Author John Mark O’Leary MRCVS is assistant professor at the UCD Veterinary Teaching Hospital in Dublin, Ireland. He is a specialist in endodontic dentistry treatment for horses and is inviting readers to be involved in his PhD research – see more details below...

Tooth infections in horses that involve the internal living part of the equine tooth – the pulp – can cause pain or discomfort leading to reluctance to drink or eat in some cases, or evasive ridden behaviour. But signs can also be extremely subtle with only minor changes in eating, biting and general demeanour being seen.

Why do horses get tooth infections?

Unlike humans, whose very common cases of tooth decay and associated infections are linked to diet, tooth fractures are a more common cause of pulp damage and inflammation in horses’ teeth.

In a horse’s front teeth (the incisors) problems are most commonly linked to a broken tooth, often associated with a history of a fall on the road.

Horses that crib bite may wear down their front teeth faster than they naturally grow – resulting in exposure of the sensitive pulp. Once the pulp is exposed, it will become contaminated with food material and bacteria from the mouth, which leads to infection.

In addition to broken teeth, the other most common cause of inflammation in the pulp of the equine cheek teeth (the molars) is a local bacterial infection that spreads through the natural openings at the tip of the tooth’s root deep inside the gum (the apical foramina) without any changes to the outer surface or crown of the tooth. This is more common in horses under six years old.

Other causes include over-rasping or over-drilling with motorised dental drills and equipment.

How can I tell if my horse has a front tooth infection?

If a horse’s front teeth are affected they may show a reluctance to drink cold water or take hay from a haynet, or evasive ridden behaviour. Horses suffering an acute case typically will resent the exposed pulp being probed with dental equipment, which results in active bleeding.

However, once the infection becomes established, often with food filling the cavity leading to the death of the pulp and the loss of nerve supply (pulpar necrosis and denervation), then there may be no obvious behavioural signs or evasive reactions to probing.

The infection can eventually extend through the natural openings at the tip of the tooth’s root (apical foramina) to invade the the tissues around the tooth (periodontium). At this stage, gum recession or draining infected tracts may develop.

How can I tell if my horse has a cheek tooth infection?

Acute infections involving the horse’s cheek teeth typically show little to no obvious signs, unless a displaced fragment of tooth is causing damage to the soft tissue inside the mouth. Recent behavioural studies have reported subtle changes in eating, biting and general demeanour associated with infections in the cheek teeth.

When an established pulp infection reaches the top of the last four upper cheek teeth, bacteria can move into the sinus chambers above, leading to a discharge of pus from the nostril on that side of the face.

Chronic infections reaching into the roots of the other cheek teeth can show up as bony swellings on the face, with or without pus from the draining tracts.

Cases with obvious surface defects on the tooth are often spotted during routine dental examinations. Determining the extent and severity of an infection may require referral to an equine veterinary dentistry specialist.

The specialist will typically undertake a detailed oral examination with a camera and assess the reserve crown and roots using diagnostic imaging. Where X-rays are unable to clearly identify the issue, a more sensitive imaging modality, typically computed tomography (CT) at a hospital centre, may be necessary.

How are tooth infections in horses treated?

Endodontics is the name for the specialised branch of dentistry that treats infections involving pulp of the tooth.

There are three treatment options:

● Vital pulp treatment (VPT), in which all or part of the dental pulp is preserved

● Root canal treatment (RCT) where the pulp is completely removed to the end of the root

● Extraction, where the entire tooth is removed.

Endodontic treatment for horses

The extent and severity of the infection within the pulp and around the root tip (apical) will determine if either VPT or RCT are feasible. Treatment is usually carried out in a standing sedated horse with local anaesthesia.

The four typical steps of endodontic treatment are:

● access with motorised dental drills, typically through the overlying dentine defect on the occlusal surface;

● removal of dead, damaged or infected tissue (debridement) with dental root canal files and disinfecting the endodontic system;

● topical application of a dentine-stimulating product to the remaining viable pulp tissue, and

● finally applying an airtight seal (in the form of a filling) within the cavity created with a material that will wear down at the same rate as the tooth

Where suitable, VPT is typically the preferred treatment procedure in acute cases. This is because it optimises the potential for return to normal pulp function; it creates a hard dentinal bridge that protects the remaining pulp and preserves blood supply, innervation and immune functions. VPT also avoids having to negotiate the complex root canal system.

RCT is used for more severe and chronic tooth infections. It involves removal of the entire pulp and disinfecting down to the level of the natural openings at the tip of the tooth’s root inside the gum (the apical foramina). This is followed by the application of dentine-stimulating medication at the root level. The remainder of the cavity is sealed to the top of the tooth (the occlusal level).

Often a diseased cheek tooth is still partially healthy and only some of the pulp needs to be accessed and treated. In such a case the inside of the tooth is now unreactive, but the tissues that surround and support the teeth (periodontium) remain healthy and the tooth should erupt normally and remain functional for chewing. However, the lack of complete vitality does predispose the tooth to subsequent development of cavities and fractures.

Extracting horses’ teeth

Extraction is typically chosen for established infections extending to the tissues that surround and support the teeth or previously failed endodontic treatments, but it’s not risk-free.

Frequent long-term conditions following a cheek tooth extraction are the overgrowth of opposing teeth and drifting of adjacent cheek teeth, with increased risks for food entrapment and subsequent inflammation of the tissue surrounding the tooth (periodontitis).

A horse may need a period of enforced rest should an extraction complication occur so, if competing, surgery is best scheduled out of the competition season.

Importantly, equine athletes that are not showing obvious signs of infection (sub-clinical) may be treated with endodontic techniques to allow the horse to continue competing for a period, with extraction scheduled for the off-season.

How successful is treatment of equine tooth infections?

Equine endodontic treatment has improved over the past 10 years through anatomical studies, improved adaptation of human techniques and availability of better materials.

Infected teeth may need two treatments one month apart to clean the pulp cavity adequately, with long-term success rates of 75% for incisor teeth and 80% for cheek teeth reported.

Most specialists are reluctant to portray such a favourable outlook for cheek teeth RCT, given the lack of procedural sterility, and microscopic guidance to debride adequately and clean the pulp chamber and root canals, as required for human patients. Re-examinations are often needed at three and six months post-operatively and then biannually.

Endodontic treatment is rarely a one-step process as it may be complex, expensive and time consuming. Significant investment in training and equipment will be required by the attending clinician in selecting and completing the appropriate endodontic technique to optimise success. It is important that horse owners are informed fully before treatment begins to help to manage their expectations.

How you can get involved

The author of this article is inviting H&H readers to take part in a short survey to aid his PhD research into this specialist area of equine dentistry. If you’d like to be involved, visit horseandhound.co.uk/endodontic-survey

• For more expert advice on equine veterinary conditions, subscribe to the Horse & Hound website for full access to our veterinary library

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Horse teeth are the source of a few colloquial idioms, such as “long in the tooth”, and “don’t look a gift horse in the mouth”. But what of the more serious aspects of equine dental care?

1. How many teeth do horses have?

Like us, horses are diphyodontous, meaning they have two sets of teeth during their lifetime. They lose the baby (or deciduous) set around three to five years of age, which are pushed out by the adult set. Adult horses have around 36–42 teeth. Male horses tend to have 40, while mares usually have 36–40. This is because the majority of mares do not grow canine teeth.

2. What type of teeth do horses have?

Equines are heterodontous – which means their mouths contain different shapes of teeth for different purposes.

• Premolars and molars, also called cheek teeth: for chewing and grazing, these make up more than half of the teeth in the horse’s mouth, with six of each on the top and bottom jaw each side.
• Incisors: the 12 teeth at the front of the mouth (six upper and six lower), used for biting off grass and grabbing hay – or nipping each other and other unwanted behaviours!
• Canines or tushes: short, sharp teeth found in male horses and a small proportion of mares, in between the incisors and cheek teeth. Originally used for fighting and serve no purpose in the modern horse
• Wolf teeth: not present in all horses. Wolf teeth are often removed as they can interfere with the bit placement in the ridden horse and cause contact issues.

3. Why do we need to rasp teeth?

A horse’s tooth and root are several inches long. Each tooth continues to erupt through the gum at a rate of 3mm per year on average, with more tooth emerging in the younger horse.

Horses were originally designed to eat coarse vegetation for 18-20 hours per day. The modern horse, however, is largely fed on lush grass and soft hay and their chewing time has changed with the different diet. Another factor is horses eating with their heads up, for example munching from haynets can alter tooth wear.

These changes produce extremely sharp points, which can damage the soft tissues within the mouth and need to be removed by rasping – also called floating.

Unlike humans, horses have hypsodont teeth, which have enamel extending into the gumline and the nerves are deeper within the tooth so floating does not cause them pain unless it is overdone. Unless, for some reason, a horse takes a severe aversion to the routine rasping process, sedation is unnecessary. However, in cases requiring motorised equipment or where a detailed diagnostic assessment is necessary, judicious use of sedation under vet supervision is appropriate.

4. Can regular dental treatment reduce the risk of colic?

Yes. Horses and ponies who have their teeth checked regularly have been shown to be at reduced risk of colic caused by large colon impaction/distension. But it is important not to over-rasp the teeth, as that may make it hard for the horse to eat and could cause colic.

The pulp is the term applied to the internal blood and nerve supply to a horse’s tooth. Horses’ teeth have a blood and nerve supply that enters at the root (apex) and travels up inside the tooth. These pulps are numerous and communicate with the dentine of the tooth, meaning that equine teeth are very much living structures, to be respected and preserved where possible. If we rasp more than 3-4mm off the surface of a horse’s tooth, we can expose these pulps and potentially cause irreparable damage.

