Bonnie D. Wright, DVM, DACVAA, CVMA, CVPP, CCRT, CCRP, explains how acupuncture can help relieve bladder and pelvic pain through the nervous system, connective tissue, and fluid pathways.

The physiology behind acupuncture for bladder and pelvic pain

 can be used to manage bladder and pelvic pain in patients, but how it works physiologically is not always well understood. In this 

 interview, Bonnie D. Wright, DVM, DACVAA, CVMA, CVPP, CCRT, CCRP, a veterinary anesthesiologist, pain specialist, and acupuncturist, explains how acupuncture influences pain and organ function in patients. She outlines 3 key physiologic pathways through which acupuncture works, and discusses why specific regions, from paraspinal sites to the medial hind limb, play a central role in treating bladder and pelvic pain.

Below is a partial transcript, lightly edited for clarity.

How does acupuncture physiologically influence bladder and pelvic pain pathways in patients?

Acupuncture works through 3 major physiologic pathways. There's neuromodulation of the nervous system, there's fascial modulation along the recognized myofascial kinetic chains, and then there's kind of a fluid, lymphatic interstitial portion of acupuncture, because interstitial fluid moves along those myofascial kinetic chains and houses the immune system. Any particular topic in acupuncture, you're going to think about those 3 mechanisms as being the ways in which acupuncture works.

I'll do each one of those for bladder and pelvic pain. The really only way to neuromodulate those through the nervous system is at the paraspinal locations that relate to where those nerve bundles emerge and dive deep and go to the organs. That is in the thoracolumbar junction as part of the innervation to the bladder, and then over the pelvic nerve, which is in the lumbosacral and sacral section for more to the bladder, and then also to the other pelvic organs.

So with acupuncture, you're—for these deep structures—only really able to get that paraspinal input for a lot of things. With acupuncture, we also want to get something closer to the organ. And of course, with both of those, that's not an option. That said, the—especially tibial nerve—has been shown to have a lot of effect on the bladder. I don't know if you've seen those nerve stimulators for incontinence that they have for people; they're basically using points on the tibial nerve that were co-opted from acupuncture points that are recognized to have crosstalk to the pelvic organs…

Videos

Cheek tooth problems constitute perhaps the most prevalent group of maladies in rabbits, said Laila Proença, DVM, PhD, MS, MV, DACZM. “A lot of the disease happens because their teeth never stop growing,” she explained during “The Art of the Pull: Mastering Rabbit Cheek Teeth Extractions,” at the recent Fetch dvm360 Conference in Long Beach, California.

But managing a rabbit’s ailing mouth means a lot more than “just pulling a tooth,” she added. These patients are prone to chronic malocclusion, apical elongation, abscessation and subsequent soft-tissue damage. By the time they present for veterinary care, teeth are often diseased, fragile and difficult to extract in one piece.

Dental health care in small herbivorous mammals, including guinea pigs and chinchillas, can pose challenges in day-to-day small animal practice. Historically, veterinarians relied on blind techniques for these animals.

But oral endoscopy and post-extraction radiographs have pushed the limits of dental care in pocket pets. Everything from diagnostics to anesthesia, and dental tools to technique, are departures from what we are accustomed to in canine and feline health.

Rabbits have 28 teeth (2 x Incisors 2/1, Canines 0/0, Premolars 3/2, Molars 3/3).

 In the resting jaw, the mandibular incisors are seated behind the central maxillary incisors, in occlusion with the smaller maxillary “peg” teeth just behind them.

Because rabbit jaws are anisognathic—the lower jaw is narrower than the upper—the maxillary and mandibular “cheek” teeth (premolars and molars) never touch.The occlusal surfaces of the maxillary cheek teeth curve buccally, while their mandibular counterparts curve lingually.

Occlusal surfaces of the cheek teeth feature wavy, “zig zag” ridges that create rough surfaces suited to grinding fibrous foods, Proença said. Their side-to-side mastication wears the teeth to a proper trim.

Rabbit teeth are aradicular; they lack true roots. Instead, the elodont—or ever-growing—dentition features open apices lined with germinal cells that continuously spawn fresh, hypsodont (high-crowned) tooth.

