By Megan Slamka, DVM
Routine 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.
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.
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.
Picture shows placement and movement (medial to lateral) of the molar forceps
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.
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.
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