December: All I Want For Christmas is No Front Teeth

December Case of the Month: All I Want For Christmas is No Front Teeth

“Thatcher” is a 25 year old thoroughbred gelding who has had a variety of dental concerns through his last few years. In 2020 Thatcher was diagnosed with EOTRH (Equine Odontoclastic Tooth Resorption and Hypercementosis). EOTRH is a progressive condition of the incisors and canines which causes painful resorptive areas on the tooth roots and in some cases excessive production of cementum – a normal component of teeth, but which can cause pain by distorting the surrounding bone when produced in excess. These changes to the teeth can also lead to gingivitis and periodontal disease causing the teeth to eventually become loose and/or infected around the roots. You can see in the attached radiographs from Thatcher that he had teeth that fit all these symptoms. The red lines outline the hypercementosis widening the tooth roots, the yellow lines highlight the areas of root resorption leading to a swiss- cheese, or moth-eaten look to the root, and the green circle highlights a large abscess around the tooth root.

When Thatcher was first diagnosed with EOTRH, he had 5 incisors which were significantly affected, including one with a large abscess pocket. His other incisors and his canine teeth also had changes, but they were milder by comparison. Thatcher’s owner was already concerned about the extraction of these most severely affected teeth, and the idea of removing all of his incisors and canines in one or two procedures seemed too worrisome, so they opted to just have the worst teeth removed first, and then would return to extract the remaining teeth. The extractions went well, including cleaning a large amount of abscess debris and pus out from the pocket highlighted in green on the radiograph.

Over the next several years, Thatcher’s remaining incisors continued to decline, and his mouth became more and more uncomfortable. While he was still eating well, when we performed a simple test to evaluate his comfort with biting with his incisors (known as the carrot test), he proved to be quite painful. In this test the horse is offered a carrot or other hard but delicious treat, but only allowed to have it if they bite it with their incisors, rather than just put it in their mouth and chew it with their cheek teeth. If the horse is comfortable, they will have no problem biting down hard and breaking the carrot, however if their incisors are painful they may try to bite it, or otherwise convince the handler to let go of the carrot, but they are not willing (or able) to bite it in half. You can see in the attached video that Thatcher wants to bite the carrot but can’t bring himself to bite down on his painful teeth.

With this knowledge that Thatcher’s mouth was once again painful, combined with radiographs showing progression of the root resorption, hypercementosis, and further abscesses, Thatcher’s owner came around to the fact that Thatcher needed to have his remaining incisors and canine teeth removed, and that was done shortly before Christmas last year. Several teeth were very abscessed, leaving large defects which took several weeks to heal in, but we are pleased to report that Thatcher is much happier without his front teeth, and is eating well and gaining weight much more readily than he had been the last few years.

Watch the Video on how to perform the Carrot Test