Ask The Vet: Equine Dental Care - October 07

Soft tissue injuries during dental work do occur occasionally due to unexpected movement from the horse, etc. However, proper use of sedatives and other restraint techniques should make significant injury very uncommon. When they do occur, an experienced veterinarian is able to educate the owner and treat with appropriate antibiotics, etc, as needed. This is yet another benefit to using a licensed veterinarian for equine dental work. It is indeed the practice of veterinary medicine and should not be performed by anyone without a license to practice medicine. Very unexpected things can and do happen during the course of routine medical procedures. Most of us who have been in practice long enough have experienced them first hand. Again, licensed veterinarians are equipped to deal with the unexpected and can usually avoid serious consequences. Also, we are fully insured to cover accidents. I wonder whether the unlicensed individual who worked on your horse’s teeth has any liability insurance at all? Was that person operating outside the law in your state? If so, even your own veterinary health insurance policy would not cover your horses costs incurred as a result of illegal activity. I’m very glad that your horse seems to be OK now. Your case points out the downside to using a non-licensed individual for medical care. I hope others can learn from your experience and avoid the same heartache.

It is certainly possible that a dental problem is the culprit. I recommend that you have a licensed veterinarian, experienced in equine dentistry come and examine your horse as soon as possible. Depending on the dental care he has had in the past, he may be experiencing premature expiration of some of his grinding cheek teeth. An experienced practitioner can maximize his useful chewing surfaces and make appropriate dietary recommendations to make up for any dental shortfalls. He/she can also recognize if or when other diagnostic test are indicated to rule out other causes of weight loss.

Cribbing is an irritating habit. However, the most recent research I have seen indicates it is NOT the health risk that we once thought it was. That is, there is no increased risk for colic in a horse that cribs versus a horse that does not. I believe there is some controversy about whether or not it is truly beneficial to use anti-cribbing devices to try and stop the behavior. Personally, and I emphasize that this is my PERSONAL opinion, I think those cribbing collars look awfully uncomfortable. The most highly recommended remedy for cribbing is a lifestyle that minimizes stress and mimics as closely as possible the natural environment of the horse: pasture turn out 24/7 and access to good quality forage 24/7, minimal or no concentrate rations and clean water.

Now, from a more practical standpoint, there is some wear to the incisors associated with cribbing. The most common is mild wear to the central two upper incisors over time. This is not typically detrimental. I have certainly seen severe wear in very old horses, but again, this is not life threatening. Regular dental care is important to keep the incisors opposite the worn ones properly reduced. Also, some cribbers will pull from the side of their incisor arcade, which can create a diagonal incisor malocclusion over time. This problem is also easily controlled with regular dental care (at least once yearly). The cheek teeth, those responsible for grinding, are not affected by cribbing.

It is possible in pastured horses to minimize this habit, if not eliminate the surfaces on which they can crib (i.e. electric fence or HTP type fencing with appropriate posts, etc.) provide little surface to grab. Confirmed, hard-core cribbers won’t stop no matter what. In this case, make sure they are not grabbing a metal or hard plastic edge, which can wear the teeth severely in a short period of time. Wood is safest and causes the least wear to the teeth.

Without a photo, I can’t be sure what you are describing. By four and a half months there should be at least four upper incisors and four lower incisors. The final set, (making six top and bottom) don’t usually erupt until 6 to 9 months of age. So, if there are only three upper incisors, you are correct, he is missing a tooth. If there are five upper incisors, he may have erupted one early and the other is coming later. An x-ray will tell you what is most likely going on, but there is little you can do to change the situation. It is not uncommon to see a missing deciduous (baby tooth) incisor and have the permanent incisor erupt normally at the normal time. It is also conceivable for the associated permanent tooth to be missing or damaged also. The permanent tooth will not be visible on x-ray at this age. I would still recommend that your veterinarian examine the foal’s mouth for other abnormalities and determine whether an x-ray of the “cyst” might be indicated. If it is hard, it could be a growth that should be removed. If it is soft or draining, it may need to be cleaned out and antibiotics administered.

The answer is that at some point in truly old horses lives, their teeth will loose the grinding efficiency they once had as younger horses. The goal of modern preventative dentistry is to postpone that day as long as possible by allowing teeth to wear as normally as possible, thereby lasting as long as possible. Under average circumstances, a horse’s teeth are only designed to last into their mid twenties. Based on genetic predisposition, some will expire sooner and some will last much longer than average, especially with regular skilled dental care. As horses teeth gradually approach expiration, (and they will, at some point) they loose the corrugated architecture that made them so efficient at grinding roughage. They become smoother or “cupped.” This cupped, smooth surface is much less effective for grinding roughage. The “quids” or half chewed hay wads that a horse spits out are the visible result of this process once things have progressed to the critical point.