If unchecked because of insufficient amounts of nutritional fiber and gnawing materials, these enthusiastic teeth can reach new heights, said Proença. “They can even grow up into the bone.”

Osteolysis and subsequent bone infections may follow, and associated soft tissue often sustains trauma and abscessation.

Dentistry in rabbits requires dental tools that conform to the unique architecture of their oral cavities. “Not only is the mouth small,” Proença explained, “but it is also long and dark. So you’re going to need equipment that you don’t use for dogs and cats.”

Although a nasal speculum might aid in evaluating the oral cavity on initial exam, stomatoscopy enables superior visualization of the tunneling bunny mouth to better spot pathologic teeth and fracture lines, and inspect abscess cavities and extraction sites.

(2.7mm/18cm/30 degree) with protection sheath, 

. A full set can be purchased online for under $1000, Proença said.

is ideal for dental procedures on rabbits, but a well-designed homemade setup can work if it firmly supports the head and permits access for mouth gags, camera and instruments.

 are essential for opening the oral cavity and creating a working corridor. Proença recommended long, slender cheek dilators that can reach the cheek teeth seated caudally, rather than the short, bulky dilators included in generic “rabbit dental kits.”

, approaching 90 degrees in bend and kept sharpened, are critical for breaking down periodontal ligaments tethering cheek teeth.

ine, curved hemostats or molar extractors 

bent nearly 90 degrees; these are superior to the chunky extractors in standard kits.

 should be stocked for retracting soft tissues like tongue and cheek, thereby protecting them from sharp working instruments.

Initial assessment of the oral cavity might begin with an exam using a nasal speculum. Stomatoscopy can then be deployed to inspect the occlusal surfaces and gingival beds of flagged teeth.

The magnification features of the camera, which can enlarge features as much as tenfold, must be kept in perspective, Proença warned. For instance, the normal ridges and depressions on the occlusal surface of cheek teeth can masquerade as sharp-edged spurs associated with tooth overgrowth and inadequate dietary fiber.

“You see how easily these can look like spurs when you magnify them,” she said. The presence or absence of spur lesions on the buccal and lingual soft tissues can clarify the situation.

The next diagnostic step is imaging, preferably computed tomography (CT). If CT is unavailable, skull radiographs may suffice. Proença recommended heavy sedation to achieve desired positioning. At minimum, she recommended left/right lateral (to include the tympanic bullae) and oblique views, and a ventrodorsal view.

Proença advised planning extractions based on thorough review of imaging:Identify diseased or apically elongated teeth, and those associated with abscesses. Decide which teeth to extract, and which to merely adjust.

Next, premedicate the rabbit, and tether it to the table. Then secure the airway through intubation (generally a 2- or 2.5-mm endotracheal tube). These procedures are long and bloody, involve flushing, and carry high risk for aspiration. Proença recommended isoflurane anesthesia, along with the same monitoring parameters used for dogs and cat, like ECG, blood pressure and pulse oximetry.

The veterinarian should then position the table to a comfortable working height and angle. The scope should be held in one’s nondominant hand, saving the dominant hand for manipulating instruments.

Diseased teeth are friable. A tempered approach to extractions— Proença recommended allotting 30 minutes per cheek tooth—may minimize the risk ofshatter. “The name of this pursuit is called patience,” she said. “You will be tempted to put your forceps in, grab the tooth and pull it.But it needs to be so loose that by barely touching it, you can just lift it out.”

Using a molar luxator, work circumferentially to sever dental ligaments, and thenemploy narrow, curved graspers to gently rotate and elevate the tooth. Avoid excessive force, which could crack the crown.

Scope sockets and abscess cavities frequently to reveal hidden fragments and debris requiring removal. Mosquito hemostats work best for fishing out tiny, lodged pieces, Proença advised, but be ready to “dig and dig and dig.” Flush sockets and tracts well, and reinspect before caulking them with sterile packing gel to achieve hemostasis.

The final crucial step is postextraction radiography to confirm removal of all tooth parts. And be prepared to clear away retained shards.

“I cannot tell you how sorry I am for my patients before I started taking x-rays,” Proença said. “I‘d feel certain I’d gotten everything, but x-rays would later show remnants.”

