Equine DentistryEquine Dentistry
ByBy Dr. Marty Langhofer DVM.Dr. Marty Langhofer DVM.
PATDPATD
Equine Dental Equine Dental ExaminationExamination
Tooth IdentificationTooth Identification
Clinical Equine Anatomy and Common Diseases of the Horse. Reigel and Hakola. Equistar Publications
Biomechanics of ChewingBiomechanics of Chewing
15 Degree Angles15 Degree Angles
Malocclusions & Malocclusions & PathologyPathology
Foxtails \ Foreign BodiesFoxtails \ Foreign Bodies
Dental EquipmentDental Equipment
Power GrindersPower Grinders Extraction ToolsExtraction Tools
Hand FloatsHand Floats SpeculumSpeculum
Equine Equine StocksStocks
Mouth SpeculumMouth Speculum
Veterinary Dental Products – Flexi-Float
TreatmentsTreatments
Dental IdentificationDental Identification
Bit SeatingBit Seating
Placement and MechanicsPlacement and Mechanics
Three Point BalanceThree Point Balance
Clinical Equine Anatomy and Common Diseases of the Horse. Reigel and Hakola. Equistar Publications
Nerve Blocks / Analgesics Nerve Blocks / Analgesics
Nerves and Blood VesselsNerves and Blood Vessels
Clinical Equine Anatomy and Common Diseases of the Horse. Reigel and Hakola. Equistar Publications
Clinical Equine Anatomy and Common Diseases of the Horse. Reigel and Hakola. Equistar Publications
Wolf TeethWolf Teeth
Do Equine use their Do Equine use their wolf teeth to fight off wolf teeth to fight off other animals?other animals?
Dental AnalgesiaDental Analgesia
Clinical Equine Anatomy and Common Diseases of the Horse. Reigel and Hakola. Equistar Publications
Clinical Equine Anatomy and Common Diseases of the Horse. Reigel and Hakola. Equistar Publications
Equine Dental CapsEquine Dental Caps
Retained CapsRetained Caps
Decidvous TeethDecidvous Teeth
Equine Dental CapsEquine Dental Caps
At what age do caps fall At what age do caps fall off horses teeth?off horses teeth? (A)(A) 6 months, 12 months, 6 months, 12 months,
18 months18 months (B)(B) 24 months, 24 months,
28months, 30 months28months, 30 months (C)(C) 3 years, 4 years, 3 years, 4 years,
5 years5 years (D)(D) 2 years 8 2 years 8
months, 2 years months, 2 years 10 months, 3 10 months, 3 years 8 months years 8 months (also depends (also depends on breed of on breed of horse)horse)
Clinical Equine Anatomy and Common Diseases of the Horse. Reigel and Hakola. Equistar Publications
Equine Dentistry, 2nd edition. Gordon J. Baker and Jack Easley. Printed with Permission.
Equine Dentistry, 2nd edition. Gordon J. Baker and Jack Easley. Printed with Permission.
Dental Cavities and Dental Cavities and FillingsFillings
Dental ExtractionsDental Extractions
Extraction TechniqueExtraction Technique
Periosteal elevatorsPeriosteal elevators Tooth spreaders-allow clot to begin formingTooth spreaders-allow clot to begin forming Apply extractors-rock, rock, rock side to sideApply extractors-rock, rock, rock side to side Wait, wait, waitWait, wait, wait Resume rocking then wait, wait, waitResume rocking then wait, wait, wait Resume rocking then wait, wait, waitResume rocking then wait, wait, wait Dental fulcrumDental fulcrum
Extraction TechniqueExtraction Technique ExtractionExtraction Pack off alveolus to control bleeding with saline soaked gauzePack off alveolus to control bleeding with saline soaked gauze Pull packPull pack Instill Bio-cell or Gel-foam in socketInstill Bio-cell or Gel-foam in socket Add antibiotics (SMZ-TMP, metronidazole, Biotene oral gel)Add antibiotics (SMZ-TMP, metronidazole, Biotene oral gel) Seal with dental wax or STAT-soft acrylicSeal with dental wax or STAT-soft acrylic Pull STAT plug in 7 daysPull STAT plug in 7 days
AlternativeAlternative Flush alveoli socket daily with Chlorhexidine gluconate dilute solutionFlush alveoli socket daily with Chlorhexidine gluconate dilute solution Then seal with Bio-cellThen seal with Bio-cell
NOTE: Gel-foam may be a holding place for bacteriaNOTE: Gel-foam may be a holding place for bacteria
Control BleedingControl Bleeding Pack with wet saline gauzePack with wet saline gauze Gel Foam (Pfizer)/Bio-stat (A/cell)Gel Foam (Pfizer)/Bio-stat (A/cell) Dental wax/ STAT-dental impression acrylicDental wax/ STAT-dental impression acrylic
