Ask the Vet: Equine Dental Care

Is your horse chomping at the bit, but not in a good way? Dropping feed while eating or head tossing while riding? These are just a few signs that your horse may need to be seen regarding his dental health. Pose your questions to our AAEP expert, Dr. Shannon Lee, during the month of June regarding equine dental care.

1
Question: I have an older horse that is at least 22-years-old or older. He is currently on a senior feed plus beet pulp and hay. I feed him away from the other horses but he still looks bony. He had his teeth done a couple of years ago and does not seem to be having trouble eating. Is there anything else I should do?
Answer: 
Firstly, let me congratulate you on taking steps to care for your horse. As you point out, the horse is older and not in the condition you would like to see him. There are several potential causes of weight loss, especially in the older horse. Just like in people, as horses age, their metabolism changes and their ability to maintain weight and muscle changes (i.e people in their 80's don't look like they did in their 40's, etc). If it has been a couple of years since your horse's last dental exam, it is in fact definitely time for a dental check up. A horse of his age would benefit from twice yearly checkups and at the same time, your equine dental veterinarian can examine your horse and look at the other potential causes of weight loss.
2
Question: We are currently trialing a young horse at the track in which the trainer and rider are having great difficulty bridling the horse and getting him comfortable when ridden. The horse is receiving exams from a horse dentist every 6 months. I notice when he last trialed, there was some blood around the corner of his mouth. His teeth are being taken care of by the dentist, so what could this be?
Answer: 
It is quite common to see horses bleed from the mouth at the end of a thoroughbred horse race. The most common cause of this is severe trauma in the mouth. Usually, it is the result of the bit forcing the cheeks against the sharp enamel points of the horse's teeth. Combined with the action of the jockey's hands, this creates a sawing action that can cause deep lacerations to the cheeks. Your horse is also showing behavioral signs associated with discomfort and is reluctant to have a bit and bridle fitted. 
 
I think it would be very wise to have an equine dental veteriniarian perform a detailed oral exam on your horse as the most likely cause of your problems may turn out to be insufficient/inadequate dental care. A detailed exam will also help to rule out other possible causes such as ingestion of a foreign object or the growth of a tumor, etc.
3
Question: I've had horses for many years and they've had treatment and oral work without sedation many times before. I hear a lot of noise these days that sedation is necessary, but my horse dentist says it's not necessary. Who's right? And if I did decide my animals would be better off sedated during certain treatment, why can't my horse dentist do this for me? Why do I need a vet?
Answer: 
That's a very good question and I'm glad you asked. While you obviously feel that your horses have received good care in the past, it is difficult to imagine that a thorough oral examination has ever been carried out in your horses. I understand that this might be difficult for you to comprehend so let's start with a bit of background.

When you visit your human dentist for a "simple" checkup, can you list the procedures that are performed to carry out this checkup?

- Your asked a series of questions by a university educated professional about your dental care, dental health and any medications, history of pain, etc. 

- Your mouth is thoroughly cleaned before examination to ensure all the mouth can be properly examined

- Equipment, such as a dental chair, suction, mirrors, probes, retractors and a very large very bright light are essential to allow the medical professional to examine your mouth

- Diagnostic tools like X-rays are used to determine more about the health of your mouth and help the health professional make decisions about your dental care

- Referral to dental specialists is available (e.g. orthodontists, periodontists, maxillo facial surgeons, etc.)

- You are offered pain relief, including the use of nerve blocks, sedation and in some cases, general anesthesia. All of which, must be carried by law by trained medical professionals with appropriate training, skill, licensing and insurance. This is done to protect you and ensure your safety when undergoing these procedures.

- Medical records are made during each visit and these allow your dental history to be transferred between health professionals at your request.

Now when we look at the same scenario for your horse's dental care, doesn't your horse deserve the same rights and standards of care?

To properly examine, let's say an 1100 pound horse, it's important that your
dental veterinarian can examine each part of the mouth and that both you and the vet are satisfied that this has occurred, and that your horse is receiving the treatment required to maintain a healthy mouth. Think about it this way, what can you see in a horse's mouth if there's not a bright light in there? Not much.

Have a look at the photos I have included here as part of my answer to your question. Now even if we use a bright light source and that mouth has been thoroughly rinsed, how carefully and completely could your dental veterinarian or horse dentist examine each part of the mouth if the horses head is not completely still?

Another point to consider, just as human dentistry is very complex and a dentist will spend 4-5 years at a university/college before graduation. Dental care of horses is equally as complex and that is why veterinarians complete two degrees (minimum 7 years of college) before treating your horse. Sedation needs to be overseen and administered by a licensed veterinarian and this is to protect the horses and horse owners. Veterinarians have the licensing, insurance training and skills necessary not just to administer these medications, but to understand how they work and interact, and to choose medications appropriate to each case. They also have the training to determine dose rates, monitor the patients health and vital signs and to provide emergency care should anything go wrong. 

