Observations of the cheek tooth occlusal angle in the horse

The angle of occlusion was evaluated in 230 mandibular cheek teeth from 21 horses. There was no significant relationship between horse condition (sedated, anesthetized, dead) and measurement of mean cheek tooth occlusal angle. Cheek tooth occlusal angle was not significantly affected by the position of the tooth in the mandibular arcade or tooth age. The measurement of individual mandibular cheek tooth occlusal angles was predictive for occlusal angle of the entire mouth. Multiple variations of the incisor separation angle technique were predictive of cheek tooth molar occlusal angle for the measured arcade and the entire mouth but was significantly different contralaterally, suggesting that the single tooth method may be preferred. However, despite the limitations of the relatively simple incisor separation angle technique, it may provide the equine veterinary dentist a rapid method of assessing cheek tooth occlusal angle to ensure proper dental floating methods and outcomes.     

The prevalence of secondary dentinal lesions in cheek teeth from horses with clinical signs of pulpitis compared to controls

Reasons for performing study: With the advent of detailed oral examination in horses using dental mirrors and rigid endoscopy, secondary dentinal lesions are observed more frequently. More information regarding the association of secondary dentinal defects with apical dental disease would improve the sensitivity of oral examination as a diagnostic aid for pulpitis. Objectives: To assess prevalence and severity of secondary dentinal defects observed on examination of occlusal surfaces of cheek teeth (CT) from horses showing clinical signs of pulpitis compared to asymptomatic controls. Methods: Records from all cases of equine CT exodontia at the University of Bristol over a 4 year period were examined. Case selection criteria included the presence of clinical signs of pulpitis, an intact extracted tooth and availability of a complete history and follow up. Cases where coronal fracture or periodontal pocketing featured were excluded. CT from cadavers with no history of dental disease served as normal controls. Triadan positions and eruption ages of control teeth were matched with those of teeth extracted from cases. CT from selected cases and control teeth were examined occlusally. Secondary dentinal defects were identified and graded. Prevalence of occlusal lesions in CT with pulpitis and controls was compared. Results: From the records of 120 horses where exodontia was performed, 40 cases matched selection criteria. Twenty‐three mandibular and 21 maxillary CT were extracted from cases. The controls consisted of 60 mandibular and 60 maxillary CT from 7 cadaver skulls. Secondary dentinal defects were significantly over‐represented in CT extracted from cases of pulpitis (P<0.001). Of diseased mandibular CT, 56.5% had defects compared to none of the controls. Of diseased maxillary CT, 57% had defects compared with 1.6% of controls. Multiple defective secondary dentinal areas and severe lesions were more prevalent in diseased mandibular CT compared with diseased maxillary CT. Conclusions and practical significance: Careful examination of occlusal secondary dentine is an essential component in investigation of suspected pulpitis in equine CT.     

Occlusal fissures of the equine cheek tooth: Prevalence,location and association with disease in 91 horses referred for dental investigation

Reason for performing study: Fissures of the occlusal surface of the equine cheek tooth are poorly understood and their association with dental disease is unknown. Objective: To describe the prevalence and location of occlusal fissures in the cheek teeth (CT) of a group of horses referred for dental investigation/treatment, and determine association with intercurrent dental disease. Methods: Digital video recordings of oral endoscopic examinations for all horses referred to the Rossdales Equine Hospital for dental investigation from November 2006 to June 2009 were reviewed. Location of occlusal fissures in relation to both Triadan tooth position and pulpar secondary dentine was recorded; direction of fissure and concurrent involvement of enamel was also documented. The CT location considered at the time of examination to be the primary site/s of disease was correlated with presence of fissures on these teeth. Results: 91 cases meeting the inclusion criteria were identified. Occlusal fissures were documented in 58.2% (53/91) cases, with a total of 227 CT being affected. Fissures were most prevalent mid‐arcade. The majority (92.1%) of fissures in maxillary CT were associated with the caudal palatal pulp horn. Fissures in mandibular CT were predominantly associated with the buccal pulp horns (95.7%). There was no significant difference in the median number of CT with fissures in relation to gender. There was no correlation between age (r²= 0.01) of horse and number of CT with fissures. A significantly greater number of CT with multiple occlusal fissures was found in mandibular compared to maxillary arcades. No correlation was found between presence of fissures and location of individual CT considered to be primarily responsible for presentation. Conclusions: Occlusal fissures in this group of animals were common and not correlated to primary site of dental disease. Potential relevance: In horses subjected to dental investigation, occlusal fissures of the cheek teeth should not be considered an indicator of tooth compromise. Location and direction of fissure propagation in most cases is inconsistent with occlusal fissures being causally implicated in slab fractures of cheek teeth, although site predilection may indicate a possible association with masticatory forces.     

