Hypercementosis

By: Rick S. Marion, D.V.M.

Hypercementosis is the name given to an emerging problem in older horses involvingHypercementosis Pic degeneration, and eventual loss of incisor teeth.  The incisor teeth are the 12 teeth that sit in the front of the horse’s mouth, the ones seen when the lips are parted. They are used for biting and grabbing hay and grass but do almost no chewing, grinding, or processing of feed stuff. As we have all observed they sit perpendicular to the jaw in young horses and almost always become long and horizontal as the horse ages. The incisors can be severely affected by objectionable habits in the horse, such as cribbing or raking on solid objects.

Hypercementosis, more properly and recently renamed Equine Odontoclast Tooth Resorption and Hypercementosis (EOTRH) is a chronic degeneration of the incisor and canine roots. The degeneration of the root is accompanied by (or possibly caused by) inflammation of the periodontal membranes, loosening of the tooth, bacterial overgrowth, and gingivitis. The cause of this syndrome is not completely understood and it may be a combination of various syndromes with many causes alone or together, resulting in the same characteristic lesion.

The progression of the syndrome is inconsistent but typically begins with the corner incisor or 20131227_102524canine teeth and progresses toward the center. As the teeth roots are variably reabsorbed and hypertrophied, the periodontal membrane becomes inflamed and infected, the gingival tissue also becomes infected, and the tooth loosens. Loose, inflamed teeth can be very painful but rarely will hinder the horse from eating.

Treatments vary tremendously, but as of now no treatment has been found to stop the degeneration and eventual loss of teeth. Antibiotics will partially control the gingiva and periodontal space infections. Anti-inflammatories, bute, banamine, aspirin, and steroids may help address the pain associated with the inflammation. Splints or braces may decrease the mobility of the teeth and also address some of the pain. All treatments will eventually end with tooth extractions. The incisors may be extracted one or two at a time as their roots fracture or the infection progresses enough to make removal necessary. However, they may all be extracted at one time to address their pain and to treat their condition as aggressively as possible.

Some veterinarians prefer to remove all the incisors at one time because they feel this more aggressive approach is the fastest and most complete way to resolve the pain, inflammation, and infection.

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Are you new to Anoka Equine?

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If you are new to using Anoka Equine as your primary veterinarian, welcome!   If you have been one of our amazing clients for many years, this may be a good chance to see what else we can offer you and your horse. Here is a little information about our clinic and some valuable resources that Anoka Equine offers.

DaveAnoka Equine provides on-farm services for routine preventative maintenance procedures, investigation of health concerns, and 24-hour emergency care. We maintain seven full service mobile units that cover our 35 mile radius around Elk River. Routine procedures in the field include: vaccinations, deworming, maintenance dental care, health certificates and passport examinations, pre-purchase exams, and Coggins testing. Many other health concerns can arise out at the barn and our doctors are prepared to evaluate them as well; examples are: lamenesses, illness, reproductive issues, ophthalmic injuries, and emergency situations (such as colics and lacerations). After an evaluation is completed on your horse, the doctor will administer the appropriate treatments, and if deemed necessary, discuss the option of referring your horse into the clinic for more intensive care and/or diagnostics. We currently possess a portable digital x-ray machine and ultrasound units to help with diagnostics on the farm.  Lastly, procedures commonly done in the field may include: physical exam evaluations, administration of medications, laceration repairs, superficial tumor removals, castrations, wound care, hoof injuries and abscess care, and joint injections. Our in-house laboratory allows our veterinarians to bring blood and other samples back to the clinic for quick results to expedite diagnosis and treatment options.

Programs

wellness-programAnoka Equine Veterinary Services offers two programs throughout the year your horse can be a part of. Firstly, our Wellness Program; it is a comprehensive program which combines our recommended routine health care checks for horses in the area at a greatly reduced cost. Enrollment in this program begins at the being of each year and payments are made at each individual vet visit (no upfront cost). For detailed information on the options this program can offer, please visit our website. Secondly, we offer Preventative Care Days from March to May on select dates. These specific dates are released in late February. For detailed information on our Wellness Programs and Preventative Care Days please visit our website; dates for the coming year’s Preventative Care Days are released in February.