Another consideration is dental pain, if you have experienced dental pain in any form then you will understand that it is one of the most uncomfortable and unpleasant types of pain. Many people are afraid of visiting human dentists and this fear is almost always related to dental pain. Again, when we make a choice for our animals, why would you want to inflict pain or cause stress if it is not necessary?
4
Question: My dad's 24-month-old colt seems to have broke off one of his top front teeth and it has a pink worm looking thing poking out of it. The colt doesn't like us trying to grab it with tweezers. What should we do? It happened a few weeks ago.
Answer: 
Hmmm, you have a bit of a problem there as your horse has fractured his tooth and exposed the "pulp" or nerve inside. It really needed veterinarian attention as soon as you noticed it so your equine dental vet could have performed a filling to protect the live remaining nerve. Your horse should be on pain relief and have some antibiotic coverage since feed and bacteria can enter the canal in the fractured tooth and eventually the nerve will die. Often the tooth will develop a painful tooth root abscess. When this happens, you have two options: 1. Extraction of the tooth or 2. Root canal therapy

Sometimes the fractured tooth walls off the remaining nerve by forming a protective layer between the outside of the tooth and the remaining nerve. This is called a dentinal bridge and is also the goal of performing the protective filling known as a pulp capping procedure.

The good news is that because of the young age of your horse, chances are the fractured tooth is a deciduous (or baby) tooth and so the fracture and any subsequent infection is very unlikely to affect the adult tooth.
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Question: I recently discovered my 14-month-old colt (a reining prospect) has a slight overbite. Can this be corrected or should I have him castrated and also forget reining? How can I tell if the overbite is hereditary or developmental? How can I find a veterinarian that specializes in equine dentistry? I live only 50 miles from Lexington, KY.
Answer: 
Thank you for your question. Firstly, let me say, don't panic. I'm sure it is very likely that your horse can continue as a colt and also persue a future in reining. There is alot of confusion amongst horse owners about overbites, overjets, parrot mouths, etc. When there is a distinct mismatch between the top and bottom jaw, depending on which jaw extends forward, the most we classify them as either "Parrot mouthed" (Top jaw extends further than the bottom jaw) or "Sow mouthed" (Bottom jaw extends further than the top jaw). The anatomical terms for this are Brachygnathia and Prognathia respectively. It is also important to understand that the position of a horse's bottom jaw relative to its top jaw varies according to the position of the horse's head. When the horse's head is held high (as at the gallop)  the bottom jaw will slide back relative to the top jaw, and when the horses head is lowered (as when grazing) the bottom jaw will slide forward relative to the top jaw. This is why when examining a horse to determine any degree of overjet (the amount the top teeth are forward of the bottom teeth when viewed side on) the horse's head must be lowered in a vertical frame. Otherwise, the bottom jaw will slide back falsely accentuating the degree of overjet. 
 
The other aspect to this condition is called overbite, which is the amount of vertical overlap of the top teeth over the lower teeth. Also, as the mismatch is usually also reflected in the cheek teeth of the horse, overgrowths (hooks) will tend to develop on the upper 1st cheek teeth and the last lower cheek teeth.Careful management and reduction of these overgrowths is a very iportant part of health care for any "parrot" mouthed horse. 
 
To answer another part of your question, yes the development of this condition is genetic, however; that does not mean that if your colt has the condition and goes on to breed that his offspring would necessarily also be "parrot mouthed". The first step is for you to contact an equine dental vet and schedule an examination. As luck would have it, one of the most experienced equine dental vets in the world, and author of the text book "Equine Dentistry" who also happens to be an expert in examining and treating foals with overbite/overjet is based in Shelbyville, KY. You can find Dr. Jack Easley's contact details here http://easleyequinedentistry.com/. 
 