Donkey dental anatomy. Part 1: Gross and computed axial tomography examinations

Post-mortem examination of 19 donkey skulls showed that donkeys have a greater degree of anisognathia (27% width difference between upper and lower jaws) compared to horses (23%). Teeth (n=108) were collected from 14 skulls and examined grossly and by computed axial tomography (CAT). A greater degree of peripheral enamel infolding was found in mandibular cheek teeth (CT) compared to maxillary CT (P<0.001). A significant increase in peripheral cementum from the apical region to the clinical crown was demonstrated in all CT (P<0.0001). All donkey CT had at least five pulp cavities with six pulp cavities present in the 06s and 11s. A new endodontic numbering system for equid CT has been proposed. A greater occlusal depth of secondary dentine (mm) was present in older donkeys (>16 years) than in the younger (<15 years) donkeys studied. Based on gross and CAT examinations, donkey dental anatomy was shown to be largely similar to that described in horses.     

Equine dental disease part 2: a long-term study of 400 cases: disorders of development and eruption and variations in position of the cheek teeth

Of 400 referred horses with dental disorders, 349 cases suffered from primary disorders of their cheek teeth, ninety of these from disorders of development or eruption, or displacements. These included 20 cases with rostral maxillary and caudal mandibular cheek teeth overgrowths, 16 with diastemata, 15 with grossly enlarged mandibular 'eruption cysts', 4 with grossly enlarged maxillary cheek teeth 'eruption cysts', 10 cases with supernumerary cheek teeth and 23 cases with displaced cheek teeth. These displacements were believed to be developmental in 16 cases and acquired in the remaining 7 cases. Long-term response to treatments, that included removal of overgrowths and extraction of teeth with deep secondary periodontal disease was excellent for most disorders except diastemata.     

Clinical findings and treatment of shear mouth in two horses associated with ipsilateral painful dental disease

Shear mouth is a rare and poorly described dental condition observed in horses. This report outlines 2 cases of unilateral shear mouth with ipsilateral painful dental disease. Both cases are young horses diagnosed with idiopathic 409 cheek tooth fractures associated with shear angles on the 100 and 400 cheek teeth rows. Corrective odontoplasty was performed in both cases to correct the cheek tooth occlusal surface angle following exodontia of the diseased molars.     

Post mortem survey of peripheral dental caries in 510 Swedish horses

Reasons for performing study: Peripheral caries (PC) of equine teeth is a poorly described disorder that can cause serious clinical problems if it progresses. Objectives: To assess the prevalence, sites and severity of PC in a population of Swedish horses. Methods: A post mortem study of 510 equine skulls was performed in 2 Swedish equine abattoirs. Results: PC only affected the cheek teeth (CT) and was present in 6.1% (31/510) of skulls. It affected mainly the peripheral cementum, and 87% of PC in the 29 affected mature horses occurred in the 3 caudal CT (Triadan 09‐11). Concurrent infundibular caries involving most maxillary CT (mean 9.7/skull) was present in 32% of skulls affected with PC. Trotting horses (mean age 8.1 years) believed to be on a high concentrate and silage diet were preferentially affected with PC in this population. Food was usually tightly adherent to the PC lesions and this feature may have promoted the progression of the disease. Significantly increased levels of diastemata were present in PC‐affected horses, and periodontal disease was present in areas adjacent to some PC lesions. Conclusions: PC is a relatively common disorder of horses under certain management conditions that can progress to cause serious dental disorders, especially if concurrent, widespread infundibular caries is present. Potential relevance: Equine clinicians should be aware of this significant dental disorder and research into its aetiopathogenesis, possible prevention and treatment are required.     

