Dental Disease in Rabbits

TL;DR. Dental disease in rabbits is a common, painful condition where their continuously growing teeth do not wear down properly, often due to a lack of dietary fiber or selective feeding habits.

A diet rich in long-stemmed grass hay is vital to provide the abrasive grinding action needed to wear down a rabbit's continuously growing teeth.

What is it?

To understand dental disease in rabbits, it is first necessary to understand how unique their teeth are. Unlike humans, dogs, or cats, rabbits have "elodont" teeth. This means all of their teeth—both the visible front incisors and the grinding cheek teeth at the back of the mouth—grow continuously throughout their entire lives. In a healthy rabbit, these teeth grow at a rate of approximately two millimeters per week.

Under normal circumstances, this rapid growth is perfectly balanced by constant wear. In the wild, rabbits consume highly abrasive, fibrous vegetation like coarse grasses and weeds. The physical action of grinding these tough plant fibers down, combined with the natural tooth-on-tooth contact during chewing, keeps the teeth at a functional, safe length.

When this balance is disrupted, the teeth do not wear down normally. The crowns of the teeth become elongated, and the normal alignment of the jaw (occlusion) is lost. This is known as acquired dental disease. As the teeth grow too long, they begin to curve and develop razor-sharp edges or spikes, called spurs. These spurs can dig deeply into the rabbit's sensitive tongue and cheeks, causing painful lacerations, ulcers, and infections. If left untreated, the pressure of the misaligned teeth can even force the tooth roots backward into the jawbone, leading to severe bone infections, facial abscesses, and permanent structural damage. Because rabbits are prey animals, they instinctively hide their pain, making this a silent but highly destructive condition that owners must actively watch for.

Causes & risk factors

Acquired dental disease is primarily classified as a nutritional disorder, though genetics and lifestyle play significant roles. The single most common cause is a lack of adequate dietary fiber. Without a constant supply of long-stemmed fiber, such as grass hay, a rabbit does not perform the repetitive, lateral (side-to-side) grinding motions required to wear down their cheek teeth.

Another major dietary culprit is selective feeding. Rabbits are naturally programmed to seek out the most energy-dense foods available to maximize their caloric intake with minimal effort. A leading European companion animal nutrition authority describes this evolutionary behavior:

"Rabbits are 'concentrate selectors' and will naturally gravitate towards food items that provide the most benefit for the least effort... choosing nutrient rich leaves and young shoots over older plant material that is higher in fibre." — FEDIAF Nutritional Guidelines, p. 9

When owners feed "muesli-style" coarse mixes containing a variety of seeds, grains, and colored pellets, rabbits will selectively eat the sweet, high-starch, low-calcium components and leave the fibrous, nutrient-rich pellets behind. This selective feeding leads to a severe nutritional imbalance. A diet low in calcium and vitamin D softens the alveolar bone (the bone of the jaw that supports the teeth), causing the teeth to shift, tilt, and become permanently misaligned.

In addition to nutritional factors, genetics can predispose certain rabbits to dental issues. For example, the Rex Rabbit has a known breed predisposition to acquired dental disease. Rabbits with naturally shorter skulls (brachycephalic breeds) are also at a higher risk because their upper and lower jaws may not align perfectly from birth, making normal tooth wear impossible even on an ideal diet.

Signs to watch for

Because rabbits hide illness, the signs of dental disease are often subtle in the early stages. However, as the condition progresses, the symptoms become more pronounced. Owners should watch closely for the following clinical signs:

• Inability to grind teeth down normally (Cardinal): The physical overgrowth of the incisors or cheek teeth, which may prevent the mouth from closing completely.
• Pain (Common): Indicated by grinding the teeth loudly (a slow, clicking sound distinct from happy tooth-purring), hunching the body, or showing reluctance to be touched around the face.
• Reduced dental wear (Common): Visible elongation of the front incisors, which may curve outward or backward into the lips.
• Poor tooth quality (Occasional): Teeth that appear chalky, brittle, discolored, or easily fractured due to underlying nutritional deficiencies.
• Gastrointestinal stasis syndrome (Occasional): A life-threatening condition where the digestive tract slows down or stops entirely, often triggered by the pain of dental disease and a lack of fiber intake.

