Update on Rocky w/updated X-rays

[TubeDriver]

There seems to be some discussion about whether this is odontoma OR an infection of some type? It certainly does not have to be one or the other, it probably is both. The x-rays show what looks like a classic case of odontoma (almost diagnostic) and the presence of an "awful" smell as a tooth falls out is suggestive of an anaerobic infection. Odontoma often leads to infection due to the calcified mass pushing into soft tissue. I'll just second STS's recommendation for Clavamox, it will probably be more effective in this situation. Good luck with Rocky, I hope you can get a good outcome for your little guy!

[SamtheSquirrel2018]

There seems to be some discussion about whether this is odontoma OR an infection of some type? It certainly does not have to be one or the other, it probably is both. The x-rays show what looks like a classic case of odontoma (almost diagnostic) and the presence of an "awful" smell as a tooth falls out is suggestive of an anaerobic infection. Odontoma often leads to infection due to the calcified mass pushing into soft tissue. I'll just second STS's recommendation for Clavamox, it will probably be more effective in this situation. Good luck with Rocky, I hope you can get a good outcome for your little guy!

Thank you for your comments, TD! Also, I presume that it was you who combined the multiple Threads pertaining to Rocky's dental issues and I thank you for that as well!
Regards,
StS

[TubeDriver]

Not I, another admin did this.

Thank you for your comments, TD! Also, I presume that it was you who combined the multiple Threads pertaining to Rocky's dental issues and I thank you for that as well!
Regards,
StS

[SamtheSquirrel2018]

Not I, another admin did this.

Well, thanks to that unknown Admin! Having all pertinent posts in order and in one Thread makes helping a poster or learning from an issue so much more effective and efficient!
Regards,
SamtheSquirrel

[Elgato5164]

Hi Elgato:
It appears that you may have overlooked the other posts on this thread that preceeded Snicker Bar's most recent post that you recently commented upon!

If so, please go back and read what others, including mysrlf, have written including comments about the x-ray films and a recommendation and rationale for use of Clavamox instead of Baytril!

How is Rocky doing?
Regards,
SamtheSquirrel

Hi Sam the squirrel,
I did read the previous posts, however, I had typed out my response in addition to adding X-rays that I believe I failed to post before. It took forever, as the site is a bit difficult for me to navigate. I got it written and then “poof,” my cat accidentally stepped on my laptop, and I lost the entire post! Since it was getting so late, I opted not to start over. Rocky is doing OK.
First let me say that I do trust this vet completely. He also does work on a lot of the animals at a zoo, which speaks volumes to me as far as experience and capability. In answer to your question regarding his experience, he does have extensive experience with squirrel odontomas and is prepared to do surgery for an odontoma should it turn out to be that. He is definitely not ruling it out.To clear up confusion, probably caused by me, I wanted to say that there are three sets of X-rays from three different days. The reason the first X-ray showed only one view is due to the fact that he was taken to my regular vet, who has no experience with exotics. I asked him to do an X-ray so that I could get a quick look at what might be going on with Rocky. Since I knew he would not be the one that would ultimately be doing the surgery, I saw no need to have him do extensive X-rays at that point. I knew when I found the right vet that extensive X-rays would then be taken to determine the next steps.The X-ray from December 14th, 2024, was the very first X-ray and was done by a regular, non-exotic vet. The second set of X-rays was done by the vet he is seeing now that treats exotics and squirrels, etc., and were taken on December 23rd, 2024. The third set of X-rays was taken on January 9th, 2025, by the same vet.Because the website doesn't allow more than 10 images per post to be uploaded, I will upload these X-rays, each in a separate post showing the date, to make it easier for everyone to compare X-rays. I can't speak to why the vet prescribed Baytril as opposed to Clavamox, but I'm quite sure he had his reasons.Anyway, look for the three sets of X-rays to be posted after this and it would be the second set of X-rays dated December 23rd, 2024, that I forgot to upload.

[Elgato5164]

Here is the very first xray of Rocky taken on 12/14/24 by my regular vet.

[Elgato5164]

Here are the X-rays that I did not upload from December 23,2024 taken by the exotic vet.

[Elgato5164]

Here are Rocky’s X-rays from 01/09/25 taken by the exotic vet.

