Equine Dentistry: Teeth Care by Specialists

Jean Llewellyn (with additional input provided by the AAEP and Todd Williams, BSc)

Horses All - March 2003

When you schedule an appointment for yourself at the dentist's office, you usually mark off a whole afternoon on your calendar. You get x-rays, receive a thorough scrutiny of each and every tooth, maybe get one or two filled. Although it seems tedious - and dentists are not always viewed as our favourite people - you know routine checkups and diagnostic examinations contribute to the overall and long-term health of your teeth. Your horse is no different. His teeth deserve practically the same care you give your own.

Perhaps the questions we should be asking is, why a newly qualified veterinarian, fresh from completing four years of college, which is not restricted to just one species, be deemed sufficiently qualified to provide the specialist care that equine dentistry demands. According to a 1997 research article, a trainee veterinarian receives less than three hours of training and no hands-on experience with a horse's teeth! (Compendium on Veterinary Education May 1997)

You wouldn't entrust the car of your own teeth to your family GP, so why is this a normal practice where your horse is concerned?

The importance of maintaining the health of your horse's mouth

• We have modified the horse's diet and eating patterns through domestication and confinement;
• We demand more from our performance horses, beginning at a younger age, than ever before;
• We often select breeding animals without regard to dental considerations.

Proper dental care has its rewards. Your horse will be more comfortable, will utilize feed more efficiently, may perform better, and may even live longer.

The horse's mouth

Horses evolved as grazing animals, and their teeth are perfectly adapted for that purpose. The forward teeth, known as incisors, function to shear off forage. The cheek teeth, including the molars and premolars with their wide, flat, graveled surfaces, easily grind the feed to a mash before it is swallowed. Like humans, horses get two sets of teeth in their lifetime. The baby teeth, also called deciduous teeth, are temporary. The first deciduous incisors may erupt before the foal is born. The last baby teeth come in when the horse is about eight months of age. These teeth begin to be replaced by adult teeth around age two-and-a-half years. By age five, most horses have their full complement of permanent teeth. An adult male horse has 40 permanent teeth. A mare may have between 36 to 40, because mares are less likely to have canine (bridle) teeth.

The following list shows the approximate age at which different teeth erupt. By referring to it, you may detect potential abnormalities of your own horse associated with teething.

Deciduous (Baby Teeth)

• 1st incisors (centrals): Birth or 1st week
• 2nd incisors (intermediates): 4 to 6 weeks
• 3rd incisors (corners): 6 to 9 months
• 1st, 2nd, and 3rd premolars (cheek teeth): Birth or first two weeks for all premolar

• 1st incisors (centrals): 2 1/2 years
• 2nd incisors (intermediates): 3 1/2 years
• 3rd incisors (corners): 4 1/2 years
• Canines (bridle): 4 to 5 years
• Wolf teeth (1st premolars): 5 to 6 months
• 2nd premolars (1st cheek teeth): 2 1/2 years
• 3rd premolars (2nd cheek teeth): 3 years
• 4th premolars (3rd cheek teeth): 4 years
• 1st molars (4th cheek teeth): 9 to 12 months
• 2nd molars (5th cheek teeth): 2 years
• 3rd molars (6th cheek teeth): 3 1/2 - 4 years

Common dental problems

• sharp enamel points forming on cheek teeth, causing lacerations of cheeks and tongue;
• retained caps (deciduous teeth that are not shed);
• discomfort caused by bit contact with the wolf teeth;
• hooks forming on the upper and lower cheek teeth;
• long and/or sharp canine (bridle) teeth interfering with the insertion or removal of the bit;
• lost and/or broken teeth;
• abnormal or uneven bite planes;
• excessively worn teeth;
• abnormally long teeth;
• infected teeth and/or gums;
• misalignment/poor apposition (can be due to congenital defects or injury);
• periodontal (gum) disease.

Recognizing dental problems

Horses with dental problems may show obvious signs, such as pain or irritation, or they may show no noticeable signs at all. That is due to the fact that some horses simply adapt to their discomfort. For this reason, periodic dental examinations are essential. Indicators of dental problems include:

• loss of feed from mouth while eating, difficulty with chewing, or excessive salivation.
• loss of body condition;
• large or undigested feed particles (long stems or whole grain) in manure;
• head tilting or tossing, bit chewing, tongue lolling, fighting the bit or resisting bridling;
• poor performance, such as lugging on the bridle, failing to turn or stop, even bucking;
• foul odour from mouth or nostrils, or traces of blood from the mouth;
  nasal discharge or swelling of the face, jaw, or mouth tissues.