So remember, good luck and stay calm. Hopefully, you and your horse have many more happy years together.
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Question: My vet came out and examined my horse and told me he has "gum disease". Do horses get gum disease? Is this something I should worry about?
Answer: 
That's a great question and it's similiar to another that has recently been asked. I encourage you to browse the previouslly submitted questions as it may be worth having a look at the answer to that question. Simply put, YES, horses do get gum disease or perio (meaning around) dontal (meaning tooth) disease. It's actually the most common disease affecting horses with around 70 percent of horses being affected so its something all horse owners really need to be aware of. Like all diseases, the earlier the problem is identified and treatment begins the better the end result for both the owner and the horse. Short answer to your question is yes, it is something you should take seriously. Whatever stage the disease is identified, your equine dental veterinarian will be able to help both you and your horse. However, scheduling regular examinations from an early age is still the best way to keep your horse's mouth healthy. Periodontal disease can occur anywhere on the horse's mouth including right at the back of the mouth. Therefore, it is very important that each dental examination is very thorough and that your vet sedates your horse, uses a very bright light and a mirror to examine each part of the teeth and gums carefully for any sign of a problem. Did you know that Bot Flies can cause periodontal disease in your horse's mouth?  Here is a direct link to a video regarding bot flies and their correlation to periodontal disease in the horse: http://equinedentalvets.com/tv/bot-fly
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Question: I have a 10-year-old Warmblood gelding that was recently diagnosed with periodontal disease affecting three teeth in his mouth. I had my veterinarian visit for a routine health checkup, which they also do dentistry and I asked him to do his yearly dental check. I usually get a dentist each year. After sedating and looking in my horse's mouth, he told me that there were sore gums with rotten food trapped between teeth. I was a bit shocked and also not sure what has caused this.I am a bit confused about what this condition is and how it should be treated. My vet has discussed different options with me but I really want your advice and help with what is going on in my horse's mouth. I was told all was well in his mouth each time the dentist came!
Answer: 
Periodontal disease
 
Introduction
 
If you own horses then you should be familiar with the term periodontal disease, and yet chances are you haven’t heard of it. This disease is the most common disease affecting horses, with around 70% of horses suffering from its effects. So what is this important disease, what are its effects and how is it diagnosed and treated? 
 
Firstly, let’s explain the word periodontal. 'Perio' means around and 'dontal' means tooth so periodontal disease is disease of the structures that support teeth; these include the gum, the bone and the periodontal ligaments. It is a disease which can affect horses of all ages, and the author has observed life threatening periodontal disease in horses as young as 18 months of age. 
 
The Periodontal Ligament 
 
The periodontal ligament plays a very important role in the horse’s mouth as it is responsible for stabilizing the tooth against the forces it experiences during chewing. It also has the ability to detach and reattach, allowing the continuous eruption that occurs in horses teeth. It works together with the tooth itself, the gum and the bone surrounding the tooth (the alveolus) to achieve this.  
 
How does periodontal disease occur? Periodontal disease is the greatest challenge for both human dentists and veterinarians in the field of oral health. There is still a lot of research going on in this area but current treatments do exist and have good success when initiated early enough. This disease begins when bacteria in the mouth proliferate around the teeth and gums. There are several factors that lead to this bacterial overgrowth, two of the more common being the trapping of food between or around the teeth and the formation of plaque. In both cases the body’s natural defences are overwhelmed by massive numbers of bacteria, which attack the gingiva or gums leading to inflammation. This is the first step in periodontal disease, it is called gingivitis. As the gum becomes inflamed it will swell and bleed, which allows the bacteria to enter the horse’s blood stream and travel around the body, so periodontal disease can affect all areas of the body not just the horse's teeth. There are links between periodontal disease and heart disease, as well as links to reproductive problems such as abortion and low birth weight. The bacteria involved in periodontal disease produce enzymes, and these enzymes feed on the structures around them (The bone, the gum and the ligament) progressively destroying them and creating room for more food to trap around the teeth. 
 
Untreated periodontal disease is a self perpetuating cycle and will simply get worse until the horse is in a great deal of pain and has teeth that move when they chew. This can cause a range of secondary symptoms or problems, such as displaced teeth that damage the tongue or cheeks, loss of muscle due to changed chewing patterns, bad breath, quidding (balling feed up in the horses cheek), a build up of calculus (a mixture of  food, saliva and bacteria), weight loss, etc. Because of the differences in the type of teeth that horse’s have (hypsodont teeth) developmental issues, missing teeth, changes in diet and eating patterns can lead to overgrowths on the chewing surface of teeth, these can be a key factor in the development of periodontal disease by further altering the way a horse chews and the pressure placed on teeth, in some cases driving teeth apart and creating diastema ( gaps between teeth). There are also breed predispositions to periodontal disease and conditions contributing to periodontal disease, broadly speaking many of the Pony breeds and Arabs and Quarterhorse’s develop severe periodontal disease from a young age.  
 
How is it identified? In order to accurately diagnose and assess periodontal disease a number of steps are required. A thorough history is useful and observing the patient eat certain feed types a can also be helpful, symptoms such as yawning, abnormal jaw movement or washing the mouth out while eating maybe observed. Any evidence of halitosis (Bad breath) would immediately identify some form of periodontal disease. The next step is an external examination of the horses head and the administration of pain relief and sedation. Changes in the muscles of mastication (those used for chewing) may be detected; most commonly an asymmetry of the temporal muscles, this type of change indicates a chronic (long term) problem. Once the horse is sedated and the head (including the eyes, sinuses, nostrils, lips and front teeth) have been examined a speculum (Gag) is applied. In order to identify periodontal disease, the mouth must be thoroughly rinsed and a bright light, a mirror and probes used to examine around teeth. Sometimes radiographs (x-rays) will be necessary to determine the direction of treatment (i.e. how much bone is left and should the tooth be treated or extracted). Teeth are checked for mobility, which indicates a loss of periodontal support, and examined for evidence of calculus and cavities (caries). This can only be done effectively with the horse standing very calm and still. Once a diagnosis has been made and prognosis (likelihood of successful treatment) determined, treatment can begin. 
 
