Veterinary examination can usually identify incisor malocclusion. Your veterinarian may use an otoscope (the instrument usually used to look in the ears) or another type of speculum during the exam to look at the molar teeth. Your rabbit may need to be held wrapped in a towel to permit this.
Sedation may be required for complete evaluation of the molar teeth. A rabbit's mouth is very small, making it difficult to see all areas of the teeth in an awake patient. Subtle problems may not be seen without sedation.
Radiographs (x-rays) of the skull may be necessary to evaluate the tooth roots for infection, and to evaluate the nearby bones for signs of trauma or fractures. Sedation is required for diagnostic radiographs of the head region. (Even the most docile rabbits will not stay still enough for the proper positioning for the required views.)
If there is suspicion of infection, cultures will be necessary to identify the type of bacteria present, and to choose the best antibiotic to fight that infection.
Treatment of malocclusion consists of the veterinarian trimming (sometimes called filing) the abnormal teeth. The incisor teeth can be trimmed without sedation in most rabbits. Sedation is required for proper trimming of the cheek teeth, and may even be necessary to completely evaluate the molar teeth. Although the procedure itself is painless in rabbits (the nerves do not extend to the ends of the tooth), it is impossible to open their mouths wide enough to trim the cheek teeth. The gums are often inflamed, and may bleed or may be nicked when trimming the teeth; however, these small areas usually heal very quickly once the inciting tooth is removed.
Treatment for malocclusion involves trimming ("filing" or "clipping") of the teeth. Although this will not eliminate the problem, it will return the teeth to a normal length so that the rabbit can eat properly, and will remove all the points which may be cutting into the gums.
The incisors can usually be trimmed without the use of anesthesia in most rabbits, but sedation may be used for your rabbit if it is particularly nervous or sensitive.
Anesthesia is almost always necessary for trimming of the molar teeth. The mouth of a rabbit is very small and narrow and can only open a small distance, even under anesthesia. This is a bit like working in a deep hole, and in order to get the instruments into the mouth, rabbits need to be sedated.
The sedation that usually works best is injectable sedation (shots given in the vein or muscle), which lets the veterinarian work in the mouth without the presence of a facemask (which would be required with gas anesthesia). The disadvantage is that rabbits wake up more slowly from the injectable anesthesias.
Any wounds inside the mouth should be cleaned by your veterinarian when the teeth are trimmed. You may be instructed to flush or clean a particular area inside the mouth at home if there is a severe wound, but most heal very quickly without treatment.
Antibiotics may be prescribed if infection is suspected, but are not routinely necessary if there is no suspicion of infection. Your veterinarian will probably start an antibiotic based on what is effective against common bacteria of the mouth, but may change that if the bacterial cultures show that a different antibiotic may be better.
In severe cases, the incisor teeth can be surgically removed. This is a permanent procedure that must be discussed with your veterinarian on an individual basis. Many veterinarians will refer patients for this procedure.
Most rabbits, once diagnosed, will require periodic trimming of the teeth for life, since the malocclusions can't really be corrected. The frequency of trimming varies with the individual rabbit and the severity of the abnormalities. Some may only be once or twice a year; others may be every two to three months.