Educational

088_anoka-equine_2012Anoka Equine Veterinary Services sends out a bi-annual newsletter to our clients via emails. This e-newsletter contains articles  pertaining to case studies and invitations to up-coming events hosted by Anoka Equine. In addition, if you sign up for our newsletter you will also receive equine outbreak information reported in Minnesota. We want to make sure all our clients are kept up-to-date on all information regarding contagious diseases found in the state and how to prevent exposure to their horses. In order to receive all this information, please sign up to receive emails from Anoka Equine as to not miss any of this valuable information in the coming year.

Starting in 2014 Anoka Equine started a weekly blog. Our blog posts range from fun to informational topics. Informational blog posts cover topics like: why we recommend certain services annually, as well as, medical issues you may face at some point during your time as a horse owner.

First Visit to Anoka Equine – How to check in

000_0250When you arrive at Anoka Equine Veterinary Services for the first time, it can be slightly overwhelming. To ease some of this confusion, we will now discuss how to check in for your appointment. When driving up to the clinic stay left of the building and park in front of the silver gate. At this point, we ask you briefly come inside to check-in with your name and the veterinarian you will be seeing. Once the front office confirms your information, they will page for one of our technicians to open the gate and greet you. When the gate opens, please drive past the lameness pad (on your left with orange cones) and park along side the right side of the lameness pad, facing the lower gate at the bottom of the hill. We ask you park this way so later appointments (with varied size trailers) will be able to get around your trailer. In addition, the lower gate is the best exit to use to get back onto 101 from County Road 37. Once parked, a technician will come and greet you, bring you in to the clinic (if there is available room), and take a brief history of your horse to share with the doctor. This brief history is meant to shed some light on the reason you are visiting us and give the veterinarian an idea of what is going on with your horse to prepare them for the direction we may need to take. At the conclusion of your appointment, the technician will be available to assist in loading your horse while the doctor is writing your discharge. After you collect your discharge information from the front office, the lower gate will be opened for you, and you will be on your way.

We hope this information has provided you with a little more information on Anoka Equine.  We hope to see you in the spring.

 

Hypercementosis

Hypercementosis

Dr. Rick S. Marion

Hypercementosis PicHypercementosis is the name given to an emerging problem in older horses involving degeneration and eventual loss of incisor teeth in older horses. The incisor teeth are the 12 teeth that sit in the front of the horse’s mouth, seen when the lips are parted. They are used for biting and grabbing hay and grass but are not involved in the chewing, grinding or processing of feed stuff.  The incisors sit perpendicular to the jaw in young horses almost always become long and horizontal as the horse ages. The incisors can be severely affected by objectionable habits in the horse such as cribbing or raking on solid objects.

Hypercementosis, more properly and recently renamed Equine odontoclast 20131227_102524tooth resorption and hypercementosis (EOTRH) is a chronic degeneration of the roots of the incisors and canines. The degeneration of the root is accompanied by, or possibly caused by inflammation of the periodontal membranes, loosening of the tooth, bacterial overgrowth and gingivitis. The cause of the syndrome is not understood and it may in fact be various syndromes with many causes alone or in concert resulting in the same characteristic lesion.

The progression of the syndrome is inconsistent, but starts with the corner incisor or canine and progresses toward the center. As the root of the teeth are variably reabsorbed and hypertrophied, the periodontal membrane becomes inflamed and usually infected.  When the gingival tissue becomes infected, the tooth loosens. Loose inflamed teeth can be very painful but rarely will stop the horse from eating.

Treatments vary tremendously but, as of yet, no treatment has been found to stop the degeneration and eventual loss of the teeth. Antibiotics will at least partially control the infections in the gingiva and periodontal spaces. Anti-inflammatories, bute, banamine, aspirin and steroids may address the inflammation and therefore the pain. Splinting or braces may decrease the mobility of the teeth and address the pain from that angle. All treatments will eventually end with extraction of the teeth. The teeth may be extracted one or two at a time as the root fractures or infection makes removal necessary, or may be done on all incisors to address the issue of pain and treat the condition as aggressively as possible.

There are veterinarians who prefer to remove all the incisors at one time thinking that this aggressive approach is the fastest and most complete way to resolve the pain inflammation, and infection.  Even with all the incisors extracted horses can comfortably eat grass and hold food normally.