There are other things that can cause quidding, such as periodontal disease and missing or loose teeth. These treatable problems should be ruled out since periodontal disease and loose teeth are painful and should not be allowed to persist. If these problems are indeed ruled out and the quidding persists, then simple old age with expired teeth may be the only remaining culprit. Each horse is an individual. As such, some horses can function with less chewing surface than others. An equine veterinarian with considerable dental expertise can usually interpret the situation for you. If expired teeth is the only culprit, then dietary management is the only and a relatively easy solution. Complete pelleted diets were made for this situation. Horses with no teeth at all can safely ingest pelleted feeds provided they are moistened and the diet is introduced gradually. Many dentally challenged patients can also handle green pasture very well.

Manure stem length is not a good indication of nutritional availability. Recent studies have shown that there is no correlation between manure fiber length and nutrient absorption. It is adviseable to use body condition and presence or absence of quids and their frequency to determine dietary recommendations. Your equine veterinarian is the best person to make such recommendations.

If this tooth is indeed a retained deciduous incisor and is protruding that far, it could certainly be causing the mouthy behavior. I can’t promise you that, but it’s possible. It should be removed, regardless. My preference is not to let this fall out on it’s own, but to have it extracted. It's possible that it was not present at prepurchase 4 to 5 months ago. The lateral incisor is shed at approximately 41/2 yrs of age, but can vary by as much as 6 months. Also, it’s possible that it was present, but not displaced, and may not have been as noticeable. If all the other incisors are permanent, this one needs to go the way of it’s peers. If it’s jutting sideways, it’s most certainly irritating if not painful and periodontal disease is a possibility. I can’t tell you if it will loosen up and shed on it’s own, but that could take weeks and I wouldn’t make him put up with it that long. Usually, elevation and extraction of these teeth is uneventful. If there is any doubt, radiographs of incisors are really easy and will tell you how much of the root is still intact.

Incisors should meet nearly perfectly with the poll in neutral flexion; that is with the head in a more or less resting position (NOT elevated to the viewer’s eye level.) A small difference of 1 to 2 millemeters probably won't make much of a functional difference IF regular dental examinations correct any minor overgrowths. If these problems are ignored, the discrepancy may get worse over time. As far as the 4 year-old goes, all growth potential, and therefore change in jaw length is pretty well over by this age. However, just removing any minor dental overgrowths can allow soft tissues to readjust and the jaws may line up a bit better even though no change in jaw length occurs. As far as the 5-month-old goes, this is the time to jump on it and give him or her the best chance at normal jaw alignment. Have a equine veterinarian experienced in equine dentistry examine the weanling to see if there are any dental overgrowths that may be inhibiting lower jaw elongation. Minor cases don’t usually require orthodontic intervention, but this is the time to consider that if it appears warranted.

First and most important, your regular veterinarian needs to know what you are seeing. The cause of the behavior you are seeing may or may not have anything to do with the dental work directly. Without seeing your horse, I cannot comment on probable cause. Your regular vet may want to come and recheck your mare to try and identify the problem. While the problem may resolve itself over time, it should most certainly be noted in her medical record. Call your regular vet right away if you have not already.

At 20 months, you are already approaching the end of the rapid growth phase when large orthodontic changes can be made. I usually recommend starting orthodontic therapy (where the severity of the case warrants aggressive treatment) at 3 to 6 months of age. Having said that, there is still some hope for useful correction, even at 20 months; especially if the case is not severe. You need to find an equine veterinarian that has specific experience in advanced equine dentistry. It may be that your filly just needs any overgrowths reduced and some management changes to encourage the lower jaw to catch up in length to the upper one. Horses with true overbites commonly have overgrown portions of specific cheek teeth that can prohibit elongation of the lower jaw. Likewise, unopposed incisors can effectively “lock” the lower jaw into the abnormal overbite position. Removal of these overgrowths on a regular basis in mild cases is often curative. If more aggressive treatment is warranted or desired, orthodontic devices may still be effective to some degree. The sooner you get an expert opinion, the better.