Electrocautery Electrocautery
Daily dental packsDaily dental packs
Surgical-oxidized regenerated methylcellulose (binds platelets and Surgical-oxidized regenerated methylcellulose (binds platelets and releases fibrin) (Surgicel-Johnson and Johnson)releases fibrin) (Surgicel-Johnson and Johnson)
Topical thrombin (Thrombostate, Pfizer) saturate with Gel-foamTopical thrombin (Thrombostate, Pfizer) saturate with Gel-foam
Microfiber collagen (Avitene, Dacroln) either colluplug or collatape (Sulzer Microfiber collagen (Avitene, Dacroln) either colluplug or collatape (Sulzer Calcitek)Calcitek)
Dental hemostatic powder/pasteDental hemostatic powder/paste
Problems with ClottingProblems with Clotting
Salivary enzymesSalivary enzymes Clot dislodgment with tongue/chewing motionsClot dislodgment with tongue/chewing motions Bleeding disordersBleeding disorders Liver or kidney diseaseLiver or kidney disease DrugsDrugs
Aspirin-platelet interferenceAspirin-platelet interference Antibiotics-decreased Vitamin K productionAntibiotics-decreased Vitamin K production AnticoagulantsAnticoagulants Alcohol/mycotoxins-causes hepatopathyAlcohol/mycotoxins-causes hepatopathy
HypertensionHypertension
Healing Process of Healing Process of ExtractionExtraction ExtractionExtraction Blood flow from alveolar bone and gingivaBlood flow from alveolar bone and gingiva Blood clot formationBlood clot formation
Forms barrier to debris, food, irritants, bacteriaForms barrier to debris, food, irritants, bacteria Forms a supporting structure for granulation tissue Forms a supporting structure for granulation tissue
Local tissue damage from extraction siteLocal tissue damage from extraction site Evokes an inflammatory reaction Evokes an inflammatory reaction local expansion local expansion
of blood vesselsof blood vessels WBC’s and fibroblasts invade the connective tissue WBC’s and fibroblasts invade the connective tissue
at the alveolus until granulation tissue is formedat the alveolus until granulation tissue is formed Leukocytes digest the blood clot as granulation Leukocytes digest the blood clot as granulation
tissue is formedtissue is formed
Healing Process of Healing Process of ExtractionExtraction Bone is layed down by osteoblastsBone is layed down by osteoblasts Coarse, trabecular, and compact bone is Coarse, trabecular, and compact bone is
used in bone remodelingused in bone remodeling
After ExtractionAfter Extraction
Pain medication (bone)Pain medication (bone) AugenalAugenal BenzocaineBenzocaine NSAIDS such as phenylbutazone and banamineNSAIDS such as phenylbutazone and banamine
AntimicrobialsAntimicrobials Iodofoam packing gauzeIodofoam packing gauze Aluyjel (Septodont)-a fibrous productAluyjel (Septodont)-a fibrous product Biotene oral gel (A/cell)-enzyme that releases iodine and Biotene oral gel (A/cell)-enzyme that releases iodine and
lactoferrinlactoferrin Calcium sulfate (plaster of paris) antibiotic plugsCalcium sulfate (plaster of paris) antibiotic plugs
SMZ-TMPSMZ-TMP MetronidazoleMetronidazole AmikacinAmikacin
Complications with Complications with ExtractionsExtractions 50% of extractions have complications50% of extractions have complications X-Rays should be taken before ALL extractionsX-Rays should be taken before ALL extractions Improper extraction toolsImproper extraction tools
Dental ElevationsDental Elevations Extraction ToolsExtraction Tools
Molar, incisor, canine, wolf teeth-long thin blade screw Molar, incisor, canine, wolf teeth-long thin blade screw driver, trephines (Michelle and Mallet) and assorted dental driver, trephines (Michelle and Mallet) and assorted dental punchespunches
Strong peridental supporting structuresStrong peridental supporting structures
Complications with Complications with ExtractionsExtractions Abnormal root morphology-divergent, hooked, Abnormal root morphology-divergent, hooked,
