Tiletaminezolazepam, 25 mg/kg IM, can be used alone to induce sedation or be combined with xylazine or butorphanol. The tusks of a barrow (a male pig neutered while young) will not grow as quickly as in a boar. When piglets are born, they have thin, needle-like teeththat farmers often clip to minimize potential damage to the litter. I second Michelles comment on how to sedate my potbelly for nail trim. Although it's not on my list of favorite KuneKune tasks, I am a HUGE advocate for regular trimming of tusks. Intramuscular sedation beforehand is advised. The best time to trim a pigs hooves is at night. Discuss options with your veterinarian. Some have yearly tusk trims, others follow their own schedule on an as needed basis. Fluoride is a problem. They just make her sleepy. toby sutton wife of frank sutton how to sedate a pig for tusk trim After injection leave the pig undisturbed for at least 15 minutes. It's best to observe this a few times before trying it yourself. 2) OB Wire and Handles (also known as dehorning wire, or gigli wire). Increased production of carbon dioxide results in hypercarbia, rapid deep respirations, and increased end-tidal CO2 concentrations. In one study, a combination of medetomidine, 0.08 mg/kg, butorphanol, 0.2 mg/kg, and atropine, 0.025 mg/kg, administered to young pigs did not provide sufficient sedation to allow blood sampling in all animals (Ugarte & OFlaherty, 2005). Sedation isnt the only option to control a pig for hoof care but it tends to be one of the most reliable heres what you should know. Pigs are very insensitive to xylazine and they tend to vomit. The dose range is 18 mg/kg depending on the effects sought, but it is recommended that a dose of 1 mg/kg is not exceeded for adult boars as higher doses can cause prolapse of the penis. From The Merck Veterinary Manual for pet owners: Dental care is extremely important for potbellied pigs. The wild hog uses its four tusks for defense. Phenothiazine derivatives are not as effective in pigs as they are in other species. However, PBPs seem to recover well after tooth extraction followed by antibiotics and tetanus prophylaxis, http://www.pigs4ever.com/pot_belly_pig_information/tusks_and_hooves.php, http://www.pigpalssanctuary.com/faqs/teeth_tusks.htm, COPYRIGHT, AMERICAN MINI PIG ASSOCIATION | Privacy Policy, Worming for Treatment of Internal & External Parasites, Mini Pig Zoning Regulations Legalize Mini Pigs, American Mini Pig Standard Colors and Patterns, What to Do For a Pig That Has Gorged on Food, AMPA Mini Pig Therapy Pet Program Therapy Pig Training Certification, Future Breeder Pig Measurement Submission, http://fluoridealert.org/studies/acute03/, http://www.healthhype.com/fluoride-poisoning-symptoms-of-toxicity.html. Tusks are used for sparring with other boars and are also the reason for the thick, hard, armour-like skin on boars' shoulders. (2010) reported that meloxicam administered in 5-day-old piglets as a single IM dose, 0.4 mg/kg, 1030 minutes before castration decreased plasma cortisol concentrations and decreased pain related behaviours 2 and 4 hours after surgery. Atropine, 0.020.04 mg/kg, or glycopyrrolate, 0.0050.01 mg/kg, IM or IV may be included in the premedication to minimize salivation. Boards used specifically for this purpose should be larger than the pig and may have handles attached on one side to facilitate manipulation of the board. 3) A sturdy tie-off spot (eg. As they have little body hair, pigs are liable to develop hypothermia when sedated or anaesthetized, or hyperthermia in a hot environment. There is an art to this. 52408), fax (519) 836-9873 or e-mail [emailprotected]. Restraint of large sows and boars is also easy if a weighing crate is available, especially one with a head catcher. 1) A snare. NEEDLE TEETH:Needle teeth are eight VERY sharp pointy teeth the piglets are born with. Ideally, the dewclaw horn should be trimmed back to about 20 mm. These elongated ivories serve primarily as weapons of defense, but they can also help with competition for food and mates as well as other creature-specific purposes. In a separate experiment, the sedative agents were either refrigerated, at room temperature, or warmed, and no differences in response to injection from the pigs were observed. Morphine and meperidine (pethidine) prolong analgesia when administered IM with azaperone and ketamine in pigs (Hoyt et al., 1986). August 4, 2020. Try to lift their head as much as possible, make sure they are secure, and wait until they stand still. I do not recommend the commercially available snares that are a wire cable, with a metal handle. She weighs 123 LB. As a result, the methods of