Equine dentist visit - peripheral caries and EOTRH in horses

On Friday the horses had a dentist day! 🦷 It's been just over 6 months since they were last done, so it was definitely needed. I know some people still think that once a year is enough, but a lot of things can go badly wrong in that time which is why we have been doing bi-annual check ups for the last 7+ years. It might be more expensive but I think having the peace of mind that my horses have healthy teeth is worth it.

After the last disaster of a visit with a different vet, this time I spent a good few hours on the different Facebook local horsey groups and looking through posts to find a really good equine dentist/dental vet. A name which kept popping up with ridiculously good reviews was Pete Ravenhill BVSc, CertEM(StudMed), BAEDT, MRCVS who is an equine dental vet at B&W Equine Vets. The reason why we wanted to get Pete to do our horses is because he has a 100% equine dentistry caseload, split between routine and advanced cases, and he also teaches equine dentistry to vets and EDT’s, both on courses and in daily practice. He is a founder committee member of EVDA (Equine Veterinary Dental Association) and his special interests are periodontal disease, minimally invasive extraction techniques and restorative dentistry. So a proper specialist who knows his stuff!

Vallu, Erik and Melisse all got okayish reviews. Erik and Melisse have both got a chipped tooth (looks like a very old chip in both) but all three had peripheral caries. Dental caries are defined as “decalcification of calcified dental tissues by microbial acids, with resultant microbial destruction of the organic matrix" which in layman’s terms is that they are cavities/areas of tooth decay. Caries is the destruction of dental tissue by bacteria in the mouth, in a similar manner to people.  Most horses have peripheral caries, and peripheral caries rarely cause any problems. Commonly you see peripheral caries in horses leading to other dental problems and there could be a link between dental caries and diastema formation (gap between teeth) and associated gum disease, and as I want to prevent this leading to any of them getting a diastema, they are all going on a very low sugar diet as well as using Hexarinse twice weekly to help keep it clean 🧼
 

Vallu's teeth

I've known that Vallu hasn't got the best teeth since 2015 when by chance managed to get a time with a really good dentist who spotted and explained how "not great" his teeth are. He gets quite sharp enamel points and excessive transverse ridges (ETR) and has a wave complex. These were all reduced as required (less than the vet would have liked to but this was to ensure no damage to the pulps) and will be further sorted in 6 months time. One of the signs on ETR in horses is that the horse feels tight and resists working in an outline and open their mouth whist being ridden. This is why I think 6 month check ups are the best, because imagine how bad the peripheral caries/ETR/sharp enamel points could have got if they'd had another 6 months without anything changing!

Unfortunately my mum's horse Rama has been confirmed to have EOTRH - which is Equine Odontoclastic Tooth Resorption and Hypercementosis. We had a feeling it might be this, but it sucks to have it confirmed 😩 EOTRH is a syndrome in horses that results in resorptive lesions of the incisors and canine teeth. As the disease progresses, the roots of multiple teeth begin to resorb  and the body tries to stabilise these teeth by laying down extra cementum, resulting in bulbous swellings around the roots of affected teeth (hypercementosis). These teeth become infected, may loosen or even fracture. EOTRH is a slowly progressive disease, and it is unknown at this point what the trigger is that starts the process and as it was with Rama the process actually begins well before owners and vets first start to recognise the signs. Most commonly it is a condition of older horses (15+), though from my research on it there have been cases in horses as young as 10-13. While this syndrome has probably existed for many years, it's only recently been properly identified and named. Diagnosis is typically made through looking at all the symptoms and the horse's teeth and then X-rays of their teeth to confirm it. This is the only way to know definitively how many teeth are affected, and how severe it is.  Many older horses are stoic, and don’t always exhibit obvious outward signs of oral pain until the clinical disease has progressed. Rama hasn't stopped eating and he hasn't shown any signs of discomfort, but when you looked at photos of horses with confirmed EOTRH his were similar. I'm sharing his journey, operation and recovery with you all so that if there is anyone going through this, they can know that they aren't alone.

So the treatment for EOTRH? Extraction of affected teeth is the recommended treatment and there is no cure for it. Horses with advanced disease may require extraction of all teeth, but Rama is only losing five teeth all together. He needs painkillers, antibiotics and rest after the op, but the vet was very optimistic about it all. Following the extractions,  horses can easily continue to eat hay and even graze as their lips take over the function of tearing off grass, and by watching them eat, you’d never know their incisors are missing. Horses that have undergone tooth extractions are typically completely healed between 4-6 weeks - but usually feel much better within days after extraction. Riding can be resumed after a few weeks of rest and a lot of owners have reported their horses getting their sparkle back after the op, so that's what we're doing next! Wish us luck 🤞🏻