locked, ankylosed, germinated, misshaped, locked, ankylosed, germinated, misshaped, tumors of the toothtumors of the tooth
Hypercementotic teethHypercementotic teeth Teeth that are weakened (eg-dental decay that Teeth that are weakened (eg-dental decay that
has been repaired)has been repaired) Teeth with abfraction or deep cariesTeeth with abfraction or deep caries Desiccated teeth or brittle teeth associated with Desiccated teeth or brittle teeth associated with
endodonic treatmentendodonic treatment Patients with inflammatory disorders Patients with inflammatory disorders
associated with alveolar bone disease or associated with alveolar bone disease or Cushing’s diseaseCushing’s disease
Complications with Complications with ExtractionsExtractions
Patients with limited opening or trismus (lock jaw)Patients with limited opening or trismus (lock jaw) Oro-sinal fistulaOro-sinal fistula Broken off root tipsBroken off root tips Fractured boneFractured bone Invasion into sphenoid bone-possible bacterial Invasion into sphenoid bone-possible bacterial
meningioencephalitismeningioencephalitis Sepsis systemicallySepsis systemically Dry socket or non-healing socketDry socket or non-healing socket SinusitisSinusitis PainPain BleedingBleeding
Factors causing a Dry or Factors causing a Dry or Non-Healing ExtractionNon-Healing Extraction Exzyme fibrinolytic productionExzyme fibrinolytic production Alveolar infectionAlveolar infection
Especially anaerobes, but can be aerobesEspecially anaerobes, but can be aerobes StreptococcusStreptococcus FusospiralFusospiral TreponemaTreponema BacteroidsBacteroids
Immunocompromised patientImmunocompromised patient Systemic diseaseSystemic disease
Treatment of a Non-Treatment of a Non-Healing SiteHealing Site
Betadine flushBetadine flush Chlorhexidine gluconateChlorhexidine gluconate Antibiotic tablets or calcium sulfate antibiotic plugs –Antibiotic tablets or calcium sulfate antibiotic plugs – SMZ/TMP + metronidazole SMZ/TMP + metronidazole Tetracycline PO or IVTetracycline PO or IV ClindamycinClindamycin
Mix capsule with calcium sulfate or gelfoam (drug of choice for Mix capsule with calcium sulfate or gelfoam (drug of choice for anaerobes) anaerobes)
Soak gauze with Clindamycin mixure and fill in alveolar socketSoak gauze with Clindamycin mixure and fill in alveolar socket Open caspules and place in alveolar socketOpen caspules and place in alveolar socket
Look for systemic diseaseLook for systemic disease
EndodonticsEndodontics
Periodontal diseasePeriodontal disease
Presence of disease Presence of disease and loss of tissue and loss of tissue structures around the structures around the tooth.tooth.
IncidenceIncidence
40 % prevalence in 3 to 5 year olds40 % prevalence in 3 to 5 year olds Eruption of permanent dentitionEruption of permanent dentition
Decreased incidence in 5 to 10 year olds.Decreased incidence in 5 to 10 year olds.
60 % in horses > 1560 % in horses > 15
Anatomy and FunctionAnatomy and Function Teeth are attached to the alveolus by bundles of Teeth are attached to the alveolus by bundles of
connective tissue.connective tissue. Periodontal membrane or ligamentPeriodontal membrane or ligament Collagen fibers attach cement covering to the boneCollagen fibers attach cement covering to the bone
Embedded portions known as sharpey’s fibersEmbedded portions known as sharpey’s fibers
Fiber transfer occlusal forces to longitudinal forces along the tooth Supports the nerves and blood vessels from
occlusal forces Tooth suspended in the alveolus but has
slight movement
Anatomy and FunctionAnatomy and Function
Gingiva attached to periosteum with Gingiva attached to periosteum with dense fibrous CT.dense fibrous CT.
Portion of the gingiva adjacent to the Portion of the gingiva adjacent to the tooth is the gingival sulcus.tooth is the gingival sulcus.
This adheres to the tooth by surface This adheres to the tooth by surface tension.tension.
If the sulcus develops periodontal If the sulcus develops periodontal disease it is called a perio(dontal) pocket.disease it is called a perio(dontal) pocket.