How is periodontal disease treated? A really important point to understand is that structures that are destroyed by periodontal disease will not repair with treatment, so early diagnosis and treatment is extremely important (once it’s gone its gone). The principles of treatment are simple, control the bacteria, thus stopping the production of enzymes and further destruction of support for the teeth, and prevent the build up of food around teeth. Depending on where in the mouth the problem occurs, the method of treatment will vary. Once a diagnosis has been made, your veterinarian will discuss treatment options. If the problem involves the incisors or canine teeth (teeth that can be examined and managed at home between dental consultations) then provided no extractions are necessary, your vet is likely to recommend removing the trapped feed regularly, applying a product to kill the bacteria (such as hexarinse) and keeping regular dental appointments, to assess treatment, scale calculus, etc. Only products designed specifically for treatment of this condition should be used. If the problem involves cheek teeth then it is unlikely to be possible to manage this condition at home and the horse will require treatment from your equine dental vet. 
 
There are two main conditions that occur inside horse mouths, periodontal pockets (holes in the gum next to or around teeth) and diastema (spaces between teeth). Both conditions allow food to trap and periodontal disease to occur. Diastemas are usually treated by carefully widening the space between the teeth to allow the food to pass through. Periodontal pockets are often more difficult to treat and the process is based on cleaning the pockets and getting them to bleed to stimulate the formation of new tissue to fill in the pocket. Treatment of diastema and periodontal pockets is done around some very sensitive structures such as a large artery and the nerves of the teeth, for this reason it can only be performed in sedated horses, by veterinarians. 
 
As mentioned above, overgrowths (or malocclusions) are an important contributor to the development of periodontal disease. These need to be identified and addressed as part of any treatment as there are many types of malocclusion it is beyond the scope of this article to cover them in more detail. 
 
Equine Odontoclastic Tooth Resorption and Hypercementosis 
 
There is a particular form of periodontal disease about which little is known and for which there is currently no cure, this disease Equine odontoclastic tooth resorption and hypercementosis or EOTRH occurs in Australia and requires careful management. Although there is currently no known cure, the symptoms and the horse’s pain can be managed effectively thus allowing these horses a better quality of life. EOTRH basically involves a progressive irreversible destruction of teeth and there support along with the production of extra cementum (part of the tooth) as the body attempts to counter the effects of the disease. Horses suffering this condition are usually in their mid to late teens when first diagnosed and experience pain and tooth mobility as well as the development of tooth root abcesses. X-rays often show dramatic differences from a “normal” mouth. 
 
Little is known about the cause of the disease but the author feels it is related to the horse’s own immune system attacking its teeth for some reason. 
 
Take Home Message 
 
Periodontal disease is something ALL horse owners need to be aware of. Early diagnosis and effective treatment are critical and if these occur then the outcome should be healthy horses free from dental pain that will benefit as they age from retaining their teeth.
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Question: My horses get yearly dental floats, their teeth/gums are in great health and woof teeth have been removed; yet they dribble their pelleted feed and sweet feed mixture everywhere. Can horses just be "sloppy" eaters?
Answer: 
Yes some horses are very messy eaters, that's one of the reasons many people use to use "nose bags" to give messy or wasteful eaters a better chance to consume their feed. It certainly sounds like you have investigated other possibilities however, some of the questions I would ask are, how old are your horses? what breed or breeds are they? how many times a day are they fed and how (i.e what type of feeder, what conditions, stabled/pasture, etc.) Are your horses very feed orientated or do they spend time looking around whilst eating? Have you noticed any other behavior such as yawning, stretching the neck or holding the jaw to oneside? Have you tried different types of "hard feed" and does this make any difference? Is the feed in wet balls or is it scattered in small random pellets?My apologies for all of the additional questions, but it is a difficult issue in which more information would be helpful.
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Question: I am a fairly new customer of yours. Infrequently, my horse (sometimes when eating) will stretch his head forward and open his mouth as if to yawn, but doesn't yawn. He juts his lower jaw to the left and holds it there for a couple of seconds, with his mouth open, then relaxes. Do you think that this is a symptom of some sort of dental problem? He has a chronic sacro-illiac issue, which generates headaches for him as the tension travels through his body. And he is having frequent therapy sessions for it and is progressively getting better. However, this behaviour I described is fairly new (approx 6-8 weeks) so I am investigating all angles.
Answer: 
There are many things that can cause this type of behaviour, most commonly it is associated with pain or discomfort. Occassionaly, it is linked to learned behaviors.
Interesting that your horse has only been showing signs of this for 6-8 weeks, which indicates something has changed recently to make him uncomfortable. I have attached an image, which will hopefully be available for you to view, it shows a horse in the middle of what I suspect you are describing. Please have a look at the image and let me know if this is similiar to your horse. 