In general, I recommend that all foals have at least a cursory dental examination at birth, at about 3 months of age and again at each vaccination appointment to make sure to catch developmental problems like this while correction is still likely. Comprehensive oral/dental examinations should begin at about 12 to 18 months of age. Yearlings will already have sharp enamel points and should have wolf teeth (if present) removed at this time. Subsequent juvenile exams should be scheduled roughly every 6 to 9 months until all permanent teeth are in place at about 4 years of age.

At the risk of sounding repetitious, EVERY horse needs a thorough oral/dental exam at least once yearly. A 24-year-old horse is of no exception. Older horses are prone to periodontal disease, extreme wear, loose teeth and sharp enamel points that need evaluation roughly every 12 months (individually tailored exam schedules can be determined by a veterinarian experienced in equine dentistry). Parrot mouth is the horseman’s term for an overbite or “brachygnathism.” It does not develop later in life. Horses are either born with it or develop it early in life. It is possible that she has had a mild case from an early age that is becoming more visibly severe if she has not had regular comprehensive dental care. She could have developed large hooks and incisor abnormalities associated with long standing parrot mouth that need attention right away.

I recommend identifying a licensed equine veterinarian who has experience in equine dentistry and scheduling an appointment at your earliest opportunity. Such veterinarians can be located via referral from your regular vet (if he/she does not have such experience), local horse owner publications, internet, and best of all, from recommendation from other horse owning friends.

I applaud your efforts to save these horses that might not otherwise get a chance at a good life. It is entirely possible that this mare’s dentition is perfectly fine. But, if she has not received a thorough dental exam and AT LEAST a floating in the last year, she is due. Due to the seasonality of the colic episodes and her “poor doer” status, in addition to the other abnormal findings, I would suggest a complete medical work up. You also cannot rule out dental problems based on the info provided. I suggest that you consult a veterinarian who has specific and extensive experience in equine dentistry. There is a small chance that some of these problems may be attributable to dental issue or an inability to chew properly. It could be something that only a very experienced practitioner could recognize. However, it is more likely that there is something else more systemic at the root of her problems. Even more likely are several small problems that when taken together really add up to big issues. You may need to consult with an internal medicine specialist. Also, make sure you have addressed all the easy management issues. Is she fed separately so that she has NO competition from herd mates? Is she given plenty of time to eat so she doesn’t feel rushed? If she is alone most of the time, could she need more companionship….a goat perhaps? Goats can really provide much needed security for blind horses without being a competitor for food, shelter, etc. This is somewhat out of the realm of equine dentistry, but as a veterinarian, these are all things I would look at if asked to examine this horse. (Yet another reason to insist on a licensed veterinarian for equine dental care since often other organ systems are involved.)

First of all, I have to discourage you from using anyone other than a licensed veterinarian for equine medical care. A licensed veterinarian may have been able to give you more information about the status of the tooth and what may have caused the damage. Unfortunately, now that the tooth is out, it may be impossible to identify the cause of the tooth loss. I would still recommend a thorough oral/dental examination by a licensed veterinarian experienced in equine dentistry to rule out other abnormalities. I would be surprised if she doesn’t need additional care given her age and questionable dental care history. She may need x-rays to make sure that there is no diseased tooth fragment remaining in the socket. Farriers are well versed in foot care, not veterinary medical care.

There are several situations that may have lead to the displaced and very loose tooth you describe. Older horses that have not had comprehensive dental care throughout their lives may experience premature expiration of teeth such that there is not enough tooth remaining below the gum line to maintain a strong attachment. These teeth will often loosen and exfoliate spontaneously. Some of them hang on at odd angles and cause great discomfort as you describe. Also, periodontal disease (more common in older horses) is a painful condition that can result in varying degrees of loss of attachment of the tooth. Again, over time, the grinding forces of the other teeth may force a loose tooth out of position resulting in the situation you saw. Fractured teeth or abscessed teeth can end in the same problem.

The American Association of Equine Practitioners, the American Veterinary Medical Association and most State Veterinary Boards include dentistry under the umbrella of veterinary practice. This means that only a licensed veterinarian may perform dentistry on animals (and collect a fee for it.) Some state practice acts allow for some limited exceptions to this general rule such that certain individuals, usually licensed animal health technicians, may perform specific tasks such as the rasping of teeth to remove sharp enamel points under a specified degree of supervision from a licensed veterinarian who in most cases must be that technician’s employer. There are some exceptions to this general regulatory picture, but they are few. These rules and regulations are in place to protect the horse and the horse owner. Modern equine dental procedures are very comprehensive, sometimes invasive and have significant effects on the overall health of the patient. The AAEP feels that these procedures are very clearly to be performed by a licensed veterinarian in order to safeguard the health of the horse.

