Menzies advises that as you perform your basic physical examination, you should assess the patient for suitability for sedation.
Some horses may be old or in poor body condition or may have arthritis.
"You can't afford to have these horses to go down on their knees or be oversedated," says Menzies. "The presence of oral pain
in such patients can make adequate sedation very challenging. Local nerve blocks are often essential facilitative therapy."
In addition, waiting to perform an oral examination may be prudent. In instances of severe periodontal disease, for example,
some horses may allow a more thorough oral examination, diagnostics and treatment only after receiving an appropriate course
of anti-inflammatories and antibiotics.
"Coming back a second time, they'll be less cantankerous, and sedation works better," says Menzies. "It's best, depending
on the condition of the animal, not to try to fix everything during the first visit. Often, it's a working diagnosis, and
response to treatment is going to guide you. If you take a more conservative approach, it may take longer to get where you're
going, but you're going to cause fewer welfare issues than by overtreating or inaccurately diagnosing and inappropriately
treating a horse."
Assuming a horse is healthy and before beginning the oral examination, Gregory has the horse eat something to assess its manner
of eating, which may illustrate the possible problem.
"When I walk into the stall, before I look at a horse's head or in its mouth, I touch the horse and attempt to pick up a foot,"
says Gregory. "A horse with a significant dental problem most likely will be in pain and therefore unhappy to allow you to
pick up its foot. If it stands with its foot planted to the ground, I'll have to take a little more time to get it to relax
before I proceed."
Once the physical examination is completed, a sedative is given, and the horse is walked into the stocks or similar restraint.
"The selection of sedative is very important, and the amount is based on the individual patient, procedure and environment
you're going to be working in," says Menzies. "I prefer to work with animals in a hospital setting for a number of reasons:
It's a controlled environment—one I'm familiar with; I have all the equipment I would need; and I have the assistance of vet
techs and other personnel."
The extraoral examination
The next step is to look for asymmetry of the head. "It could be skeletal—maybe a compression fracture of the maxillary sinus
or frontal sinus," Menzies says. "You might see a swelling that's discharging from the mandible, a tooth-root abscess, a fractured
jaw. A mild skeletal asymmetry might show as a tooth wear pattern that's not within the normal limits but appropriate for
that individual. Each horse is assessed according to its specific anatomy."
As he performs an extraoral examination, Gregory uses all of his senses as each gives him information. "I also palpate the
head, check muscle and jaw function, check the temporomandibular joint and the mandible for possible fracture or abnormality
and note any odor from the nose or mouth," he says.
"Often there might be a lump on the side of the face, a malodor or a nasal discharge that leads you in a direction before
you even open the mouth," Gregory continues. "Between the external and internal oral examinations, I open their lips and look
at gum color and incisors and again check for odor from the mouth. That gives me a start. If I have a direction—a lump, pain
or swelling—I go in that direction."
Menzies says that viewing the incisors can give you an idea of the animal's age as well as abnormal wear patterns, periodontal
disease, equine odontoclastic tooth resorption and hypercementosis, which is becoming a well-recognized condition affecting
He also advises palpating the masticatory muscles as part of the extraoral examination. "An abnormal chewing pattern often
will be reflected in myositis because the muscles will be working abnormally or overworking," says Menzies. "They may become
swollen and sore."
Be sure to take note of any discharge. An ocular discharge, for example, may be the result of a functionally occluded nasolacrimal
duct resulting from inflammation around an infected tooth root as the duct travels down from the eye to the nose, says Menzies.
A nasal discharge, whether unilateral or bilateral and no matter the amount or character, warrants further investigation to
determine the cause. Appropriate treatment will vary considerably depending on the diagnosis. Dental disease may be implicated.
Also monitor air flow for any malodor coming from the nostrils, mouth or oral cavity. And check around the lips—look for wounds
caused by a bridle, the bit or vegetation.