The two most common causes of this are:

1- feed becoming trapped between cheek teeth in gaps we call diastema.

2- pain or discomfort due to changes or degeneration in the region of the joint between the top jaw and the bottom jaw.

You have mentioned that your horse exhibits the behaviour both when eating and at other times, and I think that in cases like this one making note of when you see the behaviour, wether it appears to be associated with anything else and wether there are any changes such as an increase in frequency can often help to pinpoint the cause.

A detailed oral exam is always a good idea and the types of problems that can be identified include diastema ( gaps between cheek teeth where feed accumulates) painful or mobile teeth, trauma from feed such as hay containing awls or grass seeds. It is also possible to simulate chewing and some of these horses will demonstrate a loud "clunk" when there jaw is moved in one direction. This is generally associated with ligaments surrounding the condylar process of the mandible (bottom jaw). Have you noticed any loud noises "clunks" when your horse is chewing? Generally, this problem affects only one side so it will only be noticeable when the horse is chewing using the affected side.

Another simple test to perform at home is to feed the horse some whole carrots and see if they have any difficulty chewing them or make faces associated with discomfort. If on examination your horse has a diastema and it is the cause of the pain, treatment should alleviate this symptom. Treatment usually involves removing small parts of each tooth either side of the space where the feed is becoming trapped (with care not to damage either tooth). This allows the feed to cycle through and breaks the cycle of bacterial growth, decay and enzymatic destruction of tissue that would otherwise lead to pain, mobility of teeth and premature tooth loss. 

Cases like this one can be very simple or very complex to workup and diagnose.

10
Question: My gelding has twice yearly dental check-ups with an veterinarian specializing in dentistry. He is quiet with his bit while being worked, but when in cross-ties or just standing with a halter on, he frequently stretches his jaw, flexes it, etc. and he is reactive when lightly massaged in the jaw area. Is he having jaw pain or tension and what do you reccommend to give him relief? This has been a long-time observation.
Answer: 
Thanks for asking this question as these types of symptoms are actually quite common in horses and can be confusing for horse owners and veterinarians alike. There is another question on here about a horse with some similiar symptoms, so it may be worth having a look at the answer to that question and the images. Although it is unlikely that your horse suffers from diastema due to your regular dental examinations, it would be on my list of differential diagnosis for a case like this. A diastema is a gap or space between teeth where feed accumulates causing pain or discomfort. Any cause of pain in the region of your horse's jaw can cause this type of behavior. Therefore, any tooth that is sensitive, painful or mobile could cause this reaction. Detecting this can be very difficult and sometimes frustrating and there may be no outward sign of a problem even after a detailed oral exam. Sometimes we turn to radiographs or, if it is available, MRI (Magnetic resonance imaging) or CT (Computed tomography) to try to locate the problem. However MRI and CT are expensive and not widely available. As mentioned in the answer to another question problems like this can also be associated with pain due to degeneration in the joint between the top and bottom jaw, however this seems less likely in your case as you have said that your horse reacts to palpation of his mandible. Has he had any therapeutic trial of pain relief NSAIDS (Fluxin "Banamine" or Phenylbutazone) and if so was there any reduction in symptoms? Again are there any lumps or swellings on his bottom jaw and can his reaction to touch be isolated to a specific part of the jaw? Does it matter which side of the jaw you touch? Is there any difference in the frequency of symptoms at different times of the year? As you can see from the many questions I have asked in regards to your question cases like this one can be difficult to diagnose and often pose many questions .

I hope that has been of some assistance. Thank you again for your question.
11
Question: My vet checked my horse and found a broken wolf tooth. He wanted to extract it. Is that normal? What is the benefit to my horse and will it make any difference when I ride him?
Answer: 
Some of the information has been covered by a question that was asked previously so I would suggest it is worth reading the answer to that question. 

Check back in a day or two and we will post some photos for your viewing.

Firstly, some background. Wolf teeth are often small vestigial teeth (vestigial refers to the fact that they are no longer used by the horse and are essentially an evolutionary throwback). They come in many shapes and sizes and are often confused with canine teeth (larger teeth that appear further forward in the mouth). Wolf teeth usually appear directly in front of the 1st cheek tooth however, they can appear beside this tooth or upto an inch in front of it. They can erupt normally (vertically) or horizontally (called a blind wolf tooth because it is usually covered in gum). Wolf teeth, like all teeth, contain nerves and as they serve no purpose and sit in a position where they can have frequent contact with the bit; it is common to remove them. It is ideal to remove them when the horse is young (6-12mths of age) as this is because they are not yet ankylosed (fused to the bone of the jaw). It is far easier to remove them without them breaking. 

