Advances in Diagnosing Equine Dental Disease – The Horse

Emerging technology gives veterinarians the tools they need to best address equine dental disease

The large mouth of an adult horse has 36 to 42 teeth. Teeth are composed of enamel (the outer covering of the tooth) and dentin (mineralized connective tissue), and this unique composition makes them the strongest substance in the horse's body. However, this toughness does not protect against tooth fractures, infection, or disease related to the periodontal ligament that secures the teeth to the jaw.

If your horse shows signs of tooth pain or difficulty chewing food, it's time to call your veterinarian for a checkup. Practitioners often use radiography to diagnose conditions affecting other parts of the horse's skeletal system, such as the bones and joints of the legs, and likewise, X-rays are a common first step in resolving dental problems. But today, veterinarians have access to a variety of imaging modalities in addition to radiography. Let's take a look at the progress they've made.

The evolution of dental diagnostic imaging

During Robert Baratt's 40-year career in equine dentistry, he held DVM, MS, FAVD, Dipl. AVDC, AVDC/EQ, founder of Valley Veterinary Clinic in Salem, Connecticut, saw and embraced groundbreaking advances in diagnostic imaging. Today, the models and techniques used by Bharat and his colleagues are more sophisticated, precise and user-friendly than those of the 1980s. This is actually a black and white distinction.

“When I graduated from veterinary school in 1981, the tools we used to evaluate a horse’s mouth were limited to speculums and pen flashlights,” he said. “Radiography is basically impossible.”

“For practitioners who were exposed to radiography before digital formats became widely available, image quality has little diagnostic value,” added Leah Limone, DVM, Dipl. AVDC is the owner of Northeast Equine Veterinary Dental Services in Topsfield, Massachusetts.

The first major development in equine dental diagnostics was the development of a portable digital radiography system by Fujifilm in 1981. .

Although the cost of the device was considerable for the average solo equine practitioner at the time, it quickly became the standard of care for dental and lameness assessments, Barratt said. Veterinarians still use digital radiography in almost all cases involving bones, including teeth. Digital radiographic images provide a relatively simple, quick, and cost-effective first look at the skeletal structure within the horse's body.

new standard of care

Times have certainly changed: digital radiography, once revolutionary, is now considered “basic” and, in many cases, limited when compared to newer, more high-tech three-dimensional imaging modalities. “For example, the increasing availability of computed tomography (CT) scans has greatly enhanced our ability to diagnose dental and sinus pathology (disease or injury),” Barratt said. “In the future, we will continue to see more horses undergoing standing CT scans, eliminating the risk of general anesthesia required to perform CT scans on 1,200-pound animals.”

Images produced by modalities such as radiography and CT can provide valuable information to practitioners, but sometimes getting the answer directly from the horse's mouth is the right approach. This is where intraoral endoscopy comes in. “This is a diagnostic tool that all practitioners should invest in,” said Barratt, a pioneer in equine intraoral endoscopy research. “The ability to carefully examine each tooth and indicate pathology to the owner in real time is invaluable.”

Advanced imaging makes surgery safer

Imaging does more than just diagnose a problem, it also helps practitioners treat said problem safely and effectively. “Digital dental radiographs and, in complex cases, CT images are critical to planning extractions,” says Limone. “We need to understand the often abnormal anatomy and pathology of the specific tooth we are extracting and determine how best to extract it in the least invasive way to avoid complications.” A detailed examination of the mouth before invasive surgery can reduce Risks and potential costs associated with blind surgery.

Likewise, horses undergoing tooth extractions and surgeries benefit from the precision and safety provided by more sophisticated tools. “Let's get back to the endoscope. Over the past 10 years, the endoscope has become widely recognized not only as a valuable examination instrument but also as a guidance tool for oral and sinus surgery,” Barratt said. Endoscopes are essentially an extension of the surgeon's vision, allowing them to see precisely where the instrument is relative to the lesion of interest.

“In addition to endoscopy, the development of new surgical instruments and techniques now allows equine dentists to perform more oral extractions and fewer rejections (the latter involves using a mallet/dental punch to push the tooth through the sinus), thereby reducing The incidence of sequelae – complications of tooth extraction,” added Bharat. “Last but not least, improvements in standing sedation techniques, particularly constant rate infusion (CRI) of sedatives and local anesthesia, now allow nearly all equine dental and sinus surgeries to be performed standing without the need for systemic sedation. Anesthesia. This is safer for the horse and more cost-effective for the client.

For EOTRH, diagnostic imaging is particularly valuable. “The earliest manifestation of this disease is usually radiographic evidence of replacement root resorption,” says Barratt. “At this stage, the disease is not yet accompanied by clinical signs of periodontal disease or oral pain. Typically, the lateral incisors (third teeth) are the first teeth to be affected.

Tooth resorption and cementum hyperplasia by odontoblasts can damage the oral cavity in various ways. These secondary bacterial infections can lead to the aforementioned inflammatory tooth resorption, alveolar bone infection, and the classic clinical signs of periodontal disease: gingivitis, gingival recession, tooth extrusion, and gingival and/or mucosal fistulas (abnormal formations between the alveolar bones). path). “This stage of the disease can cause pain in the mouth,” says Barratt. Therefore, the goal is to intervene before pain occurs.

The painful progressive course of this disease and its increasing incidence require improved early diagnosis. “Unfortunately, early radiological diagnosis of EOTRH does not impact our ability to prevent the inevitable,” Baratt said. “There is currently no known treatment (other than tooth extraction).”

Take home message

Now more than ever, veterinarians are better equipped to make quick, accurate decisions about a horse’s oral health and provide the safest, most effective care. The days of simply looking into a dark mouth with a flashlight have been replaced by well-lit intraoral endoscopy. Clear, high-resolution digital radiographic images have put the blurry early days of computerized radiography aside. “We can now use oral examinations combined with advanced imaging modalities to make accurate diagnoses,” Limone said. “Most conditions can be diagnosed on-farm, efficiently and cost-effectively, and plans for treatment and long-term management can then be developed.”Number

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