Tag Archive | equine dentistry

A Canine Switch

So Biz and I headed back up to the clinic on Monday to see about having two of his canine teeth removed, as they seemed to be causing him a lot of pain. After further consulting, we decided to try continuing the daily painkiller for awhile and then extract later if it is still needed.

If you are newer to this blog, you may not know that Biz has EOTRH, more officially known as equine odontoclastic tooth resorption and hypercementosis disease.  In very simplistic terms, it is kind of like osteoporosis of the teeth. The tooth root begins to break down and get spongy (the tooth resorption), and then the body tries to strengthen the weakening root by creating a ball of “cement” (the hypercementosis) around the damaged root.  The ball of cement presses on the gums, causing pain.  Not to mention the teeth become loose, and can eventually just break off either at or below the gumline.  More pain.  Interestingly, people and cats get their own version of this disease.  Something to look forward to!

Although it isn’t a new disease, it has become much more recently studied in horses, because, in the past horses didn’t live long enough for it to matter.  They died of something far more usual (colic, laminitis, etc.) long before some vet ever started poking around much in their mouths…  Horses are living longer, more leisurely lives, just like people, and now the diseases of old horses are becoming more common.

Biz is 30; considered an old horse.  Domestic horses, like people, have a wide variation in longevity, and most statistics point to an average lifespan of 25-30 years.  He has had 9 of his 12 incisors pulled already, and his canine teeth are now affected.  One canine had already broken off at the gumline sometime in the last year and healed over on its own.  That left three canines…  Two of these canines were the ones that we were eyeing for potential extraction today.

After we decided to go with the more conservative daily painkiller approach, the vets then went to do a routine float on his molars and cheek teeth, and get rid of a sharp edge on the one canine that seemed to not be a problem.  “Floating” a horse’s teeth is the process of filing down the sharp edges to keep them from pinching or poking the horse’s cheeks and gums.  The process of chewing hay and grass just naturally creates these sharp edges over time, as the teeth wear unevenly.  This too, can cause pain.  Most of the time anymore, floating is done with a power tool in the horse’s mouth. Biz LOVES this, I can assure you!  (that was pure sarcasm, in case it wasn’t obvious…)

Well, filing down that sharp edge on that one canine tooth (the one that had seemed to be the most stable), caused it to break off from the vibration of the floating tool.  It was immediately apparent that it was just suddenly very loose, and ended up having to be removed. A quick pull with a pliers and the entire crown of the tooth came out.  The root was left in, in the hopes that the gum will just heal over it.  This same thing actually happened with his other upper canine, and Biz is a great healer, so fingers crossed.

We are hoping that perhaps that upper canine, or the sharp edges on his molars and cheek teeth, might have been causing at least some of the pain that has made him so reactive lately.  And that solving those problems will make the daily painkiller work well for him, or even be unnecessary.  Sadly, Biz never did learn his words, and doesn’t even have fingers to point to a particular spot and say, “that’s where it hurts.”  He’s a prey animal, and prey animals instinctually hide pain…  And even worse, he HATES having his mouth messed with on his best day, so he’s always more inclined to act like it hurts EVERYWHERE!  Hopefully, we will know more over the next couple weeks, as he heals from today.

 

Biz, looking regal before the sedative…

 

So, in true Biz fashion, he lost the canine they didn’t plan to extract today, and kept the other two. He can’t ever just do the expected…  Touche’ Biz… You never can seem to stick to a plan…

How to Pull a Canine…

Biz’s canine tooth extraction surgery is coming up.  We postponed it a couple weeks ago after finding out the issue was not with his incisors, in order to give the vet some time to consult with specialists.  Said consulting has been done.  Monday morning, we are traveling back to the clinic to give it a go.  They will start with his lower right canine.  And ugh, it sounds awful…

When the vet called Friday to explain what he had found out about the procedure and how to best do it, “bone grinding tool, levering against jawbone, and risk if ligament has calcified” were phrases used…  Yuck.  I asked all my questions and he offered the option of having the extractions done by the dental specialist, but that involves either waiting longer until she will be in the area, or traveling two hours south.  Trailering Biz two hours south into the big city and its horrendous traffic doesn’t sound like a good time for a 30 year old man…  So we are going to give it a go at home.

Basically, they will cut off the crown of the tooth (the part above the gumline), then grind away a portion of the jawbone to expose the root to make it easier to access and extract.  This, although it sounds terrible, is the better way to go because it reduces the pressure on the jawbone that occurs when they have to lever against it trying to loosen the tooth.  Hopefully, the ligament that is holding the tooth below is still relatively healthy, and has not calcified, because that bony calcification makes it harder to remove the root.