There are no “schools” for equine dentistry recognized or accredited by any veterinary governing body. There is no standardized or universally accepted curriculae or performance standard for practitioners of equine dentistry. A “certification” in equine dentistry from a for-profit “school” does not carry the same legal standing or educational depth as a license to practice veterinary medicine. I support the position of the AAEP and can only recommend using a licensed veterinarian (one experienced in equine dentistry) to provide veterinary dental services for your horses.

Keep in mind that our profession responds to market pressure just like any service profession. If horse owners demand high level dental skills from their equine veterinarians, those skills will be provided by an equine veterinarian in that market. It might not happen overnight, but it will happen. (It IS happening.)

Most states consider dentistry part of the practice of veterinary medicine and as such must be performed by a licensed veterinarian. There are many veterinarians with advanced training and experience in equine dentistry. Our numbers are growing on a yearly basis. Many veterinarians who limit their practices to equine dentistry are accustomed to traveling significant distances to service caring owners and their horses. Word of mouth from other satisfied horse owners, the internet and local/regional horse publications are good sources for locating a veterinary dental practitioner in your area. Make sure you check out his/her experience and get references. Dentistry has far reaching effects on the entire horse and his overall health. A licensed veterinarian experienced in equine dentistry is the only person who should be performing medical procedures on your horse. Would you trust an unlicensed lay person who may (or may not) have attended an unaccredited school for a few weeks to provided health care for your child or yourself?

There’s not a lot you can look for yourself. Sedation, a full mouth speculum and a bright light source are necessary for a thorough oral/dental examination. Your veterinarian can perform this exam for you or refer you to a colleague who has advanced skills in equine dentistry. Causes of foul odor from a nostril include maxillary tooth root abcess, sinus infection, referred odor from the mouth from periodontal disease, etc. Only a thorough oral exam can point you in the right direction. X-rays or other more advanced diagnostic tools might be necessary to fully diagnose the cause of the problem.

The area of the palate directly behind the incisors can appear quite “puffy” in some individuals. Unless you know for certain that this is a new appearance for your horse, it is likely normal. A thorough oral/dental exam should be performed by a veterinarian experienced in equine dentistry to rule out other painful issues that might be causing a reluctance to accept the bit. Remember that all horses need such an exam at least once per year.

Dropping grain/pellets/concentrates is not necessarily evidence of dental problems. If you are satisfied that the work was done properly, it is likely that the horse is simply a sloppy eater. I’m more concerned with the horse’s ability to properly masticate hay and other roughage. A second opinion is always an option if you wish to rule out more subtle dental issues.

You are smart to question the credentials of any equine dental practitioner. Hopefully, a licensed veterinarian knows enough about the anatomy and the capability of his/her tools to avoid any damage. The bottom line is that the degree of precision and the speed with which corrections can be made are huge positives for the judicious use of power equipment. The time required to make significant occlusal corrections by hand is just not in the best interest of the horse (mouth open too long, additional sedation, etc). It is up to the horse owner to advocate for their horses and make sure that the veterinarian comes highly recommended, can answer questions fully and honestly about the risks and benefits of motorized dental tools and can provide evidence as to advanced education and experience in equine dentistry as well as references. Don’t be afraid to ask the tough questions! Any responsible veterinarian should be more than happy to share their knowledge or be willing to refer to a colleague who has the needed experience.

Keep in mind that there is nothing inherently wrong with the use of power dental tools. ANY tool is only as useful or safe as the hand of the practitioner holding it. Experience counts.

Bottom line: I can’t tell you why he’s losing his baby teeth at this age. It is not normal. Are you sure he was not kicked? He should not loose those teeth until approx 2.5 years of age. Normally, they would shed at this age and be replaced in short order by the permanent ones. He may or may not have permanent teeth that will erupt at 2 + years of age. An x-ray at this age may not tell you anything as the permanent teeth may not be mineralized enough to show up on films. Besides, there’s nothing you can do about it anyway. Either they are there, or they’re not. I would recommend that your regular vet examine your colt and make sure there are not any other dental abnormalities that might need attention. (Also, I might respectfully suggest you consult with him/her about your colt’s diet. It might not be the best ration for him depending on breed, size, growth rate, etc.) Long-term prognosis is the same as for any horse missing teeth. The opposing teeth must be regularly reduced since they will not be worn down naturally. Other than that, missing incisors are not a serious detriment to long term health.

