Pain Tolerance in a Stoic Species

January 2015

Epulis

This photo depicts what I refer to as Epulis. This is my clinical diagnosis, as I have not biopsied these lesions nor had them identified histologically. In humans, it may also be called a granuloma or a benign tumor.These lesions are often related to gingival trauma which is not obvious in this case. Actually, you are viewing the 107 and 109, as the 108 was extracted several years ago and rostral (mesial) drift has completely closed the gap. So, trauma could certainly have been the primary insult.

I have seen four other similar cases and had others sent to me for evaluation. One such case could not be reproduced digitally but involved the entire oral cavity. The clinical significance for dental practitioners is to be able to recognize the condition and document same.I advise the client that this condition should be evaluated for treatment if it becomes significantly enlarged. Surgical removal is reported to be quite successful, with or without subsequent biopsy. In this particular case, we note the proximity of the Palatine artery.

February 2015

Pain Tolerance in a Stoic Species

The postmortem image speaks for itself. No one can ever know if the behavior of this horse was related to the severe malocclusion, but it would be easy to presume so. Pain management is now a big issue, but the level and severity of pain is still quite difficult to objectively measure.

The other two images, are of a six-year-old warmblood, competing very successfully on the Gran Prix circuit with no evidence of discomfort.The stench from the impacted food material was extreme and the dark stained surfaces of the fracture suggested anything but a recent occurrence. If this was not enough to deter performance, a 405 wolf tooth was also present. It was worn quite smooth by the bit, with this brave mare creating her own bit seats!The patient had just arrived in this yard, and the pre-purchase exam stated that the dentition was normal, but the highly skilled trainer and rider typically cover all the bases and scheduled a dental exam with a qualified provider.

March 2015

Upper 12s

The original complaint in this case was that the horse bleeds from the mouth while being ridden and it did not seem to be due to interaction of the bit with the cheeks. On speculum examination, it would appear that the puncture of the left side of the tongue would be the likely reason! I would presume that bleeding also occurred while eating but the evidence was being swallowed. After the more obvious was noted, further examination revealed a sagittal fracture of 209 and a deep periodontal pocket at the palatal 111-112. When asked about nasal drainage – “Oh yes, that has been an occasional event for the last eight years!”

April 2015

Guess What It Is!

This is a very unique case. This horse has very worn upper molars 6-11 at the age of 9 years. The clue is the tongue. It is thick, dry and abraded. A normal tongue would have a more slick, soft and wet appearance. The answer~ He hasbeen eating rocks! Upon examination, 4 rocks about the size of peasfell into the provider's hand!Closer inspection found smaller rocks in the bottom of his water bucket as well. This situation was not man-made, it was caused by the horse's own choice and environmental.

May 2015

Canines

There has been a request for some simple everyday things - possibly seen daily but not recognized as important when the emphasis is on getting the job done and going on to the next case. These photos of canines are such an example. No gingivitis is noted but there is some gum recession and accumulation of food. We can overlook this or take a moment to scale the calculus and clean up the gingival margins. Then, rather than rush to the next client, we could stop, take a deep breath and ponder a couple things.

The lower canines could certainly be reduced and cause less interference with the tongue and placement of a bit, but the uppers are flat with sharp edges on the entire perimeter. This is nearly a universal finding - is this tongue action and also the reason that calculus seldom accumulates on upper canines? And how often does your client ask, "what are those cute little bumps on the side of the tongue -all lined up in a neat row?" I tell them that they are taste buds but I must admit that I cannot find anatomical verification of this in any text.

June 2015

Retained IncisorCap

With EDPA certification the emphasis has been more on the everyday issues that make up 90 % of equilibration. So, what is more common than a retained incisor cap? Not quite as common, is a retained impacted incisor cap. Now, take a look at what a seemingly ordinary occurrence can cause! The retained deciduous 202 had forced the permanent 202 and 203 to erupt in a lateral position and unopposed, they super erupted to the point of causing a complete block. The post extraction and alignment photo shows the immediate solution but only time will tell if mesial drift will close the diastema in a 13-year-old horse.

July 2015

Dorsal Curvature

This is a good example of a Dorsal Curvature. The 102 is missing with mesial drift that filled the gap, but it was not likely part of the original trauma nor is it certain what contribution the trauma had to the dorsal curvature. One can only guess the sequence of events but to me, the most interesting event is the 402. The entire tooth is in a state of avulsion from occlusal surface to apex, with the pulp cavity completely exposed but still the apex was not involved. This is an example of the profound regenerative and reparative potential of equine dentition.

August 2015

How long do we wait to remove a 308 cap?

The facial swelling on this 10-year old horse might bring to mind an abscess or food packing in the buccal cheek area. The latter possibility was quickly eliminated, as the swelling was quite hard. On further examination, it was found that the 308 cap, that should have shed uneventfully during his 4thyear, was firmly imbedded in the cheek and almost completely encapsulated by scar tissue.Attempts to remove the cap with standard forceps proved futile but use of the custom instrument shown was finally successful. I know some practitioners feel that I remove caps at too early a stage but I think an extra 6 years is enough!

September 2015

Using a radiograph as a diagnostic aid...

It is often and correctly stated that radiographs are a ‘diagnostic aid’ and one should not ‘treat a radiograph’, but in this case, it is safe to say that the 209 is severely affected, both apically and within the body of the tooth.

There was no oral evidence, such as open pulps, to confirm the diagnosis in this 5-year-old and the source of infection was considered blood-borne (anachoretic). Following extraction, it was determined that there was in fact communication from the apex to an infundibular cemental defect, which is considered rare in the literature but has proven more common than previously thought.

October 2015

Slobbers

“Slobbers” or simply excess salivation:

This sometimes-spectacular event may be common to those of us in the eastern half of the country, whereas those in the western half may never have seen this condition. It is caused by a toxin that is produced by a fungus that grows on red clover. I have never seen this condition in horses grazing on pastures with an abundance of red clover but the first cutting of hay can cause dramatic salivation. Contrary to the literature, I have fed second and third cutting with no problems for 15 years, as long as the quality of the hay was good. Also, contrary to other sources of dental information, excessive salivation (ptyalism) is almost never caused by dental pathology. This is not to say that a subject with this symptom may well have dental issues – even major abscesses and fractures, but the pathology does not cause the salivation. It is not within the scope of this discussion to cover all the causes such as rabies, chemical burns and the occasional over producer that can cause youto “wear” a face full during an incisor correction!

November 2015

Deciduous Trauma of the Incisors

When a young horse experiences a traumatic incident, we always like to be optimistic and usually are able to remind the client that there are permanent counterparts to the damaged incisors that will likely erupt unaffected by the previous incident. HOWEVER, it is wise to remind the owner that the situation does not always develop the way we would like. This is a case of a 10-year-old that was kicked in the face at age three and seemed to have escaped serious injury. The photos of the resulting pathology and subsequent extractions proved otherwise.

December 2015

A412

And for those of you who prefer – a supernumerary 411. There was no permission to attempt a major procedure, so reduction and a relief cut were the only options. If an extraction would have been attempted, the most complete set of extraction equipment would likely be wanting as I have not seen a molar spreader designed to operate on a 45-degree angle.