If, and this is a big if, he is tolerant and the extraction of the right lower canine goes well, then they will try to also pull the left lower canine.  If it’s too difficult, or takes too long, and they are concerned about his reaction or how long he is sedated, then it will be left for another day.

I’m cringing as I write this.  It sounds painful.  Biz on his best day doesn’t like people messing with his face and mouth.  A power tool grinding his jaw bone is going to be interesting. Not sure there are enough drugs in the world for him to tolerate that easily.  But leaving him in pain isn’t an option.  So all I can do is pray that it all goes well, and be there in whatever clothes I don’t care about getting blood on, pulling his ear to distract him, talking to him, and holding him up when he’s sedated.  It’s just what we do.

Getting down on his level – waking up from the sedative a few weeks ago…

 

I am going to need more than one glass of wine when I get home Monday.  For sure.

 

The Surgery that Wasn’t… Yet…

All has been pretty quiet in Biz news lately… He’s been doing well, using his three remaining front teeth and his mostly-worn-down molars to eat a complete diet of equine senior pelleted food.  Sometimes he gets beet pulp, if he likes it that day…  His weight has been good, and his skin has been good, and he’s overall just been hanging out – good.  I like that.

About 10 days ago I noticed he didn’t want me to look in his mouth at his incisors, which I do whenever I am out to see how they are doing.  At some point they are going to have to go.  Last Friday night he REALLY didn’t want me to look in his mouth…  NOT. FOR. ONE. SINGLE. SECOND…  He’s hurting…

Saturday morning I was on the phone with the vet’s office to discuss proceeding.  Antibiotics, painkillers and a vet appointment at the clinic this morning to x-ray and remove those last three teeth.  I was sure of it…

Well Biz had another thing in mind.  Because he can never do anything the easy way…  The incisors are fine.  Still stable.  Instead, it is the canine teeth; the two lower canines in particular.  And don’t get me started on why horses have teeth called canines?

Canines are harder to extract, because the roots are more deeply embedded in the jawbone.  It means a harder surgery, longer healing time, and more potential for complications, especially when both sides of the mouth are affected.  So his x-rays and photos were emailed off to an equine dentistry specialist, and my vet will consult on the best option.  Pull the whole tooth, or cut the tooth off at the gum line and let the gum heal over the root of the tooth.  Biz, it seems, already decided that the second option is the preferred method, because one of his upper canines has already broken off at the gum line, and the gum has healed completely over without us even noticing…  The body is a fascinating thing…

 

Getting down on his level – waking up from the sedative…

In a couple weeks, we will make the return trip up to the clinic for round 2.  Wish an old man luck!  Sometimes it’s hard being 30…

Another Year, Another Tooth

Biz, my soon-to-be twenty-six year old Quarter Horse, had his dental check up last week.  Biz has EOTRH, which is a degenerative disease that affects his teeth, causing them to become spongy and weakened over time.  We have been watching them for a few years now, because the disease has no cure other than to pull the teeth as they become painful.  As it affects the incisors, which are a horse’s tearing teeth and not their chewing teeth, a horse can function perfectly well even after the affected teeth are pulled.

Two years ago he had a tooth pulled, and last year he almost lost two more.  Upon the recommendation of my vet and the equine dental specialist he works with, we decided to let the teeth stay and instead we adopted a watch and wait approach.  So, last week he had a new set of X-rays to see how the disease has progressed.  Unfortunately, two of Biz’s teeth have further deteriorated to the point where they are almost certainly causing him pain.  Like cats, horses are prey animals and they try to hide their pain if they are ill, so even though he doesn’t appear to be in pain, we have to guess that he probably is.  The good news is that he is still eating well and holding weight on, and my vet shared X-rays and photos with other vets who specialize in equine dentistry and they were all impressed with his overall appearance for his age.