Without examining your horse, I cannot say for certain what might be causing the quidding. However, based on your description, if I were to examine him, I would first look for signs of periodontal disease since this is one of the leading causes of quidding. Since you mentioned tartar and tooth loss, I’m suspicious of periodontal disease issues. Also, keep in mind that the final chewing process before swallowing occurs at the last two sets of molars. If these are the teeth that your horse is missing, he may really be incapable of consistently creating a bolus suitable for swallowing. All the “floating” in the world is not going to change that. I’m assuming from your statement that he was quidding before the floating as well as after, but improperly equilibrated teeth could also be the cause of the problem, but is not likely if you used an experienced dental practitioner. Geriatric mouths can be some of the most challenging to maintain in a pain-free, but still functional state. So, a second opinion may be an option if other causes are ruled out. If I was to play the odds, I’d bet on periodontal disease or just plain expired teeth (not enough effective chewing surface due to extreme wear) as the cause of the problem. Periodontal disease must be treated as it is quite painful. If his teeth are just worn out, dietary management is your only option. Equine senior is made for horses that can’t chew hay. Your regular vet can formulate a plan for your horse that will meet his nutritional needs even though he may not be able to chew hay.

I am sorry that you’ve had a bad experience with your regular veterinarian. I’m sure you understand that I cannot comment on what may have caused your horse's symptoms without examining them. The fact remains, however, that you need to find a solution. It is true that skilled veterinary dental care may be more difficult to find in some areas than in others. I would encourage you to make sure you have expressed your concerns clearly to your regular veterinarian and made sure there is no way to remedy that situation before you move on. If you feel you must find a more skilled provider, I still encourage you to seek out another licensed professional. There are many equine veterinarians that have limited their practices to equine dentistry. A high percentage of them are accustomed to traveling distances to service groups of horses, and I know from experience, some of my clients are willing to haul great distances to make sure their horses get the best care available. So, you are not alone. Sounds like you have more than one or two horses though. I’d suggest contacting the veterninary teaching hospital in your area to see if the equine department might be aware of a practitioner in your state that might be able to meet your needs. Many states have Horseman’s Yellow Pages that might be a source of information. Try an internet search with “equine dentistry + your state” in the search box. That is how a lot of new clients find my practice. The best way to find a new dental practitioner is, of course, word of mouth. Good recommendations are the best advertising. Do you have horse owning friends in more populous areas of your state? Most equine dental practitioners are located closer to larger metropolitan areas. But, that doesn’t necessarily mean they won’t travel. Think about assembling a group of your friends and neighbors with horses to make up a day or two’s worth of work for an experienced practitioner and I bet you can find someone to fill your needs.

Yes. At a minimum, a horse missing permanent teeth will need very regular care (at LEAST once yearly) to reduce the crown height of the opposing teeth since they will have nothing to grind against and will thus erupt without being worn down. This will eventually result in an incisor malocclusion, which may cause serious difficulty in properly grinding his food. While the incisors are not used for grinding, they directly impact the function of the grinding teeth further back in the mouth. Do not ignore them. More frequent attention may be needed if the horse is younger than about 6 to 7 years of age.

Wave mouth is a very common malocclusion (teeth that meet abnormally at the chewing surfaces) involving the entire arcade of teeth. Instead of all six teeth in each arcade being roughly the same height, in a wave mouth, there is an overall change in the height of the teeth from front to back of the arcade. The most common configuration is for there to be a shallow spot in the center portion of the upper arcade with a corresponding high spot in the lower arcade. Over time, the entire arcade is affected forming a “wave” formation if you were to look at the arcades through the cheek from the side of the horse’s head with alternating high and low areas. I don’t think anyone knows for certain how the wave develops yet. Speculations include a weak area in the upper arcade that allows it to be more quickly worn by the stronger lower teeth, thus forming the wave. We are pretty sure that equine teeth have to be aligned in a very set configuration in order to wear evenly. If a given horse’s teeth don’t line up just right, it’s possible that naturally stronger areas may grind against naturally weaker areas, which sets up the scenario above. The important part for the owner to understand is that an unaddressed wave mouth will get worse with time and likely lead to premature wear/disease/loss of the overly worn teeth involved in the wave mouth. A properly equilibrated mouth can minimize or even reverse the damage caused by a wave mouth over time. The earlier a wave mouth malocclusion is recognized, the easier it is to correct. Very old horses with significant wave mouths may not be able to be corrected completely, but even these horses can be helped significantly.