restraint and administration of anaesthetics vary accordingly. Were very careful around our big George, but sometimes when were in the field with him, we do wish wed decided to go the other route. Worming for Treatment of Internal & External Parasites, Mini Pig Zoning Regulations Legalize Mini Pigs, American Mini Pig Standard Colors and Patterns, What to Do For a Pig That Has Gorged on Food, AMPA Mini Pig Therapy Pet Program Therapy Pig Training Certification, Future Breeder Pig Measurement Submission. Frequency may increase with hoof deformities, cracking, or with the development of arthritis. The noise disturbs everyone around them. Tusk trimming can be done at home if you have experience. Mature gilts were injected using 19 gauge 5 cm needles at four sites: in the neck muscle 5 cm caudal to the base of the ear; in the triceps muscle midway between the point of the shoulder and elbow; in the middle gluteal muscle at the centre of a triangle between midline, tuber coxae and tail-head; and in the quadriceps muscle in the cranial third of an imaginary line connecting patella and tuber ischii The degree of sedation at 16 minutes after injection was not significantly different between the injection sites, although the range of times to recumbency was narrower after injection in the quadriceps muscle. See Figure 1 for a cross-sectional view of the boar tusk. While small pigs are easily restrained, large sows and boars may prove both difficult and dangerous. Pigs do not like being handled and create quite a lot of noise. Why she waited for his arrival to then become a non stop 24/7 wrecking crew, Ill never know except I do know its MY FAULT for not properly training these monsters and blah blah blah. Geriatric PBPs may have abscessed and/or exposed tooth roots; sedation (tiletamine-zolazepam 2.2 mg/kg, IM, in ham) and examination of the oral cavity with or without endoscopy is indicated if anorexia and/or bruxism are reported. Like I said, its not the recommended method, but it is common. Dosages of agents used in sedative and anaesthetic protocols in pigs. Gigli saw wire used to trim Sasquatchs tusks. Epidurals -The site for needle placement is on the midline and caudal to a transverse line between the cranial prominences of the wing of the ilium (iliac crest) on either side, 0.5 to 1.5 cm in pigs weighing 10 to 50 kg and 1.5 to 2.5 cm in pigs weighing 50 kg or more. Miniature Companion Pig Sedation and Anesthesia, JS Smith, VCNA/Exotics, 2022- lots of good hints about handling, restraint and drugs, Guidelines on Anesthesia and Analgesia in Swine,UMI, 2018, Practical sedation and anaesthesia of pigs, In practice, 2007, Overview of Malignant Hyperthermia, Merck, Anesthesia agents and complications in Vietnamese potbellied pigs, JAVMA01 July 2011, Vol.239(1), pp.114-21. Many farmers, though, just grab a pair of hoof clippers of bolt cutters to do the job. Rawhide is dangerous to all pets, through risk of choking, impaction, and the chemicals used on them. You can use an angle grinder or straighten it and to remove the excess wall horn beneath the area where buckling occurs. However, tusk growth is fueled by testosterone. 2023 PRICING: $60 travel fee + $30 per pig. Salivation may be increased in anxious pigs and by administration of dissociative agents. Accurate identification of MH relies on the presence of clinical signs and the more signs present the more likely that the patient has MH (Box 14.1). Disadvantages of butorphanol are that it has a short-lived duration and that the analgesia provided is inadequate for major surgery, particularly orthopaedic surgery. Pigs should have their hooves trimmed once a week to once a month, depending on the type of pig you have and your ultimate goals. No. I prefer a rope, and often will re-purpose the rope halter used for my cows, so I can tie it off to a sturdy structure. Both males and female pigs possess modified upper and lower canine teeth or tusks, however, the tusks of the male retain an open root that allows these teeth to grow throughout life. Food is generally withheld for 812 hours and water for 2 hours before anaesthesia. Animals27 potbellied pigs (14 female and 13 male) ranging in age from 0.25 to 15 years old and ranging in body weight from 5.9 to 169 kg (13.0 to 371.8 lb) that were anesthetized on 32 occasions between 1999 and 2006. In PBPs properly vaccinated with tetanus toxoid, a tetanus antitoxin injection is unnecessary. Flip the Pig for Hoof and Tusk Trimming. Ultimately, the animal becomes hypoxic and without treatment usually dies. Anesthesia of Exotic Pets. If they have not been clipped you may speak with your vet about clipping them. The