[SamtheSquirrel2018]

Hi Sam the squirrel,
I did read the previous posts, however, I had typed out my response in addition to adding X-rays that I believe I failed to post before. It took forever, as the site is a bit difficult for me to navigate. I got it written and then “poof,” my cat accidentally stepped on my laptop, and I lost the entire post! Since it was getting so late, I opted not to start over. Rocky is doing OK.
First let me say that I do trust this vet completely. He also does work on a lot of the animals at a zoo, which speaks volumes to me as far as experience and capability. In answer to your question regarding his experience, he does have extensive experience with squirrel odontomas and is prepared to do surgery for an odontoma should it turn out to be that. He is definitely not ruling it out.To clear up confusion, probably caused by me, I wanted to say that there are three sets of X-rays from three different days. The reason the first X-ray showed only one view is due to the fact that he was taken to my regular vet, who has no experience with exotics. I asked him to do an X-ray so that I could get a quick look at what might be going on with Rocky. Since I knew he would not be the one that would ultimately be doing the surgery, I saw no need to have him do extensive X-rays at that point. I knew when I found the right vet that extensive X-rays would then be taken to determine the next steps.The X-ray from December 14th, 2024, was the very first X-ray and was done by a regular, non-exotic vet. The second set of X-rays was done by the vet he is seeing now that treats exotics and squirrels, etc., and were taken on December 23rd, 2024. The third set of X-rays was taken on January 9th, 2025, by the same vet.Because the website doesn't allow more than 10 images per post to be uploaded, I will upload these X-rays, each in a separate post showing the date, to make it easier for everyone to compare X-rays. I can't speak to why the vet prescribed Baytril as opposed to Clavamox, but I'm quite sure he had his reasons. Anyway, look for the three sets of X-rays to be posted after this and it would be the second set of X-rays dated December 23rd, 2024, that I forgot to upload.

Thank you for your update and additional photos, Elgato! I want to start this post by saying that I do NOT want to appear to be trying to get between you and your Veterinarian or to appear that I am challenging your Vet as NEITHER are my intentions! TSB is a Forum for providing advice, recommendations, suggestions and commentary in a supportive manner for those with issues and/or questions pertaining to Squirrels! Many of us have an extensive background as Rehabbers or in animal care, medicine, sciences or whatever but none of that trumps ones own Veterinarian! That being said, I'll provide some additional commentary in general and specifically related to what I have already posted and then I will be available but I am going to "step back" somewhat as I don't need to run the possible risk of causing you frustrated, resentful or irritated by my statements especially when you "trust this Vet completely." I do not mean to intrude on this trust or undermine it in any way!

Certain things beyond technology and general knowledge have changed in Veterinary medicine and Human Medicine as well in the past several decades! It used to be that both professions were quite "paternalistic" and a practitioner of either profession simply told the owner/client or the patient as the case may be; what the problem is, what needs to be done and a treatment plan or simply a plan was rendered and no questions were ever asked, and there were little or no expectations for understanding by the owner or patient as it was considered unnecessary! Even prescriptions were given in many cases without the clients or patients even knowing what they were! This "paternalistic" approach has changed for what I consider a vast improvement in practice and now; virtually all Veterinarians and Physicians for Humans as well; consider the owner's/client's and patient's understanding, education and opportunity to ask questions and get thorough and complete answers to questions a vital and necessary part of ensuring satisfaction and most importantly, a successful intervention or treatment! There is no harm in discussing any issues with your Veterinarian even if you don't expect or even seek any changes and most every Veterinarian or Physician nowadays will gladly answer any appropriate questions without feeling threatened! I would like to encourage you to discuss all actual and potential issues with your Veterinarian!

I'll offer my comments on Rocky's x-ray studies and what I perceive to be Rocky's pertinent medical condition(s) for whatever they may be worth and then as I mentioned, I will "step back" and read what I hope will be your continued updates on Rocky!

1) IMO; there does not seem to be any significant diminishment in the size of the "popcorn-like" density at the base of right upper incisor in any of the serial x-ray studies! Any spontaneous decrease in size would actually be unexpected as the intense radiopacity (the mass is bright with and solid which indicates that no significant portion of the x-ray beam passed through it!) is as the same as the teeth and its morphology (its particular appearance and shape); and its location (at the base or root region of the tooth), all serve to to strongly suggest or diagnose the presence of an odontoma. Odontomas are made up of normal dental tissues that are "simply" disorganized and they do NOT ordinarily decrease in size or resolve without intervention!

Many, or probably most; odontomas involving the mandibular (lower jaw) incisors do not require urgent intervention (or intervention at all) and can oftentimes simply be monitored BUT odontomas involving the maxillary (upper jaw) incisors almost always need an intervention because they usually become suspected and diagnosed by after already being associated with infection and often impingement and even obstruction of the nasal passages!

