VN October 2023

Oktober 2023 39 Dental Column Until we can find a better estimate of Expu, I always advise having a veterinary dentist involved with the procedure (preferably one with experience in elephants or tusk anatomy) to address any inadvertent exposure immediately. Personally, I would shorten a tusk with the utmost care and often do it incrementally – especially if you are trying to remove a crack (Fig. 4). What to do in the case of pulp exposure? It is important to always make sure of your diagnosis. Elephant tusks have a very small discoloured canal that runs in the centre of the tusk distally from the terminus of the pulp. This is compaction of the soft tissue of the pulp that gets trapped in the developing tusk. When you amputate the tusk in this area, there may be a black discoloured hole that is devoid of dentin in the central portion (Fig. 3). Even though this is connected to the pulp, there is no report in the literature to show this may cause pulpitis. Further research is needed to elucidate the relationship of the living pulp with this central canal. Importantly, this canal is not uniformly present in elephant tusks. The presence of blood will be the determining factor if the pulp is exposed. If blood is present, a partial pulpectomy should be performed as a matter of urgency (Fig. 2). The longer the pulp is exposed the higher the risk of infection and the poorer the prognosis to save the tusk. This pulp exposure may or may not be associated with pain. I will however always advise anti-inflammatory treatment for the first day and until the partial pulpectomy can be performed. The benefit of systemic antibiotics in these cases is highly questionable, as we know systemic antibiotic use does not improve the outcome of endodontic treatments in humans (3) or dogs (4). In fact, in dogs where no antimicrobial treatment was used, showed a higher success rate compared to those having had antimicrobials just pre-operative or those having had antimicrobials pre-operative and 10 days post-operative (4) Initially the exposed pulp is only contaminated, but after 24-48 hours bacteria will have colonised the exposed pulp and start multiplying leading to infection. If the surgery will not be performed immediately, flush the exposed pulp twice daily with an appropriate flushing agent like lactated Ringer’s solution. Try to remove the animal from areas where they will have access to faeces/mud/sand which they can use to soil the exposed pulp. Success of partial pulpectomies. Partial pulpectomies, especially those done at the time of exposure are more successful than those performed days/weeks/months after the insult. This is also true in dogs where the prognosis reduces drastically for success, with every 24 hours that pass. Tusk shortening (amputation) should be considered carefully before it is performed. A team needs to be consulted including colleagues with diagnostic imaging interests as well as a veterinary dentist. Reasons for shortening the tusk must be clearly defined to help determine how much of the tusk should be amputated. Once the pulp is exposed the correct surgical treatment should be performed as soon as possible and anti-inflammatory drugs should be used to reduce any discomfort the patient may feel. Partial pulpectomies are much easier to perform than tusk extractions and should always be pursued as soon as possible after exposure. Tusk extractions are complicated procedures that may even require multiple operations which will drastically increase the cost of treating the animal. Acknowledgements: I would like to thank Birmingham Zoo (Alabama, USA) for the radiographs and clinical pictures (Figs. 1-3) they allowed me to use in this column. Figure 4. Multiple cut segments of an African elephant tusk that was sectioned to remove a longitudinal crack. This is often necessary if you do not know how far the tusk extends in the tusk. >>> 40