A good rule of thumb is for horses to see the equine dental technician at least once a year, but if there are issues needing monitoring, they may suggest more frequent check-ups.

5. Can dental issues be linked directly to poor performance?

Yes. When a horse is uncomfortable he may hold his head in an unnatural position, which can cause pain in the poll, neck and back. When a horse is asked to work in an outline, he needs to be able to work comfortably in the vertical head position. This means the lower jaw moves forwards slightly owing to the change in body position, so it’s important to make sure there are no overgrowths that would affect this. A tight noseband may make this more uncomfortable for a horse. There is a view that rounding off the front of the second pre-molars helps reduce discomfort — the so-called bit seat.

6. How can you tell a horse is suffering from dental pain?

Slow eating, weight loss, choke, dropping food (quidding) and bad breath are all signs of possible dental pain and should be looked into immediately. But often the signs are much more subtle. As detailed in point 5, some horses may indicate pain in their mouth through poor performance or bad behaviour. Research has also found that the horse grimace scale can be used to identify dental pain.

A horse’s natural chewing action may change in response to pain, but obvious signs of discomfort may not be apparent. They can adjust their chewing patterns to adapt to dental pain, often to the point where owners are unaware that there is a problem. When they eventually show the problem, it may be too late to treat. Meanwhile, the result is the abnormal wearing of the teeth, which may eventually result in severe overgrowths and other painful dental disease.

The good news is that early intervention, through regular veterinary checks and careful rasping, may well prevent many future dental issues.

6. Why might it be necessary to X-ray a horse’s teeth?

Traditional oral examinations can only show about one-tenth of the horse’s tooth. In some cases changes in horse’s teeth can be picked up through a thorough oral examination with sedation, and with use of a dental mirror and more sophisticated techniques, oral endoscopy (examination by camera) shows us a clearer magnified view of the teeth.

Such examinations, however, will only show the part of the tooth visible in the mouth — the clinical crown. To assess the remaining tooth, many vets now use digital X-rays and, in some cases a CT (computerised tomography) scan or a combination of both of these to examine the tooth beneath the gum.

7. How do I care for my veteran horse’s teeth?

Equine teeth continue to erupt until around 18 years of age. The older horse needs to be treated with caution because, unlike young animals, their cheek teeth have stopped growing and there is no reserve crown left, so any tooth rasped away will never be replaced.

As the horse ages, molars eventually wear out and become level with the gums — this is sometimes called “cupping” or expired teeth. Once this has occurred the horse will require special dietary management. Horses can also develop gaps between their teeth, known as diastema. These gaps become impacted with food, which can lead to painful gingivitis.

Look out for chewed-up balls of forage, and quidding, where the horse spills and drops feed as they chew. Foul-smelling breath and pain when chewing can also indicate tooth abscesses or the presence of compacted feed in a diastema.

Veteran horses with poor dentition will need to be fed appropriately to ensure they receive all the vital nutrients. Short-chopped fibre feeds are a good alternative for horses struggling to chew long-length forage. You could also feed pelleted fibres or feed that needs soaking to ease chewing such as sugar beet pulp. Most feed companies offer a veteran range.

You should also consider a digestive supplement to help the microbes in the gut.

8. How do I tell a horse’s age by its teeth?

This is harder than you might think – it depends on what sort of nutrition the horse has had and how much wear on the teeth. Beyond the age of 10 it’s more of an estimate, even for the experts. Five things to look out for are:

• Occurrence of permanent teeth – for instance, by the age of five, most horses have a full set of adult teeth; tusks in male horses tend to appear around four or five
• Disappearance of cups – indentures in the centres of the surface of the tooth, which gradually disappear to become smooth from six to around 11 years
• Hooks – a hook appears through wear on the upper corner incisor around seven, disappears a year later; repeating at around 13
• Angle of incidence – the older the horse, the more acute the angle of the incisors
• Galvayne’s Groove – a vertical line occurs on the upper corner incisor at around the age of 10, reaching halfway down the tooth at around 15 and the whole way by 20. It then gradually starts disappearing, and is gone altogether on those horses who reach the age of 30

You may also be interested to read…

Would you spot if your horse had a tooth infection? Find out how and what treatment is available

Everything you need to know about dental issues in young horses

From caps and gaps to troublesome wolf teeth, Neil Townsend MRCVS outlines the importance of keeping an eye on dental

Ask H&H: equine dental fillings

Can they be used to plug a front-tooth gap?

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Have you ever wondered how your horse manages to eat his hard feed but leave his medicine at the bottom of his feed bucket? Here’s what you need to know about your horse’s tongue — a vital yet often over-looked part of the equine anatomy

1. The horse’s tongue is made up of more than a dozen different muscles and is a highly specialised working tool.

2. The mobile front section works together with the horse’s teeth and lips to select and pick up feed or nip off blades of grass. They are adept at eating only the choicest bits of food.

3. The frenulum, where the tongue starts to attach to the underlying tissue, plays a vital role in chewing and swallowing.

4. Specialised protuberances called papillae, which cover the entire upper surface of the tongue, help guide food into position before it is pressed up against the ridged roof of the mouth.

5. This forces food on to the chewing surfaces of the teeth, where it is ground down and passed across the tongue again and towards the rear of the oral cavity in a spiral motion.

6. The now thoroughly pulped food encounters a thickened area of the tongue called the lingus, which pushes it back for swallowing.

7. Despite being covered by a thick membrane (muscosa), the tongue is an extremely sensitive organ and detects pain, heat, pressure and taste.

8. It also plays an important part in keeping the teeth clean as the horse moves it around to dislodge remnants of food.

Common causes of tongue injuries

9. Bits are the most common cause, perhaps through harsh rein action or because the horse is tied by or tangled in the reins and pulls back.

10. Teeth are a cause too. The horse may accidentally bite his tongue if he falls or is kicked.

11. Holding the tongue can help immobilise the horse’s head and keep his mouth open, but if pulls away he may bite it. The pulling force could also cause neural damage.

12. Lacerations can be the result of a sharp object while the horse browses for food, or a superficial — but often very sore — cut if his tongue rubs against a sharp tooth.

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13. Foreign bodies such as thorns, twigs and the awns of some wild grasses can become lodged in the tongue.

14. Younger horses and foals in particular tend to nibble and chew on things they shouldn’t, so check hay for foreign objects and remove any debris from your yard.

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Dental check-ups should be a regular feature in your horse’s basic health care routine. Andrea Oakes looks at problems that can arise in the mouth

When it comes to equine dentistry, the days of a quick “once over” with a rusty rasp are long gone. Regular and detailed dental check-ups are now the norm for the well-cared for horse, allowing skilled practitioners to detect developing issues before they become real problems.

Since a comfortable mouth is a mainstay of good condition, behaviour and performance, it makes sense to start this routine care in a horse’s early years. When is it best to begin?

“Up until the age of five, a horse’s adult teeth are erupting and shedding their ‘caps’ – the remnants of the deciduous, or baby, teeth,” says Dr Kieran Rowley, an RCVS advanced veterinary practitioner in equine dentistry.

“We would generally recommend a first examination at around two to three years of age, provided that specific issues have not already become apparent.

“A check-up every six months is a good idea with the young horse, so that we can monitor the development of the mouth,” he adds. “We can also deal with any troublesome wolf teeth that may interfere with bitting and require extraction.”

Ideally, routine care will then be ongoing. A preventative approach is a must, explains Kieran, since horses can be surprisingly stoical when it comes to tooth problems.

“As a prey animal, a horse tends to hide pain – so an issue is usually quite advanced once outward signs become apparent to his owner,” he says. “For the adult horse we advise an examination every year, as an absolute minimum, and in some cases more often. This comprises an extra-oral exam, to check facial symmetry and the movement of the jaw and the temporomandibular joints that connect it to the skull, along with an intra-oral examination, inside the mouth, frequently using a gag, a bright head torch, mirrors and small instruments called picks.

“The vet or equine dental technician will be looking for periodontal [gum] disease and tooth problems including holes, gaps, fractures and misalignments, known as malocclusions,” says Kieran, who adds that observations should be noted and records maintained. “It may be necessary to rasp any sharp points and edges. Other issues that cannot be dealt with at the time can be booked in, while more complex problems may be referred to an equine veterinary dental specialist.”

The anatomy of the equine jaw

A horse’s routine requirements will be influenced by his lifestyle, age and dental history.

“Different feedstuffs require different amounts of chewing,” says Kieran, explaining that the anatomy of the equine jaw and the lateral chewing motion naturally create sharpened points. “In theory, a largely grass kept horse will develop sharp points at a slower rate than a horse eating a lot of concentrates. Other factors such as breed and mouth conformation do come into play, however, so more frequent examinations may be necessary.

“Horses doing a lot of collected work with more rein contact, especially in dressage, can also benefit from treatment every six months,” he adds, explaining that “mouthing” or fussiness with the bit, often caused by sharp points pressing on the tongue or inner cheeks, can lead to a deterioration in performance and loss of marks. “Other cases requiring twice-yearly examination include horses who’ve had a molar removed, to prevent overgrowth of the opposite tooth into the empty space, and older horses approaching their twenties and beyond.”

Despite the best care, problems can still arise – especially in the ageing mouth.

“From late teens, abnormal gaps called diastema can form between the horse’s teeth, resulting in painful periodontal disease,” says Kieran. “It’s important to be vigilant with a horse of any age, however, for behaviour that may signal tooth pain.