Effect of premolar and molar occlusal angle on feed digestibility, water balance, and fecal particle size in horses

OBJECTIVE: To determine whether occlusal angle of the premolar and molar teeth (ie, molar occlusal angle) was associated with feed digestibility, water balance, or fecal particle size in adult horses. DESIGN: Observational study. ANIMALS: 40 pregnant mares ranging from 3 to 19 years old. PROCEDURE: The horses were randomly allocated to 1 of 5 feeding groups with 8 horses/group. Horses were sedated, and molar occlusal angle was measured with 2 methods. An oral examination was performed, and total number of dental abnormalities was recorded. Feed digestibility, water balance, and fecal particle size were measured 7 and 16 weeks later. RESULTS: Molar occlusal angle ranged from 6.3 degrees to 19.3 degrees and was not significantly associated with feed digestibility, water balance, or fecal particle size. The number of dental abnormalities was not associated with feed digestibility. Molar occlusal angle did not vary significantly with horse age. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicate that molar occlusal angles between 6 degrees and 19 degrees do not adversely affect feed digestibility, water balance, or fecal particle size in adult horses. Additionally, there was no association between age and molar occlusal angle.     

Repulsion of maxillary and mandibular cheek teeth in standing horses

Objective: To report the technique and results of cheek teeth repulsion in standing, sedated horses. Study Design: Case series. Animals: Horses (n=12), ponies (6). Methods: Medical records (2006–2009) of horses that had cheek tooth repulsion while standing were reviewed. Inclusion criteria included: maxillary or mandibular cheek tooth disease diagnosed by clinical and radiographic examination where attempted oral extraction failed necessitating repulsion. Horses were sedated and a local nerve block performed. Intraoperative radiographs facilitated instrument positioning and ensured repulsion of all dental remnants. Alveolar cavities were packed postoperatively and secondary dental sinusitis treated with lavage. Results: Median horse age was 7 years (range, 1–30 years). Maxillary (n=15) and mandibular (5) cheek teeth were removed successfully. One horse was euthanatized 1 week after tooth removal because of concurrent liver disease and 10 horses (59%) had resolution of discharge after the 1st treatment; 41% of extractions required follow‐up medical or surgical treatment to resolve signs [6/12 maxillary sinusitis and 1/5 persistent mandibular drainage]. Conclusions: Standing repulsion of diseased and fractured cheek teeth is an effective means of resolving clinical signs of dental disease when oral extraction fails. Chronic sinus involvement increased the risk of postextraction surgical treatment for sinusitis.     

A post-mortem study on the prevalence of peripheral dental caries in Scottish horses

Peripheral caries (PC) is an increasingly recognised equine dental disorder with unknown predisposing factors that differs from the well described maxillary cheek teeth infundibular caries. Advanced PC can lead to premature wear and fracture of cheek teeth and thus is of welfare importance. Recent studies have shown large variation in the prevalence of PC in different European countries, with a trend towards a greatly increasing prevalence. One hundred and one equine heads sourced from a Scottish rendering plant were examined for the presence and grade of PC using the modified Honma equine dental caries grading system. The presence of cheek teeth calculus, diastemata and fractures was also recorded. Peripheral caries was present in 91% of horses; only affected the cheek teeth and was predominantly (72.6%) Grade 1 Class 1 (localised pitting lesions only affecting cementum). The caudal three cheek teeth were more commonly affected (74.7% prevalence) as compared to the rostral three cheek teeth (32.1% prevalence). The palatal aspect of maxillary and the buccal aspect of mandibular cheek teeth were significantly (245% and 170%, respectively) more commonly affected by PC than the opposite sides. Female horses were more commonly affected than males. Because post-mortem examination allows the most detailed oral examination to be performed, this may partly explain the higher PC prevalence found in the current, as compared to previous studies, in addition to the particular population examined in this study.     