My gut response is that if your mare is 36 and she’s just now quidding “a little”, you are doing GREAT!!! Horses of that age are likely to be experiencing loss of effective grinding surfaces. If your mare has already lost some teeth, that just compounds the issue. The fewer teeth in good strong contact, the more difficult it is to grind roughage until the critical point is reached where they just can’t quite get it right all the time and they start dropping quids. I would recommend that she is examined again soon if she has just started quidding just to make sure that she’s not got a loose tooth or periodontal disease that could be causing the quidding. But it is possible, maybe even likely, that she’s just running out of chewing capacity. Horses’ teeth have a finite lifespan and will run out of effective chewing surface if the horse lives long enough. Proper preventative dental care aims to prolong the useful life of the teeth, but not indefinitely! 36 is a VERY respectable accomplishment. Congratulations!

Senior diets were created for this situation. Your veterinarian can make appropriate dietary recommendations to make sure that all her nutritional needs are met despite her reduced ability to grind roughage. Geriatric horses do have some special dietary needs and it’s always a good idea to have your vet go over her physical status and address any other age related issues on at least a yearly basis.

It does seem a bit more frequent than “normal.” However, 2 to 3-year-olds are erupting teeth and shedding caps really quickly. If your trainer is very sensitive to such matters, it’s possible that at least two such visits would have been beneficial to smooth sharp edges from newly erupting permanent teeth. It is amazing how quickly sharp edges can reform in young horses. As long as dental work is performed properly, there is probably no detriment to such frequency. I can’t tell you if it was necessary without seeing the mouth. I like to see my 2-year-olds every 6 to 8 months under normal conditions.

There may be some online resources, however I am not aware of them off the top of my head. Aging a horse by appearance of the teeth is unreliable at best. After a horse reaches roughly 9 to 10-years-of age, it gets very difficult to determine age by teeth with any accuracy at all. The guides are just that…GUIDES. Once you get familiar to the topography of the teeth, you can make a pretty good guess within a few years for a mature horse. One can determine, however, whether a horse is 10 vs 20 by the appearance of his teeth. AAEP publishes a very good pictorial guide and is available for purchase through the AAEP office.

Always remember to be careful opening a horse’s mouth! It’s amazing how fast they can accidently nab a finger!

Without hearing the noise, it’s hard for me to guess what might be causing it. I can tell you that a cracking sound when eating is NOT normal and is probably NOT a good thing. I don’t think you have an emergency, but I would ask the veterinarian who did the dental work to reassess the horse’s functional occlusion. If any part of one arcade is coming into contact at the wrong time, it could push the mandible out of place causing a noise from the TMJ (temporomandibular joint) as it pops or clunks back into place. Over time, this could be problematic. Again, not being able to see/hear the horse, I can’t give you specifics. It may not be a critical issue, but I think you should have it checked. I don’t place too much importance on the problem of dropping grain while eating. Lot’s of horses are just sloppy eaters. I am more concerned with how efficiently they process roughage.

Fussing with the bit can have any of a number of causes, some of which have nothing at all to do with the teeth! Every horse I see receives a “bit seat.” I hesitate even to call it that since the term is rather ambiguous. I make sure that there are no sharp edges on any of the tooth surfaces that could possibly come into contact with soft tissue (cheeks or tongue) through bit pressure, caveson pressure, bosel, hackamore, etc. I do NOT change the general size or shape of the teeth or remove any of the chewing surface. In my experience, chronic fussers will fuss until you either find a bit they “like” or get rid of the bit altogether. Removing significant portions of the teeth (aggressive or deep “bit seat”) is medically unsound and I won’t do it. It sounds like you’ve already found that a Mullen mouth type bit works well for him. That, in combination with regular dental care to maintain comfort and proper equilibration, may be all you need.

My own opinion is that horses that fuss with the bit often do it out of anxiety or frustration or boredom. There are also horses that just won't relax with anything in their mouths. This may not be the case with your horse since the Mullen helps. I say stick with it.

Every horse should have a thorough dental exam at least once yearly… period. I can’t tell you it’s ok to wait 3 years.