According to Proença, tooth fragment retention is a looming risk for any bunny undergoing extractions. The fallout is infection, inflammation, recurrent abscesses and non-healing tracts.

She shared an old case in which she jiggled a tooth she assessed as loose enough to easily pluck out. The rabbit spooked, and the tooth fractured. To track down the entrapped tooth segment, she widened the socket to the point that the chip was able to migrate out into the sinus and create more havoc.

Rather than “nibbling” repeatedly at one of these dental disasters, she endorses early specialist referral. She also advised referring when one is not equipped for—or experienced with—rabbit dentistry.

Proença’s last word of caution for veterinarians working with rabbits was to refrain from taking initial exam findings at face value. Anesthesia and imaging go a long way in identifying concealed issues within the oral cavity: “Not seeing something in an awake rabbit does not rule out a problem. And sometimes they don’t even have clinical signs,” she said.

Proença L. The art of the pull: mastering rabbit cheek teeth extractions. Presented at: Fetch dvm360 Conference; Long Beach, California. December 5-6, 2025.

. Ft. Worth: Zoological Education Network, 2005.

Articles

To properly address the anatomic and physiologic characteristics of lagomorphs, veterinarians must refine their diagnostic and treatment strategies.    

Charting a flop-free approach to rabbit dentistry

Jane Sykes, BVSc, DACVIM (SAIM), PhD, MPH, MBA, FNAP, discusses what researchers still don’t know about canine leptospirosis and where progress may be coming.

What we still don’t know about leptospirosis in dogs

Veterinarians know leptospirosis is on the rise, but many of the most basic questions about how dogs become infected are still unresolved. In this interview with 

, Jane Sykes, BVSc, DACVIM (SAIM), PhD, MPH, MBA, FNAP, a researcher and professor of medicine and epidemiology at the University of California, Davis, School of Veterinary Medicine, discusses the research gaps that matter most and what progress may be on the horizon.

Below is the transcript, lightly edited for clarity.

What gaps in leptospirosis research still need to be addressed, and what developments do you anticipate in the next few years?

We still don't really understand transmission cycles in dogs, and that's really the focus of our research right now—is really trying to understand what serovars are out there, and how they're circulating among different animal species and the environment and their risk to humans. And that’s a difficult thing to study, because really the only way to understand it is to do whole-genome sequencing on isolates from urine.

We were able to do that in the West Los Angeles outbreak, and we were able to show that at least in the post-peak period, the organisms were a little bit different from one another in several dogs. So it didn't suggest that there was, you know, dog-to-dog transmission occurring during that period, although there could have been during the peak. So we need more studies like that to kind of understand, you know, are rodents infected with the same strains that dogs are infected with? You know, what about other wildlife species—urban wildlife species—and their role in transmitting infections to dogs, and what's out there in the environment too? So it's a real One Health problem.

So we badly need that. We also badly need vaccines that are not serovar-specific. And I think once we have vaccines that are broader and not serovar-specific, then, you know, a lot of this stuff about understanding serovars will not be so important, because we're still trying to understand serovars so that we can design appropriate vaccines to protect against those serovars, because they're serovar-specific. But as soon as we have vaccines that are non-serovar-specific, it'll become less important to know what serovars are infecting dogs.

And really importantly, you cannot use the MAT test as a serovar test. It's a diagnostic test for leptospirosis, and serovars are added to improve the sensitivity of the test, not to help identify serovars—because you could easily keep adding on more and more serovars to the panel and see higher and higher titers to additional serovars. So it's not a good serovar test.

Happy Friday dvm360 readers! We hope everyone had an amazing week and are looking forward to a weekend full of relaxing, good food, and good times. With the Super Bowl this week, dvm360 may have something hitting the field that will be a touchdown for veterinary professionals, so be on the lookout!

While we get ready to watch the Puppy Bowl, here is this week’s top stories.

 it has granted Emergency Use Authorization for a parasiticide to help prevent New World screwworm (NWSW) infestation in cattle, Ivermectin injectable solution (Ivomec 1%; Boehringer Ingelheim Animal Health), which is available over the counter and was approved by the FDA previously to control and treat over 30 parasite species and stages in cattle, swine, reindeer, and American bison.

 of The Vet Blast Podcast presented by dvm360, Clare T. Walker, DVM, shared more about her dual career as a veterinary professional and a suspense author, plus how she uses her life as a veterinarian to create plot lines in her books.

