Equine Dental Exams in Five Easy Steps

Learn how a systematic approach can help practitioners identify minor dental issues before they become serious problems.

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Most equestrians are familiar with systematic approaches. From which boot to apply to a horse’s leg first to which horse gets breakfast and dinner first, doing things “in order” quickly becomes habit, and when you break your habits sometimes you forget things.

To stay organized and carry out the most thorough exams possible, veterinarians often adopt systematic approaches, as well. And at the 2014 American Association of Equine Practitioners Convention, held Dec. 6-10 in Salt Lake City, Utah, Travis Henry, DVM, reviewed a five-component, stepwise approach to carrying out equine dental exams.

Henry, of the dental practice Midwest Equine Services, in Elkhorn, Wisconsin, explained that protocols used in other species focus on several specific aspects examined systematically to thoroughly evaluate areas of importance.

“Using a systematic approach to oral examination minimizes the risk of overlooking oral pathology and helps the veterinarian formulate an appropriate treatment plan for the patient,” he said.

Based on those protocols, Henry uses the following components in his dental exams:

  • Extra-oral examination;
  • Occlusion evaluation;
  • Periodontal tissue evaluation;
  • Evaluation of the endodontic structures of the clinical crown; and
  • Oral soft tissue evaluation.

Then, he described each part of the exam for veterinary attendees.

Extra-oral Examination Henry said this portion of the evaluation should be performed prior to sedation, which allows the practitioner to “more accurately evaluate symmetry and whether the patient reacts painfully to palpation of different skull structures or abnormal areas of the head.”

Normally, a horse’s head appears symmetrical, he explained. Issues that could result in facial asymmetry include:

  • Muscle atrophy;
  • Soft tissue enlargement;
  • Bony enlargement or indentation;
  • Neurologic problems;
  • Skull deformities; and
  • Temporomandibular joint swelling

Abnormal head swellings can result from:

  • Tooth-root disease;
  • Eruption cysts;
  • Neoplasia (tumors);
  • Sinus problems;
  • Trauma;
  • Guttural pouch enlargement;
  • Lymph node enlargement;
  • Salivary gland enlargement; and
  • Odontogenic cysts (cysts formed from tissues involved in tooth development).

“In some instances, if abnormalities of symmetry or abnormal swellings of the head are encountered, additional diagnostic testing—such as lab work, radiography, or computerized tomography—may be indicated,” Henry said.

Occlusion Examination This evaluation of how a horse chews has several steps, Henry said:

  • Incisor examination—Before applying a speculum, the veterinarian should evaluate the horse’s incisors. Henry said that when the jaw is in a square position, “normal occlusion between upper and lower incisors when viewed frontally is a level bite.” When viewed from the side in a neutral head position, the upper and lower incisors should meet evenly.
  • Cheek teeth examination—”The horse’s anatomy results in a sloped chewing surface with enamel points on the buccal aspect (the side of the teeth next to the cheek) of the upper cheek teeth and the lingual aspect (the side of the teeth next to the tongue) of the lower cheek teeth,” Henry said. The lower cheek teeth should appear slightly narrower than the upper cheek teeth, he said, and the rostral (front) portion of the upper cheek should curve slightly toward the head’s midline. Additionally, Henry said, horses’ upper and lower cheek teeth chewing surface has a normal upward curvature toward the back of the jaw.

Abnormalities of the occlusal surfaces are termed malocclusion, which veterinarians typically treat with frequent occlusal adjustments or “floating techniques,” he said.

Soft Tissue Examination An evaluation of the oral soft tissues—including the tongue, lips, cheek, mucosa, hard and soft palates, and interdental spaces—can reveal a variety of abnormalities, including:

  • Bleeding;
  • Mucosal or gingival enlargement;
  • Abnormal growths;
  • Ulceration;
  • Abrasions; and
  • Lacerations.

Henry said that, during the exam, practitioners should biopsy abnormal masses, radiograph mucosal enlargements, check for retained teeth, and radiograph or ultrasound tongue injuries to check for foreign bodies.

Periodontal Examination Henry said structures relating to the periodontia include the gingiva (gums), gingival sulcus, periodontal ligament, cementum (tissue that covers the sides of the tooth and is yellow in color), and the alveolar bone (the socket in which the tooth sits). Abnormalities include:

  • Periodontal pocketing of roughage;
  • Gingival enlargement;
  • Gingivitis and bleeding;
  • Pathologic diastemata (space between teeth);
  • Gingival recession;
  • Halitosis (bad breath); and
  • Calculus accumulation.

One important abnormality is periodontal disease, which is an often-painful progressive condition preceded by gingivitis, Henry said. If the alveolar bone becomes involved, he said, the condition is termed periodontitis (an irreversible condition); if this condition sets in he recommended taking radiographs of the affected area to assess how much bone loss has occurred.

Endodontic Examination “Structures to be examined include the occlusal aspect of all teeth, including the infundibula of the incisor teeth and maxillary cheek teeth and the pulp chambers of the incisor teeth and pulp horns of the cheek teeth,” Henry said.

Dentin should be ivory-colored to dark tan, and any dentin abnormalities could be associated with more severe problems, Henry said. As a result, veterinarians should assess abnormalities further. Any areas where food adheres to teeth should also warrant further evaluation.

“Small fissure lines through occlusal dentin and enamel are frequently identified in cheek teeth, but the significance of these subtle lesions is not understood,” Henry said.

Tooth fractures and infundibulum (invaginations of enamel on the occlusal surface normally filled with cementum) abnormalities are also sometimes identified on endodontic exam, he added. Treatment of these conditions depends on their severity.

Take-Home Message

“The oral examination should result in a complete assessment of the patient’s oral health, and using a five-component protocol helps bring greater understanding to the veterinarian of oral lesions as they pertain to specific dental disease categories,” Henry concluded. “Adhering to a systematic approach should improve the veterinarian’s likelihood of identifying and managing equine oral pathologies prior to becoming advanced problems.”


Written by:

Erica Larson, former news editor for The Horse, holds a degree in journalism with an external specialty in equine science from Michigan State University in East Lansing. A Massachusetts native, she grew up in the saddle and has dabbled in a variety of disciplines including foxhunting, saddle seat, and mounted games. Currently, Erica competes in eventing with her OTTB, Dorado.

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