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The bear necessities
3rd Feb 2006
A Sussex dentist is bringing essential dental care to India’s sloth bears. Jo Bladd reports Even 20-years of endodontic expertise couldn’t prepare Sussex dentist Paul Cassar for his next patient. Weighing 190kg and splayed furry tummy-up on the operating table, 14-year old Anthony is a sloth bear with a very sore head. Or, more precisely, an ossifying fibroma in his lower gum. ‘When I said yes to this,’ said Paul ruefully, ‘I didn’t quite realise just what a big job I'd be taking on.’ Getting on board For most dentists, root-treating doesn’t often come in this size. Anthony is one of the 166 sloth bears that live in the Agra Bear Rescue Facility in India. Supported by International Animal Rescue (IAR), a UK-based charity, the facility rescues and rehabilitates dancing bears. Like most of the residents, Anthony’s teeth were smashed out when he was 10 months old to make him easier for his owner to control. His roots, left to become infected, cause him extreme pain. Paul, as an IAR trustee, has been familiar with the bears' plight for some time. But it was only after Alan Knight, chief executive of IAR, showed him photos of the bears’ mouths, that he took the step from the board into the surgery. ‘Alan showed me the photos and asked, “what do you think?”’ Paul said. ‘I could see the bear’s canine teeth were just festering roots. It had draining sinuses and suppuration everywhere. It must have been in terrible pain. I said, ‘If they were human, we'd be treating them.’ Rethinking tradition Dancing bears are a familiar sight in India. Stolen from their mothers as cubs, the bears are used by Kalandar nomads to beg for money from tourists. A hole is pierced through their lips, nose or palate, and a chain or rope is attached. It can then be pulled on to encourage the bear to ‘dance’, as it tries to avoid the pain of the raw wound. IAR, alongside an Indian charity Wildlife SOS, has been working with the Indian authorities to stamp out the practice. The project is particularly innovative because the sanctuary offers handlers an alternative way of earning a living. The bears can be traded in for a grant of 50,000 rupees (£625), allowing the handler to start up a business. The handlers sign a legal contract, promising not to buy another bear, and are monitored to ensure the grant money is used appropriately. New dental skills Paul joined up with veterinary dentist Lisa Milella for his trip to India. Overseen by Lisa, Paul has been preparing for the trip for a year, honing his skills on dogs’ mouths. Canine teeth, especially bull mastiffs, are closest in design to that of a sloth bear. ‘I’ve had to learn a whole new set of skills,’ Paul admits. ‘Lisa and I operated on dogs together, but a bear’s canine tooth can grow to more than six inches, so there’s still a huge difference in scale.’ Aside from new dental skills, Paul also needed to source essential dental equipment to be sent over in advance. Several companies donated products and the sanctuary is now the proud owner of a full dental surgery. ‘We were very lucky,’ Paul says. ‘People were very generous. Clark Dental, Septodont, Dentsply Ash and Kerr all really helped us out.’ Endodontics ‘bear-style’ During their week at the sanctuary, Paul and Lisa have operated on nine bears. With a daily routine that started at 6am and ended at 2am, the experience gave new meaning to the term ‘dental treadmill’. As Paul explains: ‘The first bear is anaesthetised and in the surgery by 10am. Then we work through till 2.30pm, break while they dart the second bear, operate again between 4pm and 8pm and then run a tutorial for the sanctuary vets between 10pm and 1am.’ Paul was, he says, ‘quite tired’ when he returned home. The lack of sleep wasn't the only hurdle. ‘One of the biggest challenges we faced with the bears was canine removal,’ Paul said. ‘The lower canines are very difficult to get at. They're deeply embedded into the mass of the mandible. It takes an hour and-a-half to do each tooth, with over an inch of buccal-plate bone to drill through. Just finding the root is tough!’ His remit, Paul says, was to root-treat as many of the bears as possible. Each root canal takes over an hour to do. 'Bears don't have an apical terminus. They have an apical sieve almost; like a colander of blood vessels feeding into a huge pulp. So things like apex locators just don't work,’ he explains. ‘We used sodium hypochlorite bleach, but at 100% strength, and it had to stay in the canal for over an hour. That's why each bear took so long.’ Online bear checks Aside from their work with the bears, Paul and Lisa are also holding daily tutorials for the facility’s vets to ‘get them in the dental mode’. It means that, between Paul’s visits, the vets will now be informed enough to assess and treat the bears. ‘They'll take clinical photographs of the teeth and jaws of every bear that comes into the sanctuary from now on,’ Paul explains. ‘If the bear is in obvious discomfort, they can email the images to the UK to Lisa and I. We’ll choose a treatment modality they can do.’ Paul stresses that he has every confidence in the vets: ‘They're highly experienced guys. They've seen 15 root canals and 20 extractions and they know what they can and can’t do. Once they get their experience level up, they'll be carrying on the work.’ Presidental sinuses Most of the bears were selected for treatment before Paul and Lisa arrived, but Paul’s tutorials led to another patient turning up. Paul said: ‘I was telling the vets that George Washington had a draining sinus in his cheek, which is why you only see pictures of him from one side. As soon as I said this, all three vets focused on this bear called Shusti. She had a great, suppurating mass under her chin. They all thought, “George Washington had a draining sinus, maybe Shusti does too!”’ Shusti, unusually, still has her four canine teeth, but they have worn down prematurely and the pulps are exposed. Paul explains: ‘The bears are kept on a 2ft rope by their handlers. Because they don't move outside that radius, the wear of their canines is completely abnormal. Shusti had four teeth with pulp death, and the mass on her chin was a result of one of these lower canines. Extraction solved the problem.’ The road to freedom The bears that join the sanctuary stay there for life. It’s impossible, Paul says, to release them back into the wild, as they wouldn't survive. ‘The bears have been humanised. They've had their claws and teeth ripped out, and many go blind through malnutrition. They couldn't cope in the wild.’ The sanctuary has just finalised a deal with the Indian government for another 140 acres of land. The expanded facility will house the growing numbers of dancing bears surrender by their handlers, in exchange for a grant. For Paul, this means there will be a steady stream of bears in the future, all needing dental work. With an expected 600 bears over the next few years, it is, Paul says, a daunting prospect. For IAR, it’s also a huge financial commitment. ‘We really need dental companies to continue to support us, and to donate the vital dental equipment and materials that the bears need.’ Paul says. ‘Other dentists can always approach the charity or me if they’d like to volunteer their time.’ And of course, Paul adds, the charity always needs donations. For bears that have spent years being forced to dance for tourists, the sanctuary provides a safe haven for the rest of their lives. ‘It’s not freedom,’ Paul admits. ‘But it’s as good a freedom as we can give them for now.’
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