Approaching a dental problem in horses is the same as for any medical issue. Start with the body as a whole, and then work to the specific. Treatment, when possible, should address the primary cause.
"It's important that knowledgeable clinicians perform equine oral examinations, make accurate diagnoses and perform appropriate treatments," says Robert Menzies, BVSc, a resident in dentistry and oral surgery at the Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania's School of Veterinary Medicine.
Armed with preliminary information from the client, as soon as you see the horse, you can begin to take its condition into account, such as how the horse is moving and its character and temperament.
But before focusing on dental matters, perform a general physical examination to assess a horse's overall health, including body temperature, weight, heart rate, lung sounds and respiratory rate. Also assess the mucous membranes, the horse's hydration status and gut sounds.
"A horse always gets a physical exam before it gets an oral exam," says Robert Gregory, DVM, owner of Seattle Equine Dentistry, "since about 4 percent of horses I see have some sort of general physical problem that excludes them from a dental exam or treatment that day."
Overview of a thorough exam
The focus of an equine oral examination should be based on the presenting complaint. Menzies notes an examination should include the following:
Photo 1: Ulceration of the right dorsal body of the tongue.
- A thorough history involving both a general and an oral history, the latter of which should include a dental history, feeding habits and biting history.
- An extraoral examination, which entails examining the horse's head, including visual assessment of facial symmetry, or the contours created by soft tissues (temporal and masseter muscles, lips, muzzle, parotid and laryngeal regions and skin, and hard tissues around the mandible and maxilla). Also check for discharge and odor from the nose and mouth. Palpate facial structures to help confirm visual facial assessment. Check percussion of the sinuses.
- An intraoral examination, including the assessment of gingiva, teeth (present and absent), bite, occlusal surfaces and occlusion. Palpate the mandibular and maxillary interdental spaces for canine teeth, first premolar teeth, unerupted teeth, bit trauma and bone irregularity.
- The use of an oral speculum to examine all soft tissues, including the tongue (Photo 1) and sublingual mucosa, hard and soft palates, lips, commissures, gingiva, mucogingival junction and alveolar and vestibular mucosa. Use a periodontal probe to check for appropriate attachment around each tooth.
- A thorough check of the teeth within each quadrant and assessment as a functional unit. Closely examine the occlusal surface for abnormal secondary dentin; tertiary dentin; open pulp horns; fissures in the dentin, enamel and cementum; dental fractures; infundibular cemental hypoplasia, infundibular caries and impacted feed matter.
Gregory says the oral examination should be consistent—the same procedure every time.