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Eating Problems Following Tooth Infection - Running Out Of Ideas...

Rusholme

Rusholme

Junior Guinea Pig
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Hi,
I'd appreciate any suggestions/suggested diagnosis for our gp who has had a bit of a roller coaster these past 3 weeks. We're running out of ideas for what to do next.

He had an infection of lower left incisor, which was removed. He is currently taking antibiotics for the ongoing infection/osteomyelitis. However, he is still not really eating or drinking on his own, but when he does it looks likes there's something very strange going on with his eating mechanics - he suddenly opens his mouth wide and moves his head around (see video link below). This happens both when being syringe fed and also when he does have a go at a leaf on his own. A CT scan has shown nothing wrong with the jaw or teeth (except for the osteomyelitis - which the radiographer believed is not so extensive that it would prevent him from eating) and several guinea pig specialist vets can't find any obvious problem from feeling around his face/jaw or looking in his mouth.

Current drug cocktail:
vetergesic, marbocyl, metacam, +syringe feeding

Link to video:
https://photos.app.goo.gl/D7RtM74kiG1SkL5v1

Please note, on the video he does eat strangely to begin, we think this is because he's missing a tooth and needs to get accustomed.

Any suggestions on what could be causing this strange eating/mouth gaping would be greatly appreciated!
 
I should add, he only very occasionally eats by himself, maybe a couple of bites every few days - he is being sustained almost entirely by syringe feeding.
 
I had a guinea pig who did something similar a few years ago. He also had a strange way of walking due to osteomyelitis. The x rays showed nothing wrong but when the vet examined him while eating his jaw wasn't
properly aligned and kept clicking out of place. Sadly I had to have him put to sleep as he ended up not being able to chew and would have starved. Hopefully treatment has improved now. Hope you can find out what is happening. Wishing a good outcome for him.
 
I am in a similar position with our boy although our vet is hoping to be able to save all his teeth. Although we are still currently stuck in a horrible limbo situation not knowing whether we will be able to successfully treat the issue enough for decent quality of life or whether we will have to put to sleep. We are awaiting lab results to find out what bacteria the infection is to decide which is the best antibiotic. He's currently on co-trimiprazole or something like that and has been for about two weeks while we wait for the results. He's also on meloxicam and since the last few days, vetergesic, which we've seen a big improvement in his general demeanour, appetite, and ability to eat more independently and faster since he's been on the vetergesic. How long has he been on this antibiotic? It may be that it's not the correct one or not the only one needed to treat the infection if it's still present? Could discuss with vet possibility of taking a culture and sending to lab to see what bacteria is there?

To be honest given everything you've said I think it sounds the most likely explanation is that he is in some pain somewhere - this could explain the difficulty eating but also the loss of appetite, him not eating himself. Our pig went a bit like this and then we put in the vetergesic and now he's doing a lot better so clearly the pain was really affecting his eating. If the pain can't be managed appropriately with all that medication you may really need to consider whether there is a future for him :(
 
Well done for getting such a clear video - what a cutie! I’m no expert, but it almost looks like he’s trying to move something around at the back of his mouth.
 
Thanks for all your thoughts.
He went to see a (different) gp/rabbit specialist again yesterday. She has established that the infection looks to have mostly cleared up (he was on AB for 3 weeks to clear that). Also she confirmed there appears to be nothing wrong with his molars.
Her initial assessment is that his jaw is dislocating, which may have been caused by the mouth spreaders used during the first surgery (although obviously it will be difficult to determine the real cause of that). She also noticed that his single lower incisor is now positioned slightly in front of the top incisors, which could also indicate there has been some movement in the jaw. That may also explain his difficulty eating.
He has gone for observation and x-rays today, to try and finally determine what the cause of these problems is. Also she will slightly file the lower incisor to remedy that problem.
I agree @Maddykins we need to consider whether he will have any real quality of life going forward. Hopefully we will be in a better position to make an assessment later today.
 