Cynthia M. Otto, DVM, PhD, DACVECC, DACVSMR, and Clara Wilson, postdoctoral research fellow at Penn Vet’s Working Dog Center, 

 more intel regarding their data from their recently published study in 

where they investigated if canines can sniff out hemangiosarcoma.

 with dvm360, Christopher Pachel, DVM, DACVB, CABC (IAABC), shared how 8-month rechecks can help veterinary professionals monitor the pets development, normalize adolescent behavior, and more.

 in her recent article how end of life and palliative care can offer veterinary professionals a sustainable veterinary medicine career.

 a statewide disaster declaration to bolster the states defense against NWS after cases in Mexico have began to spread upward closer and closer to the US.

Wrap up: New world screw worm updates, and other news 

Naomi Hoyer, DVM, DAVDC, discussed how to distinguish the condition from other oral diseases and treating it.

Providing stomatitis care

How is stomatitis identified, and how can it be treated? Naomi Hoyer, DVM, DAVDC, an associate professor of dentistry and oral surgery at Colorado State University in Fort Collins, provided insight about stomatitis, in a continuing education (CE) session at the 2026 Veterinary Meeting & Expo (VMX) in Orlando, Florida.

at VMX, Hoyer discussed how to distinguish the condition from other oral diseases and provided recommendations for stomatitis care in cats and dogs.

The following is a transcript of the video, lightly edited for clarity:

How do you distinguish stomatitis from other oral diseases?

: Usually where the inflammation is is the best place to distinguish it. So in cats, it's not just the gingiva, so not just the soft tissues that are next to the teeth. We're actually looking in the very far back of the mouth, that the hollow muscle folds and in dogs, for their variety of stomatitis that they get, we're looking at the mucosa, which is the lining on the insides of the cheeks, where that's contacting the teeth. That's actually one of the best places to locate stomatitis. So most people think of only looking at the teeth, but for stomatitis, we want to look at the rest of the mouth too.

: What are some current recommendations for care?

:Well for cats, unfortunately, our best recommendation initially is still to take the teeth out. We don't really have a great way to manage this condition without removing teeth, so extractions are a very, very common first step. We also want to provide a lot of pain support, because these are very painful conditions. And then we have a series of medications that we can use in the postoperative period to help keep cats more comfortable. There are standard things like anti-inflammatory doses of steroids. And then there's some new things on the market, like, if you have a cat where you have taken out all the teeth and it hasn't quite resolved it, maybe consider stem cell use, if it's calicivirus-positive, maybe we test for calicivirus and think about whether something like molnupiravir would be appropriate. So lots of good things up and coming, but we always have to start with extractions.

For dogs, it's a little bit different. We can do a lot to help keep the teeth plaque free, and that will help the symptoms of stomatitis in dogs.

For more industry news and coverage of VMX, visit 

Hoyer N. Stomatitis in cats and dogs: Tackling the inflammation! Presented at: Veterinary Meeting & Expo; Orlando, FL. January 17-21, 2026.

Naomi Hoyer, DVM, DAVDC, discussed how to distinguish the condition from other oral diseases and treating it, in a dvm360 interview at VMX 2026.

Providing stomatitis care for companion animals

Mary Berg, BS, RVT, RLATG, VTS (Dentistry), presented a virtual VMX session on the complete oral health assessment and treatment (COHAT). Her objective was to explain to teams how to work efficiently while still providing high-quality standard of care. The 

 team sat down with Berg and asked her to share her insights. In this Q&A, she focuses on workflow, infection control, instrument technique, client conversations, scheduling and follow-up, and more.

What was the focus of your session at VMX?

: My VMX talk was on the steps to a COHAT and ways to make the procedure more efficient. It’s more than just cleaning teeth. It includes getting the client on board, doing a complete oral exam, taking radiographs, and then using tips and tricks that together reduce anesthesia time. The main goal is to do a good, thorough job while making sure the pet is well cared for.