Equine Dental Extraction

By Megan Slamka, DVM

Introduction

6a00d834529d8769e20120a8bb0e23970bRoutine dental exams are a vital part of general horse health. Dental examinations can reveal very common oral pathologies such as diseased, fractured, loose and retained deciduous teeth (caps) that need to be removed.  Failure to remove these teeth can lead to more than discomfort for the horse, but serious infection as well. This handout will describe the indications, procedures, and potential complications for extracting equine teeth.

Indication

Horses of all ages may require dental extraction. Extraction can be done under general anesthesia via repulsion of the tooth or standing with heavy sedation. Recently, standing extractions have become more popular with veterinarians and owners for its advantage of not having to undergo general anesthesia, as well as minimizing damage to associated bony structures. That said consideration of the horses age, temperament, tooth location, amount and condition of exposed crown must be taken into account. As horses age, their teeth continuously erupt therefore the amount of reserve crown (amount of tooth below the gum line) becomes less and less. Therefore, younger horses with extensive amounts of reserve crown make extraction difficult.

Procedure

Prior to extraction of the problem tooth, dental radiographs should be taken to verify the extent of pathology, as well as, to identify if associated structures such as adjacent teeth or sinuses are affected.

The procedure as mentioned above, can be carried out under general anesthesia or standing with heavy sedation. We will discuss the procedure for standing extraction, as this is the most common option for uncomplicated cases.

After a thorough oral exam and radiographic exam, the process of extracting the tooth can begin with appropriate sedation on board.

Local anesthetics are used to minimize pain, as well as injectable drugs that provide both pain relief and sedation.

The horses head is elevated and suspended with either a dental halter or headstand with the mouth held open with a dental speculum. Due to the duration of this procedure horses are given breaks every 30-45 minutes.  For cheek teeth; the gum is detached from underlying alveolar bone with a dental pick.  Placement of molar separators at the front and back of the tooth in the interdental space are used to loosen the periodontal ligament1. The molar separator is held in placed for 1-3 minutes and then moved to the opposite side of the tooth.  After applying the molar separator, a molar forceps is placed as in figures 1 and 2. The molar forceps are used to wiggle the tooth from side to side with slow and steady pressure on the tooth. Care is taken to not fracture the tooth roots or adjacent teeth. As the tooth loosens, a squeaking sound can be heard.  When the tooth is sufficiently loosened, extraction can be attempted. The tooth is extracted using the molar forceps and a fulcrum as seen in figure 2. After extraction, the alveolar pocket is packed with dental impression material.

Tooth Ext pic 1
Picture shows placement and movement (medial to lateral) of the molar forceps
Tooth ext pic 2
Molar fulcrum placement and tooth extraction

Incisors are removed in a similar manner whereby an incision is made on either side of the tooth and along the gingival margin. The alveolar bone at the front of the tooth (labial surface) is removed down to the level of the reserve crown. A small periodontal elevator or osteotome is used to loosen the tooth and the tooth is removed with forceps . Incisor extractions are closed with suture that is removed in 10-14 days unless the suture falls out, which is a common occurrence.

Follow-up Care

Food and water should be withheld for 4 hours post extraction. For cheek teeth, the extraction site should be inspected and lavaged with warm water daily if possible.  Non Steroidal Anti Inflammatories (NSAIDs) such as Bute or Banamine will be used pre and post operatively to alleviate pain and inflammation. Finally, a broad spectrum antibiotic may be used to minimize potential for infection to develop.

Potential Complications

Post operative complications are rare. However, potential complications include secondary sinusitis with infected maxillary cheek teeth (08-11), sequestration (infection of bone), loosening or damage of adjacent teeth, hemorrhage and myalgia of masticatory muscles. Figure 3 shows the location of a maxillary cheek tooth in relation to the sinus. If sinusitis is present or develops, a hole (trephine) will be placed in the sinus to lavage the sinus twice daily.  Frequent dental equilibration (floating) is necessary to avoid development of a step or wave mouth.

Overall, prognosis for horses requiring tooth extraction is good to excellent with consideration and planning of the extraction procedure and post-operative care.

Signs of oral pain in your horse

• Problems with biting; head shaking, gaping at the mouth and overall discomfort when the bit is placed in the mouth.

• Quiding (dropping feed when eating)

• Increased salivation

• Facial/Mandibular swelling

• Malodorous nasal discharge; can be unilateral or bilateral and may indicate a sinusitis secondary to dental disease or fracture