“Signs range from resisting the bit or contact to becoming unusually head shy,” he adds. “The horse may tilt his head or display abnormal jaw movement when eating, or struggle to bite harder foods, such as carrots. Look out for packing of food in the cheeks, like hamster pouches, facial swelling, bad breath, nasal discharge, usually from a single nostril, or ‘quidding’, where the horse drops unchewed food as he eats. Signs may be so subtle, however, that you don’t notice until the horse loses weight.

“Any of these issues warrants a check-up, but certain situations require emergency treatment. These include a recently fractured incisor tooth, which we can often save with a simple technique called pulp capping, or a badly swollen face that might indicate a tooth root abscess.”

Modern treatment techniques include swift and effective extraction methods, fillings and endodontics – the term for root canal work. Yet perhaps the biggest advance in equine health, believes Kieran, has been a greater understanding of what can go wrong and the ability to identify these issues during routine examination.

“Correct and regular care can prevent long-term problems or loss of teeth, potentially extending a horse’s active years and easing the ageing process,” he says. “It’s a huge advantage to pick conditions up in the early stages.”

Avoiding erosion

Thankfully, there’s no requirement for twice-daily brushing of a horse’s teeth. Where food tends to become stuck between gappy incisors, however, Kieran suggests removing it gently two or three times a week with a toothbrush or a soft pick.

“Another measure to prevent decay is to be selective with the treats,” Kieran adds. “Something natural is best. Avoid mints that are sugary or chewy, as these can stick to the teeth and potentially cause erosion.”

Who’s qualified?

How can you make sure your horse is in safe hands? Neil Townsend, an RCVS specialist in equine dentistry, answers some frequently asked questions…

Who should I entrust with caring for my horse’s teeth?

“Either a vet or a suitably qualified equine dental technician (EDT). These are the only people sufficiently trained and legally allowed to diagnose and treat equine teeth, and both groups must hold indemnity insurance and undergo regular professional development training.

“All equine vets are highly trained in dental care and are qualified to carry out any procedure in a horse’s mouth, but some have a special interest in dentistry and go on to pass EDT exams or to become advanced practitioners or specialists. Qualified EDTs have undergone training and examination to become a member of the British Association of Equine Dental Technicians (BAEDT) or the Worldwide Association of Equine Dentistry (WWAED).”

For basic work, is it worth considering an unqualified EDT – or someone sometimes incorrectly termed an equine dentist?

“By law, anyone can use a hand rasp to file sharp points in a horse’s mouth. Yet a so-called ‘equine dentist’ has had no regulated training and has no recognised qualifications, while an unqualified EDT has not met the rigorous BAEDT or WWAED standards. Neither group can use motorised equipment or diagnose or treat issues in a horse’s mouth, and in neither case can you be confident that your horse is receiving quality care with appropriate protection should anything go wrong.”

What about more complex treatment?

“Only a vet can diagnose issues, administer sedation if required, or treat problems such as fractured teeth or diastemata. A qualified EDT will be keen to work with your horse’s vet, carrying out routine examination and corrective rasping but referring any abnormalities for further veterinary evaluation and treatment.”

Ref Horse & Hound; 12 November 2020

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Would you spot if your horse had a tooth infection? Find out how and what treatment is available

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Animal behaviourists have come to appreciate that horses can display a range of subtle facial expressions that indicate mood and pain. Vets routinely assess pain in conditions such as colic or laminitis by reference to pulse rate, sweating, posture or restlessness, but even low-grade discomfort can affect the expression on a horse’s face. So can facial expressions identify dental pain in horses?

A team at the veterinary school in Utrecht developed a system called the equine Utrecht University scale for the facial expression of pain (EQUUS-FAP), which showed how horses with colic can be scored, while behavioural scientists at the universities of Portsmouth and Brighton developed the equine facial action coding system (EquiFACS) to map and catalogue the complete range of possible facial expressions.

Vets and behaviourists in Germany and Italy have been working on a scoring system they call the horse grimace scale, to narrow down the changes in expression that specifically indicate pain. Studies showed that this was accurate in revealing pain after castration.

Different breeds and even individuals may be more stoical and less reactive to pain but, nonetheless, these facial expressions appear to be reliable.

Signs of dental pain in horses

A Brazilian team used the horse grimace scale to assess possible dental pain in horses used in rodeo work or cattle ranching. None of the horses had any particular dental problems, as far as the owners or riders were aware, and none had received dental treatment for at least six months.

The scientists scored the horses using the established grimace scale, with its six key indicators: ears held stiffly backwards, tension above the eye area, tightening around the eye, prominently strained chewing muscle, mouth strained with pronounced chin and strained nostrils with flattening of the profile.

The scores were made by trained assessors looking at the horses in the flesh, and photographs were taken for other trained assessors to score the horses. Photos were also given to equine vets – who were not trained in the use of the scale – to score the pictures for signs of pain using their professional experience alone.

The horses, 33 in total, then underwent full dental and oral examination, under sedation. Any sharp tooth edges, ulcers and hooks or other abnormalities were treated.

Two weeks later, the assessment process was repeated by all groups. None of the vets or scientists knew which horses had been found to have dental problems.

Settling scores

There was surprising correlation between high scores for pain on the horse grimace scale and significant dental disorders found in the dental exams.

All the trained assessors using the six key indicators – those who saw and scored the horses in their stables, and those who looked at the photographs – could tell which horses were in pain. But the horse vets who were not trained in the use of the established scale could only guess, based on overall appearance, and were only randomly correct in line with general probability.

This research reveals that dental problems and associated pain are common yet are frequently overlooked or unappreciated by owners and riders. Trained assessors can detect dental pain in horses by reference to facial expressions. Yet even experienced horse vets cannot accurately determine pain just by looking at the faces of their patients, unless they have been trained in the use of an objective scale.

Further reading…

● Facial expressions: Applied Animal Behaviour Science 225, 104970-76

Ref Horse & Hound; 7 May 2020

When it comes to teeth, we have more in common with dogs and cats than we do with our horses. As brachydonts, our teeth have short crowns – the part that protrudes from the gum. But horses are hyspodonts, meaning that their teeth feature tall, enamel-covered crowns that extend well below the gum surface and continue to grow, or “erupt”, throughout life.

Until now, much of our knowledge about the structures surrounding horses’ teeth has been based on studies in brachydont species. A European research team has revealed that while equine gingiva (gums) do indeed share similarities with brachydont gingiva, they also have characteristics of their own.

“The study examined the heads of 20 equine cadavers (which has been euthanised for reasons other than dental problems), looking in detail at the gingival anatomy of both the incisors and cheek teeth,” says Neil Townsend MRCVS, who is a specialist in equine surgery and dentistry, based at Three Counties Equine Hospital in Tewkesbury, Gloucestershire.

“Specifically, the researchers noted diastema – gaps between the teeth – and periodontal pockets, where gum recession extends into the periodontal ligament that anchors the tooth in its socket.

“They also looked at the natural pocket around each tooth, known as the gingival sulcus,” Neil adds. “Previously, this was thought to measure up to 5mm in depth in the horse. Every sulcus studied measured less than 3mm, however, and in 90% of teeth no more than 1mm.

“As with humans, equine gums are wrapped tightly around the teeth – so any gap that is present may indicate disease.”

Bacterial barrier

As well as outlining the first scientific description of healthy equine gingiva, the researchers gained valuable insight into periodontal disease – known as periodontitis.

“Every head examined had at least one periodontal pocket,” explains Neil. “Given that the horses used ranged from nine months to 26 years old, this shows that periodontitis affects all ages.

“All periodontal pockets present were between the teeth, which is consistent with previous anatomical and clinical studies,” adds Neil. “In humans and small animals, periodontitis can occur anywhere along a tooth and is initiated by the formation of bacteria and plaque, but horses differ in that the condition is initiated by diastema and food impaction between teeth. This destroys the gingiva and allows penetration of bacteria, leading to destruction of the tooth substance and pocket formation.”

The research also observed that the prevalence of diastema increased with age and was more common in cheek teeth than incisors. Neil concludes that such detailed anatomical knowledge helps to underpin our approach to equine periodontitis, enabling treatments used in other species to be adapted where appropriate.

“The equine gingiva is securely attached to both incisors and cheek teeth, acting as a barrier to food and bacteria,” he says. “Periodontitis begins with the breakdown of this barrier. The most effective preventative measure is regular – at least yearly – examination of your horse’s mouth by a vet, or an equine dental technician qualified with the British Association of Equine Dental Technicians (BAEDT) or the Worldwide Association of Equine Dentistry (WWAED).”

Detecting gum disease in horses

Gingivitis (gum inflammation) or periodontitis of the incisors is easiest to spot, given the location of these biting teeth at the front of the mouth. Food packed between the incisors may be visible, and once removed will usually reveal that the gum has receded to expose more of the tooth. If left untreated, this will eventually damage the periodontal ligament, loosening the tooth and causing further pain.

Specialist equipment is required to detect periodontitis affecting the cheek teeth. Early signs may include quidding, where the horse drops balls of semi-chewed long fibre such as hay or haylage, or halitosis (bad breath). A particularly stoical horse may show few clinical signs but may be unsettled when ridden.

A sedated oral examination in the very early stages can reveal subtle signs, allowing prompt treatment.

Treatment for gum disease in cheek teeth

Treatments for gum disease around the cheek teeth caused by erosions of the gum tissue, leading to infected pockets where a stinking mash of food and saliva builds up, vary from simply removing the packed-in food with a pick, to filling the gap with acrylic. A third option is to widen the gap further by grinding the sides of the molar teeth with a motorised burr.