Hope you have some answers now. I know how awful it is especially just being stuck in a limbo not knowing what is going on and so being unable to make informed choices.
 
well we have some answers of sorts...
Frustratingly, x-rays didn't reveal much other than the fact his oral cavity looks larger than normal. This, combined with the fact that his lower incisor has now moved in front of the uppers could indicate there has been some movement in the jaw. The vet also studied him eating and played gently with his jaw while under anesthetic, and her opinion is there is some 'slackness' that allows side-to-side movement of the jaw.
From her experience of piggies that have damaged jaws following surgery it could take ~6 weeks to heal. I'm not exactly clear on what will 'heal', but my understanding is that the jaw is held in place by surrounding tissue (rather than ligaments) and that tissue could have been damaged.
So he is now on metacam as an anti-inflammatory and it's just a matter of waiting and hoping it begins to heal. We've started feeding him with emeraid, which is apparently a better choice for long-term feeding. But it is still a real battle keeping his weight up at the moment :(

I know it's a long shot, but I saw a thread from 2010 who recommended Simon Maddock in Northampton as a good dental vet. Does anyone know if he is still around/in practice? At this stage we'd be willing to try anything to help our little guy. The only other option we have would be referral to Edinburgh University, but the cost of that would be too much for us :(
 
...I've checked on google on Simon does still practice in Northampton. That might be an option worth considering :)
 
if you are able to travel.the best treatment for diagnosing and treating dental issues is at the cat and rabbit clinic.it is still very much in demand.:)
 
Simon is amazing! He is the vet we use here at TEAS and in fact TEAS wouldn't exist without him. He has worked wonders with all the guinea pigs who come to us here with dental disease. People travel the length and breadth of the country with their piggies with dental issues, to see him! Please consider making the journey to see him, as I can promise you, it will be well worth doing.

www.catandrabbit.co.uk
 
Thanks for the recommendations and good wishes. We have contacted the Cat and Rabbit clinic and are sending details of the case over, to see whether it is something Simon could help with. Fingers crossed :)
 
Update: My wife spoke to Simon today, who after watching the video above thinks the current diagnosis could be wrong. We have an appointment with him on Monday! I'm quite excited to think we may finally get to the bottom of this and be able to help Pendleton! :)
 
Simon is amazing, he and his wife Kim have helped so many of my pigs over the years and recently provided round the clock care to my Dulcie. If anyone can sort out a dental issue it is Simon, he sees so many dental pigs each week. My Sophie and Barley both also had an infected lower incisor, they were on Zithromax for a while which cleared it and then they had dentals about every 6 weeks to deal with any alignment issues (they only had one lower incisor by that point) and the back teeth. Hope all goes well on Monday.
 
Just wanted to give a quick update, in case this info is of use to anyone else.
Pendleton went to see Simon on Monday (a 6 hour round trip!), and he was able to identify that the back molars were overgrown with spurs and the front incisors were also overgrown. I have no idea how the previous 4 or 5 vets, CT scans and x-rays failed to spot this, but maybe it's very subtle and difficult to notice! Simon is obviously very good with these dental problems!
I'm pleased to say that Pendleton was eating veg again later the same day, which was a huge improvement compared to last week (and a huge relief!). We have been able to get his weight up by ~100g with the help of syringe feeding. He is still finding it difficult to eat a lot of foods, but seems to be okay with large leaves. I think part of the problem is that he now only has 1 lower incisor and he lacks the precision to pick up hay.
Anyway, he needs to go back after 2 weeks for some further work. Hopefully that will help him improve even more! I really want him to start eating hay again so we can stop syringe feeding him and so I can get some sleep!
 
Fantastic news! Simon is awesome and the results he achieves are amazing. I just find it very disappointing how so many vets just want to carry out expensive tests, but don’t actually do anything practical to sort out the problem. There are so many very dedicated owners, who are being let down badly. A very sad situation x
 
he does eat grass, but nowhere near enough to sustain his weight, so we are still syringe feeding. He ate a few pellets this morning - the first for over a month! Progress is slow, but better than no progress!
 
Glad he's doing well! A lot of vets are just not that experienced with guinea pig teeth and don't spot problems. Having a specialist vet can make all the difference!
 
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