Treatment of maxillary cheek teeth apical infection caused by patent infundibula in six horses (2007–2013)

Six young horses presented with clinical signs of maxillary cheek teeth apical infection (bilateral in 2 horses) that included the presence of rostral maxillary swellings with discharging sinus tracts and were unexpectedly found to have no evidence of endodontic infection in 7 affected teeth. The apical infection of these teeth was attributed to infundibular dysplasia that allowed inoculation of the periapical tissue with contaminated oral contents. Treatment was by debridement and obturation of affected infundibula from their occlusal aspect using techniques normally used for endodontic therapy. Five out of 6 cases showed resolution of clinical signs over a mean follow‐up period of 19 months (range 6–48 months). These cases demonstrate that patency of the infundibular apex is a potential cause of cheek teeth apical infection in young horses, which can be successfully treated by debridement and subsequent infundibular restoration.     

Immunohistochemical identification of lymphatic vessels in the periodontium of equine cheek teeth

Immunohistochemical detection of lymphatic capillaries was performed in the periodontium of maxillary and mandibular cheek teeth from 6 horses (aged 3-23 years). Tissue sections of the periodontium were taken at 4 different horizontal levels along the long axis of the tooth. The specimens were processed for immunoreaction with anti-Prox1, in order to distinguish lymphatic endothelium from blood vascular endothelium. Lymphatic vessels were detected in all periodontal tissues except for the dental cementum. Lymphatic capillaries were most densely distributed in the gingiva compared to other tissues of the periodontium. Lymphatic capillaries were found most consistently in samples taken from the gingival and subgingival regions in all horses examined. Within these levels, the gingiva as well as the spongiosa of the maxillary and mandibular bone had the greatest incidence of lymphatic vessels. Considering the distinct distribution of the lymphatic capillaries in the periodontium of the maxillary and mandibular cheek teeth, two complementary lymphatic drainage pathways are proposed: (1) superficial lymph drainage via the gingiva, emptying into the mandibular lymph nodes; (2) deep lymph drainage via the mandibular and maxillary spongiosa, emptying into the mandibular and retropharyngeal lymph nodes, respectively.     

An anatomical study to evaluate the risk of pulpar exposure during mechanical widening of equine cheek teeth diastemata and 'bit seating'

Reasons for performing study: Cheek teeth (CT) diastemata are a major equine dental disorder that can be treated by mechanically widening the diastemata. There is limited anatomical knowledge of the spatial relationships of the individual pulps to the adjacent interproximal surfaces; on the risks of exposing the 6th pulp horn when performing the clinically unproven ‘bit seating’ procedure on Triadan 06s. Objectives: To describe the anatomical relationships between the occlusal and interproximal surfaces of CT and the adjacent pulp horns; and between the 6th pulp horn and the occlusal and rostral surfaces of Triadan 06s. Methods: The CT from 30 skulls of horses subjected to euthanasia for non‐dental reasons were sectioned to expose the rostrally and caudally situated pulp horns to allow the anatomical relationships between the pulp horns and the occlusal and interproximal aspects of the CT to be assessed. Results: Pulp horns were mean ± s.d. of 5.74 ± 1.45 (range 1.3–10.8 mm) from the nearest interproximal surface, with 5.3% of pulp horns being <3.5 mm from the interproximal surface. In contrast to expectations, pulps tended to became closer to the interproximal surface (and also to the occlusal surface) with increasing age. Teeth with physiologically tall clinical crowns, and also those in the Triadan 09 position had pulps that were closer to the interproximal surfaces than the remaining CT. The more caudally situated pulp horns, i.e. in particular, the 4th maxillary and 5th mandibular pulp horns were closer to the interproximal surfaces than the remaining pulp horns and these pulp horns also had the thinnest sub‐occlusal secondary dentine. Pulps that were close to the interproximal surface were also found to be close to the occlusal surface of the CT. Conclusions and potential relevance: While diastema widening is theoretically safe between the majority of CT, a small proportion of pulp horns are only 1.3 mm from an interproximal surface and others lie just 1.6 mm beneath the occlusal surface, and such pulps are at risk of pulpar exposure and to thermal injury during this procedure. The risk of pulpar exposure increases when dental tissue is removed from the caudal aspects of CT.     