Enlargement of the space in this way allows normal mouth and tongue activity to keep the space food-free, but some vets and dental technicians have been worried about the long-term effects of the procedure.

Clinicians at Edinburgh and Glasgow vet schools have reported a survey of diastema widening in more than 300 horses, some of which underwent more than one surgical procedure.

The results, published in the Equine Veterinary Journal (EVJ), reveal that in more than 70% of cases the clinical signs — which had included quidding, weight loss, bitting difficulties or bad breath — had completely resolved when the cases were followed up months later.

The incidence of complication was very low.

The conclusion is that diastema widening is safe if undertaken with care. The surgery may need to be repeated to achieve long-term benefits, but, overall, it appears to be the treatment of choice, provided there is no other dental disease in the mouth.

The owner of a horse who was due to be put down owing to his “dangerous” behavioural issues, which were found to be caused by sharp teeth, has urged others to check their equine dental technicians’ (EDT) qualifications

Laura Kent from Hertfordshire booked an EDT for her 15.1hh part-bred Highland Teddy at the beginning of 2018.

“Teddy had started being quite naughty after I bought him in December 2017 so I got his back checked. I got lots of recommendations from people about an EDT they were using so I booked the person and automatically thought he was qualified. When he saw Teddy he said there were no issues with his mouth,” Laura told H&H.

“Six months down the line Teddy went lame but the vet couldn’t find anything. We decided to give him four months in the field to see if that helped but when I tried bringing him back into work he was a nightmare; he would rear vertically.”

Laura arranged for the same EDT to look at Teddy again.

“The EDT said everything was ok but Teddy had stopped eating and drinking properly and he was becoming depressed and dangerous. I was thinking the worst and thought he had mental issues but the vet still couldn’t find anything,” she said, adding that she tried “everything” to find the cause of the issues.

“We thought we weren’t going to be able to fix him. There was nothing obvious as to why he was lame and the vet said he seemed perfectly healthy. The vet didn’t look at his teeth because the dentist had said his mouth was fine.”

Teddy was booked to be put down in April 2019.

“It was heartbreaking but my mum didn’t want me riding a dangerous horse and we had tried everything for him,” said Laura.

“A week before he was due to be put to sleep another EDT was at the yard and I asked him to have a look at Teddy. The EDT said Teddy’s teeth were awful – they were so sharp they cut his hand and he found lots of mouth ulcers. When I told the EDT who I had been using, I was told he wasn’t qualified.”

Laura said the change in Teddy’s behaviour once the qualified EDT had treated him was “amazing” and when she got back on he was a different horse.

“Teddy needed two visits to fix everything and I’ll be getting six-monthly check-ups from now on. We think he was showing signs of lameness because he was trying to avoid the bit when he was being ridden and the way it was making him carry himself. He would look sound in the field when he wasn’t ridden,” she said.

Article continued below…

Pony left with painful overgrown teeth: calls for owners to check teeth specialists’ qualifications

The pony had been receiving annual treatment by an unqualified EDT

Rasping, ageing and helping the long in the tooth: 8 key questions answered about horses’ teeth

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“It’s a miracle thinking at one point we thought we would have to have him destroyed.”

Laura has urged others to check EDT qualfications on the British Association of Equine Dental Technicians register online.

“I’ve spoken to other people who used the unqualified EDT and they’ve had problems too. I want people to check qualifications and don’t risk their horses’ mouths being ruined.”

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An equine dental technician (EDT) has issued a warning about the importance of checking for qualifications before having horses’ teeth done after an owner was unknowingly using an unqualified individual.

Vikki Fowler, who is also a qualified vet, attended a 15-year-old pony on 7 March who had been receiving annual treatment by an unqualified EDT.

Vikki told H&H: “The owners moved the pony to a yard where I do all the horses’ teeth and the yard owner suggested to them I looked at their pony. The owners had been using the same EDT for most of the pony’s life.

“The back teeth were overgrown by 2cm and pressing into her gums – it’s a huge overgrowth. The pony was missing its top back teeth which is why they became so overgrown. It’s probable they had never been there and she had never developed them down to a conformational fault.”

Vikki said the pony had not shown signs of “quidding” but had “runny and swollen” eyes.

“Quidding is when a horse or pony tries to chew its food; they’ll take a mouthful but they can’t chew it enough so they spit it out on the floor. Usually quidding is one of the first signs owners think of when it comes to dental pain or they will see pain through the bit if the horse is ridden, but for horses and ponies who aren’t ridden owners rely on eating. This pony was not being ridden often and doesn’t eat a lot but the owner assumed it wasn’t a great eater,” she said.

“The pony had runny eyes for many years; while I can’t say for certain, it seems highly likely that the pressure from the teeth pressing up into the orbit of the eye caused everything to become inflamed and swollen. When the area around the eye is inflamed and swollen it blocks off the tear ducts and the eye is constantly weeping, making it a prime suspect for attracting dust and flies.”

Vikki said the pony is going to require treatment at three-monthly intervals for up to five visits to get on top of the issue, after which six-monthly visits will be needed.

“The owners were devastated – nobody owns a horse and wants it to be in pain. They thought they were doing right by this pony, they didn’t realise the EDT was unqualified,” she said.

“I’ve seen three cases almost identical over the past few days, by different people performing the work.”

Vikki warned that it is not illegal to work as an EDT without relevant qualifications.

“At the moment there is no legal standing; anybody can buy equipment off the internet, call themselves an EDT and go out there and practice. More terrifying is if one of these unqualified people did something wrong and permanently injured a horse there is no comeback because there is no governing body for them – it’s horrific,” she said.

Equine dental specialist devastated after £30k tools stolen along with his car

The car was spotted some three miles away, going through red lights, but has not been seen since

Rasping, ageing and helping the long in the tooth: 8 key questions answered about horses’ teeth

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Vikki added owners should check for one of the two Defra-recognised qualifications; the British Association of Equine Dental Technicians or the World Wide Association of Equine Dentistry. The registers of EDTs holding these qualifications can be found online.

“It is very easy to check – the registers have a full list of members, areas covered and telephone numbers,” said Vikki.

“Nobody thinks that someone practising unqualified is legal, you don’t question a human dentist’s qualifications because you automatically assume they are qualified, and people assume it’s the same in the horse world. A lot of people just don’t know that anyone can buy rasps and go out and call themselves an EDT.”

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Like chestnuts, ergots and splint bones, wolf teeth in horses have become functionless in the course of evolution. Yet these pointed or peg-shaped curiosities can be surprisingly problematic.

“Wolf teeth push through the gums when the horse is between five and 12 months old,” says Nadine Page MRCVS, of Page and Gunstone Equine Vets in Cheshire. “Unlike other teeth, they do not continue growing and stay relatively small throughout the horse’s life. They usually emerge only from the top gums, although some horses grow them top and bottom.”

The location of wolf teeth in the interdental space — the gummy gap between the biting incisors and the molars (cheek teeth) — means that they are sometimes confused with the deeper-rooted “canines” or “tushes” that can emerge in the same area. Canines appear further towards the incisors, however, and are rarely seen in mares. But both sexes can grow wolf teeth — and it’s their situation just in front of the premolars (the first cheek teeth) that can cause discomfort.

“In most horses, the bit lies in contact with the lower jaw and does not usually interfere with wolf teeth in the upper jaw,” explains Nadine. “Where head carriage is higher, however, in racehorses and some sport horses, the bit can catch the wolf teeth and cause pain. It’s thought that behaviour such as pulling, head-tossing and rearing may be associated with this.

“Teeth that aren’t tight and close to the premolars seem to be most troublesome.”

In or out?

While wolf teeth do not cause discomfort for all horses, some owners choose to have them removed before work starts — just in case. Is routine extraction a good idea?

“Removal allows better access to premolars so that they can be shaped at rasping, a procedure called bit-seating,” says Nadine. “There’s also less risk of the horse developing behavioural problems or bad habits associated with dental discomfort, and no need for a training break for removal if wolf teeth later prove problematic.

“There’s no chance, however, to see whether removal is really necessary for that horse.”

Nadine explains that removal should always be performed on the sedated horse by a vet, or a qualified equine dental technician under veterinary supervision.

“The preferred method is to use an instrument called an elevator to stretch and separate the periodontal ligament surrounding the tooth,” she says. “This should loosen the tooth sufficiently for easy removal with forceps. There are also instruments that can be used to cut and knock the tooth out.

“Removal is not without risk — the biggest being damage to the palatine artery in the roof of the mouth, which can cause a nasty bleed. There’s also a possibility of leaving part of the root in the gum, although this is usually absorbed by the body and rarely causes a problem.

“Extraction can be tricky in the younger horse, where there’s little tooth crown to grasp, or with a ‘blind’ tooth that has yet to erupt through the gum,” she adds.

“Most removals are straightforward, though, and heal quickly with rest and painkillers. The horse should not be bitted for a few days and the hole should be flushed with water to remove food.”

Deciding whether to extract first or wait and see is difficult, says Nadine, because knowledge is largely anecdotal or based on opinion.

“We would generally recommend routine removal of wolf teeth that are not very close to the premolars, as well as those in horses with high head carriage,” she concludes.

Ref Horse & Hound; 12 October 2017

Teething troubles often go unnoticed in a young horse. Any problems with the growth and shedding of a youngster’s deciduous teeth (often called temporary or milk teeth) can lead to long-term issues when permanent teeth arrive, affecting not only the horse’s physical development but also his attitude towards work and his willingness to accept a bridle.

