In this episode of the Disease Du Jour podcast, Bruce Whittle, DVM, owner of Honey Creek Veterinary Hospital, in Trenton, Missouri, discussed all things equine dentistry, from the basic oral examination to common abnormalities and strategies for addressing them. He also offered advice for veterinarians hoping to improve their dental skills.
Equine Oral Examination
Whittle emphasized the importance of performing a thorough oral examination on every horse. “I think in medicine in general, we’re kind of getting away from the importance of the exam, and we try to skip on to more advanced things too early,” he said.
The first step of Whittle’s examination involves collecting a thorough history on the horse, including their diet, bitting, and amount of time spent grazing. He performs a general physical examination on the horse to ensure it’s healthy enough to sedate and looks at the horse’s head overall.
Once the horse is sedated, he examines the incisors. This is when he might identify sore teeth in young horses shedding their baby teeth or old horses with equine odontoclastic tooth resorption and hypercementosis (EOTRH). He also performs a functional incisor exam, looking at the horse’s excursion to molar contact and rostrocaudal mobility of the mandible. This helps him assess the horse’s ability to chew.
Next, he places a speculum in the mouth and palpates the teeth, using either a mirror or an oral endoscope to get a clear view of the horse’s mouth. He records all his findings in a dental chart and treats the horse based on these findings.
“Instead of treating it as the horse is presented to us for floating, it’s really presented to us for an oral exam,” said Whittle. “We figure out what’s going on, we get a diagnosis, and then we treat based on that.” He recommended performing oral exams in a dim environment because glare can make it more difficult to see into the horse’s mouth.
Common Dental Abnormalities in Young, Middle-Aged, and Old Horses
Whittle described the dental abnormalities he sees most frequently in young, middle-aged, and older horses.
In young horses, he tends to see issues related to the teeth not shedding properly, such as maleruptions. Young horses often have wolf teeth to address, which he says can be controversial. “I’m probably going to err on the side of extracting wolf teeth unless they’re smooth or placed where I don’t think they’re going to cause a problem,” said Whittle. “But if it’s going to be a broodmare, I’m not going to worry about the wolf teeth.”
Whittle typically recommends twice-annual oral examinations on young horses to catch problems early. “In their first five years of life, they’re going to erupt 24 baby teeth, they’re going to lose those over time, and they’re going to erupt up to 44 permanent teeth,” he said. “Sixty-eight teeth are coming and going in their mouth in the first five years of life, so there’s a lot going on.”
In middle-aged horses, he worries about early malocclusions, sharp enamel points, and infundibular cavities.
In older horses, he often finds more severe abnormalities, such as severe malocclusions (“wave mouth”), periodontal disease (which can occur at any age but is more common in seniors), and EOTRH. Many senior horses are missing teeth and have difficulty chewing. In these cases, nutritional counseling might be necessary.
Addressing Periodontal Disease
Whittle explained that in horses, periodontal disease is often caused by malocclusion. If the horse has a tall, sharp section in the mouth that’s wedging the opposing teeth apart, periodontal disease can occur. In these cases, addressing the sharp area can resolve the problem.
If periodontal disease has progressed to the point that the horse has significant bone loss, causing the tooth to loosen dramatically, extraction might be necessary. “If you can move it a few millimeters in any direction, or especially if you can push it into the socket, that tooth needs to go,” said Whittle.
Whittle noted that if the tooth is only slightly mobile, sometimes you can take a little bit off the tooth’s occlusal surface, a little bit off the opposing tooth, take them out of occlusion, and find the tooth has firmed up again after a few months once the periodontal ligament has had a chance to heal. “The periodontal ligament is continually remodeling,” he said. “Periodontal disease can be improved, but if we get bone loss, we can’t make new bone.”
Equine Dentistry Advice for Veterinarians
Whittle said veterinarians interested in starting dentistry should focus on performing a very good oral exam. “The more you look, the more you’re going to see,” he said.
He said it’s necessary to use either a mirror or a scope in examinations to get a clear view of the mouth. You should also have some basic equipment to help you with extractions, especially for getting the roots out when extracting geriatric teeth. He recommended a T-handle set with interchangeable tips. Whittle also advised veterinarians to get comfortable with radiographing the teeth, as radiographs can provide a lot of valuable information before you attempt to extract a tooth.
Whittle said veterinarians looking to improve their dental skills should consider taking a course on the basics. They should also work on deepening their understanding of the mouth’s anatomy.
“I think the biggest thing is just looking in horses’ mouths and doing a good exam,” he said.
Final Thoughts
In closing, Whittle reflected on how discovering his passion for equine dentistry has been key to his long-term happiness in equine practice.
“Every horse really needs dentistry, and it’s something that we as a profession are probably not providing to the degree that we should, so there’s a huge growth opportunity there,” he said. “Young veterinarians that develop an interest in it, I think they can kind of write their own ticket.”
About Dr. Bruce Whittle
Bruce Whittle, DVM, graduated from the University of Missouri in 1994. He and his wife, Gayla Whittle, DVM, moved to Trenton, Missouri, purchased two acres, and established Honey Creek Veterinary Hospital two weeks post-graduation. He has always considered himself a mixed large animal practitioner. He has a passion for horses and developed an interest in equine dentistry that keeps growing to this day. He began as a volunteer instructor for student AAEP equine dentistry workshops in 2009 and has since taught 48 courses at 24 veterinary schools. He also established an equine dentistry seminar and wet lab through the Missouri Veterinary Medical Association (MVMA), of which he is an active member and past president. Whittle has been active in scope of practice issues both for the MVMA and AAEP. At the insistence of his wife, he also developed an interest in small animal dentistry and helps teach student small animal dentistry surgery labs at the University of Missouri. In his free time, he loves teaching equine dentistry and enjoys backpacking, fly fishing, kayaking, and woodworking.
Related Reading
- Equine Tooth Extractions: Know When to Refer or Abort
- Disease Du Jour: EOTRH
- The Business of Practice: Dentistry-Only Practices
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