DISEASE SUMMARY PAGE

Tusk Injury in Elephants

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Summary Information
Diseases / List of Physical / Traumatic Diseases / Disease summary
Alternative Names See also:
Disease Agents
  • Elephants may damage their tusks in a variety of ways, including through fighting or sparring, injuries from spears or bullets, excess rubbing of the tusk on solid surfaces in captivity, etc. (B384.8.w8, B453.7.w7, J337.93.w1, P6.6.w2)
  • Secondary bacterial infection of the pulp may occur if the root canal has been exposed through trauma. (D301.3.w3)

Further information on Disease Agents has only been incorporated for agents recorded in species for which a full Wildpro "Health and Management" module has been completed (i.e. for which a comprehensive literature review has been undertaken). Only those agents with further information available are linked below:

Infectious Agent(s) --
Non-infectious Agent(s) --
Physical Agent(s)
General Description Tusks have a prominent structure, which makes them predisposed to injuries. (B450.12.w12)

The types of tusk injuries that have been described in elephants include:

  • Superficial cracks, breaks or splinters where the pulp is not exposed. (B23.79A.w11, B450.12.w12, P505.7.w2)
    • These are relatively common. (B23.79A.w11)
  • Deeper injuries, such as abrasions, fractures and cracks, where the pulp is exposed and consequently becomes infected from environmental contamination. (B16.18.w18, B450.12.w12, J4.183.w3,  J4.189.w4, P1.1985.w5)
  • Longitudinal fracture of the tusk and subsequent infection has been reported. (J4.192.w1)
  • Transverse fracture of the tusk and subsequent infection has been reported. (J2.20.w4)
  • Loosening of a tusk in its socket has been described. (B10.49.w21)
  • Complete or partial loss of the tusk has been reported. (P5.41.w6)
  • In some cases the injuries affect both tusks, causing traumatic pulpitis when the pulp cavity is exposed. (J4.183.w3, P1.1985.w4)
  • Infection, abscessation, necrosis, sinusitis and loss of the tusk are common sequelae following injury to the tusks involving exposure of the pulp. (J2.20.w4)
  • Pulp infections following tusk injuries can persist for months or years and may be debilitating and in some cases even fatal. (B450.12.w12, J4.183.w3, P505.5.w1)
    • Discomfort due to infection may result in general malaise and/or aggressive behaviour. (B23.79A.w11)

Clinical signs:

  • Superficial cracks or breaks in which no pulp is exposed. (B450.12.w12)
  • Deeper injuries, such as fractured or abraded tusks, where the pulp is exposed. (B450.12.w12, J4.185.w2, J4.189.w4)
    • Fractures may occur in different planes: a portion of the tusk may be broken off or a break may occur along the tusk. (J4.185.w2)
  • Haemorrhage may occur if the pulp is reached. (J337.93.w1)
  • Purulent exudate may be found around the tusk (J4.185.w2), draining down the tusk (P505.7.w1,) or draining from the distal end of the tusk. (J2.20.w4, P506.4.w1)
    • The pus has a distinctive, unpleasant, smell. (P506.4.w1)
  • Note: a black area at the distal tip of an injured tusk (even a small black spot) may indicate pulp exposure. (B450.12.w12, P505.5.w1, J2.20.w4, V.w82)
  • Tract in the tusk, with purulent exudate. (D301.3.w3)
  • Dirt, sand and dung may be packed into the affected area. (P506.4.w1)
  • A tusk which has been loosened in its socket by a sharp blow points in the wrong direction. (B10.49.w21)
  • The elephant may show signs of severe pain. (P6.6.w2)
Further Information
  • Severe tusk injuries occur in wild elephants. (B462.3.w3)
  • Chips, beaks and broken edges of tusks in wild elephants gradually wear smooth with time. (B462.3.w3)
  • The tusk has a great regenerative ability; the abundant vascularisation of the tusk pulp facilitates the healing process. (B450.12.w12, J332.38.w1, P5.41.w6, P504.1.w4, P505.9.w4)
  • Several examples are known in which elephants' tusks have been broken, but a mass of ivory has subsequently been deposited in the pulp cavity, resulting in the pulp becoming naturally sealed off from the external environment. (J332.38.w1)
  • In male Elephas maximus - Asian Elephant, and both male and female Loxodonta africana - African Elephant, the pulp cavity is close to the tip of the tusk and is commonly exposed if the tusk is injured. (B452.14.w14)

