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Oral Health in South East Queensland Koalas: Prevalence of Periodontal

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Oral Health in South East Queensland Koalas: Prevalence of Periodontal __ Oral health in South East Queensland Koalas: Prevalence of periodontal disease and other pathologies Lyndall M Pettett Bsc (Hons 1st Class) (Microbiology) A thesis submitted for the degree of Doctor of Philosophy at The University of Queensland in 2016 School of Veterinary Science Abstract The koala (Phascolarctos cinereus) is one of Australia's most highly specialised folivores with a diet exclusively of eucalyptus leaves to provide all nutritive needs. For this it is dependent on good dentition for optimal health and quality of life. The purpose of this study was to characterise and describe the level of oral health and disease in koalas and then create tools for ongoing analysis. The historical records over a 17-year period were noted for the koalas admitted to the Moggill Koala Hospital in South East Queensland. Further, in this study the conclusions were that oral health issues when they existed were only being identified as “low key” due to the lack of investigative tools being used during examinations. This provided the reasoning and impetus behind developing tools to determine the true extent of oral health conditions in the koala. A suitable assessment tool for diagnosing the oral health was designed based on the index scoring methodology and the layout of the Moggill Koala Hospital admission chart, a new oral health chart template was developed. The chart was based on examination of 30 “free-range koalas” and validation and quality assurance analysis of four examiners of varying qualifications. The chart was separated into three sections; containing general animal information such as sex, age, and current systemic health; the General Oral Cavity section and containing information on 12 koala-specific health questions and finally a section on the periodontal health. The charting data is multifunctional with analysis of individual koalas, (sex, group or age). The data from each section provided an index value that was compatible with values from other species clinical charting systems. Using the chart, populations of 200 “free-range” and 95 captive koalas (from three zoos) were examined. Three major indexes were developed during the chart development process and used the following equation; General Oral Cavity (GOCI) + Oral Health Index (OHI) = Final Oral Health Index (FOHI). Initially, the three major index values plus all additional information of each chart were analysed to show the current baseline values of oral health conditions in the koala. Any i comparison based on singular or multiple animals would either show a decline, same rate or increase from the baseline. These baseline parameters could be compared against any other species that uses the same 0-3 index system. The proportion of koalas from the whole population with an orally related problem was 86%.The average FOHI for the koala as a species was 3.78 ± 3.19, median 3.00. This is the mild category and held 84.5% of all cases. The maximum scores for the groups showed Zoo 3 as having lower range (Zoo 1; 11.42 for a TWC 1 male, Zoo 2; 13.40, Zoo 3; 4.13 and “free-range”; 15.98). The third zoo was the only group to have also had significantly better oral health than “free-range” koalas. Captive koalas showed high scoring at young age (11.42), the “free-range” comparable age score was 3.84. At population level when controlling for age there was no sexual difference in any of the three indexes. Index level increased with age. In both koala communities periodontal disease increased in extent, severity and prevalence with age. When split into young, adult and old groupings the proportion of koalas with an oral complaint were: Young (TWC 1 and 2) 12.6%, Adult (TWC 3 to 5) 45.4%, and Old (TWC 6 or >) 42%. The median score for the GOC index was 3.00 with the most common score at 1.00. Proportionally 77.8% of the GOCI cases were mild, 19% moderate and 3% severe. Further analysis of a “free-ranging” population of 200 koalas showed that 74% percent of the free- range population had Periodontal Disease (PD). One in every 16 koalas from Tooth Wear Class 4 had evidence of developing periodontal pockets, gingival recession and loss of gingival attachment. Fifty percent of the population had gingivitis. The range of gingivitis index levels were between 0.14 and 2.57, Calculus deposits were present in the oral cavities of 173 koalas of the free-range population The average calculus severity index for the population was 0.95 (sd. 0.72, min. 0.14, ii max. 3.00, mdn. 0.85, mode 0.42). Severe levels of gingivitis and calculus were seen on most tooth sites with highest levels on the mandibular premolars and incisors. Periodontitis cases represented 28% of the “free-range” koala population, with