There is growing awareness among vets and owners about the importance of dentistry for equine health – particularly with an increasing geriatric horse population – and many equine vets are keen to develop their skills and understanding in this area. In his talk at the BEVA Congress, European specialist in equine dentistry Neil Townsend explained the importance of performing regular oral examinations and described what a vet should be doing every time they look in a horse’s mouth.
Before you go into the mouth
Neil began his talk by reminding the audience that whether presented with a horse for a routine check or to treat dental problems, there will be a horse attached to the mouth. “Dental disease can be manifestations of other systemic disease and can cause other problems – like weight loss and coat changes,” he said.
The next stage is to watch the horse eat. Does it chew with both sides? Be aware of any semi-masticated bits of food around the stable – this may mean the horse is experiencing mouth pain.
It is then recommended that you part the horse’s upper and lower lips and look at the lateral excursion to molar contact – distract the mandible to either side and look at the point where the incisor separates. It should be symmetrical to both sides. By moving the horse’s head up and down, you can also look at the rostro-caudal mobility of the mandible and get a general idea of the temperament of the horse, Neil explained.
Other things he recommends looking for are: deviations in the nose, sharp enamel points, packing food up into buccal spaces (which can suggest it’s trying to stop ulcers in that area contacting the teeth), temporomandibular joint swelling, enlarged submandibular lymph nodes, and food in the cheeks; also, palpate the masseter muscles to feel if there is any difference between the two sides.
Going into the mouth Neil listed a minimum level of equipment that is required for an oral examination:
- A bright light source
- A syringe
- A mirror
- Some explorers
- A headstand
An incisor speculum can also be useful, as can a cheek retractor so you can show owners what’s going on.
While it can be possible to examine a horse’s mouth without sedation, explained Neil, it won’t be in every case. If you can’t see everything, you need to be honest with the owner and, if possible, have that horse sedated. If a horse has known dental problems, it’s best to insist on sedation. To do this, Neil routinely uses an alpha 2 agonist in combination with butorphanol.
Checking the incisors
It is recommended that you first inspect the incisors without a gag in place; Neil says you should:
1. Check for an overbite or overjet, or underbite.
2. Look at the occlusal surface of the incisors, checking for any pulp or exposure.
3. Count the incisors (checking for supernumerary incisors, retained deciduous dentition, or any missing incisors).
4. Check the incisors for mobility (if they are loose and mobile, the horse may not settle with a speculum).
5. Check for draining tracts, which can be apical or present on the gingival margin.
6. Check for calculus.
7. Check for diastemata between incisors.
8. Check for pulps exposed on the occlusal surface (make sure you know the difference between the infundibulum and the pulpar anatomy).
Canines and wolf teeth
By palpating the mouth, you can feel for blind wolf teeth or unerupted canines before putting a speculum on, Neil said. Once the speculum is on, he washes the mouth out and looks at the canine area, checking for fractures and palpating the bars of the mouth for blind wolf teeth. Theseare usually more rostrally or medially displaced and angled buccally, he noted.
Wash the mouth out
In diastema and periodontal disease cases, the food doesn’t come out when flushed with a hose or dental syringe, so you will still be able to see where food is packing. Without a mirror, Neil recommends looking for evidence of overgrowths, soft tissue trauma and dental fractures, and checking the angles of the teeth. Then you should palpate the teeth with your fingers or an instrument – this, he says, is the only way of assessing mobility. The occlusal surface, both margins and the interdental space should be palpated.
Using a mirror
“It is a minimum standard to use a dental mirror now in every single case,” Neil claimed. You should check the occlusal surface of every tooth. Use a systematic approach – front to back in the first quadrant, looking at the occlusal surface and interdental spaces, then go through the other quadrants.
- On the mandibular teeth, look for pulpar exposure and diastema formation.
- On the maxillary teeth, look at pulps in infandibulae, and interdental spaces.
- On the occlusal surface, look for evidence of food in the infandibulae and occlusal fissure fractures.
Using pulpar explorers is often overlooked. These should be used to test the integrity of secondary dentine over the pulp cavity, Neil said. “In mandibular teeth, this is very easy – every single black bit in the top of the tooth is pretty much going to be a pulp cavity. Just remember that in the upper cheek teeth, there’s the infandibulae in the centre.”
This can be very important in cases where the horse is showing signs of pulpitis – in those cases, Neil suggests that every tooth in that quadrant is probed. If you probe them all, you won’t miss anything. If you aren’t going to do them all, choose which to probe based on their occlusal appearance – probe pulps that are bigger and blacker than they should be or have food packing in them, Neil advises, adding that if the horse is showing clinical signs, you should probe those teeth.
Evaluate the periodontium
Ensure the mouth is as clean as possible. If the horse has very bad periodontitis, Neil advises sedation and sometimes a local anaesthetic gel. The food should be removed from the interdental spaces using double-jointed forceps and a graduated periodontal probe should be used to probe the depth of the pockets, he explained.
Document your findings. Use charts with occlusal surface anatomy on and plan the follow-up treatment.