Advances in equine dentistry
Equine dentistry is an area of medicine and surgery that, on the whole, has remained very basic and neglected for many years until relatively recently. All of us are aware of the requirement for routine treatment of horses’ teeth to reduce sharp points that can cause pain and reduced chewing or ridden performance. This is most often at 12 monthly intervals but can be more frequent if deemed necessary. There have been, and continue to be, a variety of people that can be employed to do this routine work with differing levels of training and knowledge. The “horse dentist” is frequently the person who will be coming to a stable yard to attend to this work, this is a name that has become embedded in the equestrian world but it is not entirely accurate and the correct title is equine dental technician (EDT). Your dentist has done a medical degree and is allowed to use local anaesthetics and perform advanced procedures e.g. fillings and extractions, the best qualified EDT is allowed to reduce sharp enamel points, small overgrowths and extract wolf teeth under veterinary supervision.
There is now a list of procedures that the variously trained people are able to do on the BEVA website. Effectively any procedure other than the routine work described above is veterinary only and these are the procedures that will be discussed in this article.
Equine dentistry in the 21st century is much closer to human dentistry in the best hands and no longer just running a hand rasp up the teeth without having examined them. Examination should involve the use of a good light source and a mirror or, even better, a oral endoscope that will show great detail of all surfaces and a full mouth gag. The recognition of dental and oral disease should be possible at an earlier stage than was done previously as research and understanding of these diseases improves. The examination should be able to note problems with the teeth, but also with the other tissues of the mouth including the gums, palate and tongue. In my opinion every dental examination should be performed under sedation as this is the only way I find you can examine the tight area at the back of the mouth properly without reaction from the horse. It will also make the experience for the horse and the person performing the examination and treatment a lot better and reduce stress on everyone involved resulting in the best job being done.
Dental and periodontal disease that requires treatment is reported to be very common in horses and could be as common as in more than 80% of horses. Periodontal disease is disease that affects the tissues around the teeth which includes the gum, periodontal ligament (that holds each tooth in position and helps with the continuous eruption) and bony socket. This type of disease is often very painful for the horse and will affect chewing and ridden performance. There are a large variety of common diseases that we see at these examinations including displaced teeth, extra teeth, fractures, diastemata (gaps between teeth), caries (infection) and apical (root) abscesses.
The treatment of these conditions has improved and continues to improve at a rapid rate with advancements in the equipment and techniques used so that a lot of these damaged teeth and severe, painful conditions can be treated successfully and we no longer leave them until the only option is extraction. The use of sedation and local anaesthetic techniques allow most of these advanced treatments to be done with the horse still stood up in stocks which is much safer and usually means a shorter hospital visit for the horse that is being treated. Treatments that are frequently performed include diastema treatment and filling of caries lesions (similar to cavities in our teeth).
Diastemata are gaps between the cheek teeth caused by disease or poor conformation of the teeth and are usually very painful. They are usually associated with a degree of periodontal disease that involves infection of the outer tissues of the associated teeth, gums, ligament and bone in the area. This requires urgent attention as the progression of the disease leads to apical infection and complete death of the affected tooth which will then only require extraction. The treatment/management of these diastemata involves widening the gap with an electric burr so that food material is less likely to get stuck in it whilst avoiding damaging the sensitive part of the tooth and then placing a temporary filling after cleaning out the pocket. The intention is that the gum repairs under the filling before it falls out or is removed at a follow up examination. These may need repeat treatment throughout the horses’ life or may develop in other areas of the mouth. Depending on the original cause there can be some drifting of the teeth after treatment or the gap may not be present when the damaged tooth has been worn and is replaced by potentially healthier tooth erupting through normal wear.
Caries can occur around the edge of the teeth (peripheral caries) or on the chewing surface in the folds of enamel (infundibular caries) This is bacterial infection that destroys the tooth material and is graded dependant on how deeply it affects the tooth. The risk with this is that it weakens the affected teeth and could lead to fractures. The horses’ teeth are sensitive and contain a large amount of nerve tissue and a healthy blood supply, sometimes they are considered inert non-sensitive tissues that just get shaped by rasping which is simply not true. Caries will be painful and requires treatment, it can progress to periodontal disease and, as mentioned before, fractures. Infundibular caries is repaired by drilling out the diseased tissue and filling it with a plastic material.
There are some equine dental specialists that are now attempting root canal treatment in some of the very diseased teeth to try to save them from being extracted. This is still very much in its infancy and the technique is really at research trial stage and will not be advised routinely yet but is exciting for the future as it could reduce the number of extracted teeth significantly.
In conclusion dental treatment and general oral medicine has progressed enormously in the last few years and we should be expecting much more of the examination at our routine dental visits and recognition of these diseases will be more common and, therefore, treatment will be necessary more common. A full examination of the mouth and subsequent treatment is best performed under sedation for the best experience for the horse and the person doing the work.