Vet Clin Exot Anim 6 (2003) 565–570

Oral disorders of exotic ungulates

Felicia Knightly, DVMa,*, Peter Emily, DDS, AVDCb
a
Denver Zoological Gardens, 2300 Steele Street, Denver, CO 80205, USA
b
1051 Independence, Lakewood, CO 80215, USA

Ungulate classification and dentition

The large group of animals known as ungulates or hoofed mammals is
divided into those animals that possess an odd number of toes and those
animals that possess an even number of toes [1].
The odd-toed ungulates (order Perissodactyla) include species such as
tapirs, rhinoceros, and horses. Tapirs have 42 to 44 teeth of lophodont form
(with transverse ridges of the occlusal surface) that are arranged 3/3, 1/1,
3/3–4, 3/3. Rhinoceros may have 24 to 34 rooted hypsodont (long-crowned)
teeth, the exact tooth form depending on the subspecies (white, black,
Indian, or Sumatran). The dental formula is 0–1/0–1, 0/0–1, 3–4/3–4, 3/3.
Finally, the exotic equids (eg, zebra, Przewalski’s wild horse) possess
the same dental formulae as their domestic counterparts, and, in many
instances, some of the same dental problems. Many informative articles
have been published on equine dentistry. Most of the techniques described
in the equine literature can be used or modified in such a way as to be useful
in the treatment of exotic equids, and, to some extent, the rhinoceros and the
tapir. The large quantity of material that is available on equine dentistry is
beyond the scope of this article; readers are advised to consult standard texts
and articles on the subject if considering treatment of exotic equids.
During the normal course of their lives most rhinoceros and tapir,
however, do not frequently require dental attention, although with increasing
age there is an increasing number of dental concerns. Most commonly, these
are related to the loss of, or damage to, aged teeth and the resulting inability
to prehend, masticate, and ingest an adequate amount of food.
This article focuses on the even-toed ungulates (order Artiodactyla).
Considerations concerning chemical restraint for dental examination and
postdental procedure treatment will be covered later in this article.

* Corresponding author.
E-mail address: [email protected]

1094-9194/03/$ - see front matter Ó 2003 Elsevier Inc. All rights reserved.
doi:10.1016/S1094-9194(03)00037-9
566 F. Knightly, P. Emily / Vet Clin Exot Anim 6 (2003) 565–570

Most present day ungulates (81 genera) fall into the group of even-toed
ungulates [2]. Examples include deer, pigs, hippopotamuses, giraffe, camels,
and all of the horned ungulates (bovids, antelope, pronghorn, and gazelle).
The even-toed ungulates can be further divided into ruminants and non-
ruminants. Among the nonruminant group are pigs, hippopotamuses, and
camels, leaving the remaining bovids, deer, antelope, and gazelle in the
ruminant category.
In general, the skull and teeth vary greatly within the group of even-toed
ungulates. The front teeth are reduced in most exotic members of this group;
only the wild boar (genus Sus) has the complete primitive mammalian
dentition of 44 teeth, 11 in each quadrant of the oral cavity [1]. The crowns
of the premolars and molars are composed of two linked crescentic segments
that are arranged in a line mesiodistally in nonruminants. In ruminants, the
crowns of the premolars and molars are selenodont, consisting of two rows
of two crescent-shaped ridges formed from the four curved cusps that are
present when the teeth erupt; these are arranged in two rows, each of which
runs mesiodistally [1].
The pigs can be divided into two families: Old World pigs (bush pig, wild
boar, warthog, giant forest pig, babirusa) and peccaries [2]. These animals
are true omnivores and their ancestors originally had 44 teeth (heterodont)
with a dental formula of 3/3, 1/1, 4/4, 3/3. Presently, some genera have fewer
teeth. Regardless of the genera, the maxillary canine teeth are typically
hollow and grow continuously. In most species the canine teeth curve
laterally and then in an upward direction adopting a tusk-like appearance;
the barbirusa show an unusual arrangement, their maxillary tusks emerge
dorsally [2]. (Also see the article on dental disorders of tusked species else-
where in this issue). Peccaries have 38 teeth (2/3, 1/1, 3/3, 3/3) and, unlike
the Old World pigs, the maxillary canines are not directed upward but point
downward.
The hippopotamus has 38 to 40 teeth with a dental formula of 2/1–2, 1/1,
4/4, 3/3. The mandibular canines typically grow long and like the tusks of
pigs, the upper and lower teeth wear together which creates and maintains
sharp cutting surfaces. The incisors and the canines have open roots and
grow continuously. This arrangement can sporadically cause secondary soft
tissue problems that require the trimming of these long teeth.
Camels generally have 30 to 34 teeth but can have as many as 38 teeth.
The canines and first premolars are hook-shaped. When camels still have
their deciduous set of teeth, it contains three upper incisors. As the perma-
nent set of teeth erupt only the third pair of upper incisors is present [1]. The
molars have long crowns with crescent-shaped surface cusps (selenodont)
[1]. Of additional interest are the mandibular incisors of the vicuna, which
possess open roots and grow continuously.
Ruminants (the majority of the even-toed ungulates) lack maxillary
incisors; the lower incisors occlude against a tough premaxillary pad. In
addition, the mandibular canines are incisor-shaped and join the incisors in
 F. Knightly, P. Emily / Vet Clin Exot Anim 6 (2003) 565–570 567

