Prevention

Generally, donkeys that receive regular dental check-ups and treatment remain in better dental health for longer. The Donkey Sanctuary has identified three to five years as the critical time period for donkeys whereby if regular, appropriate, high quality dental treatments have not been carried out, oral health rapidly declines. In a donkey with poor oral conformation, such as congenital displacements, anecdotal reports show a decline in dental health over just a few months in the absence of appropriate treatment, depending on the initial severity.

Generally, in situations where donkeys are lacking the provision of dental treatment, their primary healthcare, such as vaccinations and regular foot care, may also be neglected.

Before carrying out dental care it is advisable to ensure there is protection against tetanus as a minimum.

The early diagnosis and treatment of oral and dental disorders in a conservative way, avoiding their development into potentially clinically significant pathology, is extensively described throughout this book. Donkeys with multiple moderate to severe and/or complex acquired dental disorders (often further complicated by systemic disorders), generally struggle to improve despite repeat treatments and adjunct therapies. The situation can be further compounded by owners failing to seek intervention until dental signs become obviously apparent, which in many cases is far too late.

PROPHYLACTIC TREATMENT

The frequency of oral and dental examination may be determined by the age of the animal, its individual oral conformation, the age at which it began receiving routine dental examinations, and the conditions found.

The following protocol is based on a donkey that receives regular dental visits from a young age:

• 0 to 5 years: This period is the most dynamic in the development of the teeth, with the eruption and exchange of deciduous (incisors and premolars) and definitive teeth (canines and molars). Therefore, it is advisable to carry out a dental examination every six months. The period from 2.5 to 5 years is even more dynamic, with the loss of deciduous teeth and the eruption of most of the definitive teeth.

• 5 to 15 years: Six monthly examination is considered the gold standard for most equids, although it is widely considered that an annual examination will be sufficient for the majority of clinically normal donkeys. Animals with oro-dental disorders including developmental problems, such as craniofacial abnormalities (brachygnatism, prognathism and, more rarely, wry nose), or those with infundibular/ peripheral caries or periodontal disease, or those that struggle to maintain/improve in terms of the treatment applied, may need to be assessed every six months or even more frequently. Craniofacial abnormalities may be detected early in time and even corrected surgically in the first months of life. This surgical procedure should significantly improve the quality of life and welfare of affected animals.
  Note that craniofacial abnormalities may have a genetic basis, so animals with these defects should not be used for breeding purposes.

• More than 15 years: An examination may be necessary every six months as teeth may start to suffer anatomical changes related with the more conical shape of the reserve crown and apex region, as well as the loss of the infundibula in the maxillary cheek teeth (CT).

In many instances a donkey will not have had regular examinations from a young age, so adaptations to this protocol will be necessary. Dental plans need to aim for a balanced mouth over a period of time, allowing the animal to eat properly, free of pain and without any mechanical barriers interfering with the correct chewing cycle.

Other factors, such as pregnancy status or any other concomitant disease, may require consideration as to the timing of routine treatments to take into account sedation, trimester and presenting conditions.

When presented with an aged donkey with poor body condition, indications of recent weight loss or other illness concurrent with chronic dental disease, it is important not to automatically assume that the dental disease is the primary or even sole source of the donkey’s poor health. In these cases it is important that a veterinarian carries out a full clinical examination, which may conclude dental pathology as the least of the animal’s concerns.

ASSESSMENT OF QUALITY OF LIFE

A ‘stiff’ animal is probably an animal in pain, whether the stiffness is an acute onset or a chronic problem, and the same applies to dentistry; just because a donkey has lived with poor dentition for years certainly doesn’t mean that the condition isn’t painful. We shouldn’t assume a geriatric patient with severe dental pathology just ‘needs the points knocking off’ to make them comfortable.

Unremitting pain or chronic discomfort will have a detrimental effect on the donkey’s well-being, health and welfare, and the animal’s quality of life should always be considered as part of any treatment or management plan.