Extraction of these teeth should always be done under sedation, with pain relief and the use of nerve blocks, otherwise the horse will experience a great deal of pain and may suffer long term problems (see another question posted here on the AAEP As the Vet - June Forum).

To answer your question, your veterinarian's reccomendation that the tooth be removed would be my reccomendation also. To answer the second part of your question, will you see any difference when you ride the horse, that will depend on a number of factors. First some more questions for you. 

1- Does your horse currently show any signs of discomfort when ridden such as head tossing, lugging, grabbing the bit, difficulty with transitions, resisitance on one lead, etc, etc?

2- Do you ride the horse in a bit and bridle?

3- What level of education does your horse have?

4- How old is your horse?

Regardless of whether your horse improves after removal of the tooth, the tooth should be extracted.

If your horse does show any of the above signs of discomfort when ridden, have you also had your tack examined to ensure it fits your horse correctly? Does your horse receive regular dental examinations from your equine dental veterinarian?
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Question: As I was bridling my 5-year-old warmblood yesterday, I noticed his right lower canine felt sharper than usual. I swapped sides to look and he's broken it somehow.

He doesn't seem bothered at all by it as he is still eating and it doesn't see to be painful. However, I'm panicking about exposed nerve endings. Does that tooth need to come out or is this manageable?
Answer: 
Firstly, let me congratulate you on being very observant and on making the effort to seek advice. Just some quick background for others reading this, the canine tooth (or bridle tooth) is found more commonly in males and erupts when the horse is around 4-6 years of age. It is often a source of confusion for horse owners because another tooth in the mouth is called the wolf tooth, so understandbly people often mix them up. The purpose of the tooth is to be a weapon used during fighting, and so in modern horses it has little function. Injury to this tooth is quite common, partially because of where it sits in the mouth midway along the bars of the mouth between the front teeth and the cheek teeth. This tooth is different to the other teeth in a horses mouth and has a different anatomical classification whereas, the other teeth in the mouth are called hypsodont as they continue to erupt over the horses life. The canine tooth is called brachydont because once it erupts, it does not undergo further change.

The most common way the tooth is injured (fractured) is what is called a pull back injury. As you know, horses are curious and often playful by nature and they will use their mouths to touch and explore their environment. If while doing this they are suddenly startled or frightened and they "pull back" without letting go. This often results in damage to their front teeth or their canines. Onto your horses fractured tooth, in the ideal world it would be possible to examine the horse, or at least see some pictures,however; without that this advice will be general.

As you correctly point out there is a nerve running through the middle of the tooth and damage to the tooth that exposes that nerve or its blood supply can allow bacteria to enter the tooth and setup infection at the tooth root. Another common problem when these fractures occur is that the fractured tooth may now be sharp and cause trauma to the horses lip or tongue. Not all fractures cause exposure of the pulp or nerve so your horse may be ok. However, if the nerve has been exposed, depending on the advice of your veterinarian, your horse is likely to need to follow depending on how recent the fracture is. If it is a recent fracture, (i.e within the last week or so) your horse should begin antibiotic and antiinflammatory therapy and should also have a type of filling placed over the remaining nerve to protect it. The filling, called a pulp cap, is designed to prevent entry of more bacteria and to stimulate a layer of sterile tissue to be layed down over the remaining nerve tissue. If succesful, then in 3-months time, a radiograph should show that layer (called a dentinal bridge) with no further problems. If the fracture occured earlier than this or if the pulp capping procedure is not succesful, it is possible that the nerve and blood supply will die and that the tooth will become painful and infected. Should this happen, there maybe very little obvious change on the outside of the tooth so it is very important to consult with your equine dental veterinarian. There will be two options at this point: extraction of the tooth or root canal therapy.

So most importantly DON'T panic, send in any pictures that you have, call you AAEP member equine dental veterinarian and have them examine your horse.

I hope that helps and if you need further assistance, please contact me again.

13
Question: I have a 4-year-old gelding pony and I noticed he has black discoloration in the center (chewing surface) of the upper and lower incisor teeth. Does the black area on the tooth indicate the teeth are not healthy?
Answer: 
This is really a very good question. Some of what I am about to discuss has been mentioned in my answer to an earlier question about aging horses, so you may wish to read some of the previosuly submitted questions and corresponding answers. 