Other common signs of dental pain include drooling (which leaves the fur around the chin and neck wet and matted), selective eating (such as suddenly refusing hard pellets or hay but still eating soft greens), dropping food from the mouth, and watery eyes (caused by overgrown tooth roots pressing against the tear ducts).

Drooling, which leaves the fur around the chin and neck wet and matted, is a common sign of dental pain and difficulty swallowing.

How vets diagnose it

While the structured clinical record for this condition does not list specific diagnostic tests, standard veterinary medicine relies on a systematic approach to evaluate a rabbit's oral health. Diagnosing dental disease begins with a thorough physical examination and a detailed review of the rabbit's diet and eating habits.

During a standard consultation, your vet will palpate your rabbit's jawline to feel for any abnormal swellings, asymmetry, or pain, which can indicate retrograde tooth root growth or abscess formation. They will then perform a conscious oral examination using an otoscope or a specialized veterinary speculum to look inside the narrow oral cavity. While this allows the vet to see the front incisors and get a limited view of the cheek teeth, a conscious exam is rarely sufficient for a complete diagnosis. Debris, saliva, a large tongue, and the rabbit's natural resistance can easily hide sharp spurs on the back molars.

Skull radiographs are essential to evaluate the health of the tooth roots, which lie hidden beneath the gumline.

To obtain a definitive diagnosis, your vet will recommend an oral examination under sedation or general anesthesia. This allows the vet to safely use mouth gags and cheek dilators to visualize every surface of every tooth using a high-definition rigid endoscopy camera. Furthermore, because approximately 60% of a rabbit's tooth structure lies hidden beneath the gumline, skull radiographs (X-rays) or a computed tomography (CT) scan are considered the gold standard. These imaging techniques allow the vet to evaluate the health of the tooth roots, check for metabolic bone disease in the jaw, and identify early-stage abscesses before they become visible externally.

Treatment options

Although the structured record does not contain specific drug treatments, the veterinary standard of care for managing rabbit dental disease is well-established and multi-faceted. Treatment focuses on relieving pain, restoring normal dental anatomy, and addressing secondary complications.

Coronal Reduction (Dental Burring)

Under general anesthesia, your vet will use a high-speed dental handpiece equipped with a specialized bur to carefully grind down the overgrown crowns and sharp spurs of the cheek teeth and incisors. This process restores the normal flat grinding surface (occlusal plane) of the teeth.

Note: Your vet will never use hand-held nail clippers or bone cutters to trim a rabbit's teeth. These tools exert immense pressure that can easily shatter the tooth shaft down to the root, leading to severe pain, split teeth, and deep root infections.

Medical Management

If your rabbit is experiencing pain or has developed secondary gastrointestinal stasis, your vet will prescribe medical therapy. This typically includes:

• Pain Relief: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to manage oral pain and reduce inflammation in the gums and cheeks.
• Gastrointestinal Support: If the rabbit has stopped eating, prokinetic medications (which stimulate gut motility) and intensive syringe-feeding with a high-fiber recovery formula are vital to prevent fatal GI stasis.
• Antibiotics: If the vet detects a bone infection or a dental abscess, targeted antibiotic therapy will be initiated, often guided by a culture and sensitivity test.

Dietary Correction

Medical and surgical treatments are only temporary fixes if the underlying diet is not corrected. Your vet will guide you through a gradual transition to a high-fiber diet. This process must be done slowly to avoid upsetting the delicate balance of the rabbit's digestive system.

To understand why fiber is so critical to a rabbit's overall health, we can look at how their digestive tract is designed to process it:

"In the caecum the digestible fibre undergoes microbial fermentation. Once this is complete the caecum empties (again under control of the fusus coli) and the digesta moves rapidly through the large intestine, during which time a layer of mucus is secreted onto the surface of the soft faecal balls or caecotrophs. When these caecotrophs are voided, the rabbit is stimulated to eat them directly from [the anus]" — FEDIAF Nutritional Guidelines, p. 9

Without adequate fiber, this entire digestive cycle collapses, leading to dysbiosis, stasis, and severe systemic illness.