Signs of periodontal diseaseSigns of periodontal diseasefour categoriesfour categories 1 local gingivitis with hyperemia and 1 local gingivitis with hyperemia and
edemaedema Erosion of gingival margin 5mm and Erosion of gingival margin 5mm and
periodontal pocketperiodontal pocket Periodontitis with gum lossPeriodontitis with gum loss Gross periodontal pocketing, lysis of Gross periodontal pocketing, lysis of
alveolar bone, loosening of bone supportalveolar bone, loosening of bone support
EtiologyEtiology
MultifactoralMultifactoral Abnormalities of wear (malocclusions).Abnormalities of wear (malocclusions). Tooth eruptionTooth eruption Plaque deposition (salivary glycoproteins + Plaque deposition (salivary glycoproteins +
bacteria + inorganic minerals from feed.bacteria + inorganic minerals from feed. Chronic oral bleedingChronic oral bleeding
tartar, perio, ulcers all secondary to tartar, perio, ulcers all secondary to exaggerated ridgesexaggerated ridges
5 yr QH
Pathology of PeriodontitisPathology of Periodontitis
HyperemiaTooth loss
Plaque build up
Edema
Loss of supporttissue
Bone loss
inflammation
TreatmentTreatment
Eliminate the malocclusion Eliminate the malocclusion Remove tartarRemove tartar Eliminate or minimize the pocketEliminate or minimize the pocket Eliminate or reduce occlusion at siteEliminate or reduce occlusion at site Open up space between teeth if Open up space between teeth if
pocketing involves entire spacepocketing involves entire space ExtractionExtraction
TreatmentTreatment PowerfloatPowerfloat
Grind off the side of affected tooth with wheelGrind off the side of affected tooth with wheel Flush mouth twice daily chlorhezidineFlush mouth twice daily chlorhezidine CheapCheap
Air abrasion Clean pocket with bicarbonate of soda
Fill with doxyrobe gel (pfizer-pharmacia) Apply impression material Expensive
Identification of Pulp Identification of Pulp Cavities and MeasurmentsCavities and Measurments #1 Pulp cavity measurements are 5-7mm #1 Pulp cavity measurements are 5-7mm
from the interdigital edge of opposing from the interdigital edge of opposing teeth (Dr. Rugby- West Virginia, USA)teeth (Dr. Rugby- West Virginia, USA)
Tartar removalTartar removal
Buccal perio pocketsBuccal perio pockets107/8 8/9 207/8 8/9107/8 8/9 207/8 8/9
Buccal perio pocketsBuccal perio pockets107/8 8/9 207/8 8/9107/8 8/9 207/8 8/9
Perio pocket 406/7Perio pocket 406/7
Perio pocketPerio pocket
Thru and thru perio Thru and thru perio pocketpocket Food material packed between two teeth Food material packed between two teeth
from medial to lateral sidesfrom medial to lateral sides Gingival erosion and odorGingival erosion and odor Visible crevice between teeth (usually)Visible crevice between teeth (usually) Tooth may be looseTooth may be loose
Perio pocketsPerio pockets
•Food packed between206/7 7/8 8/9•All teeth firm
Advanced perioAdvanced perio•Food packed either side of 207•Tooth loose•Should be extracted•Minimal gum attachment •Food frequently packed above & under the attached gum
Powerfloat burrsPowerfloat burrs
Diastema treatmentDiastema treatment
Diastema TreatmentDiastema Treatment
Perio pocket after openingPerio pocket after opening
•Minimal bleeding•Local not used•Pack w/ metronidazole tabs•Flushed twice daily with chlorhexidine•Healing in 10-14 days
Advanced perioAdvanced perio
Diastema treatmentDiastema treatment
•Low speed to prevent heat buildup•Remove gloves—apply chlorhexidine 5% teat dip full strength to area
Diastema treatmentDiastema treatment
26 year old mare26 year old mare5 perio diastemata5 perio diastemata
106/107 107/108 burred open106/107 107/108 burred openimmediate post treatmentimmediate post treatment
Two months laterTwo months later
Perio pocket 207/8Perio pocket 207/8
Two months post Two months post treatmenttreatment
Exaggerated ridge probably Exaggerated ridge probably contributed to this perio pocketcontributed to this perio pocket
Diastema burringDiastema burring
The treatment has been criticized as The treatment has been criticized as potentially damaging to;potentially damaging to;
the periodontal ligamentthe periodontal ligament gum tissuegum tissue tooth tooth possibly opening a pulp cavity from the possibly opening a pulp cavity from the
side. side.
Diastema burringDiastema burring
The burr does not remove any tooth below the The burr does not remove any tooth below the level of the top of alveolar bone.level of the top of alveolar bone.
The pulp cavity does not extend above the The pulp cavity does not extend above the level of alveolar bone.level of alveolar bone.
There is already loss of interproximal tooth There is already loss of interproximal tooth material, (cementum); the burr removes only material, (cementum); the burr removes only 1-2 mm more from each tooth. 1-2 mm more from each tooth.
Regeneration of healthy gum and solidification Regeneration of healthy gum and solidification of the tooth within the alveolus occurs within of the tooth within the alveolus occurs within weeks.weeks.
Diastema treatmentDiastema treatment
•Chlorhexidine soln
•Flush mouth twice daily for 7 10 days
•Oral antibiotics +/-