The eruption sequence (when a horse’s teeth break through the gums) is far from straightforward, with multiple deciduous and permanent teeth being present in the mouth at any one time.

Between the ages of one and five, a horse will erupt 24 permanent cheek teeth and 12 incisors — and in some cases an additional four canine teeth. Dental examinations during these years should look for a normal eruption sequence and any sources of soft tissue pain, such as cheek ulceration from sharp enamel points on the upper cheek teeth.

Mind the gap

Deciduous teeth that are about to be pushed out by their permanent counterparts are commonly known as caps.

Very worn and loose caps can cause the horse pain by pulling on the gingival tissue at the gumline. This allows food to accumulate between the cap and the permanent tooth, causing periodontal (gum) disease.

Loose caps and those packing food are easily removed with a pair of cap forceps. It is preferable to extract the contralateral (opposite) cap at the same time to allow the mouth to remain balanced.

The mouth should also be examined for the correct number of teeth and their proper positioning. This is easiest in the incisor region, where six upper and six lower incisors should be present.

When a deciduous incisor is retained, it commonly causes a lingual (towards the tongue) displacement of the permanent tooth. If the permanent incisor develops beside the deciduous incisor there will be seven in the row.

Occasionally, radiography may be required to distinguish between the two.

Retained deciduous incisors are easily removed under sedation and local anaesthetic.

Supernumerary (extra) incisors can also be present. If these are not causing major problems with contact between the upper and lower teeth, or periodontal disease, they are often best left in place.

Supernumerary cheek teeth may also emerge — most commonly at the front or back of the mouth, although occasionally in other abnormal locations. These have delayed eruption compared to other cheek teeth. Because they often have nothing opposing them, they are prone to overgrow and require regular rasping.

Abnormally shaped or misaligned supernumerary cheek teeth can pocket food, leading to periodontal disease. In such cases, removal of the extra teeth is often the best course of action — although this can be difficult, particularly at the back of the mouth.

Dealing with diastemata

Diastemata are defined as inappropriate spaces between teeth.

They are classified as “open” where the gap is the same width at the occlusal surface (the grinding or biting face of the tooth) as at the gingival margin (the very edge of the gumline). Where the gap is smaller at the occlusal surface, they are termed “valve”.

Diastemata can be further classified. “Primary” refers to those caused by insufficient angulation of the cheek teeth, or because the dental buds (the developing teeth) are too far apart. “Secondary” describes those caused by displaced cheek teeth or large overgrowths. Both can be present in younger horses due to eruption disorders.

Misalignment of the cheek teeth may lead to diastemata. If these teeth are identified early, palliative rasping may limit further displacement and the severity of subsequent disease.

Many clinicians believe that disease due to diastemata is the most painful oral cavity disorder.

Quidding is a common clinical sign, where the horse drops semi-chewed food from his mouth. Most horses cope with eating grass and hard feed, but may struggle with long fibre and fail to maintain body condition.

The most common site for problematic diastemata is in the spaces between the rear three lower cheek teeth.

Diagnosis is made with a careful oral examination, which is greatly aided by sedation. Food is then removed from between the cheek teeth, usually with water lavage or right-angled picks.

Many treatments are available, although some are more suitable for certain cases than others.

The mainstay of treatment is high-quality rasping by a veterinary surgeon or qualified dental technician to remove transverse ridges of the surface of the teeth opposite the diastemata.

A deep periodontal pocket between teeth can be packed with dental impression compound to aid gingival healing. A small subset of diastemata can benefit from widening to make the gaps bigger, although there is potential to do serious damage to the cheek teeth.

Cases with secondary diastemata due to severely displaced cheek teeth ultimately may require removal of the offending tooth.

Treatment of diastemata cases is likely to be prolonged, with some cases requiring lifelong care.

Feeling the pinch

Wolf teeth in horses are normally positioned just in front of the first cheek teeth, but not all horses have them. Most cause no problems, but some horses experience discomfort due to pinching of the cheek onto the tooth, caused by a bridle or headcollar.

Provided they are normally positioned, wolf teeth can be removed by a vet or a qualified equine dental technician under direct and constant veterinary supervision. I would recommend the use of local anaesthetic (which must be administered by a vet), in addition to sedation.

Wolf teeth in the lower jaw, or those that are malpositioned or blindly erupted (still below the gum), generally cause problems and should be removed — a procedure that can only be carried out by a vet.

Early identification and treatment of many eruption conditions can limit their severity, so regular dental checks from yearling age onwards are recommended.

The removal of problematic wolf teeth or sharp enamel points will aid trouble-free bitting when the horse is old enough for breaking.

Ref: Horse & Hound; 7 January 2016

The British Equine Veterinary Association (BEVA) has launched the Equine Happy Mouth campaign to increase awareness of equine oral health.

Leaflets were sent to equine practices last month outlining the risks of disease and dental problems in horses and donkeys and website material and slides are also available.

BEVA spokesman Henry Tremaine said: “Dental health is considerably more complex than just rasping teeth as owners may have traditionally believed.

“Research has increased our understanding of the anatomy of equine teeth, clinical signs of dental disease and many other oral health issues.”

He said that with new sedation techniques it was possible to carry out more thorough dental examinations and catch dental disease at a much earlier stage.

A clinical workshop in equine dentistry for vets was held in March at Newbury and four courses in equine dentistry have been run during 2010, including one specifically about the care of elderly horses’ teeth.

The equine happy mouth campaign is the first of a series of annual equine health projects to be championed by BEVA.

Future topics include laminitis, obesity, metabolic disease and mare and foal management.

This news story was first published in Horse & Hound (9 September, ’10)

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More veterinary equine news

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The link between dental cavities in children and sweets or sugary drinks is well known. But it has only recently been recognised that horses can suffer from dental cavities just like humans, although the causes are not so clear.

It seems there are two forms of the disease; one affecting the centre of the table of the tooth, on the grinding surface, and the other causing cavities in the sides of the teeth, where they meet the gums.

Scientists studied the teeth and mouths of more than 500 horses humanely killed at abattoirs in Sweden post-mortem. The history of the horses was obtained from their owners.

Overall, just over 6% of the horses examined showed signs of significant dental cavities in the sides of the teeth, but there were some interesting facts within this basic statistic.

Nearly all the cavities occurred in the last three molar teeth at the back of the mouth, which the scientists thought might be because the tube that discharges most of the saliva, a substance that protects teeth, into the mouth enters the mouth about halfway along the jaw.

They also found that young warmblood trotters suffered a higher incidence of this kind of tooth decay. Rather than this being a breed difference, they concluded this was a lifestyle and management issue.

The vets suggested that the increased rate of tooth decay in young Swedish trotters was because they were fed high-concentrate diets and were given haylage rather than hay. Both cause increased acidity in the mouth, which in turn is known to increase dental disease.

For the full article on the latest veterinary research and developments, see the current issue of Horse & Hound (15 July, ’10)

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Q: My horse injured his jaw in an accident in the field, fracturing three of his teeth. I understand that dental fillings can be performed on hollow or chipped equine teeth. Is this common? And can a filling be used to fill a gap between two incisors?

GC, Borders

Equine dental filling — or endodontic treatment — is not performed as commonly in equines as in human dentistry, or in small animal dentistry, according to Professor Paddy Dixon, Professor of Equine Surgery at the Royal (Dick) School of Veterinary Studies at The University of Edinburgh.

“This is largely due to the different anatomy and larger size of equine teeth, which consequently have fewer requirements for endodontic treatment,” he explained.

“There are, however, some situations where such treatment is suitable for horses, such as for treating fractured incisors that have exposure of the pulp — the inner structure of the tooth, consisting of nerve and blood vessels.

“A few universities and equine practices in the UK have trained personnel and equipment to allow these procedures to be performed,” said Professor Dixon.

“If successful, treatment will allow the fractured tooth to survive, and in time it will likely erupt back to the level of the other teeth.”

Professor Dixon told H&H that such fillings can also be performed in non-fractured incisors with exposed pulp, or hollow defects in the tooth, but that the procedure is not suitable for filling gaps between front teeth.

“Crowns, or fillings placed in spaces between incisors, is not feasible because of the massive and constant forces the horse places on its incisors when grazing, and especially when pulling hay from a net — this action would dislodge the strongest crown,” he said.

“Although spaces between the incisors may be unsightly if large, such wide spaces rarely cause the horse any problems.

“Other instances where dental fillings are used in horses include to fill defects in the ‘cups’ of the upper cheek teeth, especially in horses that are likely to develop fractures of a weakened tooth,” he said.

“These cheek teeth may need X-ray evaluation before treatment, as the defects may extend very deeply into the reserve crown and root area. Such specialised work should only be performed by a vet.

“Although these types of treatment are becoming more popular in equine dentistry, it should be noted they are a relatively new procedure and as yet, no critical large studies have been published to confirm their benefit to the horse’s oral health in the longer term.”

Information

Royal (Dick) School of Veterinary Studies www.vet.ed.ac.uk

The British Equine Veterinary Association www.beva.org.uk

This Q&A was first published in Horse & Hound (1 January, ’09)

Lantra, the government’s learning and skills body, has issued a report calling for recognised training standards in equine barefoot trimmers and dental technicians after a survey revealed significant variation within the professions.

Although there are currently organisations, such as the Equine Podiatry Association and the British Association of Equine Dental Technicians, that provide courses, diplomas and register members, it is legal to practice as a “paraprofessional” without formal qualifications.