the rostral portion of the mandible. All of the members of this group are
herbivores and chew by moving or sliding the tooth rows over each other
with a wide lateral (side to side) motion. Only one side of the mouth is used
at a time while the tongue positions the food in the mouth. Notable
examples in this large group of animals are:
Mouse deer (chevrotain) that have 34 teeth (0/3, 1/1, 3/3, 3/3) and
a sexually dimorphic dental characteristic. The maxillary canines in the
male protrude in a sharp, tusk-like fashion whereas the same teeth in
the female look like small studs [1].
Musk deer that also have tusk-like maxillary canines.
Moose possess 32 teeth (0/3, 0/1, 3/3, 3/3).
Other deer. With the exception of the mouse deer and the musk deer
mentioned previously, deer generally have 32 to 34 teeth with a dental
formula of 0/3, 0–1/1, 3/3, 3/3.
Giraffe have 32 teeth along with pronghorn and most of the other horned
ungulates.

Anesthetic considerations
Unlike most domestic animal species, most exotic animals, regardless of
their size, will require immobilization before even a cursory dental exami-
nation. The most acceptable anesthetic protocol depends upon the species
involved and the anesthetist’s personal experience. Many articles and other
texts recommend anesthetic protocols and the available journals and texts
(eg, Journal of Zoo and Wildlife Medicine, Journal of Wildlife Diseases,
Handbook of Wildlife Chemical Immobilization, and The Capture and Care
Manual) should be consulted for specific information on protocols and
dosages. The following are basic recommendations based on the senior
author’s personal preferences and experience. Rhinoceros can be immobi-
lized with potent narcotic agents, such as etorphine or carfentanil. Although
standing sedation can be accomplished with combinations of detomidine
and butorphanol, this protocol may not be sufficient for thorough dental
examination. Tapirs may also be immobilized with a combination of deto-
midine and butorphanol. Exotic equids generally require potent narcotics
(etorphine or carfentanil) with preliminary sedation using an alpha-2
agonist (xylazine or detomidine). Pigs can be adequately immobilized with
telazol (tiletamine and zolazepam) with or without preliminary sedation
with an alpha-2 agonist, such as xylazine. Camels may be safely immobili-
zed with a combination of ketamine and the potent alpha-2 agonist,
medetomidine. Hippopotamus are difficult to immobilize successfully
because of their size and weight. This increases the risk of simple dental
examinations as well as routine canine and incisor trimming. It also
emphasizes the importance of an operant conditioning program for species
that are at a greater than normal risk while anesthetized because of their
568 F. Knightly, P. Emily / Vet Clin Exot Anim 6 (2003) 565–570

size, weight, age, or underlying disease. Most of the ruminants can be

successfully immobilized with potent narcotics, such as carfentanil or
etorphine in combination with an alpha-2 agonist, such as xylazine. Proto-
cols using ketamine and medetomidine are also useful in many of the
animals in this group. Regardless of the choice of injectable anesthetic
agents, significant dental work will most likely require intubation to
maintain anesthesia by way of gas (isoflurane, cevoflurane, or halothane).

