Senior Dental Problems: Consider the Whole Horse
“It’s going to be necessary for owners, as a horse ages, to make adjustments to their feeding and husbandry programs to maintain the horse in more ideal body condition,” said Cleet Griffin, DVM, Dipl. ABVP-Equine Practice, AVDC-Equine, at the 2021 American Association of Equine Practitioners’ Convention, held Dec. 4-8 in Nashville, Tennessee. “I think it’s upon us as veterinarians to equip ourselves with information to be able to advocate for the horse in those situations.”
In his session, Griffin, who is a clinical associate professor of Equine Field Services and Equine Dentistry at the Texas A&M College of Veterinary Medicine & Biomedical Sciences, in College Station, reviewed what practitioners should watch for and how they can help maintain their patients’ well-being.
“It’s very, very common for us to see horses that are 30, 31, 32, 33, 34 years old presented for treatment and evaluation,” he said. “It’s a very common age group, and it’s an important part of our practice.”
Why It’s Essential
Griffin said in his experience old horses seem to fall into two categories: “Those that are doing really, really well, and those that aren’t doing well.” Few seniors fall in the middle of the spectrum.
“The little Arabian gelding,” he said, referring to a photo on the screen, “I think he’s 26 years old. He has no access to fresh grazing or lush pasture (which could contribute to metabolic issues); he lives in a huge drylot. He prances and darts around there with no lameness, no hoof abnormalities, no issues at all. He’s fed lots and lots of chopped hay, lots and lots of alfalfa pellets, and lots and lots a ration formulated for older horses. He also eats a fat supplement. I’m not too worried about him.”
Still, when it comes time for the gelding’s an annual work-up for concurrent medical conditions, Griffin said he’s always sure to perform a thorough oral exam to see if any issues have arisen.
“The other two horses,” he said, referring to additional case examples in his slideshow, “they’re way too thin. The mare, I hadn’t seen her in a few years, but she was a body condition score (BCS) of 7 the previous time I saw her. Something’s going on medically or with the husbandry program that’s caused her to get so thin.
“And the other horse, he has a great husbandry program, but he’s still not doing very well,” he continued. “By the looks of the long curly hair coat, I’m certain we’re probably dealing with some type of uncontrolled pituitary dysfunction and maybe other medical problems.
“Yes, we’re talking about dentistry, but we’re also talking about older horses,” he added. “Don’t just focus on the teeth. We need to look at the whole horse.”
Evaluation Tips and Findings
When evaluating a senior horse with potential dental issues, practitioners should not only conduct thorough oral exams but also gather as much information as possible and pursue additional diagnostics as needed.
“Be really curious with your history about the horse’s management program, especially the types and the amounts of roughage and feed that the horse is receiving,” he said. “If older horses are too thin, I’m going to encourage you to get a complete blood count and a chemistry panel with electrolytes.”
He also recommended tests to check for pituitary pars intermedia dysfunction (formerly known as equine Cushing’s disease) and fecal egg counts to evaluate parasite burden.
Griffin said practitioners can learn a lot from watching a horse eat: “I want to see that they’re eager to graze, I want to see their ability to graze or to chew roughage. … Typically, when they’re struggling with forage, either because of discomfort or because of malocclusion (when the jaws and teeth don’t align), you’re going to see that the horse is going to be spitting out these spongy balls of hay quidding. I look around the hay pile or the feed bowl.
“On the other end, in the manure—instead of a pretty uniform, really short fecal fiber length—, you’re going to find long and chewed stems and unshaved leaves from the forage.”
During the oral exam Griffin said practitioners might observe issues such as:
- Missing, loose, or damaged teeth, which can cause pain and reduce a horse’s ability to chew;
- Sharp enamel edges that can cause tissue damage;
- Misaligned overgrown teeth, which can also damage tissues;
- Periodontal disease (inflammation and infection of the periodontium—collectively, the gingiva, periodontal ligament, tooth cementum, and alveolar bone), including gingivitis;
- Gaps between teeth, where roughage can pack and cause periodontal disease; or
- Equine odontoclastic tooth resorption and hypercementosis, which causes severe changes to the tooth roots and surrounding gingiva—often the incisors.
He said senior horses can also develop tooth-related sinus issues, such as a nasal or oroantral fistula. This typically involves a fractured tooth or some severe periodontal disease around a tooth, and results in hay stems, roughage, and oral contents going up into the nose.
Griffin said these sinus problems can be frustrating to manage, and treatment involves plugging the hole that’s allowing oral contents into the nasal passages.
Finally, Griffin touched on how practitioners can offer nutritional advice that can help owners turn their old horses’ lives around. “(It) is so very important to their overall well-being,” he said.
He shared an example of a horse he and his team were called to evaluate due to weight loss.
In their work-up, they observed the mare quidding severely, and her only roughage source was a coarse Bermudagrass hay in a very tightly wound round bale.
After test results came back, he said, it was clear the mare also had a high parasite burden and was anemic (the team attributed that to debilitation and inadequate energy intake). Based on those and the physical exam results, Griffin and his team recommended some simple diet modifications.
“Based on her oral exam and quidding, she was not going to be able to handle the coarse roughage,” he said. “So, we switched her to chopped hay and alfalfa pellets. We’re making sure that she gets about 1.5% to 2% of her body weight of those per day. We put her on a senior pelleted ration that’s formulated for older horses at about 1.5% body weight per day.”
She’s also receiving a fat supplement and eating no more than 4 to 5 pounds at a time, which means multiple feedings each day. Additionally, she was dewormed.
Griffin said the mare could have used a dental float on Day 1, but he was concerned about the effects of sedation in her current state. They scheduled a float for three months later.
“The transformation was remarkable,” he said. “Just three months with really simple recommendations, and she’s a much better body condition, her hair looks better, and her overall demeanor is much better. And then at that stage, I feel pretty good about doing her teeth.
“That’s really what I want to drive home,” he said. “We’re here talking about teeth, but especially in these older patients that aren’t doing as well, we just want to equip ourselves and be able to be really good advocates for them.”
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