2) As the incisor was apparently extracted without any resistance and this was accompanied by an "awful" odor suggests that there was a dental abscess (pus pocket) at the root regions of that tooth! The intense unpleasant odor that accompanied the tooth extraction suggests the presence of anaerobic bacteria. Often, a dental abscess is polymicrobial (caused by several different bacteria) but anaerobes are extremely common in this mix! Often, simply facilitating drainage of an abscess will be enough to permit resolution of the infection and subsequent healing BUT when there is an odontoma associated with an infection in an upper incisor; usually the infection has spread to the odontoma itself, the surrounding soft tissues and maybe even into the nearby bone of the maxilla and while drainage will be of benefit; interventions such as antibiotics and surgery are often necessary! This, along with my strong suspicions of an anaerobic bacterial component to the existing infection; forms the basis for my questioning the use of Baytril b because Baytril provides NO appreciable action against anaerobic bacteria! That is why I suggested the Clavamox! Another option, if you Veterinarian felt that Baytril was necessary, might be an option to add an antibiotic such as Clindamycin or metronidazole; both of which provide good anaerobic coverage!

Okay, Elgato, I will stop here with making commentary or offering advice or suggestions! I most certainly hope that I did not offend you in any way by my having offered my comments! I will monitor Rocky's Thread! Thank you for your care of and love for little Rocky Squirrel and I wish Rocky and you the very best!

Regards,
SamtheSquirrel

[TubeDriver]

There is an adage that time will always clarify diagnosis. In this case, in the short term, the correct antibiotics will certainly help to relive many of the symptoms that Rocky is presenting with. Much in the same way that prednisone will temporarily relieve all sorts of inflammation and pain but often without addressing the underlying issue. If Rocky is suffering from Odontoma, these symptoms will eventually return. So let's hope that these symptoms remit and stay that way. If they return, consider what STS has said.

[SamtheSquirrel2018]

Hello again Elgato and I apologize for not immediately "stepping back" as I intended to do but I had also meant to ask a question in my recent post and just realized that I had inadvertently neglected to do so! The question was whether or not your Veterinarian had been able to obtain a specimen from the root region of the tooth socket to send to a laboratory for what is termed a Culture and Sensitivity (C & S). This is a particular series of actions performed in a specialized laboratory where any bacteria present in the specimen are allowed to grow on certain nutrient mediums so that they can later be identified and then subsequently be challenged with various antibiotics to determine what antibiotics might be useful in treating the particular infection! It is not always possible to obtain a satisfactory specimen but if this was able to be done; it may provide definitive information regarding any culprit bacteria and the optimal antibiotic therapy that could be utilized in a treatment protocol!
Regards,
StS

[Elgato5164]

Hello again Elgato and I apologize for not immediately "stepping back" as I intended to do but I had also meant to ask a question in my recent post and just realized that I had inadvertently neglected to do so! The question was whether or not your Veterinarian had been able to obtain a specimen from the root region of the tooth socket to send to a laboratory for what is termed a Culture and Sensitivity (C & S). This is a particular series of actions performed in a specialized laboratory where any bacteria present in the specimen are allowed to grow on certain nutrient mediums so that they can later be identified and then subsequently be challenged with various antibiotics to determine what antibiotics might be useful in treating the particular infection! It is not always possible to obtain a satisfactory specimen but if this was able to be done; it may provide definitive information regarding any culprit bacteria and the optimal antibiotic therapy that could be utilized in a treatment protocol!
Regards,
StS

STS,
I’m not offended or off put as I understand you are only trying to help. I have access to Clavamox tablets that I can mix with water to give to him and I’m not opposed to giving it concurrently with the Baytril. My friend, a certified rehabber, should be able to give me the dosage tomorrow. I did not mean to come across as defensive, I only wanted to be straightforward in what I was trying to explain without extra “fluff” or confusion. I do hate giving Rocky antibiotics as he hates it so much and I can tell he isn’t happy with me. Adding another syringe of antibiotics is really going to upset him. He is mostly a docile guy but he has become a bit aggressive in the past couple of days. He even chased one of my cats across the kitchen counters and into my dining room and was literally on her back at one point! Although I do have a crazy squirrel that does this quite often, Rocky has never done it. My cats are traumatized (which isn’t necessarily a bad thing lol) but it is not in Rocky’s nature to be aggressive.
I also forgot to say that the vet did give Rocky an anti inflammatory injection both times.
I’ll take any information and advice that I can get as I love this squirrel!
However, there is one thing you and I disagree on and that is seeing a shrinkage of the infection, not the probable odontoma. I’ll post a comparative of 2 X-rays that I did at the bottom of this post so that you can see where I am coming from.
As I stated in the beginning, the vet thinks surgery will be the end result but clearing up as much infection as possible will allow him to better see the area/odontoma in the xray.
Additionally, he does work on the animals at the zoo and last time I was there he had a wolf that he was treating and an otter!! His passion is wildlife and he has been working with wildlife for 20 years. I’ll try to get in touch with him tomorrow to see if I can find out why he chose Baytril over Clavamox.
Again, I’m not offended, etc., I understand where you are coming from.
Regards,
Lorie

