Debra is a 21 year old Haflinger mare who had no physical complaints. As a therapeutic riding horse, her day to day physical demands are not very taxing. Nevertheless, her owners wanted the best for her and wanted to be sure that there were no underlying problems or metabolic disorders that they could be treating, so they signed her up for a senior health check. The senior horse program offered by SSEC includes a complete physical exam, ophthalmic exam, oral exam (with sedation, if necessary), complete blood screening (CBC, blood chemistry, electrolytes and fibrinogen), and metabolic screening tests (ACTH level testing for Cushing’s disease; and insulin level to test for insulin resistance), a fecal egg count, and a complete nutritional assessment and recommendations. Often senior horses have more than one problem and repeat visits become necessary (and expensive) to uncover all aspects of the underlying issues. By doing all of these items at one visit as a Senior Program, they are greatly discounted by 33%, require only one call, and it allows us to get a complete picture of the health status of the older senior horse.
Debra’s physical exam was normal, with a normal heart rate and rhythm. Her ophthalmic exam revealed abnormal pigment in the back part of her eye, the fundus. This pigment is indicative of vitamin E deficiency and suggests that further testing and/or supplementation is indicated. She was given a mild sedative to facilitate relaxation of her large cheek muscles, TMJ and jaws, and to optimize her comfort for an oral exam. Debra was offered a treat for her blood draw as she has a dislike for needles. She was noted to chew the treat oddly.
An oral was conducted under light sedation with sedation as she does not like her mouth poked and prodded. Her oral examination revealed a previously fractured, overgrown and offset lower left molar tooth # 309. (See Figures 1 and 2) This tooth was offset laterally and was digging into her cheek, creating a very large ulceration on the inside of her cheek inside her mouth. This malocclusion was most likely causing her constant discomfort as well as interfering with her ability to chew. The trainer was astonished at this finding as Debra has had once or twice a year dental care from a non-veterinary dentist as long as they have owned her. It is likely that such a finding would be missed without appropriate sedation and examination of the teeth using a full mouth speculum. We recommended that Debra have the tooth removed for comfort and to allow her to chew properly. This procedure could be done either on the farm or at the clinic. The trainer consulted with the owner and scheduled an appointment to have the removal done at the clinic.
In the meantime Debra’s blood results returned. Her metabolic panel and blood screening were normal; however, she also tested positive for Lyme disease. Her owners elected to admit her to the clinic for tooth removal and to receive a course of intravenous Oxytetracycline, as this has been shown to be the best available treatment in killing and eradicating Lyme disease from the body. Debra arrived at the clinicon a Saturday and treatment was initiated. She was given a couple days to settle in.
On Monday, Debra was given a mild sedative and local anesthesia was applied to the nerves of the left mandible (lower jaw) to numb the area so that she would not feel any pain during the procedure (much like Novocain given to people when they have a dental procedure performed). Tooth extraction in horses can be a 20 minute to a many hour long procedure depending on the disease status of the tooth, roots and surrounding soft tissues. Debra’s tooth was diseased and actually fractured towards its base, so it came out in one large fragment with a few smaller fragments (See Figure 3). After the extraction, an X-Ray was taken to make sure the entire tooth had been removed (See Figure 4). The x-ray showed evidence of a remaining tooth root fragment. Just as extensive dental procedures in people are often performed over multiple visits, we felt that Debra had had enough for that day.
Figure 3. Extracted molar.
Figure 4. Radiograph (X-Ray) showing root fragment
Extracting a tooth root fragment also takes considerable time and patience to be sure it is extracted in one piece. It was time to rest her jaw and allow the sedation and Novocain to wear off so she could eat. The area was packed with antibiotics to prevent feed material from packing into the socket. Debra did well, starting to eat almost immediately after the sedation and local anesthesia wore off.
Two days later she was again given a mild sedative and local anesthesia. The periodontal ligament surrounding the tooth root was fatigued and elevated around the tooth root using special horse dental instruments. Using a special forceps, the tooth root fragment was removed in one piece (See Figures 5 and 6).
The socket was now flushed and radiographed to ensure all pieces had been successfully removed. Complete extraction of all fragments was confirmed with a final X-ray (See Figure 7).
Figure 7. Radiograph showing complete extraction of tooth root fragment.
The socket was flushed and packed with antibiotics and dental impression material. This prevents the socket from filling in with feed material and allows the area to fill in with healthy tissue. Debra spent 2 more days at the clinic finishing up her course of IV Oxytetracycline. She was also given an anti-inflammatory to relieve any discomfort she may feel as a result of the extraction. She never skipped a beat! She ravenously ate all of her senior feed and hay – probably much easier than previously, before the tooth was extracted! She was sent home on 5 days of oral antibiotics and mouth flushes.
The packing was removed a few days later to reveal a healthy granulation bed. The cheek ulceration is completely healed and Debra is eating normally and back to her daily routine as a therapy horse.