: 5 practical tips to improve efficiency and safety in veterinary dental procedures

Berg dentistry tips

What common workflow mistakes do you see, and what should teams change first?

: One big change is to take dental radiographs early. I teach doing radiographs with the patient in sternal and dorsal, so they are intubated, connected to monitors, and warm, and then when they reach a surgical plane of anesthesia, take the dental rads. That lets the veterinarian review images while the technician is charting and cleaning. If something unexpected appears, you can call the owner right away without stopping the procedure to hunt for permission.

Another step is team training on charting and oral evaluation so technicians can recognize abnormal findings. Those basics reduce delays and improve decision making during the procedure.

Any simple infection-control or prep tricks that change the case?

Berg: Yes. After charting, brush the tooth surfaces with a soft toothbrush and power-wash the mouth with the air-water syringe, both buttons pressed. That removes more than 80% of plaque bacteria. Plaque is hard to remove with the scaler and when you aerosolize with the scaler that bacteria spreads up to 6 feet and stays in the air for 8 to 12 hours. Brushing first removes most of the plaque, so you can then dry and rapidly remove gross calculus. It shortens the case and improves the working environment.

One practical tip is to soak a toothbrush in chlorhexidine, rinse it well, and send it home with the owner so they have a toothbrush for the pet.

What about scaler tips and polishing. Any efficiency tips?

: Many hospitals use only the universal tip, but the universal tip is large and slow for crown work and too big for deep pockets. Use a beavertail tip on crowns to remove gross calculus quickly, using only the distal 2–3 millimeters of the tip with a light touch and fast motion. Then switch to a periodontal tip for subgingival cleaning. Changing tips takes seconds but saves huge amounts of time overall.

For polishing, instead of filling the cup repeatedly with pumice, I spread the pumice paste on the teeth with my finger and then polish. It saves time without sacrificing the finish.

How do you coach teams to explain cost and value to owners?

: First, change the vocabulary. The word “dental” is vague. I prefer COHAT—comprehensive oral health assessment and treatment—because it communicates that this is an involved procedure, not just a quick cleaning. I also avoid jargon like “periodontal disease” and say “a painful infection in the mouth.” Owners understand pain, and they understand infections.

When discussing cost, price procedures by stage of disease. A stage 1 or 2 case is faster and should be less expensive than a stage 4 that requires extractions. Keeping early-stage pricing accessible encourages owners to bring pets in earlier, which is better for the pet and for scheduling. Offer third-party payment plans rather than doing in-house financing.

Finally, make the conversation two-way. Ask what the owner knows, validate their concerns, explain how you make anesthesia safe, and then ask them to tell you what they understood. That engagement helps owners commit.

How important is the discharge appointment and home care?

: Very important. Schedule a tech discharge appointment when the patient is dropped off so you can meet the owner at pickup and explain what you found, what was done, and what to do at home. Discuss home care options, but don’t just hand over a VOHC list. Recommend one or two products you trust and explain why they work. If owners won’t brush, offer other practical home-care options. Also schedule a follow-up tech check in a week or two to see how home care is going. That follow-up reinforces the bond with the clinic.

Do you talk about the mouth–body connection with clients?

: Yes, I explain that oral infections can affect the rest of the body. In people, periodontal disease is linked to heart disease, stroke, and kidney problems. We don’t have as much data in animals, but there is evidence and strong clinical suspicion. I tell owners that keeping the mouth healthy may help prevent other problems and can help pets live longer and healthier lives.

Should clinics be forward-booking dental appointments?

: Definitely. Human patients always leave with the next appointment booked. Veterinary clinics should do the same. When owners leave and the appointment is already scheduled they are far more likely to show up than if they have to remember to call later.

Any final practical takeaways for teams wanting to improve their COHATs?

: Train your team on a consistent workflow, take radiographs early, brush before scaling, use the right scaler tips for crown and subgingival work, polish efficiently, schedule tech discharge and follow-up appointments, price by disease stage, forward-book when possible, and communicate clearly and confidently with owners. Small changes add up to big improvements in safety, efficiency, and patient care.

Mary Berg walks through the steps of a comprehensive oral health assessment and treatment and shares small, practical changes that may shorten anesthesia time and improve patient outcomes.