“(Periodontal disease) is one of the most common things that we recognize that we treat in our dental practice at the university right now,” said Cleet Griffin, DVM, Dipl. ABVP-Equine Practice, AVDC-Equine, clinical associate professor of Equine Field Services at Texas A&M’s College of Veterinary Medicine & Biomedical Sciences, in College Station. He reviewed how practitioners can identify and evaluate equine periodontal disease at the 2021 American Association of Equine Practitioners’ Convention, held Dec. 4-8 in Nashville, Tennessee.

Periodontal disease (PD) is inflammation and infection of the periodontium (collectively, the gingiva , periodontal ligament, tooth cementum, and alveolar bone).

“In some study populations the prevalence is up to 75%,” Griffin said. “The severity is variable. It can range from gingivitis, which is just redness and bleeding over that marginal gingiva, to periodontitis, which is when the subgingival structures are involved. Ultimately, it leads to attachment loss and tooth mobility.”

Loose teeth can result in poor and painful chewing, he added. And as periodontitis progresses, it can lead to additional issues, from abscesses to nasal and sinus structure involvement and, ultimately, tooth loss.

While PD often becomes  more prevalent and serious in horses as they age, Griffin said gingivitis is also common in young horses. “We’ve all seen where eruption of a permanent incisor creates gingivitis and inflammation during the shedding of the deciduous dentition,” he said.

Simple things—irritants in hay or forage, for instance—can cause sometimes serious gingivitis, and older horses with equine odontoclastic tooth resorption and hypercementosis can develop severe gingival recession and gingivitis.

Griffin said the most common cause of PD he deals with starts in the tiny spaces between the cheek teeth. “The little gap … allows roughage fibers to become compacted and compressed between the teeth in the interproximal space. The oral bacteria will ferment the carbohydrates in the roughage, which leads to inflammation and necrosis (gingivitis and periodontal disease and tissue death). It is a progressive condition that can result in a pretty severe periodontitis.”

A thorough oral exam is the mainstay of identifying PD. “We want to treat it just like any wound on a horse anywhere,” Griffin said. “If we find roughage trapped in a gingival pocket, you have to clean it out, get a good look at it, and assess and see how deep the problem is.”

He said horses should be well-sedated for the oral exam. Instrumentation is important for evaluating PD and should include:

• A dental halter or head stand;
• A bright light source/headlamp;
• A speculum to keep the mouth open;
• A cheek retractor;
• A dental mirror or oral endoscope to visualize hard-to-see areas;
• A periodontal probe (for exploration and to measure pockets; “Just be careful,” Griffin said. “This is like a toothpick going into the horse’s mouth. If the tongue’s flopping around and there’s a bunch of chewing, you can break this or embed this into the soft tissues of the tongue, palate, or interproximal space.”);
• A dental scaler (to assess tooth mobility);
• A pressurized oral irrigation instrument (to clean out debris and inspect affected areas);
• Periodontal forceps (for debris cleanout); and
• An X ray unit (you might not need radiographs with all cases, but Griffin said it can be useful for assessing bone loss, tooth and tooth root architecture, and other changes in cases of moderate to severe PD).

Griffin said these tools can help veterinarians determine the extent of the PD and develop an appropriate treatment plan.

Take-Home Message

Periodontal disease is a very common issue in horses, but veterinarians must take the time to examine and evaluate cases closely.

“The severity is really variable with periodontal problems in horses, but first step is that you’ve got to find them,” Griffin said. “You have to figure out if this is an early-stage disease or a moderate or advanced stage issue. That’s what’s going to lead you to the most appropriate treatment planning.”