MH syndrome does not always occur at the onset of anaesthesia, but may develop at any time during anaesthesia and in the first few hours after anaesthesia. Some families choose never to trim tusks, leaving them natural. Acetylpromazine around 0.05 mg/lb (10 mg for your pig) into muscle. Your pig will probably scream and carry on while youre getting it into this position, but dont worry you wont be doing any harm. Telazol was a favorite for awhile but it leads to really long recoveries and has more issues. Obese animals need drug reductions (roughly 15-20% if 5/5) to be dosed appropriately for estimated lean body weight. The bottom two are called cutters for a boars tendency to use them to slash and stab, while the upper two usually grow to about four inches in length. . Before that he was acting just like your male. Figure 14.2Maintaining a clear airway by pushing forward on the vertical ramus of the mandible. Although surgery may be performed on the farm using either local analgesia or general anaesthesia, whenever possible pigs requiring more than minor surgery should be transported to a veterinary clinic having the equipment and personnel needed should complications arise. Release of catecholamines causes an initial increase in blood pressure with tachycardia and multifocal ventricular dysrhythmias. Medetomidine produces a dose-dependent sedative effect in pigs that is substantially greater than from xylazine. There is a risk of breaking the jawbone, infection, and therefore is not a healthy or safe option. If teething pains are terrible your pig can have childrens or buffered aspirin WITH FOOD. Opioids administered alone are unlikely to induce sedation in healthy pigs. Pigs do not like being handled and create quite a lot of noise. I try to avoid sedation in my pigs as much as possible as pigs are more prone to complications during sedations (ie tracheal spasms resulting in cessation of breathing). Salivation, even if not excessive, can contribute to airway obstruction and promote laryngospasm. Since venous access can be tricky, this canbe handy for nail trims and ear cleaning. Pigs should be maintained on a 6 month trimming schedule in order to avoid adding stress to their feet and joints. Specific patients, such as those with a history of vomiting or recent trauma, may require other precautions for anaesthesia. Vet Clin North Am Exot Anim Pract. Multifunction Cow Hoof Trimmer Nipper, Cow Hoof Pincers, Cattle Shoeing Pliers, Hoof Nipper, Farming Airmax Stock Tank Defense, Livestock Water Trough Cleaner, Clean Drinking Tanks for Horse, Cattle, Chicken Farming Poultry Hatching Automatic Incubator for Eggs Duck Eggs Wild Goose Various Birds. If you try. Most owners have tusks trimmed yearly or every 2-3 years. The Importance Of Livestock Newborn Umbilical Care, Raise & Market Specialty Poultry For Meat & Profit, Start Collecting & Using The Water On Your Farm, Successful Strategies For Profitable U-Pick Farms, Eliminating this threat is a matter of trimming the boars tusks. Xylazine doesnt work well in pigs. Azaperone is a licensed and commonly used pig sedative in Europe and is available for use in wildlife in the USA. If the pig is awake and restrained for the procedure, use ear protection as their screams are deafening. It depends on the veterinarian, so it's best to ask when you are scheduling the appointment. Anaesthesia of sheep, goats, and other herbivores, General pharmacology of the inhalation anaesthetics. The addition of midazolam, 0.20.5 mg/kg, to these combinations increases the quality of sedation. The anaesthetic agents listed in this chapter may not be available in all countries and many are not licensed for use in pigs. Let's Talk Tusks - How to Tusk Trim a Kunekune Boar. Longley LA, Fancy pig anaesthesia. Sedation. In pigs, medetomidine has a greater vasoconstrictive effect on the pulmonary circulation and, although increases in pulmonary arterial pressure are not severe when compared with the cardiovascular effects of ketamine or tiletamine, the consequences of these effects should be taken into consideration when anaesthetizing pigs for cardiovascular research or pigs with cardiac disease (Sakaguchi et al., 1996). If these needle teeth are clipped before you get your baby, the teeth will not grow back. splinter the tusk it can cause a nasty infection as well. It depends on the veterinarian, so its best to ask when you are scheduling the appointment. Dantrolene is a hydantoin derivative that was synthesized in 1967 (, Discontinue inhalation anaesthetic administration, increase oxygen flow, Start artificial ventilation and hyperventilate, Sodium bicarbonate slowly IV, starting