Dental examination and abnormalities

Detecting a dental abnormality in exotic ungulate species begins with
careful observation. Many of the species are stoic and do not show external
signs of any disease until the ailment has progressed significantly. Frequent
observation of the animal’s normal anatomic appearance and body condi-
tion may help when disease begins to affect these external characteristics.
Dental abnormalities commonly cause changes in the animal’s ability to
prehend and masticate food. Certain food items may be dropped, hyper-
salivation may be evident, or mastication time may be increased.
Despite having the patient anesthetized, dental examination in several of
the exotic species can be challenging. The use of a mouth gag to provide
adequate exposure of the dental arcades is highly recommended. No single
type of mouth gag will work effectively in all species, but with some modi-
fication something useful can be fashioned for most. In many cases,
visualization and palpation of each tooth is not always adequate to
effectively diagnose underlying dental disease. Often, by the time ungulates
are showing gross evidence of a dental problem significant damage has been
done to the tissues adjacent to the diseased tooth (bone, gingiva, peri-
odontia). Radiography is an invaluable method to aid in the diagnosis of
dental disease. Obliqued radiographs of each side of the skull provide
screening images of each tooth root without overlap between the arcades. If
necessary, this can be supplemented by the use of intraoral film placement
using occlusal dental film or flexible screen cassettes. Radiographic inter-
pretation can be combined with the gross dental examination findings en
route to a diagnosis.
In comparison with the variety of dental abnormalities that are found in
other species, including carnivores and primates, the list of dental disease
processes in even-toed ungulates is short. Typically, one of the most fre-
quently found dental abnormalities is aveolitis with accompanying
osteomyelitis, often referred to as ‘‘lumpy jaw’’ [3–5]. Commonly, periapical
abscesses that are associated with this dental disease yield a variety of
pathogenic bacteria such as Bacteroides spp, Actinomyces spp, and
Fusobacterium spp [6]. The possible etiologic factors that are responsible
for this disease process have been studied and debated for many years. With
the exception of agreeing upon a multifactoral etiology, few lists of believed
 F. Knightly, P. Emily / Vet Clin Exot Anim 6 (2003) 565–570 569

causative factors are identical. In addition, it is difficult to determine which

factors may contribute more heavily or frequently. Population density, food
sources, individual age (chronologically in years, as well as in an evol-
utionary sense as a subspecies), gender, and geographical location have all
been considered throughout the study of this condition [4,5].
Other less commonly seen dental abnormalities in ungulates include
supernumery teeth, eruption cysts, malocclusions with secondary abnormal
occlusive wear, oral teratomas, abnormal wear and damage to teeth from
inappropriate behaviors (eg, cribbing), and traumatic fractures of tusks/
canine teeth. Neoplasia is also seen occasionally. Little primary periodontal
disease has been seen in exotic ungulates.