The major “pro” of a root canal is saving the tooth. Horse’s chewing mechanisms function best with all the components in place. Having said that, the equine masticatory system is also very adaptable and very forgiving. It can function effectively in the absence of several teeth as long as the system is maintained in equilibrium. The major “cons” of root canals is the cost and the necessity of laying the animal down for a general anesthetic procedure. Also, not all teeth are equally amenable to endodontic procedures. Age can make a difference since the size of pulp chambers/canals changes with age. Location of the tooth matters too. Mandibular teeth are easier to access and fully instrument than maxillary teeth. Likewise, the more distal (further back) the tooth is, the more difficult the approach. However, each case must be assessed individually by a practitioner experienced with the procedure. My advise to you is to consult with your regular veterinarian and/or your surgeon or dental practitioner to decide if this individual would benefit from a root canal procedure AND it fits within your budget and expectations.

Extractions are not without risk either! They come with their own set of possible complications. Your veterinarian can go over those with you. Most teeth can be extracted in the standing animal with sedation and local anesthesia greatly reducing the risk of serious complication. Some teeth, however, may require surgical repulsion in a recumbent patient. Repulsions and “lay-down” procedures both increase the risk of complications.

In a nut shell, every case is unique and must be approached based on it’s own set of circumstances.

Your best option would be to have some high quality x-rays taken of the fractured tooth and the surrounding structures along with the opposite arcade for comparison. A tooth should never be extracted without evidence of disease or pain. It is possible that a fractured tooth will “heal” itself. It is also possible that the pulp chamber(s) will become very inflamed or infected causing much pain. I would not recommend waiting until you see signs of pain. Most horses are very very stoic when it comes to dental pain and will continue eating regardless. Having said that, if there is not radiographic evidence of infection, and she eats and performs well, there is probably no reason to contemplate extraction at this time. Radiographs taken now will provide a baseline in case the tooth starts to present problems later on. Intra oral films may be necessary to properly assess the pulp chambers and periodontal structures. Depending on your veterinarian’s capabilities with this diagnostic tool, he may wish to refer to another veterinarian for the intra oral films.

Also, regular visual inspection of the tooth (I might recommend another exam in 3 months) even if there is no obvious change in her habits, would be advisable to monitor the fracture site.

I have to agree with the recommendation of at least once yearly for all horses. There might be a RARE individual that doesn’t need at least sharp enamel points reduced, but that animal still needs a thorough exam at least yearly. I have a very hard time buying that a horse could only need dental work four times in a lifetime! If a horse doesn’t start to re-develop sharp enamel projections within approximately 12 months of his last equilibration, I’d be a little suspicious that he may have been too aggressively treated the last time he received dental work. I won’t say there cant’ be any exceptions to the rule, but I can say they are extremely rare.

Horses kept on pasture 24/7/365 MIGHT be able to go just a little longer than average, but not by far.

Oral ulcers are most frequently caused by sharp projections from the teeth. The cause is usually readily identified upon oral exam. Once the offending sharp projection is removed, the ulcer will usually heal without direct treatment. In the case of an immunocompromised animal, such as one with Cushing’s syndrome, twice daily rinsing with warm salt water might be helpful possibly in combination with a short course of broad spectrum antibiotics if the ulcerations appear very inflamed. Other causes of oral ulcers include foreign bodies, hay/feed contaminants, chemical exposure and viral pathogens. Removal of the offending cause is curative. Oral ulcers accompanied by loss of appetite and or increased salivation, could have a contagious viral cause and should be examined promptly by an equine veterinarian. Very rarely, I have seen horses that will habitually chew their own tongue or cheeks creating ulcerations. I try to rule out chronic pain sources as a possible inciting cause for this behavior (such as gastric ulcers), but it is usually a behavior issue. Change in lifestyle might help in these cases.

Every horse, regardless of age, should have his/her teeth examined at least every 12 months. Young horses, under the age of 5 and 6 may need more frequent examinations/treatment since young mouths are changing fast and young teeth develop sharp enamel points faster than older teeth, on average. Almost ALL horses will develop sharp enamel points within 12 months of dental care. That is the nature of equine dentition. Additionally, since young teeth are erupting at very fast rates, they tend to get sharper faster than a middle aged horse. Most veterinarians experienced in equine dental care recommend that young horses under the age of 5 and 6 receive dental care every 6 to 9 months until all their permanent dentition is well in wear. Once horses reach dental maturity, most can go to a yearly schedule. Horses with severe malocclusions that require staged corrections, and mature horses in competition or those with extreme sensitivity may require more frequent examinations also.

Young horses can develop problems in addition to simple sharp enamel points. Teeth that erupt out of line with their neighbors may develop severe periodontal disease in a very short span of time. Teeth that erupt asynchronously are predisposed to more severe malocclusions that get progressively worse over time. The sooner these problems are addressed, the better the chance of successful correction.