Oral exams should be an essential part of an annual physical examination by a veterinarian. Every dental exam provides the opportunity to perform routine preventative dental maintenance. The end result is a healthier, more comfortable horse.

Floating and preventative maintenance

The process of rasping or filing a horse’s teeth is known as floating. This is the most common dental procedure veterinarians perform on horses. Floating removes sharp enamel points and can create a more even bite plane. It also helps keep incisors and cheek teeth at a desirable length. When turned out on pasture, horses browse almost continuously, picking up dirt and grit in the process. This, plus the silicate in grass, wears down the teeth. Stabled horses, however, may not give their teeth the same workout. Feedings are more apt to be scheduled, not continuous, and to include processed grains and hays. Softer feeds require less chewing. This may allow the horses teeth to become excessively long or to wear unevenly. Adult horse’s teeth erupt throughout their life and are worn off by chewing. Unfortunately, cheek teeth tend to develop sharp enamel points even under normal grazing conditions. Because the horse’s lower jaw is narrower than its upper jaw and the horse grinds its feed with a sideways motion, sharp points tend to form along the edges. Points form on the cheek side of the upper teeth and the tongue side of the lower teeth. These points should be rasped to prevent them from cutting the cheeks and tongue.

Floating is especially important in horses who have lost a tooth, or whose teeth are in poor apposition and do not fit together well. Normally, contact with the apposing tooth keeps biting surfaces equal. When cheek teeth are out of alignment, hooks can form. If left unchecked, these hooks can become long enough to penetrate the hard or soft palate. Small hooks can be removed by floating. Longer hooks are usually removed with molar cutters or a dental chisel.

Wolf teeth

Wolf teeth are very small teeth located in front of the second premolar and do not have long roots that set them firmly in the jaw bone. They rarely appear in the lower jaw. A horse may have one, two or no wolf teeth. While not all wolf teeth are troublesome, veterinarians routinely remove them to prevent pain or interference from a bit.

The age factor

The age of a horse affects the degree of attention and frequency of dental care required. Consider these points:

• Horses going into training for the first time, especially two- and three-year-olds, need a comprehensive dental check-up. Teeth should be floated to remove any sharp points and checked for retained caps. Caps should be removed if they have not been shed. This should be done before training begins to prevent training problems related to sharp teeth.
• Even yearlings have been found to have enamel points sharp enough to damage cheek and tongue tissue. Floating may improve feed efficiency and make them more comfortable.
• Horses aged two to five years may require frequent dental exams than older horses. Deciduous teeth tend to be softer than permanent teeth and may develop sharp enamel points more quickly. Also, there is an extraordinary amount of dental maturation during this period. Twenty-four teeth will be shed and replaced during this time, with the potential for 12 to 16 teeth to be erupting simultaneously. Horses in this age group should be examined twice yearly, and any necessary procedures should be performed.
• Even the best dental program may not be able to solve or alleviate all of a young horse’s teething discomfort.
• Mature horses should get a thorough dental examination at least once a year, whether or not there are signs of tooth problems.
• It is important to maintain an even bite plane during a horse’s middle teens in order to ensure a level grinding surface into its 20s. If you wait until the horse is in its 20s, the surfaces may be worn excessively and/or unevenly, and since the teeth are longer erupting at this age, alignment may be impossible.

Developing greater awareness

• If a horse starts behaving abnormally, dental problems should be considered as a potential cause.
• Teeth should be floated and maintained as indicated by an annual examination performed by an equine practitioner.
• Wolf teeth are routinely extracted from performance horses to prevent interference with the bit and its associated pain.
• Sedatives, local anesthetics, and analgesics can relax the horse and keep it more comfortable during floating and other dental procedures. Such drugs should be administered only by a veterinarian.
• Loose teeth are generally unhealthy teeth. If your equine practitioner finds a loose tooth, he or she will likely extract it. This reduces the chance of infection or other problems.
• Canine teeth, generally present in mature geldings and stallions and sometimes mares, are usually clipped and filed smooth to prevent interference with the bit. This also reduces the possibility of injury to both horse and human.
• Depending on the condition of your horse’s teeth, more than one visit from your equine practitioner may be required to get the mouth in prime working order.
• It is important to catch dental problems early. Waiting too long may increase the difficulty of remedying certain conditions or may even make remedy impossible.
• Older horses should have their teeth checked at least twice yearly.

More serious dental ailments

Serious dental conditions can develop, such as infections of the teeth and gums, extremely long hooks on the molars, lost or fractured teeth, and others. These conditions may require surgical treatment and/or extraction by a veterinarian. Your equine practitioner can recommend the best treatment.