Lantra’s industry partnership manager Lisa Jarvis says the body will work in partnership with professional organisations and Defra to develop industry-wide occupational standards for these paraprofessionals’ training, skills and qualifications.

“This will ensure that people undertaking the work are suitably experienced and competent,” she said.

David McDowell, RSPCA representative for the National Equine Welfare Council, agrees that both paraprofessions need a protocol.

“There should be a formal legislation so that only qualified dental technicians and barefoot trimmers can work, and if they behave badly they can be struck off,” he said. “For horses, owners and other professionals, we need a protocol to remove the scope for malpractice.”

Although barefoot trimming falls outside the Farriers (Registration) Act 1975, Felicity Heather, registrar at the Farriers’ Registration Council, would welcome the move.

Apprentice farriers have to complete over four years of apprenticeship and pass an exam.

“The council would like to see all those involved in equine hoofcare trained to a competent standard and regulated as vets and farriers are,” she said.”

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Henry Tremaine MRCVS, senior lecturer in equine surgery at the University of Bristol, sets the scene: “During the late 20th century, it became clear that there was a greater demand for equine dental services and this demand was partly met by lay dental practitioners.

“In the early 1990s, it became apparent that there was a need to foster better collaboration between veterinary professionals and lay dental practitioners to ensure any procedures being performed in horses’ mouths were based on scientific principles, and that no damage was being done to horses’ mouths out of well-intentioned ignorance.”

British Equine Veterinary Association (BEVA), collaborating with the British Veterinary Dentistry Association (BVDA), established an exam for lay practitioners wishing to work to a high professional and ethical standard, within the law.

The successful candidates formed the British Association of Equine Dental Technicians (BAEDT) and a register of those who have passed this exam is on the BEVA website (www.beva.org.uk).

There are other associations of equine dental technicians which have their own training programmes and qualifying tests in the USA and Europe, but are not currently endorsed by BEVA.

Discussions are ongoing between the relevant bodies to broaden the scope of work legally permissible by dental technicians to include “selected non-invasive procedures”.

This information formed part of a veterinary feature published in Horse & Hound (18 January, ’07)

The routine dental check-up for your horse will involve a thorough inspection of the teeth to look for any disease or abnormalities. The equine dental technician (EDT) — we cannot call them dentists as this term is legally protected for the use of human dentists — may need to remove any sharp bits that can impinge on the soft tissue and cause an injury. This is known as rasping.

Rasping accurately is a precise dental treatment that necessitates the horse wearing a gag and keeping its head relatively still. It can be carried out with either a manual or powered instrument. Consequently, if more than routine rasping is required, the EDT may suggest that sedation and therefore a further appointment, is necessary.

If the horse is in pain, complicated procedures are involved, or the technician wishes to use power tools, sedation will be recommended. And, under the current legislation (the Medicines Act — Veterinary Medicines Regulations 2005) this has to be done by a vet.

In these circumstances, unless your dental technician is also a qualified vet, a second appointment with the vet and the EDT is needed. The scope of work performed by non-vets is also limited by the Veterinary Surgeons Act 2006, so any invasive or surgical procedures must also be done by a vet.

Why does a horse need sedating?

“Many owners express concern at the use of sedation for dental treatment,” says Henry Tremaine MRCVS, senior lecturer in equine surgery at the University of Bristol, “but the benefits greatly outweigh the negatives. Sedatives reduce the horse’s anxiety, reduce its sensitivity to outside noises, relax the muscles and relieve any pain, making the treatment less noxious. Modern sedatives can be used safely in healthy horses if administered correctly by a veterinarian, and side effects are rare.”

And, if possible, it is advisable to use a vet with knowledge of the horse’s medical history, as all the details can be taken into consideration.

Rob Pascoe MRCVS, from Bell Equine in Kent, is one of a handful of vets who are also qualified EDTs. Rob is the current chairman of the British Equine Veterinary Association (BEVA)/British Veterinary Dentistry Association (BVDA) EDT exam committee. He opts for sedation if the horse’s temperament makes it necessary, whenever he is about to use powered tools, for advanced work, and occasionally when an owner may describe a problem that needs close examination.

“I sedate so many horses during the course of dental work that I have a set of drugs I like to use, as I know the differences in their effects,” says Rob. “For me, during motorised work, the horse must be sedated. If it isn’t, it takes one instant, one wrong move, and it’s possible to catch the tongue or the palate and do a tremendous amount of damage in a short space of time.”

Using powered rasping tools

With the modern advances, the use of power tools has become more acceptable. Where once the average so-called horse dentist’s only option was his rasping tools, power tools have developed greatly in recent years and there is now specific equipment available for this purpose. The safe use of this equipment requires restraint and, although some horses may tolerate the quieter instruments without sedation, it is potentially very dangerous.

“Using potent powered instruments to attempt precise treatments in unsedated, moving horses can be like threading a needle in a rowing boat on a rough sea,” points out Henry Tremaine.

“Treatments can be performed with less distress to the horse using powered tools,” continues Henry. “Modern mechanical tools are quiet and can remove a lot of tooth in a few minutes, which means that the horse’s treatment can be performed quickly, precisely and efficiently.

“However, if they are used inappropriately it is possible to damage the horse’s teeth. Without due care, excessive amounts of dental tissue can be removed, resulting in possible permanent damage. The mineralised dental tissues are non-regenerative, so this damage may not be apparent for some years.”

Rob Pascoe adds: “I want to be able to see what I’m doing while I’m using a motorised tool so I can assess how close to the sensitive part of the tooth I am and know when to stop.”

This feature was first published in Horse & Hound (18 January, ’07)

When you first learn that a horse has wolf teeth, you might think he must have sprouted werewolf-like fangs. It is easy to confuse them with the larger canine teeth or tushes. These sit in the middle of each side of the horse’s jaw, between the incisors or biting teeth that fit in front of the bit, and the chewing or molar teeth at the back of the mouth behind the bit. Wolf teeth, however, are usually tiny and not easy to see at all.

Horse owners are often surprised when the vet shows them the vestigial remnants that are the wolf teeth. The standard responses vary from “Where?” as they peer over, looking for something dramatic to “Oh, is that all it is?” or even the logical: “How can that cause a problem to an animal the size of a horse?” to which it can be hard to provide a satisfactory answer.

Such comments are valid because we are not talking about elephant tusks here. The majority of horse wolf teeth are only a few sizes larger than the child’s tooth left under the pillow for a tooth fairy to find.

When you realise how small and apparently innocuous wolf teeth are, added to the fact that when in their proper anatomical position, they should not interfere with the bit, it is hard to see how they cause a problem. It seems logical that they may irritate if there is something unusual, such as a loose wolf tooth that may wobble uncomfortably, a tooth that has erupted in the wrong place or a particularly sharp tooth. Otherwise, they may be best left alone, on the basis that if it isn’t broken, don’t fix it.

Do wolf teeth need to be removed?

The role of wolf teeth in causing oral discomfort has been widely debated and is controversial. Tradition and client pressure are the most common reasons for their removal. Also, cynically, whoever extracts them will earn a fee. So historically wolf teeth removal has been customary practice, as it can be preferable to do something to the horse rather than modify other factors, such as riding style.

I believe most wolf teeth cause no problem to the horse, but do concern their human connections. This is because:

• The presence of a wolf tooth can affect the rasping of molars to form a bit seat, This is when the edge of the second check tooth is rounded to accommodate the bit and is said to be beneficial to the performance horse
• Displaced or sharp wolf teeth can cause pain on the cheeks when pressure is put on by the bit and bridle
• Some wolf teeth do become loose, diseased or associated with persistent ulceration, which may cause pain
• There are cases where wolf teeth problems have been blamed for all sorts of horrors, such as headshaking.

Without a proper scientific trial controlling other factors such as tack, rider and many other variables, it is impossible to know if wolf teeth hinder a horse.

If done properly, effective wolf tooth extraction is unlikely to be harmful. The fact that the horse has some time off while the gum wound is healing may also allow other issues to subside. Following extraction, the horse should not be ridden for up to two weeks, or sometimes even longer, while the gum heals and any bruising goes down.

How are wolf teeth are removed?

Wolf teeth extraction can usually be successfully performed in the standing, conscious horse. There are specially designed cylindrical or half-curved dental elevators that are used, along with various dental luxators and forceps. The objective is to extract the tooth without it fracturing or causing discomfort to the horse.

Not only can the wolf tooth snap off, but also it is possible to cause inadvertent damage to the palatal artery, which lies nearby within the roof of the mouth. If this blood vessel is damaged, it will result in a profuse haemorrhage that will be unpleasant for the horse, alarming for the handler and embarrassing for the individual performing the extraction. To make life easy for all concerned, it can help to sedate the horse and administer painkillers and local anaesthetics as necessary.

It is also important that the horse is vaccinated against tetanus before or at the time the tooth is removed. Technically, the procedure does not require strength, but practical skill and expertise help things to go smoothly.

Who should take wolf teeth out?

Any dental procedures such as the extraction of wolf teeth should only be carried out by those with training and experience in the use of the required instrumentation.

At the time of writing, the Royal College of Veterinary Surgeons (RCVS) and the Department for Environment, Food and Rural Affairs (DEFRA) are debating amendment of the Veterinary Surgeons’ Act 1966 so that it may be possible for removal of a normal, fully erupted and non-displaced wolf tooth to be performed legally by properly qualified equine dental technicians (EDTs), who have passed the requisite examinations and have appropriate insurance cover.