[Elgato5164]

STS,
I forgot to answer your question regarding a culture sensitivity test. No, a test was not done.
Lorie

[SamtheSquirrel2018]

As I stated in the beginning, the vet thinks surgery will be the end result but clearing up as much infection as possible will allow him to better see the area/odontoma in the xray.
Additionally, he does work on the animals at the zoo and last time I was there he had a wolf that he was treating and an otter!! His passion is wildlife and he has been working with wildlife for 20 years. I’ll try to get in touch with him tomorrow to see if I can find out why he chose Baytril over Clavamox.
Again, I’m not offended, etc., I understand where you are coming from.
Regards,
Lorie

Hi Lorie and thanks for your reply! First off, I have several other suggestions in light of the fact that Baytril has been "on board" for a relatively long time and especially if the Baytril is to be continued and another antibiotic added and those would be; 1) to coordinate any change in therapy with your trusted Veterinarian. I am certain that your Vet will listen to you and be receptive to reasonable compromises but I do feel that this professional should be in on the planning so to speak; 2) both Baytril and Clavamox are considered Broad Spectrum Antibiotics and while that is usually a benefit and necessity for empiric (therapy based upon knowledge, experience. likelihoods etc without knowing the definitive causative bacteria) treatment of dental and oral infections, they do kill bacteria that are not involved in the infection and may even be beneficial bacteria and the normal microbial "balance" is affected especially when a broad spectrum antibiotic is utilized and this potentially adverse effect will be magnified considerably by use of two broad spectrum antibiotics concurrently and even sequential use of two broad spectrum antibiotics (one discontinued and the other started)! The major concern with use of Baytril with dental infections is that it does not have appreciable action against anaerobes and anaerobes are a very common bacterial component of a dental infection (and Baytril also exhibits somewhat of a "hit or miss" with streptococci) and it may be more prudent (especially if Baytril is to be continued), to simply add an antibiotic whose primary action is against anaerobes! To facilitate this option, I would humbly recommend use of Metronidazole! There is ample experience with dosing and use of Metronidazole in rodents and specifically with Squirrels! Your Vet could facilitate this option if agreeable!

Almost always, surgery is required for any definitive elimination of infection involving the maxillary (upper jaw) dental structures! Fortunately, your Vet is experienced with this!

However, there is one thing you and I disagree on and that is seeing a shrinkage of the infection, not the probable odontoma. I’ll post a comparative of 2 X-rays that I did at the bottom of this post so that you can see where I am coming from.
As I stated in the beginning, the vet thinks surgery will be the end result but clearing up as much infection as possible will allow him to better see the area/odontoma in the xray.

Again, no offense intended, but I don't understand "seeing a shrinkage of the infection, not the probable odontoma." The probable odontoma visible on the x-ray films is the very dense, white, roundish, popcornlike mass visible at the base (root region) of the right upper incisor. Are you saying that you see a "shrinking" of "the infection" that is different from the mass (again, I don't see any appreciable change in the mas)? I truly hope that there is a shrinkage of the the likely infection accompanying the mass that does appear to be an odontoma but I am not sure how one would ordinarily be able to recognize this effectively on an x-ray film!

While there is an infinite degree of densities possible from an x-ray beam passing through an animal; there are in a sense, three primary densities with variations of each. These are; a) air (such as the lungs) which permit most of the radiation to pass though it and in black on the film, b) water (such as the muscles, some large blood vessels, some organs and the skin to some degree) which permits the passing of some of the x-ray beam but not all and this results in a faint to moderate "whiteness" on the x-ray film, and c) bone (such as of course the bones but also the teeth and also by any significantly mineralized mass such as an odontoma, calcified tumors or some foreign bodies such as bullets). Infections themselves, especially if they are a cellulitis (in the skin itself) or are present in bone or teeth are truly unlikely to be identified on a plain film x-ray study as there is no real interface (a difference in radiographic density) between that and the "water" density of the skin or the "bone" density of surrounding bone or teeth and it becomes difficult to recognize these! Even a true intact abscess may be very difficult to recognize without a definitive interface between it and the surrounding predominant density (if water or bone).

So anyway, I am not sure about my recognizing the infection on the x-ray films or seeing changes on the films indicative of an improvement in the infection but my hopes, nonetheless, are that any possible resolution or improvement of infection has been effectively facilitated by the removal of the tooth and subsequent drainage and hopefully by the antibiotics as well!

Please keep on with the updates on Rocky! Thanks again for your love and concern for this tough little Squirrel!

Regards,
SamtheSquirrel