Choose an equine veterinarian that is experience in equine dentistry. Many general equine practitioners have advanced skills or are willing to refer to a colleague who has such skills. There are more and more equine veterinarians that treat dental cases exclusively. Proper dental care is essential to overall health. Only an experienced licensed veterinarian should provide dental health care for your horse.

In the absence of reliable referrals, the following are some guidelines to watch for:

- A thorough dental exam REQUIRES sedation, a full mouth speculum, a strong light source and a clean mouth.

- ROUTINE equilibration may take anywhere from 30 to 60 minutes depending on the amount of corrective work necessary.

- A dental mirror should ALWAYS be used to examine parts of the mouth that are not easily visible

- Owners should expect cost to reflect the time and expertise needed to perform a thorough exam and treatment.

The most common causes of a very smelly mouth are advanced periodontal disease and/or an abscessed or fractured tooth. Other causes, and one that cannot be overlooked with this sudden onset, is a foreign body lodged in the mouth. I have found wire’s skewered through tongues, and wood fragments wedged across the hard palate. These items cause local tissue necrosis that smells terrible and marked inappatence. Foreign body is easily diagnosed with a thorough oral exam. Removal of the offending item is usually curative. Short term antibiotics and anti-inflammatories may be needed.

In the case of periodontal disease, food becomes trapped, and then packed between adjacent teeth and slowly ferments over time. The resulting environment is perfect for the growth of bacteria. The byproducts of this bacterial growth cause more damage to the adjacent soft tissue around the teeth and to the structures that hold the teeth firmly within the bone. A painful cascade reaction usually results, that left unchecked, will eventually result in tooth loss.

A fractured tooth is often initially quite painful and could cause loss of appetite. Also, food can accumulate in the area of a missing fragment and start to smell badly.

An abscessed tooth is usually only smelly if it is draining into a sinus or into the mouth itself. Nasal drainage from an abscessed tooth is often quite fetid.

A thorough oral exam will diagnose periodontal disease as it is usually plainly visible, but high quality dental x-rays are required to diagnose a tooth abscess. Most tooth abscesses require extraction to eliminate the infection. Most teeth can be extracted in the standing animal through the mouth and don’t require a lay-down procedure. Many cases of periodontal disease can be successfully treated by an equine veterinarian experienced with advanced dental therapies. Good quality x-rays (possibly intra-oral films) are absolute necessities to properly describe either problem.

As a 7-year-old, it is unlikely that the lump is related to normal permanent tooth eruption. Depending on where, precisely, the lump is located, ie: on the bone, or between the jaw bones in the soft tissue, there are several diagnostic rule outs.

Let’s first assume it is a lump that is obviously associated with the jaw bone itself: Likely rule outs would include (but are not limited to) trauma (fracture or acute periosteal reaction,) tooth root abcess or possibly osteoma. The first two are usually painful to firm palpation, but not always. A fracture should be diagnosed as soon as possible. A tooth root abcess may respond to antibiotics, and the sooner started, the better the likelihood of avoiding an extraction. Most tooth root abcesses result in extraction. An osteoma is a benign tumor of bony tissue that is quite common along the lower jaw line of horses. They commonly stick out quite obviously and become more discrete over time. Some actually look like a small (or not so small) golf ball on a tee. Removal is only required if the growth interferes with tack. A definitive diagnosis is made through good quality radiographs.

Next, let’s assume that the lump is associated with the soft tissue between the jaw bones. The most likely culprit in this case is an enlarged lymph node. An enlarged lymph node is not necessarily a bad thing. Lymph nodes enlarge in response to a stimulus to the immune system. So, if a horse is exposed to an upper respiratory bug, his local immune system would respond appropriately and kick into high gear to fight the invader enlarging the lymph nodes in the immediate area. There are a few sets of lymph nodes in the area. The ones further back, nestled between the widest part of the jaws are the most commonly noticed. They are firm, but not rock hard, and may or may not be painful to palpation. These usually only require treatment if other symptoms are present, such as a persistent cough, green nasal discharge, drainage from the enlarged lymph node, etc. Less likely, soft tissue rule outs would include tumors, etc. A qualified equine veterinarian should be able to diagnose an enlarged lymph node on physical examination. Bloodwork might be indicated to rule out more serious problems. Lastly, a needle biopsy to identify cell type would definitively diagnose the nature of a soft tissue lump.

In conclusion, your experienced equine veterinarian is the one who can and should examine your horse to properly diagnose any physical abnormality and formulate a treatment plan if necessary.