSIS

Decision to perform

* Extraction or

* Root Canal treatment based on clinical examination and radiographs

Surgical Extraction of Upper Canine:

– 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.

* EXTRACTIONS

* EXTRACTIONS

* EXTRACTIONS Dilacerated roots Resorbing roots

* EXTRACTIONS

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

suction force

POST-EXTRACTION

HEALED TISSUE

* ROOT CANAL TREATMENT

Most teeth had necrotic pulps

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

* 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

* ROOT CANAL TREATMENT

Flushed with 5.25% NaOCl

Dried with pipe-cleaners and paper points

* ROOT CANAL TREATMENT

Filled with sealopex using a veterinary length lentulo.

Paste syringed in initially

due to volume

* ROOT CANAL TREATMENT

Restored with glassionomer (chemical cure)

Final restoration - amalgam

MULTIPLE ENDO AND TIME CONSIDERATION

RECOVERY

•The bears were carried back to the dens.

•Most bears were up within 30 minutes

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

CASE STUDY 1

•Diagnostic imaging done.

•Extraction performed.

•Excised tissue subjected to histological examination and found to be a cementifying fibroma.

•Post-operative monitoring of bear done.

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.

REMOVED FIBROUS MASS

AFTER HEALING

Dimensions of Incised bony mass = 4 x 3 x 2.5 cm.

On slicing a part of the canine teeth

was also seen.

Chronic inflammation of hyperplastic squamous lining epithelial cells.

HISTOPATHOLOGY FINDINGS

HISTOPATHOLOGY FINDINGS Fibrocollagenous tissue showed:

Islands of irregular cementum formation Rimming of cells observed

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.

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.

PERIAPICAL ABSCESS

CASE STUDY 2

Ventral aspect of the lower jaw of Tikku Bear (Left) and Chotu Bear (Right)

The opening of Periapical abscess fistula from the infected canine

Radiograph showing Periapical Abscess of the infected lower right canine of Tikku bear (left) and Chotu Bear (right).

DENTAL RADIOGRAPHY

Infected Root Canal of Lower Right Canine(s) (Red Arrow) of Tikku Bear (Left) and Chotu Bear (Right)

EXTRACTION PROCEDURE

DENTAL ELEVATION

• 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.

DENTAL DRILLING

AFTER EXTRACTION

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.

POST OPERATIVE CARE

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.

ETIOLOGY OF DENTAL DISORDERS IN BEARS

DENTAL SURGERYON TIGERS

Karnataka, India

DENTAL SURGERY-TIGERS

Next day…

MOHAN POST-OP

MANEKA POST-OP

www.wildlifesos.org

Wildlife S.O.S

Thank You

International Animal Rescueand