The use of oral endoscopy for detection of cheek teeth abnormalities in 300 horses

The main objective of this study was to evaluate an endoscopic examination protocol for routine dental examination in horses. The oral cavities of 300 standing, sedated horses were examined under field and hospital conditions with a rigid endoscope using a standardised technique that included examination of the occlusal, lingual (palatal) and buccal surfaces of all cheek teeth rows. The most common cheek teeth abnormalities detected were sharp enamel edges (present in 96.3% of horses), focal overgrowths (64.3%), fissure fractures (54.3%), diastemata (24.3%) and infundibular hypoplasia/caries (48.3%). Rigid endoscopy of the equine oral cavity was found to be a safe non-invasive diagnostic technique that appeared to be superior to clinical oral examination for detecting subtle cheek teeth changes.     

Structure of peripheral cementum of normal equine cheek teeth

The structure of peripheral cementum of mandibular and maxillary cheek teeth was studied by gross observation, light microscopy, and scanning and transmission electron microscopy. Teeth from four horses aged 4, 8, 17, and 30-years-old were examined. The cementum of the occlusal surface was thicker on the buccal aspect when compared with the lingual aspect of mandibular teeth. The cementum of the occlusal surface was thicker on the palatal aspect when compared with the buccal aspect of maxillary teeth. There was no peripheral cementum on the interdental aspects of either mandibular or maxillary cheek teeth. In the adult tooth, cementum covered the crown and root surfaces. The peripheral cementum of the gingival region showed a dramatic increase in thickness compared with cementum covering the alveolar portion of the embedded tooth. At a microscopic level, three layers (primary, secondary, and tertiary) were identified within cementum. The increase in cementum in the gingival region was of tertiary cementum. All three layers contained vital cementocytes. There was a well-developed vascular system within the cementum. Nerve bundles were also present. Three cementoblast profiles were identified at the junction of the cementum with the periodontal ligament. The results reported in this paper show that cementum is a dynamic vital tissue. These findings should contribute to a greater understanding of the etiology and pathogenesis of cemental caries and periodontal disease in the horse.     

Evaluation of the long-term oral consequences of equine exodontia in 50 horses

The aims of this study were to objectively evaluate and quantify the process of post-extraction cheek teeth (CT) dental drift in horses, and to report on associated disorders of CT wear and long-term periodontal health. Fifty horses that had CT oral extraction because of apical infection were prospectively re-examined and a full oral examination, including measurements of some dental parameters, was performed.Narrowing of the extraction space was noted in all cases with complete closure occurring in 18% of horses. The rate of dental drift was calculated as 15.7% of extraction space/year (range 4–50%) and was not associated with the age at extraction (P = 0.78) or frequency of dental care since extraction (P = 0.48). There was a significant negative relationship between the rate of dental drift and the duration of time since extraction (P = 0.008). Overgrowths were present on the opposite CT row in 98% of horses, including opposite the extracted CT and on the Triadan 06s and 11s. No significant difference was noted in either the number of diastemata (P = 0.9) or periodontal disease score (P = 0.8) between the extraction and the contralateral cheek tooth rows.     