The incisors (or front teeth) of a horse have two areas on the chewing surface (or occlsual surface) that tend to be dark in color (either black or dark brown) in a young horse like yours. The area closest to the lips is a wide smile shaped dark stain. This is darkly colored dentine that is sitting over the nerve of the tooth (sometimes called the pulp or pulp horn). Behind this area, there is a deep well or "cup" in each tooth, and this is called the infundibulum. These structures are normal parts of the tooth and they will change as the horse ages. However, if the horse has trauma (an injury) or perhaps someone cuts or shortens the incisor teeth as part of a dental procedure, then it is possible to damage the sensitive nerve tissue (the pulp). When this happens, the pulp horns will turn black over time. As the tooth is worn away, it will be possible to pass a fine probe into this part of the tooth. Feed can then pack into the pulp horn allowing bacteria to reach the tooth root and overtime an abcess may form causing the horse pain.The dark areas you are seeing are most likely the "cups" or infundibulum, and the next step in answering your question would be to see a clear picture of the chewing surface of your horse's incisors.

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Question: My mare that I was using for dressage and jumping was very "heady" while being ridden. I had an equine dentist recommended to me, but not a veterinarian. He floated her teeth, which really started to make her play up and carry on, but he said she would also need a wolf tooth removed. With me holding the twitch and her, and with no real explanation as to what he was doing, he seemed to "bang" it out. I was horrified! She struck out and reared, and only by luck, no one was injured. She was really hard to bridle and deworm for many months after this event even though she and I had good trust together.

My question is how do veterinarians do it differently?
Answer: Click To View
Firstly, let me say that sounds like a horrible experience for everyone, especially the horse. I hope your mare has recovered and that neither of you ever have to go through anything like that again. This type of story is one I have heard many times and it saddens me that horses still suffer like this, as you are no doubt aware an enormous number of people are scared of going to the dentist, and mostly this is because they have experienced pain and would rather live with diseased mouths than experience that pain again. 

Today, equine dental veterinarians offer a humane alternative, that is simple, cost effective and ensures horses are free from pain. You mentioned that when the Equine Dentist (not an equine dental veterinarian) floated the teeth, the mare played up and carried on, and I belive I understand what you mean. Let's think about it for a minute. Was the mare provided with pain relief, did she have anything to reduce stress or relieve her anxiety? Was a detailed examination able to be carried out or was she moving about making a detailed exam difficult or impossible? Equine dental veterinarians provide horses with pain relief, we give them safe medications to reduce stress and anxiety and once the horse is calm and relaxed we use bright lights, mirrors, cameras and probes to thoroughly examine the mouth. To use an analogy, can you imagine trying to cut someone's hair while they rapidly shake their head? Doesn't sound very safe does it? And I don't think the client would be very happy with the haircut. Trying to perform a dental exam on an 1100 pound horse without appropriate steps such as pain relief and relaxants is very similar, not to mention dangerous. 


On the subject of the extraction of teeth, it's pretty simple and it comes back to why so many people are afraid of the dentist. PAIN! All mammals, including horses, have nerves in there teeth and gums so whenever it is necessary to remove a tooth, we need to prevent pain. 

You also mentioned that the horse was very heady when ridden and that you used her for dressage and jumping, both disiplines that have a fair amount of movement and the potential for bit contact. It is likely that the bit was making contact with the wolf tooth as this tooth has a sensitive nerve inside and as the tooth is not used to chew, it was reasonable to remove it. An equine dental veterinarian has undergone many years of training and is licensed to perform nerve blocks and provide pain relief (just like a human dentist). Wolf teeth should only be extracted once nerve blocks have been performed and the horse cannot feel any pain. It is also important to carefully breakdown the ligaments that keep the tooth anchored to the bone of the jaw, otherwise you may simply snap the tooth off. When this happens, it is possible to leave the sensitive nerve endings exposed. Horses having extractions with pain relief, sedation and nerve blocks on board should be calm and free from pain and will usually attempt to eat straight after the procedure with none of the behavioural problems you described such as the difficulty deworming or bridling.

As you say, it was very lucky no one was injured and I hope I have answered your question as to how equine dental veterinarians offer a humane alternative.
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Question: I bought a mare a while ago but am not sure how old she is. Her corner teeth show the Galvaynes groove down to the bottom of her tooth and the grinding part is totally white, no dental star (not sure what that means). She also has a sway back, but the veterinarian said she could have been born with it or carried several foals. My vet thinks she is 16-years-old, but what do you think?
Answer: 
These types of issues around aging of horses are very common, so thank you for asking this question as I'm sure there will be many other horse owners out there with similiar questions. Aging of horses is not an exact science, although the AAEP publishes a very good pocket guide to aging, which has great photos of the incisor (front) teeth of horses of different ages, so if you (or your vet) haven't seen it, you may want to consult it. The most useful tool in trying to help age your horse would be some good photos of your horse's incisor teeth including pictures of the occlusal (chewing) surface. When aging a horse from their teeth, it is very important to understand that as a horse gets older, dental aging becomes less and less accurate. This is because there are so many factors that affect the wear of an individual horse's teeth such as diet, breed, dental care, etc. The things I always do first when aging a horse are:

1 - Ask the owner how old they think the horse is.
2 - Check for any freeze brands, fire brands, lip tattoos or microchips.