In many cases the horse will require sedation and medication, so the presence of a vet will be required, as it is illegal for anyone other than a vet to prescribe and treat a horse with local anaesthetics, sedatives, anti-tetanus vaccinations or other medication. Any advanced dental procedure or surgical procedure must be performed by a vet.

If in doubt, ask your vet (or consult www.beva.org.uk, the equine vets website) or the British Association of Equine Dental Technicians: www.equinedentistry.org.uk

It is important to remember the aim, as famously described by JG Lane FRCVS, a well-recognised equine vet and surgical specialist, is to “remove the right tooth, the whole tooth and nothing but the tooth!”

• This veterinary feature was first published in Horse & Hound (28 September, ’06)

Horse dentistry, and who should carry it out, is a much-discussed topic among horse owners. In reality, many people use either a vet with a specific interest and proper equine dentistry training or a trained and qualified equine dental technician, but some still use the local “tooth fairy”. Such individuals are known as “tooth raspers” — because that is basically all they are permitted to do without a properly approved qualification.

As more people want their horses’ teeth looked at properly, equine dentistry has developed from the quick “while you are here, will you just check the teeth?” to a major part of veterinary practice in the UK. It also provides employment for many equine dental technicians (EDTs), who have undergone recognised training and care for horses’ teeth as a full-time career.

The Veterinary Record recently published an interesting report on routine preventative dental care in horses in the UK and Ireland. This was the result of a questionnaire completed by horse owners, trainers and equestrian managers (807 in the UK and 47 in Ireland) on their attitudes towards prophylactic dental care for their animals.

Overall, the vast majority (83%) of respondents said they arranged routine treatment at fixed intervals. A few (10%) arranged treatment when they felt it was required and even fewer (7%) provided no treatment at all.

Equine dental technicians (EDTs) provided all the treatment for more than half (53%) of owners, while just over a third (35%) of owners relied solely on vets. According to this survey, only 1% of those questioned used unqualified individuals who were neither vets nor EDTs, although this may reflect the group surveyed. Those who never bother with their horses’ teeth are presumably unlikely to fill in a survey to admit their neglect.

The same survey commented that there was confusion among some horse owners concerning the qualifications of EDTs. Some stated that they were more likely to choose a vet than an EDT because they were more qualified for the work, but almost as many said they chose an EDT because they felt these had more qualifications. There is now a recognised qualification for EDTs and even a three-year degree course is available — see http://www.equinedentistry.org.uk for more details. However, some individuals advertise their skills when they have minimal qualifications. The survey indicated that horse owners found it hard to differentiate between different levels of qulification.

The survey showed large differences between different areas. For instance, in Midlothian, owners were nearly three times as likely to have their horses teeth treated at six-monthly intervals. In the same area, only vets performed dental work for more than half (52%) of owners, whereas in the adjacent Scottish Borders and Dumfries and Galloway, they performed dental work for less than a quarter (24%). In Kent, only vets performed routine dental care for approximately half the owners, while Kent vets were cited as the main source of information on equine dentistry for nearly three-quarters of horse owners there (73%). The fact that they did not do as much dentistry suggested that they may have recommended other individuals to do it.

Use of sedation for routine dental treatment varied. Just over a quarter (27%) of owners in Co Durham, Kent, Ireland, Somerset and Yorkshire had some of their horses sedated for dentistry. Sedation was used more often when vets rather than EDTs performed routine dentistry. Legally, a vet should sedate a horse and give other treatments, such as anti-tetanus vaccinations, which should be up to date if the teeth are being treated.

When giving reasons about who was selected to do their horses’ teeth, some (6%) of owners chose a vet because they sedated their horse, while a similar number (7%) chose EDTs because they did not sedate them.

The possession of a wide range of clean, effective equipment was cited by many owners in choosing the best person to do their horse’s teeth. Certainly, the days of the vet having a couple of tooth rasps at the back of the car are in the past. It is now possible to fill a large van with shiny kit specifically designed for the job of improving horse’s teeth in one way or another.

In some areas surveyed, it was pointed out by some owners that failure to use a full mouth gag (speculum) indicated an inability to do the job properly. The truth is that as an observer it is hard to judge the competency of the dental treatment performed. It is important that the horse’s teeth are properly cared for, but the difficulty is being certain that this is happening.

Comments from the same survey showed that the interest and enthusiasm of the provider of the service was crucial and related to the frequency of dental treatments. Another obvious consideration is the fact that if you ask your vet to check the teeth “while they are there”, they may not have the time to do as thorough a job as if a proper visit had been scheduled.

If horses are going to have such time devoted to their dental care on a regular basis, it must mean that there is a need for properly trained, enthusiastic individuals to provide this service. Whether it is a vet or an EDT, it is essential that they work effectively together to ensure horses get the best treatment.

This veterinary feature was first published in Horse & Hound (10 February ’05)

The latest techniques and research are giving a bite to equine dentistry. You might not be able to teach your young horse to floss, says vet and dental specialist Graham Duncanson MRCVS, but widening diastemata – the small gaps between adjacent cheek teeth – can often make a huge difference to a horse showing signs of pain.

New techniques involving fitting braces to foals can help in some cases of parrot mouth. And, thanks to research at the University of Edinburgh, some horses suffering from decaying cheek teeth could now be candidates for fillings, using similar techniques and materials to those in human dentistry.

“A classic example for widening a diastemata would be the five-year-old who shows discomfort on eating, and quids, or spits out his food,” explains Graham.

“In a young horse, you might have one or two diastemata that cause problems, but not multiple ones, as with old horses. Older animals seem to cope with it, but young horses quite often get food trapped in there.

“This, in turn, causes gingivitis (inflammation of the gums), which leads to pain and spitting out of food.”

In most cases, the technique used is quite simple in qualified hands, and involves taking problem teeth out of contact with each other.

“I would rasp off just a tenth of an inch (2mm) from each tooth so they don’t meet”, explains Graham. “When the rotting food is cleaned out from the hole, that often solves the problem. If it doesn’t, we burr down between the two teeth using special diastemata burrs and widen the gap. It’s the equivalent of flossing.”

Grahamis also enthusiastic about work being done by researchers at the University of Edinburgh.

“They are working on infundibular necrosis in cheek teeth – teeth that are decaying,” he says. “This isn’t a new condition, it’s something that has probably always been there, but it’s only now that work is being done on it. Again, it’s seen more often in young horses that have got their full set of adult teeth.

“At Edinburgh, they are probing areas of necrosis very gently with dental picks. If they are shallow, they leave them alone, but if they go deeper, they drill out the decayed area and fill it with a material similar to that used in human dentistry.”

Graham says that the jury is still out on whether sugar can damage enamel. However, infundibular necrosis does not have a dietary cause. While a small amount of necrosis may be the norm, problem-causing quantities are relatively rare.

“From every thousand appointments, I would expect to see only three or four needing further attention,” says Graham.

While dental work has a higher profile, there are risks that it can be carried out too often.

“There are two things to stress,” says Graham. “First, that the horse only has three inches (7.5cms) of tooth to last him a lifetime and wears it down naturally at about one tenth of an inch per year.

“Because the first permanent check tooth comes into wear when he is about a year old, he has a natural maximum of 30 years’ worth – so if you are aggressively wearing teeth down too often, you are not helping the horse.

“Second, as the horse has evolved, so have his teeth. Things like transverse ridges, the irregular grinding surfaces, have evolved to make it easier for him as a grazing animal.

“Again, by taking them away, you aren’t doing him any favours and it’s something English vets don’t think is a good idea. Some US vet sand dentists grind them absolutely smooth, so when you put your hand in a horse’s mouth, it’s like running your hand over a set of billiard balls.”

There is also a myth, says Graham, that transverse ridges affect the horse’s ability to come into collection.

“Some people believe that the cheek teeth need to slide over each other,” he says.

“In fact, when the mouth is closed, the incisors meet but the cheek teeth don’t touch.”

Another American idea, the bit seat, is something that Graham looks on as a viable option in some cases. This involves burring back the teeth next to where the bit lies, to try and make the soft tissue sit more comfortably behind the bit.

“I don’t like the idea of the Texas bit seat, so called because everything that comes out of Texas is bigger,” he says. “But the Kentucky bit seat, which is smaller, can be a good option.

High-tech dental tools make the vet’s work easier, but only belong in skilled and qualified hands.

“There is some serious equipment available now,” he says. “And while you’re unlikely to over-rasp with the old-fashioned hand rasp, that can happen with an electric ‘powerfloat’, which is why it needs careful use and is only available to vets.

“Personally, I think that because of the dangers of electricity and water in the horse’s mouth, battery ones are safer.”

Management and feeding can promote good dental care. Graham advises feeding from the ground dand feeding long fiber, which will ensure that the horse’s teeth weaar correctly.

“If it’s a choice between feeding poorer quality long fibre and more hard feed, change to better quality long fibre and less feed.”

So what is the best dental routine for a horse, from cradle to grave?

“Foals should be checked soon after birth to see if they are parrot-mouthed,” says Graham. In some cases, new techniques involving the fitting of braces might be considered.

This needs to be done by the time a foal is about four months old, which is why a veterinary check soon after birth is so important.

If such techniques are not appropriate, the horse will need careful attention to dentistry throughout its life.

“If foals are normal, there is not much point doing anything until the two-year-old stage, when you need to check that dental caps are not causing problems,” says Graham.

“It’s also a good idea to get the horse used to the rasp, putting it in the mouth and moving it a little.