Equine dentists vs. Veterinarians

Throughout this article, you will have noticed that there are numerous references to ‘veterinarians’ for consultation, diagnostics, treatment, and maintenance of your horse’s teeth and mouth. I would, however, ask you to recall the opening sentences. Like human dentistry, equines too require specialist knowledge. The question is, can such a professional service be offered by someone other than a licensed veterinarian? The answer, according to Todd Williams BSc, himself a practicing, ‘uncertified’ equine dentist since the early 90s not only does he perform a valuable and specialist service, he is supported professionally by veterinarians who have themselves recognized that his role is both integral and vital. In fact, Todd works side-by-side with a number of veterinary practitioners because his ‘unofficial’ status does not allow him, by law, to administer routine sedatives to horses who otherwise may be difficult to handle. “Effective and proper practice of equine dentistry has always involved specialized skill and training, as well as aptitude. In 1990 when I started working full time in the field of equine dentistry it was considered by most if not all veterinarians to be beneath their skill level and their presumed high status to do such work. Very little was known as to how the mouth worked and how teeth could be worked to establish the best situation on a long-term basis for horses. Equipment was lacking, most veterinary clinics did not own a reliable mouth speculum. This is a device that holds a horses mouth open so that dental work can be done. Rasps were rudimentary and usually in poor repair, and the skills to operate them effectively were non-existent. Many horses getting teeth rasped without regard to what was being accomplished and only the ‘sharp stuff knocked.’ Some veterinarians were using a single ‘tool’ called a ‘Thompson Universal Float’ to supposedly work the whole mouth of a horse. This is a notion that is similar to taking your truck to a mechanic who only uses one adjustable wrench for every moving part! Horse teeth were very poorly treated and poorly understood.

“I still have a letter from a client who, in the early 1990s, owned a horse named Mucho Question Mark, a Quarter Horse that was shown quite extensively and was always difficult to keep weight on. The owner had, within a three- or four-month period, taken the horse to two equine veterinary clinics in the Calgary area and had Muchos' teeth filed, thinking that the problem was the horse's teeth. This did nothing for the horse, but it did cost the owner some money. On examining Mucho I discovered that both of the veterinary treatments had filed some of the sharp points off the horses grinding teeth, but had done nothing to alleviate the four large ramps or hooks that were slowly and insidiously protruding into the flesh of the opposite jaw.

"We contacted a veterinarian in Cochrane who agreed to sedate the horse so that we could remove overgrown and unopposed teeth, and then adjust the incisors of the horse so that he could actually get his feed chewed small enough to swallow. Not surprisingly, Mucho made a rapid recovery and was soon in top shape with less feed consumption and better attitude about his work. This type of story has been repeated thousands of times over the last 1 years. The problem is that there is so little understanding for the horse and what its real needs are. The response to my work and the work of other non-veterinarian horse dentists from the veterinary community has been varied. Some veterinarians' egos have been completely shattered by the fact that a non-veterinarian has been working on horse teeth. They consider this area their exclusive domain. Other veterinarians have spent some time medicating horses for me to work on and now consider themselves as fully competent in the field. I guess this is learning by osmosis. Still other veterinarians consider hose dentists to be a valuable asset to the horses that they care for and use the services of non-veterinarians as consultants and or resource people.

"A recent court case involving a non-veterinarian who works on horse teeth and the Alberta Veterinary Medical Association resulted in a court decision that horse dentistry is not a practice of 'veterinary medicine' in Alberta. The court very definitely indicated that they are defined by legislation. Equine dentistry is not a part of the legislation. This decision also allows other people who provide health related services to animals to continue their work. Animal owners in Alberta currently have the right to choose how their animals are treated and by whom. This ruling is clearly a victory for animal owners who are enlightened and desire other health care options for their animals and pets."

Yet, it appears, that in some countries the veterinary profession is trying to outlaw 'alternative' practitioners in the animal sciences; not only equine dentists, but also herbalists, acupuncturists, behavioural psychologists, holistic healers ... etc. In actual fact, 'out-law' is perhaps not the right word because, apparently, what the veterinary profession would like to see happen, is that vets and only vets are permitted to make decisions about animal treatments. Currently, it's the Alberta Veterinary Medical Association (AVMA) that regulates the professional activities of all Alberta veterinarians, and supposedly determines the required competencies for veterinarians to safely perform equine dental services in this province. This must be difficult for them in light of the small amount of education that they receive in Veterinary School. In fact not veterinarian in Alberta has ben given a practical or even a theoretical exam on their ability to correct horse dental issues and provide treatments.

One would have to ask again the question "does your gynecologist or proctologist fix your teeth?" Being qualified and licensed to administer drugs does not necessary equal competence to treat horse teeth.