Prognosis

Long-term prognosis data for acquired dental disease in rabbits is limited in the structured clinical record. However, in veterinary practice, the prognosis depends heavily on how early the disease is detected and how committed the owner is to lifelong management.

Acquired dental disease is generally considered a chronic, manageable condition rather than a curable one. Once a rabbit's teeth have shifted out of their normal alignment, the forces of chewing will continue to apply uneven pressure, meaning the teeth will likely always grow abnormally. Most affected rabbits will require regular, lifelong veterinary dental adjustments under anesthesia every 4 to 12 weeks.

If the disease is caught early, before the tooth roots are severely damaged or abscesses have formed, rabbits can maintain an excellent quality of life with routine veterinary care and a strict, high-fiber diet. However, if deep bone infections or facial abscesses develop, the prognosis becomes much more guarded, requiring aggressive surgical intervention and long-term medical therapy.

Prevention

Fortunately, most cases of acquired dental disease are entirely preventable through proper husbandry and dietary management.

The Golden Rule of Feeding

At least 80% to 90% of your rabbit's daily diet must consist of high-quality grass hay (such as Timothy, orchard grass, or meadow hay) or fresh grass. Hay should be available at all times, and the volume offered daily should be roughly the size of the rabbit's body. This ensures they spend hours every day performing the natural grinding motion required to keep their teeth worn down.

Avoiding Selective Feeding

To prevent selective feeding, avoid muesli-style mixes. Instead, feed a measured, limited amount of uniform, high-fiber extruded pellets. Because every pellet is identical, the rabbit cannot choose only the sweet, low-calcium pieces. Nutritional guidelines suggest that pet food manufacturers can optimize these products to protect rabbit health:

"Where companies make coarse mixes / non-pelleted or non-extruded products, they can optimise such products by ensuring the recipe is high in fibre ingredients, has a suitable calcium content, is well balanced for palatability of components and that clear instructions on correct feeding (not feeding more until the previous portion is finished) are on-pack, so as to reduce or eliminate selective feeding" — FEDIAF Nutritional Guidelines, p. 33

Avoiding Dangerous Ingredients

When choosing treats or mixes, be highly selective. Avoid products containing hard, unprocessed seeds or kernels, which can pose physical risks to the teeth and digestive tract. Historically, certain unprocessed ingredients have caused severe health crises in rabbits:

"In the late 1990s there were reports of a few cases of gastrointestinal obstruction caused by locust bean seeds and dried maize kernels, which escaped processing. In the case of the locust bean seeds, these hard, shiny, dark brown seeds would have ordinarily been removed from the locust bean pods, and the dried maize kernels flattened during the maize-flaking process." — FEDIAF Nutritional Guidelines, p. 33

When to call your vet

Because dental disease can rapidly lead to fatal gastrointestinal stasis, you should contact your veterinarian if you notice any changes in your rabbit's eating habits or behavior.

You must seek emergency veterinary care immediately if your rabbit:

• Stops eating entirely for more than 12 hours.
• Produces no fecal pellets for 12 hours.
• Exhibits extreme lethargy, sits hunched in a corner, or is unresponsive.
• Is breathing rapidly or grunting in pain.

Schedule a non-emergency veterinary appointment within 24 to 48 hours if you notice:

• Drooling or wet fur around the chin, neck, or front legs.
• A sudden preference for soft foods over hay.
• Dropping food from the mouth while chewing.
• Swelling or lumps along the jawline or under the eyes.
• Chronic discharge or wetness around one or both eyes.

For specific breeds

If you own a Rex Rabbit, you must be exceptionally vigilant. Because this breed has a documented predisposition to acquired dental disease, proactive monitoring is essential.

Even if your Rex Rabbit appears completely healthy and is eating a high-fiber diet, they should receive a professional oral examination by a veterinarian at least twice a year. Early detection of minor tooth misalignment can allow your vet to make small adjustments before painful spurs, ulcers, or root infections develop, ensuring your rabbit remains comfortable and healthy.

Sources

• FEDIAF Nutritional Guidelines for Companion and Exotics Pets (2024), pages 9, 33.