“Then check at six-monthly intervals in case dental caps are retained. The horse will have its full set of teeth by about 5½ years. From about seven to 12 years, you can often move to an annual check – though if there are problems at any time, you need to get them investigated.

“From 12 onwards, it’s generally best to go back to six-monthly checks. With the truly old horse, including those who lose teeth, good dental care can make a big difference to their health and condition.”

• This veterinary feature first appeared in H&H (9 September 2004)

Canine teeth are usually absent or less developed in female horses, but erupt in most male horses by the time they are between four-and-a-half and five years old.

They are situated in the interdental space (between the incisors and cheek teeth). The lower canines sit behind the corner incisors, and are generally further forward than those in the upper jaw.

Originally “fighting teeth”, they have no occlusal contact, i.e. the opposing upper and lower canines do not meet, so they are of no benefit in the eating process.

They can be 5-7cm long, most of which is reserve crown (not visible above the gum). The lower canines especially are prone to a build-up of tartar – sometimes to the extent that the tooth resembles a large, light brown acorn in appearance.

If left, tartar will lead to gum disease (gingivitis), so a qualified equine dental technician (EDT) or vet should remove any such build-up during routine checks and possibly advise the owner to brush the canines with a toothbrush a few times per week to prevent further tartar.

Sometimes canines may have a delayed eruption, not fully emerging until the horse is six years old or even older – this may be a normal variation in some horses.

In other cases the canines may permanently lie superficially beneath the gum, so-called “blind canines”, where the overlying gum may be swollen, bruised and sore. Advice should be sought from a vet or a qualified EDT.

Although canines do not continue to erupt throughout the horse’s life in the same way as other teeth, by the time some geldings or stallions reach middle-age their canines may have become tall and sharp.

Such teeth are potentially serious weapons, posing a significant risk to the owner’s hands when fitting the bridle, to operators during dental examinations and treatments, to other horses in fights, or even to the horse itself, by damaging the tongue or catching and breaking the tooth on some fixed object.

Any concerns over these teeth should be discussed with a vet or EDT, who may advise that canines be reduced and filed smooth.

Canine teeth

• A horse may occasionally develop displacement of canine teeth that can cut the cheeks or even stick out of the mouth when it is bitted
• Extraction of canines is a major procedure requiring x-rays and extensive jaw surgery to remove the deeply embedded reserve crown and so only the displaced, visible crown will usually be ground away. Prominent, tall canines can reduce the space for the tongue so some horses may suffer tongue pain due to excessive bit pressure.
• If the space between the canines and cheek teeth is short, there may not be enough room to fit a double bridle.

H&H (14 March 2002)

As a general rule, horses do not suffer from dental necrosis and caries (rotting teeth), and their teeth are not affected by sugar-coated feeds.

During the course of routine examination, a practitioner will occasionally come across a tooth in which food has become trapped and which is decaying.

Equine molars (cheek teeth) are mainly formed of three substances of differing hardness “folded” around each other.

The upper cheek teeth also contain two blind pockets of enamel known as infundibulum. Many normal horses have small holes in the cement that fills their infundibula, and some develop larger, dark cavities (caries).

If a horse is particularly prone to these and its diet is high in sticky, heavily molassed hard feed, this could potentially cause further decay. In such cases, the only real course of action has been to leave well alone until the decay is so advanced that the tooth needs to be removed.

Recently, however, the use of fillings has been explored in the USA. The technique uses human dentistry equipment to etch out (drill clean) the hole, then seal and plug it layer by layer with dental composite of the type sometimes used to build up broken human teeth.

Each layer is set using an ultraviolet light and the process, under intravenous sedation, usually takes about 30 minutes.

The composite is enamel coloured and, because it is intended for human use, the tooth colour can be matched.

BEVA-qualified Equine Dental Technician Matt Carter, who has been using this procedure in the UK for some time, explained his views of the benefits.

“If a horse has severe dental caries, the affected tooth may eventually rot. Dental composite wears at the same rate as the tooth, so if we clean and fill a 5mm cavity, as the tooth wears down and is replaced with newly erupting reserve crown, when that 5mm has been worn away both cavity and filling will have gone. The tooth will be well again,” he said.

“The equipment I use also has a high-pressure jet wash, which is used to remove tartar build-up, cleaning the teeth and gums, in much the same way as when we visit the dentist for a de-scale. For good measure, the horses also get a peppermint flavoured anti-bacterial mouthwash!”

This article first appeared in Horse & Hound (11 April 2002)

Horses can suffer irreversible tooth damage from burns incurred during dental treatment, an award-winning research project has found.

Lynne Uttley was presented with the Eqvalan Thesis of the Year at the British Equine Event for her undergraduate study at Hartpury College into the use of electrical teeth grinding equipment. It has highlighted the need for further investigation into the damage that can be done to horses’ teeth through misuse of tools.

Lynne developed an interest in equine dentistry after spending a placement year at Edinburgh University, and realised how little is known about the subject. In her thesis, the first study of its type, she set out to determine whether teeth grinding using power tools can cause “thermal damage” – in other words, burns.

“The kind of instruments used without coolants for teeth grinding are doing enormous damage,” she said. “What we need to know is the right temperature for grinding teeth. Working at the wrong temperature can cause 100% irreversible damage. We need to manufacture a tool with its own cooling system so that temperature doesn’t cause damage.”

Vet Karen Coumbe, who was on the panel of judges, said: “Lynne’s work will be very useful in the short-term. All five of those short-listed deserve credit and recognition for the effort they put in.”

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Q: A friend recently told me that when her equine dental specialist rasps her horse’s teeth, he creates bit seats. What are bit seats and what is their purpose?

John Edmunds replies: Creating bit seats involves rounding and smoothing the front surfaces of a horse’s first cheek teeth to create a more comfortable condition for the horse when he has a bit in his mouth, enhancing his performance and improving his attitude to work.

Upper bit seats let the bit ride higher in a horse’s mouth, freeing the tongue and allowing it to maintain a more forward position.

Lower bit seats avoid puncturing, pinching and bruising of the lower area of the cheek.

The combination of upper and lower bit seats prevent loose flesh over the lower bars of the mouth from becoming trapped and pinched between a horse’s cheekteeth.

As the rider takes up a contact on the horse’s mouth, some bits (especially those with a single joint) tend to narrow quickly. Bits with a D ring or a full cheek can then apply pressure on the cheeks pushing them against the teeth. Bit seats help to eliminate this discomfort.

It takes a lot of experience to create good bit seats, and they are easier to maintain than to form. When installing bit seats the dentist should consider:

• what type of bit the horse is ridden in
• the heights and angles of the teeth, as the bit will rest on the bit seats when a contact is taken up
• the length of the mouth and its width and height

Horses are extremely good at hiding pain. If they feel discomfort most adapt their way of going and soldier on. As the horse changes its way of going, its performance is likely to be adversely affected.

Discomfort in the mouth can affect the way the head – a very heavy weight on the end of a long neck – is carried. Compensation can cause tension in the jaw joint (temporal mandibular joint or TMJ), which in turn affects the poll, neck and back.

To try to avoid pain from its teeth, the horse may

• go better on one rein than the other
• resist contact with the bit when being ridden
• have slight stiffening through the back
• display a general unwillingness to work.

Sharp teeth frequently cause cuts or ulcers to the inner cheeks and/or tongue. Tongue ulcers are exacerbated by pressure from the bit, while nosebands, bit ringsor cheek pieces often irritate cheek ulcers.

The horse needs to slide its lower jaw forwards when lowering its head to work on the bit, or to graze. Anything affecting this can cause pain and tension.

If a horse has dental overgrowths it will have to open his mouth to slide his lower jaw forward. A tight noseband will prevent the mouth opening and exacerbate the problem.

Regular inspections and routine rasping by a qualified practitioner will alleviate many of the dental problems before they can cause damage.

Q: In the last week my two-and-a-half-year-old Thoroughbred mare, who I have owned for three months, has lost two front teeth. How long will it take for the permanent teeth to grow through? Will she lose all her teeth, including the molars?

Jo Holmes MRCVS replies: Your horse’s teeth are developing right on schedule. Incisor, premolar and molar milk teeth are all shed sequentially, most having developed in the foal by two months of age.

The horse possesses six upper and six lower incisors at the front of the mouth. The middle two in each jaw are known as the centrals, those flanking them are the laterals and the outer incisors are those on each corner.

The permanent centrals erupt at two-and-a-half years of age and grow down to come into wear by the time the horse is three. The laterals will erupt at three-and-a-half years, to be in wear by four years and the corners will erupt by four-and-a-half years to be in wear by the age of five.

The first permanent premolars, commonly known as wolf teeth, develop at six months of age and are not often shed unless removed by the vet. The second, third and fourth premolars erupt at two-and-a-half, three and four years respectively – virtually synchronised with the incisors.

Molar eruption is less systematic. The first permanent molar appears at one year, the second at two years and the third at approximately four years of age. Permanent premolars and molars grow down into the mouth continuously throughout the life of the horse, as they are gradually worn down.

They leave behind large bony cavities in the jaw and skull as they grow, which become known as sinuses and are filled only with air.

Your mare’s mouth should currently contain a mix of milk and permanent teeth. Conformational defects such as parrot mouth and vices such as crib biting can affect the wear of the teeth and cause them to be shed sooner than necessary.

Because tooth eruption follows such a strict timetable, it is possible to age most horses up to five years of age to within six months of accuracy. Beyond this point, wear can vary hugely between horses, which is why vets may be cautious when asked to age an older horse.