February is Equine Dental Awareness Month, and it’s a great time to remind clients to schedule their horse’s annual dental exam and float. If your veterinary practice is primarily small animal, you likely don’t spend much of your time peering into a horse’s mouth. Erika Wierman, DVM, received her veterinary degree at Ohio State University and took an internship with Rood and Riddle Equine Hospital in central Kentucky, where she developed an interest in equine dentistry. Wierman ultimately opened an equine dentistry practice in Versailles, Ky, but spent some time working for mixed species clinics and says she knows that dealing with equine oral health can prove a challenge for veterinarians who spend most of their time with dogs and cats. Along with client input, a good oral exam can help veterinarians identify and treat problems early, before they begin to seriously impact the horse’s overall health. Horse Dental Care: What to Look For Start an exam by checking in with clients on their horse’s eating habits, riding frequency, bit type, odors or nasal discharge. Besides the obvious sharp points resulting from continuing eruption and attrition horse’s teeth, Wierman said the most common issues in the mouth are malocclusions, where the top and bottom teeth don’t rest against each other symmetrically. This is something that a practitioner could spot on visual examination, or diagnosis may stem from a set of symptoms recognized by the client. “With a performance horse that works better in one direction than the other, for example, you want to make sure that the teeth are meeting equally on both sides, that the occlusal angles are within an appropriate range,” she said. Malocclusion can also be a symptom of another problem, like a tooth fracture that has resulted in an overgrowth of the opposing tooth and gradual shifting of the jaw. Looking at the mouth both open with the speculum, and closed, can give you a more complete idea of what’s going on. And, Wierman says, write it down — charting and photos will help you track the evolution of a problem later if one arises. Equine Dental Problems to Consider Obviously, older horses are more at risk for dental problems, as their teeth have worn more smooth on the chewing surface, removing some of the ridge and groove architecture that makes up the occlusal surface of the tooth. Chewing hay and forage becomes less efficient for the horse. Wierman advises soaking hay and adding oils to the concentrate to help keep calorie counts up as intake is reduced. Once teeth are lost however, it gets harder to manage the animal — especially since food and other matter can become trapped in the spaces where teeth are missing. “A horse’s teeth are designed to function as a unit,” Wierman said. “Each row of cheek teeth is meant to act as one grinding surface. For horses that have very little left in their mouths, you feel like there’s not a lot left you can do besides changing their diet.” Horses can survive relatively well after losing front teeth, since their lips and tongue can adapt well to picking up food, but loss of cheek teeth like molars and premolars proves a greater problem. When examining an older horse, Wierman advises veterinarians check for gaps between teeth. Older horses’ teeth lose surface area as they wear away, leaving gaps between teeth that put the horse at risk of getting feed stuck in the gaps, leading to periodontal disease. Radiographs can tell you whether the teeth are salvageable and whether periodontal treatments or widening of spaces between teeth to encourage feed material to fall out as an alternative to extraction. Wolf teeth could be a concern in immature horses. According to Texas A&M University, about 70 percent of horses develop wolf teeth between six and 12 months of age, but they do not pose a health threat in most cases. “There’s some controversy about whether they’re actually bothersome or not, and whether they should be pulled,” Wierman said. “Most performance horse people probably will want them extracted.” Fortunately, wolf teeth have shallow roots and can be removed fairly easily with little risk of complication. Wierman has also found that certain breeds can be predisposed to crowding of their teeth due to their skeletal conformation. Miniature horses are especially likely to experience this issue. fotoedu/istock/Thinkstock When you start an exam, check with the client on the horse’s eating habits, riding frequency, bit type, odors or nasal discharge. The Problems With Lay Practitioners One area of much debate among veterinarians is the use of lay dentists. Depending upon the state you practice in, it may or may not be legal for non-veterinarians to work on a horse’s teeth. In places where it is legal (or largely overlooked), Wierman believes it’s something to be careful with. For one thing, lay dentists can’t legally administer sedation by injection, which means they probably can’t safely place a speculum in the horse’s mouth, which prevents them from seeing the mouth as they work on it. Sedatives, said Wierman, are used for the safety and comfort of both humans and animals. “It’s quite the controversial subject,” Wierman said. “Veterinarians should help clients understand that lay dentists are not ‘specialists’ and that there is no educational standard or governing body overseeing lay dentists.” There are also health and welfare concerns with lay dentists who may attempt extraction on their own, during which they can not legally use or prescribe nerve blocks, antibiotics, sedation, or pain medications. Wierman understands the temptation to refer clients to a lay dentist—floating teeth requires its own set of tools which aren’t used for any other type of work. Hand floats take extra time, while more expensive power tools require familiarity and training to use safely. Veterinarians may choose to purchase a speculum or may opt for a “blind float,” where they run the tools through the horse’s mouth by feel. “My argument with the blind approach is how do you know what you’re treating if you can’t see it?” Wierman said. “A dental exam Is not complete without a mirror and a bright light.” Final Notes Wierman said that the recommendation to clients that horses’ mouths be examined yearly isn’t an arbitrary timeline: the amount of tooth that can safely be removed in one session is approximately equal to the amount that erupts from the gum in one year. This means that if you detect a problem on an annual examination, you should be able to correct it quickly, but a malocclusion that has been forming for a few years will be more difficult and time-consuming to fix safely. “Not all horses need to be floated annually,” Wierman said. “The other thing is that horses on lots of turnout tend to have better teeth because the lateral movement of the jaw is significantly increased when they’re grazing over when they’re chomping grain. Horses that are grazing for 16, 17 hours a day do a better job of shearing down those sharp points. That’s something to tell clients—for multiple reasons, turnout is good for horses.”
