| Cool Cases Case 2 |
Signalment: "Squirt" is a 12 yr. old QH mare which was referred by another veterinarian
for chronic dental problems. The owner reported that the mare had been having dental
problems for the entire 3 years that they had owned her, but previous treatment had not
been successful. The mare had a history of being a chronic pacer when stalled
Physical Exam: The mare was in good flesh and was not depressed. Upon oral exam,
it was noted the first upper pre-molar on the left was dead, with all pulp cavities open.
There was a foul, necrotic odor in the mouth.
Initial Treatment: Since this is the first molar in the arcade, we elected to try to save the
tooth to prevent collapse of the arcade. The gingival area was cleaned and packed, and
the opposing tooth was taken out of occlusion. The mare was put on Equine Senior for
3 weeks, and given 10 days of antibiotics and bute.
Initial Response: The mare improved dramatically, and her pacing stopped. Upon
re-examination, the tooth was stable in the socket, and their was no odor
Follow-Up: The mare continued to do well for approx. 6 months. However, she then
resumed her pacing, and we believed her to be in pain.
Radiographic Examination: Stall-side radiographs were taken, and a large root
fragment was clearly visible and separate from the tooth.
Treatment: We elected to do a standing extraction. The mare was sedated, and the
first pre-molar removed uneventfully (see pictures). The fragment was large, and had
migrated medially into the palate. Although difficult, the fragment was removed and had
an extremely necrotic, foul odor. the socket was flushed, and no evidence of other
fragments found.
Post: Following the procedure, additional radiographs were taken. It was noted that
there were 3 additional fragments present, but that they were buried deep in the soft
tissue. Since agressive surgical exploration was going to be necessary to retrieve the
fragments, the owner elected to wait and see how the horse did. The mare was placed
on antibiotics and bute for pain.
Follow-up: Squirt had immediate improvement, and several weeks later was still doing
well. She was eating well and had stopped pacing.
for chronic dental problems. The owner reported that the mare had been having dental
problems for the entire 3 years that they had owned her, but previous treatment had not
been successful. The mare had a history of being a chronic pacer when stalled
Physical Exam: The mare was in good flesh and was not depressed. Upon oral exam,
it was noted the first upper pre-molar on the left was dead, with all pulp cavities open.
There was a foul, necrotic odor in the mouth.
Initial Treatment: Since this is the first molar in the arcade, we elected to try to save the
tooth to prevent collapse of the arcade. The gingival area was cleaned and packed, and
the opposing tooth was taken out of occlusion. The mare was put on Equine Senior for
3 weeks, and given 10 days of antibiotics and bute.
Initial Response: The mare improved dramatically, and her pacing stopped. Upon
re-examination, the tooth was stable in the socket, and their was no odor
Follow-Up: The mare continued to do well for approx. 6 months. However, she then
resumed her pacing, and we believed her to be in pain.
Radiographic Examination: Stall-side radiographs were taken, and a large root
fragment was clearly visible and separate from the tooth.
Treatment: We elected to do a standing extraction. The mare was sedated, and the
first pre-molar removed uneventfully (see pictures). The fragment was large, and had
migrated medially into the palate. Although difficult, the fragment was removed and had
an extremely necrotic, foul odor. the socket was flushed, and no evidence of other
fragments found.
Post: Following the procedure, additional radiographs were taken. It was noted that
there were 3 additional fragments present, but that they were buried deep in the soft
tissue. Since agressive surgical exploration was going to be necessary to retrieve the
fragments, the owner elected to wait and see how the horse did. The mare was placed
on antibiotics and bute for pain.
Follow-up: Squirt had immediate improvement, and several weeks later was still doing
well. She was eating well and had stopped pacing.
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| Pre-op click to enlarge |
| Post-op |
Cool Cases
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Tooth and fragment after removal
Signalment: "Rolo" is a 16 yr. old QH gelding which was initially presented for a
routine dentistry. This was a new horse for the owner, and the previous owner had not
noticed any abnormalities. The new owner believed that the horse may have a dental
issue based on his eating habits and reluctance to be bridled.
Physical Exam: This gelding was slightly underweight, although he appeared alert
and responsive. He was reluctant to permit oral examination. After sedation, it was
noted that there were multiple abnormalities with the upper incisors. The lateral
incisor was fractured, and deviated laterally - which means that the tooth was
protruding out the side of his mouth. The remaining incisors appeared intact, but were
slightly loose. When manipulated, small, pinpoint pockets of pus were evident just
above the gum line.
Treatment: Radiographs were obtained of the upper incisors. All incisor roots were
decayed. It was explained to the owner that even though he had incisors, he was
unable to use them to prehend (due to the pain), and therefore, it would be best to
extract them. Additional sedation was given, and local blocks used. All incisors were
removed with roots intact. The sockets were cleaned and flushed. Due to the bacteria
present, it was elected not to pack the sockets. The owner was asked to flush the
mouth twice daily with salted water and diluted chlorhexidine. The horse was also
placed on oral antibiotics for 10 days and phenylbutazone for 5 days.
Follow-Up: At 2 weeks, Rolo was doing remarkably well, and had gained weight. 2 of
the sockets had still not healed to my satisfaction. After sedation, the sockets were
cleaned and dried, and packed with an alginate product mixed with antibiotics. This
product is designed to stay in the socket for a period of 4 - 14 days, and will fall out on
his own. 1 month following this procedure, the packing was out, the sockets all
healed, and Rolo was looking better than ever! There were no more eating or bitting
problems.
routine dentistry. This was a new horse for the owner, and the previous owner had not
noticed any abnormalities. The new owner believed that the horse may have a dental
issue based on his eating habits and reluctance to be bridled.
Physical Exam: This gelding was slightly underweight, although he appeared alert
and responsive. He was reluctant to permit oral examination. After sedation, it was
noted that there were multiple abnormalities with the upper incisors. The lateral
incisor was fractured, and deviated laterally - which means that the tooth was
protruding out the side of his mouth. The remaining incisors appeared intact, but were
slightly loose. When manipulated, small, pinpoint pockets of pus were evident just
above the gum line.
Treatment: Radiographs were obtained of the upper incisors. All incisor roots were
decayed. It was explained to the owner that even though he had incisors, he was
unable to use them to prehend (due to the pain), and therefore, it would be best to
extract them. Additional sedation was given, and local blocks used. All incisors were
removed with roots intact. The sockets were cleaned and flushed. Due to the bacteria
present, it was elected not to pack the sockets. The owner was asked to flush the
mouth twice daily with salted water and diluted chlorhexidine. The horse was also
placed on oral antibiotics for 10 days and phenylbutazone for 5 days.
Follow-Up: At 2 weeks, Rolo was doing remarkably well, and had gained weight. 2 of
the sockets had still not healed to my satisfaction. After sedation, the sockets were
cleaned and dried, and packed with an alginate product mixed with antibiotics. This
product is designed to stay in the socket for a period of 4 - 14 days, and will fall out on
his own. 1 month following this procedure, the packing was out, the sockets all
healed, and Rolo was looking better than ever! There were no more eating or bitting
problems.
| Case 1 |
click on images to enlarge