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How Are Bacteria A Rose And An Elephant Alike
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Botswana Authorities Identify Cause Of Mysterious Elephant Deaths
Treatment and outcome of tusks fractures in African savannah and Asian elephants (Loxodonta africana and Elephas maximus) on five continents
Josephine B. Rose 1, 2, *, Austin Leeds 3, Linda M. Yang 4, Rachel LeMont 5, Melissa A. Fayette 6, Jeffry S. Proudfoot 6, Michelle R. Bowman 6, Allison Woody 7, James Oosterhuis 7 and David A. Fagan 7
Received: 15 February 2022 / Revised: 22 April 2022 / Accepted: 22 April 2022 / Published: 27 April 2022
When a tusk fracture occurs in a groomed elephant, it can expose the soft tissue and rich blood supply of the tusk pulp. Treatment strategies and clinical outcomes for these fractures vary in the literature and in the collective experience of elephant managers and clinicians. Outcomes range from improvement with conservative treatment to life-threatening systemic infection. Elephant veterinarians from around the world completed a detailed study of the signs and treatment of tusk fractures and their subsequent outcomes. A larger diameter of the pulp canal at the time of fracture and the use of tap water during treatment are associated with an increased risk of infected and inflamed pulp, which warrants further investigation. Endodontic treatment of a fractured canine with pulp is associated with a reduced risk of canine extraction. These guidelines can help elephant managers and clinicians make clinical decisions about these severe events.
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Fracture of an elephant’s tusks is a clinical challenge that can affect the overall health of the animal, especially when it involves contact with pulp. An international survey was sent to veterinarians to understand individual fracture characteristics and treatment strategies related to outcomes, with the aim of better understanding treatment procedures. The dataset consisted of 79 fractures from 64 elephants (including Asian and African males and females), 44.3% of which were class III fractures with pulpal involvement. Of this subset, pulp canal exposures >0.5 cm were 23.8 times more likely to develop pulpitis than <0.5 cm fractures, although canal size did not affect healing and extraction outcomes. The odds ratio showed that treatment including endodontics was 12.0 times more likely to improve than teeth treated with medical assistance alone, although no association was observed for reduced risk of pulpitis. Furthermore, pulpitis was 7.58 times more likely to occur when tap water was used to rinse exposed pulpal tissue; a finding that deserves further investigation. The use of endodontic treatment compared with medical treatment alone was significantly associated with better restorative outcomes (ie, reduced extraction risk) in pulpal dentin fractures.
Loxodonta sp.; Elephas sp.; ivory fracture; endodontics; partial pulpotomy; pulpitis; Extraction of ivory from Loxodonta sp.; Elephas sp.; ivory fracture; endodontics; partial pulpotomy; pulpitis; ivory extraction
Traumatic tusks in managed elephants present a serious clinical challenge to veterinarians and elephant caretakers. Fractures caused by pulp exposure may increase bacterial infection and/or pulpal inflammation [1, 2, 3]. Uncontrolled pulpitis can result in a nonviable canine that eventually requires extraction  and has been reported as a cause of sepsis and death . Pain may be present, especially with pathological enlargement of the periodontal ligament and/or pulpal apex [5, 6, 7]. Fracture management can be technically and logistically difficult to coordinate and may require anesthetic events . Elephant anesthesia requires specialized knowledge, of the 159 reported elephant deaths between 1988 and 1999, 5 were related to anesthesia or peranesthesia events . Moreover, even if tooth extraction is performed, severe apical disease requires multiple procedures to resolve the infection and complete tooth extraction, especially if there is tertiary dentinal ankylosis in the surrounding alveolar bone [10, 11, 12].
While many reports describe different techniques for ivory repair and extraction [1, 3, 6, 13, 14], the decision to preserve or extract damaged ivory is based on the dentist’s previous clinical experience [1, 11]. A decision-making matrix has been developed to guide clinicians in cases of exposure to ivory pulp, emphasizing the importance of removal of diseased pulp tissue and endodontic treatment to optimize outcomes . This matrix has been successfully used in institutions . Clinical decision-making regarding dentin fractures, particularly those resulting in pulpal exposure, requires further investigation. The abundant blood supply of elephant tusks can facilitate significant healing or function in severe ascending infections [4, 15]. An endodontic approach that preserves the viability of the dentin pulp while protecting the pulp from further contamination is the “best practice” in the treatment of dentin fractures [11, 16]. A critical appraisal of the status, treatments and outcomes of ivory fractures should be a valuable addition to the case and paper techniques mentioned above, contributing to best practice guidelines for clinical cases. In particular, a multi-institutional approach to assessment should be cost-effective given the logistical challenges and specialized veterinary skills required to treat fractures, and as reports indicate that ivory fractures can heal with a relatively conservative approach and/or limited human intervention . , 18, 19].
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The aim of this study is to better understand how elephant tusks can be optimally managed by establishing a relationship between variables and tusks outcomes. A deeper understanding of these relationships will help veterinarians and dentists develop management strategies for these complex clinical cases.
The purpose of this study was achieved by developing a survey (available for download in the Supplementary Materials) that served to achieve the five research objectives. First, to determine the individual characteristics of elephants with broken tusks, including elephant species, sex, elephant age at the time of fracture, and elephant weight in kilograms at the time of fracture. The elephants in this study were classified into age classes based on the reported age description of tusk development . This metric was developed for wild African elephants, and no similar metrics have been reported for Asian elephants to the authors’ knowledge. This classification of data was performed to reflect potential differences in dental development in the study population and to examine its association with fracture outcomes. The authors acknowledge that Asian elephant tusks are absent or so-called “residual”, rarely extending beyond the gingival sulcus, but are now fully developed [2, 11]. Therefore, they were included in the analysis, although if there was any indication that the magnitude of dimorphism might affect the interpretation of the results, additional separate statistics were performed.
The second objective was to describe the characteristics of tusk fractures in elephants under care. Part of this survey asks about the affected side of the tusk, the approximate length of the broken tusk, whether the tusk has had a previous tusk fracture, whether pericoronitis is present, whether there is hanging pulp tissue at the fracture site, the diameter of the tusk. exposed pulp canal, proximal extent of fracture, presence of reparative dentin in the pulp at the time of fracture, evidence of periodontal ligament disruption, and whether clinical signs of infection are present fracture. Other definitions are given in Table 1.
For this study, fractures were classified as Class I (involved) fractures.
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