At the 2014 American Association of Equine Practitioners Convention, held Dec. 6-10 in Salt Lake City, Utah, Caroline N. Niederman, VMD, FAVD/Equine, described how veterinarians can incorporate both nutritional assessment and dietary modification into a regular equine dental care program.
“The annual oral examination provides the equine practitioner with the opportunity to not only identify dental abnormalities, but also to document the loss of cheek-teeth chewing surface area that occurs with age as a product of normal dental eruption and wear,” said Niederman, owner of Complete Equine Dental Maintenance, in Houston, Texas.
Dental abnormalities can have a negative impact on how horses—especially older ones—consume and utilize the nutrients in food. As such, performing a complete oral exam affords the veterinarian with the opportunity to educate owners on how to provide adequate nutrition as the horse ages to prevent choke, impactions, and pronounced weight loss.
The Complete Dental Exam
“A complete oral examination begins with taking a dental history,” Niederman said. She recommended collecting as much information as possible by asking the owner detailed questions, including:
- What and how often do you feed your horse?
- Does he have pasture access?
- Is your horse still able to consume hay? Does he leave any chewed, but undigested, boluses of hay behind (termed “quidding”)?
- Where is your horse fed, and is he separated from other horses at feeding time?
- How long does it take your horse to finish meals?
- Has he gained or lost weight in the past year?
- What do his fecal balls look like? Are they formed and moist, dry, or have pieces of undigested hay?
- Is your horse on any medications?
After collecting the dental history, Niederman recommended veterinarians observe their patients. This allows the practitioner to assess the horse’s body condition, eating habits (i.e., the ability to prehend food and any evidence of quidding hay), and fecal consistency, she said.
Additionally, an external exam allows the veterinarian to identify signs of possible internal problems, she said. If the veterinarian suspects problems, Niederman recommended carrying out a complete blood count, chemistry, and other specific tests to identify conditions such as anemia, kidney or liver dysfunction, or pituitary pars intermedia dysfunction (equine Cushing’s disease) that could impact dietary recommendations.
And finally, an in-depth dental exam can provide veterinarians with important information regarding how a horse chews the food he consumes. Niederman said the oral exam, from a nutritional perspective, should focus on evaluating the cheek teeth’s occlusal (chewing) surface and enamel loss.
“Enamel loss decreases the chewing surface area used to masticate hay,” she explained. “The term ‘smooth mouth’ describes teeth experiencing this process.”
Niederman said other common problems veterinarians should watch for include:
- Cupped teeth—These occur when maxillary (upper) cheek teeth’s exposed crown wears below the apical (away from the occlusal surface and closer to the tooth roots) extent of the infundibulae (a crescent-shaped depression in a tooth’s crown) but above the gums; this condition can also occur in mandibular (lower) cheek teeth, but there’s not a specific term for this, she said; and
- Expired teeth—Maxillary or mandibular cheek teeth at the end stage of wear, where the teeth are worn down to the cemental roots.
She said veterinarians should document all abnormalities in the horse’s dental records.
“The next important step is to educate the owner by showing them the changes observed during the examination,” Niederman said. “Intra-oral photos and drawings can be used to reinforce the findings for both present and absentee owners.”
Niederman said “appropriate nutritional advice is not possible until all aspects of the clinical examination have been completed.” At that point, the veterinarian can use the findings to suggest dietary adjustments to improve their patients’ health.
“For example, the thin geriatric horse scheduled for examination may be the one seen standing out in a paddock with a round hay bale along with other younger and fatter horses,” she said. “That older horse’s teeth are simply unable to chew the hay and, thus, that horse can only stand aside as other horses feed.
“Another common scenario is that the owner has called for an appointment because, despite eating 20 pounds of a senior feed each day, the horse is still thin,” she continued. “It may be useful to find out how long it is taking the horse to eat each feeding. A good rule of thumb to use is that if a horse takes longer than 45 minutes to finish each meal, switching to a more calorically dense feed is warranted.”
Niederman said educating owners about how horses’ teeth erupt throughout their lives and common wear patterns could help them better understand how to feed their horses.
“Dietary recommendations should be a part of these conversations before the horse has lost weight” and his teeth are in poor condition, she said.
For instance, when a horse’s last three maxillary cheek teeth are all either cupped or expired, she said, it’s time to look for a long-stem hay alternative, especially if the horse doesn’t have pasture access.
For senior horses with diminished chewing function (and assuming lab work has precluded problems such as renal or hepatic dysfunction), Niederman recommended a diet such as:
- Chopped or soaked grass or grass/alfalfa-mix hay cubes at a rate of 1 to 2% of body weight per day;
- A senior feed comprised of 12 to 14% crude protein, 8 to 20% crude fat, and 5 to 10% crude fiber; and
- If needed, a cup of edible oil or 0.5 to 1 pound of rice bran per day.
“The routine oral examination presents an opportunity to improve client awareness of the significance of age-related tooth wear and to discuss proactive dietary modifications,” Niederman concluded.