MANAGEMENT When is tooth removal advisable?
Q:
I have a 22-year-old gelding who was recently diagnosed with EOTRH. From the reading I did online, I thought he would need to have most of his incisors removed, but I was told by the equine dentist that it was better to wait and remove only very loose teeth as needed. Won’t this make him uncomfortable? What is the current thinking about treating this condition?
A:
Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH) most commonly occurs in horses over age 15. Characterized by a combination of tooth resorption (loss of dental tissue) and hypercementosis (proliferation of dental tissue), this condition is of unknown origin. Several factors may contribute to EOTRH, including interaction of autoimmune response, bacterial infection, masticatory (chewing) forces, genetics and/or endocrine disease.
EOTRH usually affects front teeth (incisors and canines) but it is also seen in the premolar and molar teeth. The condition usually causes discomfort, with signs including bitting problems, headshaking, weight loss, bad breath and behavioral changes. Signs of the condition can be subtle and easy to miss. A horse may become resistant to being haltered or bridled, reluctant to bite into carrots/ apples or become head shy. On the other hand, owners sometimes don’t recognize EOTRH signs prior to treatment but notice a marked improvement in their horse’s demeanor after surgery.
To diagnose EOTRH a veterinarian must conduct a complete sedated oral examination—looking for fractured or loose teeth, pustules or draining tracts around the teeth, swollen gums and receding gums. In addition, radiographs must be taken to determine the stage, location and severity of the condition and to guide and monitor treatment.
EOTRH is a progressive and painful condition with no known cure other than removal of the affected teeth. Once a diagnosis is made, the veterinarian will determine when or if extraction is needed based on clinical signs, exam findings, radiographic findings and concurrent disease processes. Reasons for extraction include fractured or loose teeth, severely receded gums (greater than 50 percent), pustules/draining tracts over the teeth, deep pockets (greater than 1 centimeter) around the teeth and/or radiographs showing resorption into the sensitive dental tissue. In some cases, all incisor and canine teeth are extracted and in others, only specific teeth require extraction.
Horses adapt extremely well to removal of these painful teeth and will eat better with no teeth than they will with painful teeth. Following surgery, they will return to grazing, eating a normal diet and performance. Owner satisfaction rates are very high following this procedure. Horses may protrude their tongue from their mouth at rest or at work afterwards; this can be a consideration for some riding disciplines. A diagnosis of EOTRH can be overwhelming but with proper monitoring and treatment, horses will thrive.
Tracy Tinsley, DVM
Elite Equine Mobile Dentistry
Holly Springs, North Carolina