aged koalas showing the highest proportion of cases, severity and extent. Thirty percent of the population finally developed advanced alveolar bone resorption (interdental and furcation) with the greatest bone loss sites being between the M2 and M3 in both jaws. The depth of bone loss measured 11.91mm at the M2. One in every three koalas with PD had vegetation compacted at the site affected. For every two koalas with systemic disease, one koala will have PD. In the captive koala population of 95 koalas over 50% of the population were affected by gingivitis, calculus and periodontitis. Fifty-six cases of bleeding were recorded, 28 cases observed spontaneous bleeding, with 82% of these cases coming from Zoo 1. All spontaneous bleeding cases were later identified as having systemic disease. Gingivitis occurred in 61% of the captive population, and was present with calculus in 36.8% of the whole population. The average gingivitis index level was 0.86 (s.d 0.84), minimum 0.14, maximum 3.00. Calculus deposits were present in the oral cavities of 49 captive koalas. The average calculus index was 0.68 (s.d 0.61, index range 0.14 – 2.40).There was 36 (38%) koalas with periodontitis. The greatest depth measurement of bone loss was 17.40mm at the M3. Attachment loss in the mandible showed the incisors had the largest average loss (I1 average 5.16, s.e 0.26). In the maxilla the incisors also held the highest average at 3.00, s.e 0.15 followed by the M2. When examining non-periodontal disease oral anomalies they were over three times more prevalent in the free-range animals than in the captive colonies. The captive colonies recorded 90 incidences of tooth abnormalities with Zoo 1 experiencing the highest proportion at 40.7% of their koalas. In iii the free-range koala group, 303 anomalies were identified. Motor vehicle and dog attack incidences caused torn periodontium, bite marks, broken teeth and jaws, hard palate irregularities, tooth loss and torn cheek flesh. Free-range animals reported 46.5% were affected by compacted vegetation, whereas in the captive group the rate was 19%. Abnormal tooth wear, supernumerary teeth, attrition, cracks, crazing, chips, abrasion and abfraction, or tooth displacement was common. Eleven “free-range” koalas had thrush, glossitis, blistering, skin loss, or bites to the tongue. The captive koala did not record any trauma-associated problems. The degree of anisognathia in the koala is 22.4%. Four malocclusion types were identified. The free-range koala possessed one malocclusion type. The captive koala had all four versions. Captive koalas also had a higher proportion (30.5%) than the free ranging koalas (22%). Dehiscences and fenestrations occurred at rates of 25.2% and 19.2%. The extrinsic black stain common to the koala mouth was found to be a useful tool in the measurement of relative attachment loss and the detection of abnormal tooth wear. Additionally, the hard palate rugae patterns were identified as an aid in the discovery of prior injuries to the maxillae. Conclusion: Periodontal problems were significant findings in 74% of “free-range” and 61% in captive koalas. Oral abnormalities associated with trauma caused major difficulties in the free-range koala. In the captive koala, the major significant abnormality was malocclusion. This standardized recording system will assist koala hospitals and zoos in managing oral problems that can affect animals. iv Declaration by author This thesis is composed of my original work, and contains no material previously published or written by another person except where due reference has been made in the text. I have clearly stated the contribution by others to jointly-authored works that I have included in my thesis. I have clearly stated the contribution of others to my thesis as a whole, including statistical assistance, survey design, data analysis, significant technical procedures, professional editorial advice, and any other original research work used or reported in my thesis. The content of my thesis is the result of work I have carried out since the commencement of my research higher degree candidature and does not include a substantial part of work that has been submitted to qualify for the award of any other degree or diploma in any university or other tertiary institution. I have clearly stated which parts of my thesis, if any, have been submitted to qualify for another award. I acknowledge that an electronic copy of my thesis must be lodged with the University Library and, subject to the General Award Rules of The University of Queensland, immediately made available for research and study in accordance with the Copyright Act 1968. I acknowledge that copyright of all material contained in my thesis resides with the copyright holder(s) of that material. Where appropriate I have obtained copyright permission from the copyright holder to reproduce material in this thesis.
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