Investigation/ Diagnosis:

  • Evaluation should be carried out as soon as possible to avoid development of complications. (B22.25.w11)
  • Intra-oral clinical examination; in some cases this may be difficult or not possible. (J4.185.w2)
  • Haematology: this may be within the normal limits. (J4.185.w2, J4.189.w4)
  • Culture and sensitivity of the exudate. (J4.185.w2, J4.189.w4)
  • Radiography may be used for detection and localisation of tusk fractures although root fractures can be difficult to detect radiographically. (J4.185.w2)
    • Due to the elephant's anatomy, particularly the large masses of both soft tissue and bone around the oral cavity, it may not be possible to thoroughly evaluate the tusk radiographically. (J4.185.w2)
  • A loosened tusk may be visibly pointing in a changed orientation. (B10.49.w21)

Treatment:

Note: If possible, treatment should aim to retain and restore the tusk, since tusks are used by the elephant for several functions. (J4.185.w2)

  • Haemorrhage from the sulcus due to breaks in this area may be controlled by packing the sulcus. (J337.93.w1)
    • Note: The elephant may remove such packing. (J337.93.w1)
  • Cracks or breaks of the tusk in which the pulp is not exposed can be managed by filing the sharp edges and restoring the smooth surface. (B16.18.w18, B22.25.w11, B23.79A.w11, B450.12.w12)
    • Note: If the break is close to the pulp cavity and there is a longitudinal crack, there is an increased risk of splitting of the tusk. (B10.49.w21, V.w82)
  • Tusk injuries where the pulp is exposed require immediate medical treatment and/or surgical treatment. (B23.79A.w11, J4.185.w2, J4.189.w4, P1.1985.w4)
  • Stainless steel bands, placed around the tusk, have been used to stabilise a longitudinal fissure. (B23.79A.w11, P505.7.w2)
    • There has not been sufficient long-term follow-up to prove that this is beneficial. It must be remembered that the pulp may already be necrotic. (V.w82)
  • A pin or bolt may be use across a longitudinal fissure to prevent further splitting. (P505.9.w4)
    • This must be inset into the tusk so the elephant cannot rub it against anything in the enclosure. (P505.9.w4)
    • There has not been sufficient long-term follow-up to prove that this is beneficial. (V.w82)
  • Simple medical management of an infected pulp is problematic; elephants are capable of removing antibiotic packing material, even if sealed using substances such as dental acrylic, and may blow debris up into the pulp canal. (P505.5.w1)
  • If it is possible to maintain vital pulp, pulp capping may be carried out, allowing the tusk to repair itself by laying down additional ivory. Infection must be controlled. (P1.1991.w3)
    • Flushing twice daily with dilute povidone iodine, antibiotics based on culture and sensitivity, and placing a filing in the tusk to keep it clean. (D301.3.w3)