Equine idiopathic cheek teeth fractures: part 2: a practice-based survey of 147 affected horses in Britain and Ireland

REASONS FOR PERFORMING STUDY: There is limited information on the prevalence of idiopathic cheek teeth (CT) fractures in the general equine population and on which CT are most commonly affected. OBJECTIVES: To obtain information on the prevalence of fracture patterns and clinical details of idiopathic CT fractures. METHODS: Details of cases with idiopathic CT fractures encountered were obtained via a questionnaire sent to suitably experienced veterinary practitioners and equine dental technicians (EDTs). RESULTS: Details of 147 horses that suffered a total of 182 idiopathic CT fractures; and median 0.4% (range 0.07-5.9%) of horses examined were diagnosed with such fractures; 133 maxillary CT and 49 mandibular CT fractures were found; maxillary Triadan 09s and 10s were preferentially fractured (46% of all fractured CT); fracture patterns included maxillary CT slab fractures (through 1st and 2nd pulp chambers) in 87 teeth (48% of all fractured CT), maxillary CT midline sagittal fractures (through the infundibula) in 31 CT; and various other types of maxillary CT fractures in 15 CT. In the mandibular CT, lateral slab fractures (through the 4th and 5th pulp chambers) were found in 28 CT and a variety of other fracture patterns in the other 21 mandibular CT. Clinical signs included quidding in 33% of cases, bitting and behavioural problems (29%) and halitosis (12%), however 39% of horses with idiopathic CT fractures were asymptomatic. Treatments included oral extraction of the smaller dental fragment in 37% of cases, extraction of the entire fractured tooth (9%); removal of sharp edges on the remaining part of fractured tooth (14%); reduction of height of the opposite tooth (4%); other surgical or endodontic treatments, or referral of case for further investigation and treatment (10%); or no specific treatment (39%). Following treatment, 81% of cases were reported to be asymptomatic, 6% had ongoing clinical problems and the outcome was unclear in 13% of cases. CONCLUSIONS: Idiopathic CT fractures are present in approximately 0.4% of horses and may variably cause none to severe clinical signs. Most idiopathic CT fractures respond well to treatment. POTENTIAL RELEVANCE: Understanding of the prevalence, clinical findings and treatment of idiopathic CT fractures will improve management of these disorders.     

Extraction of 22 equine cheek teeth with displaced sagittal fractures using polymethylmethacrylate stabilisation (2011–2016)

Displaced sagittal cheek tooth fractures are a cause of oral pain, quidding and apical infection. Intraoral extraction is the preferred technique to remove affected teeth, but can be difficult due to displaced and friable fracture fragments. Stabilising fracture fragments via filling of the fracture space with polymethymethacrylate (PMMA) prior to removal may be a useful method to facilitate intraoral extraction. Case details were examined retrospectively. A total of 22 cheek teeth required extraction in 20 horses because of displaced sagittal fractures. Clinical diagnoses were made using oral examination, oral endoscopy, skull radiography and computed tomography. All procedures were performed in standing, sedated horses in stocks. Fracture spaces were cleaned and packed with PMMA and teeth removed using a routine intraoral extraction technique. Digital photographs of extracted teeth were taken and tooth measurements calibrated using digital image software. Intraoperative difficulties, as well as post-operative complications were recorded. A total of 21 maxillary and one mandibular cheek teeth were extracted. All maxillary teeth had advanced infundibular caries. Intraoral extraction was successful in 16 cases; six were unsuccessful and required repulsion due to tooth fragmentation or abnormal dental anatomy. In 11 cases, maxillary or conchofrontal sinus trephination was performed to either treat sinusitis, repulse the tooth, or both. Two horses developed short-term complications following local anaesthesia of the maxillary nerve. The mean ratio of fracture depth to tooth length was 0.59 and mean ratio of fracture width to tooth width 0.53. The limitations of the study are its small sample size, retrospective nature and lack of control group to compare extraction success in PMMA and non-PMMA groups. It was concluded that using PMMA to stabilise displaced sagittal fractures in equine cheek teeth is a simple, effective method of facilitating intraoral extraction and may reduce the need for more invasive procedures.