with 1.5 mEq/kg, Dantrolene IV 2 mg/kg increments up to 10 mg/kg, repeat 1 mg/kg each 6 h for 24 h. caudal to the base of the ear; in the triceps muscle midway between the point of the shoulder and elbow; in the middle gluteal muscle at the centre of a triangle between midline, tuber coxae and tail-head; and in the quadriceps muscle in the cranial third of an imaginary line connecting patella and tuber ischii The degree of sedation at 16 minutes after injection was not significantly different between the injection sites, although the range of times to recumbency was narrower after injection in the quadriceps muscle. Neutered and spayed pigs do get tusks. Must be buffered and given with food. By: Louisa Asseo DVM DABVP (Canine/Feline Practice), Reviewed by: Valerie Tynes, DVM, DACVB, DACAW, Keywords: dentition, sedation, trim, tusk. Tusk Trimming and the Gum Line Tusk trimming requires extreme precision and care. Pigs are mean drunks! All pigs grow tusks; males, females, even spayed and neutered pigs. Flunixin meglumine is the only approved NSAID. Clinical signs of malignant hyperthermia syndrome, Rapid deep breathing, high end-tidal and arterial CO2 concentrations, Sinus tachycardia, hypertension, ventricular dysrhythmias. Tusk trimming can expose the pulp which contains the nerve and contribute to the development of gum inflammation. Acepromazine has been commonly used with ketamine for anaesthesia in young pigs. If the surgery is to be performed using local analgesia, sedation can be added to facilitate restraint. Isoflourane gas is the safest anesthesia for pigs, but it is expensive and not feasible for traveling veterinarians. An intact boar is going to have the fastest tusk growth because it is fueled by testosterone, whereas a neutered male and intact female's tusk grow slower. If the angle of the cut is not done properly, it can cause the tusk to grow back wrong causing pain for the pig. Choice of agents used will also depend on the pig as a food animal or not, its health, the procedure to be performed, and where the procedure will be performed (e.g. Dantrolene is generally administered IV for rapid effect. The skin should be clean before injection to avoid production of an abscess. If that sounds like way too often for you, consider the housing for your pigs. One exception resides with intact male pigs, or boars, who sometimes need oral intervention. Medetomidine induces bradycardia and clinical and experimental studies have included atropine, 0.020.04 mg/kg IM, or glycopyrrolate, 0.0050.01 mg/kg IM, to increase heart rates. Must be buffered andgiven with food. The carbon dioxide absorber in a rebreathing anaesthetic circuit becomes very hot to touch and the granules rapidly develop intense indicator colour. Recommended dose rates for xylazine are 12 mg/kg by IM or IV routes and these will induce a calming effect for about 30 minutes, however, the pigs arouse easily when disturbed and little sedative effect will be apparent. Although Kunekunes are docile breed, and boars can be housed together, there is still a hierarchy that needs to be established through sparring. Large pigs can be restrained by a rope or wire snare placed around the upper jaw, caudal to the canine teeth (Fig. Removal is challenging even for skilled surgeons and may result in mandibular fractures. George L. Veterinary Management of Miniature Pigs. School of Veterinary Medicine University of California Davis. Treatment of malignant hyperthermia syndrome, Discontinue inhalation anaesthetic administration, increase oxygen flow, Start artificial ventilation and hyperventilate, Sodium bicarbonate slowly IV, starting with 1.5 mEq/kg, Dantrolene IV 2 mg/kg increments up to 10 mg/kg, repeat 1 mg/kg each 6 h for 24 h, Change CO2 absorber granules as necessary. His instincts kick in and emotions take over, that takes quite a toll on them. All inhalation anaesthetic agents, except nitrous oxide, and the neuromuscular blocking agent, succinylcholine, are triggering agents. We now know that sudden death may occur in MH-susceptible humans in response to high environmental temperatures, exercise, or stress. There are a couple different drugs you can give, but they are prescription drugs that a vet needs to prescribe. 