If these don't exist, we look at several different areas of the teeth and use the information from each part to estimate an age range. You mentioned the Galvaynes groove. For anyone unfamiliar with the Galvaynes groove, it appears in some horse's corner incisor. (It is the groove that you feel not anykind of staining you might see on the tooth.) Funny enough, the groove is named after Sydney Galvayne who was an Australian (like me). It appears at the top of the visible tooth (near the gumline) at around 10-12 years of age. The rule of thumb is that by around 15 years of age it runs from the gumline to halfway down the tooth, by about 20 years of age, it has reached the bottom of the tooth. By 25 years of age, it begins halfway down the tooth and runs to the bottom, by 30 years it has been worn away. As I said not all horses get it, and it should never be used as the only tool to determine a horses age. But, from what you have said about your horse, that piece of information suggests the mare could be around late teens to early twenties.

You mentioned the dental star (or lack of it). Firstly, to explain when you look at the chewing surface of a horses incisor teeth there are several areas we identify. To begin with there is a thin wide mark (Dark in color) at the front and a deep well behind it. The dark smile shaped area is the dentine overlying the pulp horn (or nerve) and the well behind is called the infundibulum (sometimes called a "Cup"). As the horse ages and wears down the tooth the infundibulum wears out and the pulphorn moves more towards to middle of the tooth. This is now what is called a "Dental Star" it is the layers of dentine that protect the pulp. You mentioned your horses did not have them but chances are it does. The dentine in these stars gets its dark color from pigments in the feed. If the horse's diet does not contain much pigment, the stars don't appear dark and are often hard to see.

Some of the other things to look closely at to help you determine more accurately the age of your mare include the shape of the incisor teeth. When you look at the chewing surface the teeth will generally be one of four simple shapes:

1 oval 
2 circular
3 round
4 triangular

This is because at each age we are seeing a cross section of the tooth and as the horses gets older the tooth becomes narrower, so generally the young horse has wide oval shaped teeth and we progress through the shapes until the horse has narrow triangular shaped incisors.

Another tip is to stand beside the mare and examine the angle of her upper and lower incisors. Generally, a young horse's teeth will appear very vertical ( Straight up and down) where as and older horses teeth will be angled steeply towards the front of the mouth.

To sum it all up, it's a great question and as you can see, dental aging is complex and not exact (more like a practised and highly educated guess). it sounds like your mare may be in her late teens to early twenties but I reccomend you check some of the things I have mentioned above and also consult the AAEP Guide to aging. Thank you for your question and if you have them, send in some pictures.

Check back in a day or two and we will post some photos for your viewing.
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Question: I have used my veterinarian in conjunction with a "Certified Dental Practitioner" to take care of my horse's teeth for years. The experience has been great for me, and I am extremely happy.My question is, Why do some vets attack the practice of using non-DVMs that have been trained specifically to precisely balance a horse's mouth? Are there talks within the AAEP to embrace these practitioners and their vast experience to better serve the horse? From what I understand, there are very few veterinary schools that teach the advanced techniques these teams are using, and if so, they are offered as elective courses.I know this may be a tender topic, but believe that it needs to be addressed in a logical and respectful manner.
Answer: 
Firstly, I think we need to clear up some points in your question. All veterinarian schools provide veterinarians with a strong background in veterinary science since that is why they graduate with a Doctor of veterinary medicine DVM. As a vet who has taught equine dentistry for a decade and as a part of the largest network of equine vets in the world (The AAEP) I'm very comfortable stating that there are a great many veterinarians able to provide equine dentistry at a very high level. The concern that comes with non-veterinarians attempting these procedures is that there have been many cases of horses being hurt or maimed because of these activities. Horses teeth are sensitive structures with nerves and blood vessels inside them, and so it is critical to do no harm to these structures.When choosing a dental practitioner, it is very important to understand the potential for this harm to occur and to thoroughly scrutinise anyone whom you may choose. Ensure they are licensed, regulated and insured. This is to protect you in the event that any damage does occur, and means that they must be under the control of a regulatory body like your state veterinary board. This is to ensure that if they are performing procedures that are causing harm, steps can be taken to prevent them from continuing to do so. The AAEP holds regular meetings and workshops on equine dentistry. In fact, the last Focus meeting (a lecture series on a specific topic) was held in Albuquerque, NM in 2011 on Equine Dentistry and was attended by hundreds of DVM's from the US and abroad. Put simply, always ensure what you choose provides for the welfare needs of your horse and make sure no harm cames to them as a result of any treatment.Again your question is a good one and very hard to answer in a short simple fashion.