Advice on Dental Problems

[lisacs]

My bunny has been struggling with dental problems for over a year now. He had a tooth abscess caused by a molar that was then removed. We had no issues for a while but then last October pus started to come out of his eye. An x-ray showed that his right, top molars are growing upwards into his jaw. We trim his teeth now, to relieve pressure but pus is still coming out of his eye. He was treated with antibiotics and antibiotic eye cream but these only helped in the short term (this was before we trimmed his teeth, though - maybe it would work better now? I've read Penicillin is effective to use with dental problems?).
The vet said we could operate and take his molars out but she doesn't really want to do it. She says the teeth would have to be taken out from the outside and it would be a very big procedure.
I don't really know how to decide and I really want to help him the best way I can.
I was wondering if anyone has had a similar situation and I am very thankful for any advice. Thank you!

This is what his eye looks like now:
He is eating normally and he seems to be doing ok for now (pain-wise)

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[RavenousDragon]

Oh smooshy faced rabbits and their never ending teeth problems. If it were me, I'd have the vet culture the pus to see what antibiotics will work against the infection (it may be resistant to the previous antibiotics). Trimming the teeth regularly should help, and removing them would also likely help. However, once an infection is seeded in a rabbit, it's very difficult to rid entirely. Have you done x-rays or a CT scan of his head to see where the pus is (e.g. is it in his sinuses, too?)?

 

[lisacs]

Yes, we have done an x-ray but the vet said she can't be sure what exactly causes the infection. Should we do a CT?
We have cultured the pus before and she then treated the eye with suitable antibiotic cream. I asked her if we should give him some antibiotic shot but she said it doesn't make sense to do it again. We will let them trim his teeth again on Wednesday and she will clean out the nasolacrimal duct. Maybe it would make sense to try antibiotics again? He hasn't had any antibiotics for at least 3 or 4 months now. Would the antibiotics be too tough on him?

 

[JBun]

I'm not sure why your vet says it wouldn't make sense to do the antibiotic shot again, unless your vet meant a specific one and is willing to try a different antibiotic. Your rabbit clearly still has an infection and I would think needs to be on some sort of antibiotic or the infection is just going to continue to worsen until it starts causing significant health issues.

Some rabbits are sensitive to certain antibiotics, so I don't know how your bun will react to any particular antibiotic. But as long as it's a rabbit safe antibiotic and given by the correct route(eg. some antibiotics aren't safe to give to rabbits orally), I don't think there are usually any problems. The biggest concern with rabbits and antibiotics, is it upsetting the gut microflora, as that can be dangerous to rabbits. So I always make sure my bun is eating tons of hay, don't feed sugary starchy foods, give benebac probiotics, and keep a really close eye out for mushy poop/gurgling stomach(go to the vet immediately and get bun on metronidazole and questran). Antibiotics usually need to be given for 1-2 months or even longer as infections in rabbits can be difficult to clear up. I've known of rabbits with head infections/abscesses, that have had to remain on antibiotics long term, changing up the antibiotic when the previous one stops being effective. It's not ideal, but sometimes it's the only option to keep the infection under control when it won't clear up completely.

Antibiotics can sometimes work successfully when surgery isn't an option. There was a study done using pen g procaine/benzathine injections(injection only, never orally) in rabbits, that showed good results, but will only be effective if the bacteria involved is sensitive to it. Pen g injections are usually well tolerated in rabbits as long as none gets ingested orally, but there is always a chance of a negative reaction occurring, as there is when any medication is used. You can get pen g from your vet, but it's also available online, and may be cheaper to get this way. Just make sure to get the right one(procaine and benzathine). I would use the Combi-pen brand myself. Here's the pen g study if you want to take a look.
http://people.umass.edu/~jwmoore/bicillin/bicillin.htm
http://www.bio.miami.edu/hare/jawabscess.html

Another antibiotic that I've heard can treat head infections well, is azithromycin. It would be given orally. Though you do need to be aware that in some rare instances it can cause severe digestive complications.

This link also has some useful info on head infections.
http://www.medirabbit.com/EN/Dental_diseases/Treatment/Facial/abs_dental.htm