Treatment
Treatment remains frustrating. In most cases, the best chance for
a positive, long-term outcome involves exodontia (extraction) with debride-
ment of any necrotic alveolar bone and soft tissues and treatment of residual
osteomyelitis with antibiotics [4]. Unfortunately, in some species, because
of anatomical differences and regardless of the severity of the infection,
extraction of the diseased tooth or teeth may not be possible from within the
oral cavity. In these cases, extraction requires an approach either through
a buccotomy incision or for mandibular teeth, by way of a ventral approach.
The use of proper instrumentation is essential, but sometimes challenging to
obtain in many of the exotic species; improvisation is often necessary [7].
The length of the rostrum, the restricted angle of the open herbivore mouth,
and the parallel convergence of the arcade width all provide obstacles
to traditional approaches and dental equipment. Attempts at long-term
medical therapy without extraction for the treatment of ‘‘lumpy jaw,’’
including antibiotic therapy or the placement of antibiotic impregnated
implants at the site of infection are, as would be expected, generally un-
successful. If treatment of the presenting problem proves successful in the
short-term, further consideration must be given to the animal’s long-term
care. The clinician should be aware of the possibility of dental problems
secondary to the resulting postextraction malocclusion. Extraction of
a diseased tooth produces abnormal occlusive wear in the opposing arcade
because ‘‘lumpy jaw’’ most commonly involves the premolars and molars
(cheek teeth). Most ungulates depend on this mechanism of occlusive wear
to maintain normal mastication. The absence of a tooth allows for over-
growth of the opposing tooth in most of these species. In the long-term,
close observation of mastication during feeding, dental examinations, and
intermittent rasping of any overgrown teeth may be required.
In most cases that involve osteomyelitis, special consideration must be
given to the ruminant digestive system and the ability to achieve adequate
serum blood levels of an effective antibiotic. Generally, parenteral
570 F. Knightly, P. Emily / Vet Clin Exot Anim 6 (2003) 565–570

administration of antibiotics remains the most effective way to provide

treatment to most ruminants eliminating a variable ‘‘first pass effect’’ which
inactivates the drug likely causing-dysbiosis when given orally. The risks of
daily handling or darting to administer the drugs at the required doses may
prove counterproductive to the animal’s well being. These factors should be
considered before, as well as during, the initial examination and dental
work. Frequently, the length of treatment, volume of antibiotic, and fre-
quency of treatment prove to be significant limiting factors in the ability
to treat this dental abnormality effectively. Another topic for consideration
is pain management. Appropriate amounts of a short- or long-acting local
anesthetic, such as lidocaine, can be helpful if administered as a nerve block
or by infiltration at an extraction site. Care is required with dosage, but local
anesthesia reduces the dosage of general anesthetic agents that is required
and will provide some analgesia during recovery.

Summary
There are many species classified as ungulates that possess a large variety
of dental formulae and dental adaptations. Despite the diversity found
within the ungulate group, the list of dental abnormalities remains short.
Regardless of the contributing factors, cases of aveolitis accompanied by
osteomyelitis (‘‘lumpy jaw’’) occur more frequently than some of the other
dental problems that are encountered in these species (fractures of tusks/
canines, malocclusion, eruption cysts). Commonly, treatment of ‘‘lumpy
jaw’’ requires exodontia with additional antibiotic therapy using a drug that
is appropriate for the type of infection and the species of animal. Regardless
of the dental abnormality, anesthetic, diagnostic, and treatment consid-
erations typically provide the greatest challenge to the clinician in these
cases.

References
[1] Grzimek B. Grzimek’s animal life encyclopedia: vol. 13. mammals, IV. New York: Van
Nostrand Reinhold Company; 1972.
[2] Nowak R. Walker’s mammals of the world. 5th edition. Baltimore: Johns Hopkins
University Press; 1991.
[3] Emily P, Frahm M. Lumpy jaw. Presented at the Proceedings of the American Association
of Zoo Veterinarians, 1991.
[4] Wiggs RB, Lobprise HB. Acute and chronic alveolitis/osteomyelitis (lumpy jaw) in small
exotic ruminants. J Vet Dent 1994;11(3):106–9.
[5] Hoefs M, Bunch TD. Lumpy Jaw in wild sheep and its evolutionary implications. J Wildl
Dis 2001;37(1):39–48.
[6] Roeder BL, Chengappa MM, Lechtenberg KF, et al. Fusobacterium necrophorum and
Actinomyces pyogenes associated facial and mandibular abscesses in blue duiker. J Wildl
Dis 1989;25(3):370–7.
[7] Holstrom S, Frost P, Eisner E. Veterinary dental techniques for the small animal
practitioner. 2nd edition. Philadelphia: WB Saunders; 1998.