So the question becomes when to do the deed.  I’m waiting to hear back on a date that works – and that will likely be in the next month or so.  After the surgery, there will be daily flushes with saline while his gums heal.  Thankfully, Biz has always been a very good healer.  I wish there were a tooth fairy for horses!  I could be cashing in!  It would all go to the vet bills anyway.  Oh, the things we do for our animals…

For previous posts on Biz and his tooth troubles…

Biz’s Narrowly Averted Surgery Last Year

EOTRH

Biz Gets a Tooth Yanked

Rain, rain go away! Today, I was back at work, after taking yesterday off to take my horse up to the vet clinic for his tooth extraction surgery. Biz has a disease in his teeth called EOTRH, which stands for Equine Odontoclastic Tooth Resorption and Hypercementosis disease.  It causes the roots of his incisors to start breaking down and becoming spongy.  Then his body creates deposits around the root of the tooth to try to prevent further deterioration of the tooth. However, these deposits are quite painful because they press against the inside of the gum. His tooth was fractured inside the gum and the vet didn’t think that it would last much longer before just breaking off and increasing the risk of an infection. So they recommended going in and pulling it.

Yesterday morning I went out to the barn early and let Biz run around and work off some energy before the trip up to the clinic. I wrapped his legs to protect them from getting banged up in the trailer or at the clinic. Biz hasn’t left the farm in about 10 years, so I was a little worried that he would get nervous about going on a ride. He has a tendency to get rather spooky when placed in new situations. But, when I led him up to the trailer, he hopped right in without so much as a pause. And when we got there, he was really relaxed and mellow.  I was shocked…

We stood out in the sunshine for awhile, while the “dental team” assembled the tricks of their trade. Then they sedated Biz, and we waited for him to get sleepy. Then came the nerve block. From my perspective, this was the toughest part of the procedure. They were trying to get the anesthetic into the mental nerve, which runs along the outside of the jaw, but he didn’t want any part of it. After considerable pulling back, head tossing, 2 dropped syringes and a bent needle, they blindfolded him. That didn’t work either. Then my vet had a stroke of pure genius and put Lidocaine on his gums to numb them. Biz liked that – then they were able to get some of the nerve block into the inside of his gums. Then after that was numb, they were back to the outside of the jaw and were able to get the anesthetic into the nerve. Biz was a happy camper.

Then came the gross part. They inserted a long thin chisel between the tooth and the gum and started tapping their way around the tooth with a hammer to loosen it up. The goal was to dislodge the tooth in as few pieces as possible, without damaging the jawbone around the tooth. So, they spent some time alternating between tapping the chisel around the tooth, and grabbing it with forceps to see how much it wiggled. I spent some time watching and cringing. Eventually, all the tapping and wiggling paid off, and they got the first big chunk of tooth pulled out. After much ooo-ing and ahh-ing and taking photos of the tooth (have I mentioned my vet is very enthusiastic about equine dentistry?), we were on to round two. The x-ray showed that Biz had a big ball of “cement” that his body had built up around where the root of the tooth was deteriorated. This cement ball was the body’s attempt at shoring up the strength of the root. After more chiseling, and tapping and rooting around in the hole, this cement ball came out. They were quite pleased that they got it out in one piece, and so we repeated the photo process with this piece, both with and without the other piece of tooth. It was actually quite interesting to see that it the cement ball was basically hollow inside, because the root of the tooth that had been inside it had become a spongy mass without any remaining integrity.

After they got the cement ball, there were several fingernail sized pieces of the tail-end of the root that they had to fish out (these weren’t nearly as exciting for the vets – so they didn’t take photos of those). They let me look in the hole where his tooth had been. It was about the size of a large baby carrot. There was less blood than I expected too.

Next up was closing up the hole. First, they flushed it out with saline. Then, they sprinkled a surgical foam with antibiotic powder, and inserted in into the hole. Once in, it will expand and fill the hole, packing it. Then they put in some surgical gauze, also with antibiotic. This will come out once the stitches break open. They sutured the flaps of the gum back together to close the wound, and plugged the remaining hole with actual plaster of Paris! Plaster of Paris is apparently biodegradable. Eventually, the stitches will fall out, but they are hoping that we get at least 8 days until they do. This will allow the tissue to start healing from the inside out, and lessen the chance of infection. They took a few more x-rays to make sure everything looked how they wanted it to, and fortunately, it did.

Biz was waking up from the sedation at this point, but he was still really out of it. We looked at the new x-rays, and they showed me the spot where he now has a tooth missing. Unfortunately, his other teeth are affected by this disease too, so it is just a matter of time before we have to pull those too.

A little while later, when he was more stable on his feet, I got to take my old man home. He was fully awake in time for dinner, and he did eat, albeit rather slowly and carefully. He’ll be on a painkiller and antibiotic for the next several days, while we hope that his sutures stay closed as long as possible.  All in all, the day was a success.  I went home exhausted – worrying does that to me.  Even though he’s an old man, he’s still my baby.