DISEASE SUMMARY PAGE

Bacterial Tusk Infection in Elephants:

Summary Information
Diseases / List of Bacterial Diseases / Disease summary
Alternative Names Pulpitis in elephants

See also:
Disease Agents
  • A variety of bacteria, including anaerobes, have been associated with tusk infections. (B450.12.w12)
  • Infection of the tusk pulp may follow tusk injury. (D301.3.w3) See: Tusk Injury in Elephants

Further information on Disease Agents has only been incorporated for gents recorded in species for which a full Wildpro "Health and Management" module has been completed (i.e. for which a comprehensive literature review has been undertaken). Only those agents with further information available are linked below:
Infectious Agent(s)
Non-infectious Agent(s) --
Physical Agent(s) -Indirect / Secondary
General Description
  • As the tusk becomes worn, the pulp cavity may become exposed and infected. (J2.20.w4)
  • Deeper injuries, such as fractures, cracks or abrasions of the tusk, may expose the pulp and create a route of infection. If infection develops, extraction of the tusk may be indicated. (B16.18.w18, B214.3.7.w3, B450.12.w12, J2.20.w4, J4.183.w3, J4.185.w2, J4.189.w4, P505.9.w4)
  • In some cases the injuries affect both tusks, causing traumatic pulpitis when the pulp cavity is exposed. (J4.183.w3, P1.1985.w4)
  • As the tusk become worn, the pulp cavity may become exposed and infected. (J2.20.w4) 
  • Pulp infections can persist for years and in some cases cause death. (B450.12.w12, J4.183.w3, J4.192.w1, P505.7.w1)

Clinical signs:

  • A black area at the distal tip of an injured tusk may indicate pulp infection. (B450.12.w12, , P505.5.w1V.w82)
  • Purulent discharge from the affected tusk. (J4.185.w2, J4.189.w4, J4.192.w1, P1.1985.w4, P505.7.w1)
    • In one case, a tract was present up the center of the tusk, measuring 57 cm long and located predominantly in the subgingival portion of the tusk. (J4.189.w4)
  • Pulp cavity exposed. (P1.1985.w4)
    • The exposed pulp cavity may be packed with mud by the elephant. (J4.183.w3)
  • Sensitive on palpation over the affected tusk. (J4.192.w1, P505.7.w1)
  • Pus, with a distinctive, unpleasant, smell, often drains from the tusk. (P506.4.w1)
  • Swollen face. (J4.192.w1, P505.7.w1)
  • Depression. (J4.192.w1, P505.7.w1)
  • Toxaemic shock. (J4.183.w3)
  • Death. (J4.183.w3)
Further Information
  • The abundant vascularisation of the tusk pulp facilitates the healing process. (B450.12.w12, P5.41.w6, P505.9.w4)
Gross pathology:
  • Purulent pulpitis. (J4.183.w3)
  • Periodontitis. (J4.183.w3)

Histopathology:

  • Subacute gingivitis of the gingiva attached to the internal socket of the tusks affected. A subepithelial infiltration of plasma cells, lymphocytes, macrophages and neutrophils was observed. (J4.183.w3)

Investigation/ Diagnosis: 

  • Intraoral clinical examination; this may be difficult or not possible. (J4.185.w2)
  • Culture and sensitivity of the infected tusk. (J4.189.w4, P1.1985.w5)
  • Radiographic studies of the tusk has been used, particularly to localise fractures and to monitor the resolved infection of the canal. (J4.185.w2, J4.189.w4, P1.1985.w5)
  • Endoscopy has been used to explore the pulp cavity. (P1.1985.w5)
  • Note: haematology may be within the normal limits. (J4.185.w2, J4.189.w4, P1.1985.w5)

Treatment:

Medical treatment: 
  • Septic pulpitis has been reported to be managed successfully with prompt and aggressive medical therapy. (B450.12.w12, J4.189.w4)
  • In a case of a tusk tip fracture where the pulp was exposed, the pulp canal was treated, under sedation, with antiseptic brushing of the area, the canal of the pulp exposed was packed with antiseptic soaked gauzes and sealed with dental acrylic. The animal managed to remove the seal and packing after seven days. The procedure was repeated weekly for a month. (P505.5.w1)
  • In an adult female Loxodonta africana - African Elephant presenting with a chronic infection of the pulp cavity, the pulp cavity was debrided, cleansed and implanted with calcium hydroxide, zinc-eugenol, dental methacrylate and dental stone in several layers, under anaesthesia. (P1.1985.w5)     
  • A six-year-old female Loxodonta africana - African Elephant presenting with an infected tusk tract was initially treated by flushing the tract using a 1:10 dilution of povidone iodine solution and water. The treatment was soon switched, based on culture and sensitivity, to daily antibiotic flushing with 2-5 g of chloromycetin sodium succinate, chloramphenicol, and sealing the packed tusk canal with an sterile set screw between treatments for 25 days. After 25 days the canal was cultured and the antibiotic was changed to daily flush with 2 x 106 penicillin G for ten more days, until culture was negative. (J4.189.w4)
    • Antibiotics were chosen based on culture and sensitivity. (J4.189.w4)
    • A replaceable set screw to seal the medicated pulp from environmental contamination was used successfully. (J4.189.w4)
    • Once the infection was resolved a permanent set screw was placed to protect the area. (J4.189.w4)
  • An eight-year-old, 1,136 kg, male Loxodonta africana - African Elephant with a fractured and infected tusk was initially treated by flushing the pulp cavity with 0.9% sodium chloride followed by povidine iodine solution, under anaesthesia. Systemic antibiotics were given also: trimethoprim-sulphamethaxazole (sulphonamides) 9,600 mg orally twice daily for 14 days. (J4.185.w2)
  • An approximately 3,000 kg, 18-year-old Loxodonta africana - African Elephant with recurrent episodes of infection was treated medically for six years with antibiotics based on culture and sensitivity. When the last episode occurred the animal was given 30 g amoxycillin orally once daily for seven days before the tusk was extracted. (J4.192.w1)
Surgical treatment:
  • Pulp therapy may be attempted at an early stage (P506.4.w1), but the results are unpredictable. (V.w82)
    • In relatively young animals with pulp exposure, with the pulp healthy at the time of treatment, there may be an 80% success rate for production of a solid layer of secondary dentine and healing. In contrast, in large, aggressive individuals, particularly bull elephants, the success rate is close to zero in the long term: either the tusk will fracture again and the pulp cavity will be exposed once more, or longitudinal splits may occur e.g. three years after treatment, while the filling material is still present in the tusk cavity. (V.w82)
  • Protection of the exposed pulp from environmental contamination is challenging, as elephant can remove caps or other protective devices and they tend to pack the open tusk canals with mud. (B450.12.w12)
  • Debridement of the pulp must be carried out carefully to avoid separation of the healthy pulpal tissue from the tusk wall. (J2.20.w4)
  • Trimethoprim-sulphadiazine (sulphonamides), trimethoprim-sulphamethaxazole (sulphonamides) and penicillin G have been used after surgical extractions of infected tusks. (J2.20.w4)
  • The following are descriptions of various cases:
    • Surgical debridement of the pulp canal, sealing with an acrylic material and capping with titanium prosthesis under anaesthesia has been reported. In this case the animal managed to remove the cap overnight. The tusk was drilled away into the sulcus using extended craniotomy burs. (P505.5.w1)
    • Amputation and partial pulpectomy was performed under anaesthesia, in a 4,500 kg 14-year-old male Elephas maximus - Asian Elephant. The skin was incised from the anterior lip margin to the ventral area of the eye. After localising the relevant vessels and nerves, a dorsal laminectomy of the alveolar wall was performed with an oscillating bone saw in order to exposed the proximal part of the tusk, followed by the amputation of the tusk in pieces using a drill (creating several 15 mm diameter holes) and chisels on the portions between the holes. The coronal pulp cavity was debrided with curettes before closure of the subcutis and skin with braided nylon tape. (P1.1985.w4)
    • A partial pulpectomy was initially attempted, under anaesthesia, in a 1,136 kg eight-year-old male Loxodonta africana - African Elephant presenting with a fractured and infected tusk. Excavators and curettes were used to excised the accessible coronal pulp, followed by flushing of the pulp cavity with sterile distilled water and the application of formocresol-impregnated cotton wools over the pulpal stump. The distal end of the pulp cavity was sealed with zinc oxide-eugenol-formocresol mixture. A week later, based on radiographic findings, the tusk was considered no longer restorable, therefore on day 12 extraction of the remaining tusk was performed using forceps in a rotatory motion. The bone alveolus was curetted and the soft tissue sutured. The alveolar chamber was sealed with a zinc oxide-eugenol plug to avoid environmental contamination. (J4.185.w2)
    • The extraction of an infected tusk, under anaesthesia, on an approximately 3,000 kg, 18-year-old Loxodonta africana - African Elephant was performed when the conservative treatment failed to control the condition. A 1.5 cm hole was drilled through the tusk 5 cm away from the sulcus and perpendicular to the longitudinal fracture, where a steel bar was placed to facilitate the rotational and longitudinal extractional forces to break the periodontal ligament and extract the affected tusk. Once the tusk was extracted the cavity was explored, remaining pieces of tooth were removed using long bone gouges and chisels. The cavity was flushed with antibiotics and antiseptic solution before the orifice was plugged with CaOH (calcium hydroxide) and the sulcus was closed. Antibiotics based on culture and sensitivity were continued for nine days. The cavity was flushed with antibiotics and antiseptics twice daily for six months. (J4.192.w1, P505.7.w1)
    • An internally collapsing tusk extraction technique, carried out under anaesthesia, has been described. The tusk is sectioned into parallel strips that are elevated from the socket. The instruments required include chisels, elevators, splitters and modified forceps. (J2.34.w3)
    • An induced tusk removal without anaesthesia has been reported using rubber elastic bands, placed around the tusk, and daily pulling on the tusk. The tusk exfoliated in three weeks. (J2.34.w3) 
      • Note: a tusk this mobile might have exfoliated spontaneously without the use of the elastic bands. (V.w82)
    • The surgical management of seven Loxodonta africana - African Elephants presenting with unilateral dentoalveolar abscessation and/or tusk injuries were described using two techniques: (J2.20.w4)
      • In six elephants the tusks were sectioned transversely and the tusk wall thinned by enlarging the tusk cavity using carbide burs. In some cases the remaining pulp was removed with a stainless steel rods and hooks. The tusk was then sectioned longitudinally into three or four segments using a wood saw. Bone gouges, osteotomes and a mallet were used to dissect the external epithelial and alveolar attachments from the tusk. The sections of tusk were removed using long screwdriver shaped stainless rods. The alveolar cavity was flushed regularly with iodine solution after surgery. (J2.20.w4)
      • One elephant required two surgical procedures. (J2.20.w4)
    • Further information on tusk surgery is provided in: Tusk Injury in Elephants (Physical-Traumatic Disease Summary)
Techniques linked to this disease
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Host taxa groups /species Further information on Host species has only been incorporated for species groups for which a full Wildpro "Health and Management" module has been completed (i.e. for which a comprehensive literature review has been undertaken). Host species with further information available are listed below:

(List does not contain all other species groups affected by this infectious agent)

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