It is important to make a full patient assessment and a treatment plan in order to prevent any unforeseen consequences from treatment.

Old age is inevitable but should not be uncomfortable. Euthanasia should be viewed as a positive welfare outcome when the quality of life of the donkey is impaired despite veterinary intervention, and the animal is in chronic discomfort.

If euthanasia is not immediately indicated or accepted by the owner, it is a valuable exercise to monitor changes or progressive decline by examining and recording specified parameters.

The owner can be given a monitoring sheet to record the health and welfare of their donkey.

The owner should be advised to complete a sheet on a daily or weekly basis and to discuss the findings with their vet regularly. The parameters included in the sheet give a good indication of the health and importantly, the welfare of the donkey. This will enable the owner to see any progress or decline and report the information that they have observed to their vet or other professionals for recording on the sheet.

This information will allow an informed and objective discussion between the owner and the vet or dental technician when the welfare of the donkey is compromised. The assessment record for the quality of life of the donkey should include discussions, owner reports and professional or paraprofessional assessment. This will include a defined end point – for example, the point at which analgesia is failing to control arthritic pain.

If the quality of life of the individual is poor and treatment options are limited by severity of disease or financial considerations, then euthanasia is likely to be the best outcome for the donkey’s welfare.

Euthanasia should not be considered a failure, but the last good thing that can be done for the donkey.

It is important to consider the companion animal when a decision has been made to euthanase a donkey. Plans must always be made to address the bereavement that the companion is likely to experience.

The End of Life project, coordinated by Advancing Equine Scientific Excellence (AESE), and supported by The Donkey Sanctuary and World Horse Welfare, found that vets provide an important role in supporting owners when making the decision to euthanase their donkey at the most appropriate time. Quality of life assessments are often made on an informal basis between the vet and the owner. However, these are rarely logged so can’t be referred back to when monitoring decline in chronic conditions. There can also be discrepancies between an owner’s perception of quality of life and what is actually being assessed, so this is an important area of education for owners. Where they were asked, owners requested more information on geriatric care and quality of life assessment.

STUDIES FOR THE EFFECT OF DENTAL CONDITIONS ON QUALITY OF LIFE

The Donkey Sanctuary has carried out dental auditing of its resident herds in the UK.

Data on cheek tooth loss, dental functional capacity and average faecal fibre length (AFFL) yield some interesting and useful information for quality of life assessment, treatment planning, and post-procedural care/ management considerations, in order to promote compliance and aid management of expectations.

The AFFL may be a marker of dental/masticative efficiency. An AFFL of greater than 3.6mm is indicative of the development of dental disease; an AFFL of around 4.5mm is indicative of moderate to severe disease. A significant reduction in AFFL to an approximate optimal average of around 2mm was seen following appropriate dental treatment.

Analysis of the audit results showed that:

• Loss of cheek teeth, dental functional capacity, and AFFL provide useful information concerning quality of life assessment, treatment planning, and post-procedural care/management considerations.

• Recording findings of the dental examination can help in dealing with owner expectations.

• The location of any missing cheek teeth has a bearing on longevity, with donkeys presenting with multiple adjacent tooth loss faring worse than those with sporadic hypodontia/exodontia.

The data collected provides valuable guidelines regarding the likely clinical outcome or longevity of a donkey according to its dental function. The likely outcome is dependent on several factors however, and these must be considered when discussing cases with owners or other professionals.

Table showing clinical indicators with the likely outcomes as seen in UK donkeys belonging to The Donkey Sanctuary.

One in ten donkeys returned or relinquished to The Donkey Sanctuary is euthanased within three years. The average age for these donkeys is 21 years; 60% have severe to very severe dental disease. These donkeys are not necessarily euthanased due to dental disease, but due to dysprehension, dysmastication, dysphagia or the addition of painful infection when otherwise ill. Suffering from multiple conditions places a huge and largely unnecessary burden on the animal’s quality of life and prognosis.