Surgical treatment

  • Surgical treatment such as partial pulpectomy or tusk extraction is carried out under general anaesthesia, with the elephant in lateral recumbency. (J2.20.w4, J4.185.w2)
    • Treatment prior to surgery may include flushing of the exposed pulp cavity with 0.9% saline followed by povidone iodine solution, together with administration of antibiotics (e.g. trimethoprine-sulpfamethoxazole). (J4.185.w2)
  • With small, fresh injuries due to acute trauma, the pulp and pulp chamber may be flushed with antiseptic solution, rinsed with a calcium hydroxide (Ca OH) slurry to increase reparative ivory formation (with care not to inject any into the tissue) and sealed using an iodoform gauze pack. (P505.9.w4)
  • A focal pulp canal infection may be surgically debrided and sealed. (P505.5.w1)
  • Partial pulpectomy, removing the exposed section of pulp, may be used where a portion of the tusk has broken off transversely (horizontal fracture) and the pulp is exposed. If successful, this allows maintenance of the vitality of the remaining pulp, since a protective layer (bridge) of dentine forms over the amputated pulp surface. (J2.20.w4, J4.185.w2, P504.1.w4)
    • Care must be taken not to separate the remaining pulp from the tusk wall, to which it is attached only poorly, as such separation produces a dead space into which bacteria may migrate. (J2.20.w4, P505.9.w4)
  • The following has been found most useful in 20 years of experience by one individual: modify the pulp cavity to produce a cylinder with length four times the diameter of the prepared canal, resecting the pulp to a healthy base proximal to this. Thread the canal with a tap, or prepare the wall with irregular undercuts (depending on the canal's diameter). Once bleeding of the pulp has been stopped, dress the pulp with a layer of zinc oxide cement. Using a fast-setting polmethylmethacrylate cement, cement a resin rod, matching the diameter of the canal, into place. (P6.6.w2)
    • Note: further contact of the tusks with walls or fences may cause further damage at any time in the future and the tusk may then fracture horizontally or longitudinally. (P6.6.w2)
    • Long-term success may be about 60% in young animals ( four to ten years) but zero in mature bulls (over 15 years of age) over a span of one to three years post treatment. P6.6.w2
    • In a male Loxodonta cyclotis - Forest Elephant, the tusk was cut off close to the sulcus to increase access to the pulp canal, the canal was cleaned of debris, flushed with surgical soap and the canal made wider and deeper using an elongated craniotomy burr attached to a variable speed power drill, until it reached bleeding, firm, vital pulp tissue. Devitalised ivory in the tusk canal was removed using a chisel and hoe-shaped curettes. The cavity was flushed with hydrogen peroxide several times then with tamed iodine and finally packed with iodoform gauze soaked in chloramphenicol, and plugged with a rubber cork. Post-surgical treatment included intramuscular injection of long-acting penicillin. The gauze and cork were left in place to guard against infection. Only slight facial swelling was noted postoperatively. By 22 months post surgery, the tusk had grown 14.4 cm out of the sulcus and the gauze and cork were still in place. (J337.93.w1)
  • A long (deep) pulp canal infection was successfully treated using initial flushing followed by threading of the distal discharging canal using a tap and placement of a sterile stainless steel set screw, under standing sedation, then, without sedation, daily flushing with antibiotic (chosen using culture and sensitivity testing) through a long catheter placed and set into the canal with sterile gauze. Periodic cessation of antibiotic flushing and removal of the catheter and packing, followed by culture and sensitivity testing was carried out to ensure that the correct antibiotic was used. Once the infection had been fully controlled, the catheter and packing were removed and a larger permanent set screw was placed and covered with steel impregnated epoxy (again under standing sedation). (J4.189.w4, P505.5.w1)
  • It has been found possible to allow regrowth of a tusk, after it has broken off deep in the sulcus, and despite infection, by treating with repeated flushing and excision of exuberant gingival tissue to maintain patency of the sulcus. (P505.5.w1)
  • In elephants with transverse fractures near the margin of the alveolus, and bacterial infection (gingivitis and peridontitis) due to sharp tusk fragments and accumulation of organic debris at the site of the fracture, but without exposure of the pulp, the site was flushed and reactive tissue of the sulcus (which partially covered the remaining tusk) was removed. Several small holes were drilled in the tusk using inverted cone dental diamond stones, to provide anchoring points, the tusk was cleaned (with conditioner polyacrylic acid), washed with water) and dried, then covered with a restorative material (glass-ionomer cement combined with a dentine adhesive and a composite resin), forming a smooth, rounded restored tusk fitting in the sulcus. The sulcus was flushed daily with 2% chlorhexidine. (B22.25.w11, P1.1991.w6)

