End-stage dental disease in bearded dragons can lead to osteomyelitis and bone necrosis due to their acrodont dentition. Risk factors have been described for dental disease in bearded dragons including age, body condition, co-morbidities, and diet. While bacterial infections are often assumed or diagnosed in association with osteomyelitis secondary to dental disease, fungal infections have not been reported to be involved in dental disease and associated osteomyelitis in bearded dragons. This case series describes two bearded dragons from a referral veterinary hospital with dental disease and associated fungal osteomyelitis. Both bearded dragons presented with a history of hyporexia, weight loss, and abnormal mandibular palpation with no apparent skin lesions. In both cases, fungal disease was initially diagnosed by cytological examination and confirmed with fungal cultures and/or biopsy. Fungal culture in one case demonstrated Fusarium spp. and the other case was most similar to the Chrysosporium anamorph of Nannizziopsis vriesii. Both cases were treated topically with debridement and one case received specialty compounded topical terbinafine (50mg/mL poloxamer 407 30% gel). Systemic treatments included voriconazole and terbinafine for a duration of at least 8 weeks in addition to antibiotics. Both cases improved clinically after initiating antifungal treatment and had static to improved osteomyelitis based on radiographs and/or debridement. Due to the unique presentation and location of fungal disease in these cases, it is recommended to complete a baseline oral exam for all bearded dragons, ideally under sedation, and to perform cytology or biopsy if there is evidence of dental disease and osteomyelitis.
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