14.3). Otherwise, hoof trimming is necessary to help ensure that your pigs can walk appropriately. Tusks can grow quite large, and are often sharp. ObjectiveTo document complications associated with preanesthetic and anesthetic agents used in Vietnamese potbellied pigs and identify predictors of complications. Although most leave natural foods, toys, and dental chews to do the work, others want to be proactive in the dental health of their beloved pig. Dexmedetomidine @ 20-40 ug/kg IM + ketamine @ 10 mg/kg IM + butorphanol @ 0.2 mg/kg IM, Reverse dexmed with 0.16 mg/kg atipamezole, Dexmedetomidine @ 5 ug/kg IM + ketamine @ 2 mg/kg IM + butorphanol @ 0.1 mg/kg IM, Detomidine @ 0.1 mg/kg IM + ketamine @ 5 mg/kg IM + butorphanol @ 0.1 mg/kg, Provides about 30-40 minutes of deep sedation (enough for moderate pain), But pig will be sleepy for the next 12-24 hours, so you could substitute benzo for ketamine. Analgesia may be provided by several methods, including administration of non-steroidal anti-inflammatory agents (NSAIDs, such as flunixin meglumine, carprofen, meloxicam, or ketoprofen), opioids, and local anaesthetic agents. Sedation or anesthesia is required. As we know how smart pigs are they are going to remember that restraint and will be more cautious to avoid the trauma in the future, causing even more difficulty getting him to a vet or other basic care done. Anaesthesia can be induced and maintained with isoflurane or sevoflurane, however, in dogs, use of an inhalant as the sole anaesthetic agent is associated with increased risk of death (Brodbelt et al., 2008). use in pigs. The caudal edge of the tusks are razor-sharp and care should be taken to avoid lacerations when handling the jaws of pigs with untrimmed tusks. In most cases, the pig will try to escape by pulling back against the snare and thus immobilizes itself. While a pig can be tranquilized, its not recommended by most vets for simple tasks like trimming hooves. Without endotracheal intubation, patency of the airway in pigs is best maintained by keeping the head and neck extended, pushing the lower jaw forward by applying pressure behind the vertical ramus of the mandible (Fig. Azaperone (also called Stresnil) 40mg/40 lbs (200 mg for your pig) into muscle. 1. When she was around 15 months, a small male pig needed a home and almost every Google article Ive read/researched, stresses companionship while almost shaming single pig families. Without trimming, the canine teeth will become elongated and cause discomfort and a misaligned bite. It binds to a specific ryanodine protein site and blocks the release of calcium, thereby interrupting the trigger and allowing signs of MH to reverse. Tusk length, pulp exposure and gum condition were assessed using a scoring system. Small pigs can be simply held in arms or restrained on their sides by grasping the undermost legs and leaning on the pigs body. Mozzachio K. Routine veterinary care of the miniature pig. Azaperone must be given by deep IM injection and the pig should be left undisturbed for 20 minutes for best effect. If you make the completely understandable decision to maintain your boars mouth, the methods are pretty standard. For shorter procedures, pot bellied pigs can be masked down. Less frequently used but the recommended method is orthopedic wire is used as a saw to cut off tusks. Its advised to observe this simple procedure with a veterinarian before attempting to do it yourself. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); This site uses Akismet to reduce spam. These teeth can also cause accidental wounds to children as the piglet plays. It can be pretty intense and having boars with tusks can result in more injury. 2 likes. . It is useful for injections, temperature taking, listening to hearts, etc. This is a piece of thick rope with a slip knot in the one end so it tightens around the top jaw when the boar pulls back. The noise disturbs everyone around them. One exception is forking - it really works to calm them and has a slight residual. Less frequently used - but the recommended method - is orthopedic wire is used as a "saw" to cut off tusks. This will soften the nail and hoof pad to make trimming easier. The video also outlines the . One of these pigs is not like the others. Therefore an intact boar is going to have the fastest tusk growth, a neutered male and intact sow will be slower growth, and a spayed female will have the slowest tusk growth. Although vomiting at induction of anaesthesia or during recovery is uncommon in pigs, it can occur and introduces risk for aspiration, and ventilation is decreased when a full stomach exerts pressure on the diaphragm. To be honest, we dont, and a. Advantages of butorphanol include increasing the sedation and analgesia provided by other agent combinations with minimal adverse cardiovascular effects. So being a gross male as I am, i still find him to be really nasty. Some breeds (particularly Poland China, Pietrain, and Landrace) and strains of pigs suffer from a biochemical myopathy which manifests itself during general