Extraction of the tusk

  • If the pulp becomes devitalised, or it will not be possible to prevent this, the tusk will have to be extracted. (P1.1991.w3)
  • If severe infection develops, extraction of the tusk is indicated. (B16.18.w18, J2.34.w3, P6.6.w2)
    • Note: the time from initial detection of tusk trauma or infection to a decision to extract the tusk may range from days to years. (J2.20.w4)
  • Extraction is required for elephants showing severe pain, for those with deep peridontal defects with purulent discharge and cassation of tusk growth, for longitudinal fractures (since these generally result in infection, and progress towards the proximal end of the tusk), and if there is chronic exposure of pulp at the tusk tip (whether a small defect or a large cavity with discharge of blood and/or pus). (P6.6.w2)
  • Extraction is required for tusk injuries in which the exposure reaches below the bone, pulp necrosis reaches the germinal area, or a fissure extends into the germinal area. (P505.9.w4)
  • Extraction of the tusk intact under anaesthesia
    • Tusks have been removed intact using longitudinal and rotational forces: (B23.79A.w11)
      • In a case involving a longitudinal fracture and infection for several years in a female African elephant of about 18 years of age, a hole 1.5 cm in diameter was drilled through the tusk about 5 cm from the sulcus, wire passed through this and wrapped around the tusk, a long chisel was used to assist in breaking down the periodontal ligament between the tusk and the alveolus, and considerable rotational forces, in alternating directions, were used in combination with longitudinal forces to loosen and extract the tusk. (J4.192.w1, P505.7.w1)
      • Complete tusk removal was required for a case in which surgical exploration and radiography revealed an extensive longitudinal crack to, or nearly to, the tusk base, in addition to the known original injury (loss of the distal tusk). Bone gouges and chisels were used to separate the tusk from the alveolar wall, with care not to penetrate the maxillary sinus. The tusk was grasped with forceps and extracted, with rotation to facilitate separation of the periodontal ligament. (J4.185.w2)
  • Extraction of the tusk by longitudinal sectioning: the internally collapsing tusk extraction technique)
    • This method is required for large, well-retained tusks. (P6.6.w2)
    • The base of the tusk may be considerably larger in diameter than the diameter of the exposed, distal portion, making removal extremely difficult, if not impossible, with the tusk intact. Longitudinal sectioning of the tusk greatly facilitates tusk removal. (J2.20.w4, P506.4.w1, P6.6.w2)
      • In brief, the tusk is sectioned transversely just distal to its point of emergence from the skull, then sectioned longitudinally. Stainless steel rods may be used as elevators for removal of the pieces of tusk. (P505.9.w4)
      • Note: appropriate, specialised drills, saws and chisels are needed to carry out this procedure in a reasonable length of time. (P506.4.w1)
      • The root canal is widened by use of appropriate rotary instruments (specialised drills), to produce a thinner remaining tusk wall (about 1/4 - 3/8 inch thickness, although this varies depending on the size of the tusk) and to create a hole sufficiently wide to allow a saw to be introduced along the whole length of the tusk to cut thorough the tusk wall. (P6.6.w2, P506.4.w1)
      • The remaining wall of the tusk is sectioned longitudinally to give several sections (usually about four or five, but the ideal number varies with the size of the tusk); pilot cuts are made with a short (five inch), coarse blade, then a much longer air saw is used to make the main cuts and a hand saw is used to finish off the cuts through to the bone of the socket. (P6.6.w2, P506.4.w1)
      • Specialised splitters and elevators are used to elevate the long sections from the walls of the socket. (P6.6.w2)
      • Modified forceps are used to extract each section. (P6.6.w2, P506.4.w1)
      • Any infected tissue is removed from the socket. (P506.4.w1)
      • Post-operatively, antibiotic cover is advisable, and the socket may be flushed occasionally with antiseptic solution. (P506.4.w1)
    • Example 1: In one case the wall of the tusk was cut longitudinally into four sections, using a wood saw inserted into the pulp chamber, the tusk was loosened from the periodontal membrane using osteotomes, then the sections of tusk were removed separately, starting with the smallest section, by grasping each section with vise-grip pliers and pulling and turning. (J2.20.w4)
    • Example 2: In five cases the tusk was sectioned transversely near the free gingival margin, using a wood saw, to provide optimal exposure of the pulp chamber of the remaining, proximal section of the tusk. Carbide burs attached to a variable-speed drill were used to increase exposure to the pulp chamber, then the remaining pulp was removed using stainless steel rods and hooks. The wall of the tusk was then cut longitudinally into several (three or four) sections, using a wood saw inserted into the pulp chamber. The tusk was loosened from the periodontal membrane using bone gouges. A specially prepared instrument was used to split the longitudinal segments from one another and free them from the wall of the alveolus; inserted between the alveolar wall and the tusk, blade in the saw cut and facing towards the tusk, this instrument was advanced towards the base of the tusk by tapping it with a metal mallet. Stainless steel rods, 24 cm long, shaped like screwdrivers, were used to free each tusk segment from its proximal attachment to the alveolar bone. The sections of tusk were removed separately, starting with the smallest section, by grasping each section with pliers. After the last piece had been removed the socket was flushed with dilute organic iodine solution. (J2.20.w4)
      • Post surgery, the alveolar chamber was flushed using dilute organic iodine solution on a daily to monthly frequency, plus post-operative systemic antibiotics. The alveolar chamber filled with granulation tissue within about four months. (J2.20.w4)
      • Caution: repeated flushing of the socket may destroy the clot, hindering formation of granulation tissue and healing. (V.w82)
      • Required instruments include chisels, elevators, splitters and modified forceps. (J2.34.w3)
  • Induced tusk extraction without anaesthesia: 
    • This was reported in an adult female Loxodonta africana - African Elephant with a chronic tusk problem and infection, rubber elastics were placed on the tusk and pushed down as far as possible using an adapted piece of PVC pipe, with repeated pulling on the tooth by the keepers. The tusk fell out after 16 days. (J2.34.w3)
      • Note: a tusk this mobile might have exfoliated spontaneously without the use of the elastic bands. (V.w82)