anaesthesia. They also stress easily and can suffer from Porcine Stress Syndrome. Pigs with elongated canine teeth may show persistent chewing motions and heavy salivation. Davis, CA. https://www.youtube.com/watch?v=qVDLySKFopY&t=23. Because hooves need to be trimmed so often, its better to get your pigs used to the process when theyre young and to try alternative techniques (such as flip the pig) to keep your pig calm for this grooming routine. Rabies is not a common disease in pigs but may occur where rabies is endemic and has been reported in Vietnamese potbellied pigs. If you can work on the pig while the owner holds them, that might help your eardrums. Large pigs can be restrained by a rope or wire snare placed around the upper jaw, caudal to the canine teeth (Fig. Droperidol, 0.3 mg/kg IM, produced sedation by 1545 minutes after administration with a duration of 2 hours in young pigs and minimal effect on heart rates and systolic blood pressures (Bustamente and Valverde, 1997). Once I have the rope in the right spot and pulled tight, I tie them off to a post. When youre trimming, take only small cuts otherwise, you risk drawing blood and injuring your pig. Tusks are used for sparring with other boars and are also the reason for the thick, hard, armour-like skin on boars shoulders. In addition, veterinarians may prefer using dental tools and/or OB wire saws with or without sedation. TEETHING:Pigs start teething at about a year old. There is an art to this. Finally, you may also need to trim the dewclaws. Informa PLC's registered office is 5 Howick Place, London SW1P 1WG. The depth and predictability of sedation can be improved by the addition of butorphanol, 0.2 mg/kg IM, and midazolam, 0.2 mg/kg IM. wet-dog shakes, crawling and dragging bellies, constant posture changes, increased vocalization, salivation and increased defaecation frequency. Most people start trimming their pigs tusks between 1.5 and 3 years of age. Tusks are tooth-like structures that grow from both the top and bottom jaw of male pigs, both castrated and intact. Dental cleaners for small animals may be used with care, positioning the head of the PBP downward during use to prevent water aspiration. Contact Widowski by phone (519) 824-4120 (ext. Given time, the wild boars domestic cousin also sprouts some pretty conspicuous canine teethactually, even female and neutered pigs grow some oversized teeth, but the boars testosterone-fueled growth results in a larger, potentially more dangerous, set. To remove the danger, tusks are sometimes trimmed once or twice a year. Some tusks can grow at a bad angle until they actually pierce the cheek of the pig. A clinical patient, a young 5.9 kg potbellied pig, developed similar signs after discontinuation of transdermal fentanyl after 9 days (Trim & Braun, 2010). We have a male pig, and we got him neutered. The tusks can be used as a way to identify gender. Piglets cannot have tusks removed as they havent grown in yet. Pigs with elongated canine teeth may show persistent chewing motions and heavy salivation. 1,551. Now 2 and a half years later, these 2 are NEVER allowed in my home, NOTHING is safe on my property unless its made of steel and can be tossed like a rag doll while not taking damage since the weight of any object made of steel is no match to those snouts. Plus, since its a known liver toxin, it can be dangerous to your pig if it has an underlying condition that you dont know about. Most adult toothpastes DO contain fluoride with a warning to spit and rinse to prevent swallowing the fluoride. Even if the jaw bone is not broken during tusk removal surgery the bone may be weaker for the life of the pig causing future breaks and infection risks more likely. TUSK TRIMMING:Females AND males do get tusks. Miniature Companion Pig Sedation and Anesthesia, Guidelines on Anesthesia and Analgesia in Swine, Practical sedation and anaesthesia of pigs. They can literally die from stress. Rigidity of the limbs and spreading apart of the digits in a pig developing porcine malignant hyperthermia syndrome. The effect varies from mild to moderate sedation with medetomidine, 0.0050.02 mg/kg IM, to heavy sedation produced by medetomidine, 0.08 mg/kg IM. Although they resent restraint, as evidenced by the struggling and loud squeals they produce, they often respond predictably to anaesthetic agents. 2) OB Wire and Handles (also known as dehorning wire, or gigli wire). This can cause side effects and there is always a risk. No depression of normal behaviour was noted in healthy pigs after application of a patch. No worries, this is simply the baby teeth falling out and making room for the next set of teeth.