Prevention:

  • Good management, with provision of a stimulating environment to avoid boredom, and a non-abrasive environment, to minimise the risk of development of tusk injuries. (P505.9.w4)
  • Tusks may be shortened to reduce the risk of their becoming damaged. (B10.49.w21)
  • Care must be taken if shortening the tusks not to cut into the pulp. (B10.49.w21, P505.9.w4)
    • It has been suggested that as a "rule of thumb", the pulp cavity may run out beyond the sulcus for the same distance as from the eye to the sulcus, and longer in young animals. (B10.49.w21, P505.9.w4).
    • In practice the situation is far more variable and this "rule of thumb" is not reliable.  The length of the pulp cavity in elephant tusks varies with the species and the sex of the individual, also with the speed and amount of abrasion which has taken place at the coronal/distal tip of the tusk. Relatively slow wear at the distal extremity will stimulate secondary dentine deposition and some tusks may be worn down to the sulcus level without a pulp exposure occurring. Therefore it is extremely difficult to predict the position of the distal extremity of the pulp cavity. Elephas maximus - Asian Elephant females generally have a pulp cavity length which may be only 30 - 75 mm long, just twice the diameter of the cranial end of the tusk, while the full length of the tusk in the socket may be ten times as long as the diameter, therefore these elephants usually do not expose the pulp chamber when the tusk is fractured, even if the fracture occurs at the level of the tusk sheath, or even cranial to it. In all other elephants, either fracture or rapid wear of the tusk tip may result in pulp exposure. (P6.6.w2, V.w82)
  • Metal (nickel-bronze) tusk caps, developed from moulds of the tusks, have been used on tusks which elephants were damaging (flaking and chipping damage) before the pulp cavity was exposed, to protect the remaining tusk and prevent further damage. (P505.11.w2)
    • Caps were attached to the tusks using Allen screws (1/4 by 1 inch i.e. 6.35 x 25 mm) and epoxy resin. (P505.11.w2)
    • Note: These will fall off in time. In young elephants, in which rapid wear can expose the pulp cavity, the presence of such crowns may encourage the elephants to work at the edge of the crowns along objects such as fences, resulting in early failure. In older elephants, moderate wear should cause deposition of secondary dentine inside the pulp cavity, so that no pulp exposure occurs as the tusk tip is worn. Pulp exposure is more likely to occur through tusk fracture than through excessive wear of the tusk. (V.w82)
Associated Techniques
Host taxa groups /species Further information on Host species has only been incorporated for species groups for which a full Wildpro "Health and Management" module has been completed (i.e. for which a comprehensive literature review has been undertaken).

(List does not contain all other species groups affected by this disease)

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