Equine Dentistry Overview - Dr.Marty Langhofer

Equine Dentistry

 By  Dr. Marty Langhofer DVM.

PATD

Equine Dental Examination

Tooth Identification

Clinical Equine Anatomy and Common Diseases of the Horse. Reigel and Hakola. Equistar Publications

Biomechanics of Chewing

15 Degree Angles

Malocclusions & Pathology

Foxtails \ Foreign Bodies

Dental Equipment  Power Grinders  Extraction Tools

 Hand Floats  Speculum  Equine Stocks

Mouth Speculum

Veterinary Dental Products – Flexi-Float

Treatments

Dental Identification

Bit Seating

 Placement and Mechanics

Three Point Balance

Clinical Equine Anatomy and Common Diseases of the Horse. Reigel and Hakola. Equistar Publications

Nerve Blocks / Analgesics

Nerves and Blood Vessels

Clinical Equine Anatomy and Common Diseases of the Horse. Reigel and Hakola. Equistar Publications

Clinical Equine Anatomy and Common Diseases of the Horse.

Reigel and Hakola. Equistar Publications

Wolf Teeth  Do Equine use their wolf teeth to fight off other animals?

Dental Analgesia

Clinical Equine Anatomy and Common Diseases of the Horse. Reigel and Hakola. Equistar Publications

Clinical Equine Anatomy and Common Diseases of the Horse. Reigel and Hakola.

Equistar Publications

Equine Dental Caps  Retained Caps Decidvous Teeth

Equine Dental Caps  At what age do caps fall off horses teeth?

 (A) 6 months, 12 months, 18 months  (B) 24 months,

28months, 30 months  (C) 3 years, 4 years, 5 years  (D) 2 years 8 months, 2 years 10 months, 3 years 8 months (also depends on breed of horse)

Clinical Equine Anatomy and Common Diseases of the Horse. Reigel and Hakola. Equistar Publications

Equine Dentistry, 2nd edition. Gordon J. Baker and Jack Easley. Printed with Permission.

Equine Dentistry, 2nd edition. Gordon J. Baker and Jack Easley. Printed with Permission.

Dental Cavities and Fillings

Dental Extractions

Extraction Technique       

Periosteal elevators Tooth spreaders-allow clot to begin forming Apply extractors-rock, rock, rock side to side Wait, wait, wait Resume rocking then wait, wait, wait Resume rocking then wait, wait, wait Dental fulcrum

Extraction Technique       

Extraction Pack off alveolus to control bleeding with saline soaked gauze Pull pack Instill Bio-cell or Gel-foam in socket Add antibiotics (SMZ-TMP, metronidazole, Biotene oral gel) Seal with dental wax or STAT-soft acrylic Pull STAT plug in 7 days

 Alternative

 Flush alveoli socket daily with Chlorhexidine gluconate dilute solution  Then seal with Bio-cell

 NOTE: Gel-foam may be a holding place for bacteria

Control Bleeding   

Pack with wet saline gauze Gel Foam (Pfizer)/Bio-stat (A/cell) Dental wax/ STAT-dental impression acrylic



Electrocautery



Daily dental packs



Surgical-oxidized regenerated methylcellulose (binds platelets and releases fibrin) (Surgicel-Johnson and Johnson)



Topical thrombin (Thrombostate, Pfizer) saturate with Gel-foam



Microfiber collagen (Avitene, Dacroln) either colluplug or collatape (Sulzer Calcitek)



Dental hemostatic powder/paste

Problems with Clotting     

Salivary enzymes Clot dislodgment with tongue/chewing motions Bleeding disorders Liver or kidney disease Drugs    

Aspirin-platelet interference Antibiotics-decreased Vitamin K production Anticoagulants Alcohol/mycotoxins-causes hepatopathy

 Hypertension

Healing Process of Extraction   

Extraction Blood flow from alveolar bone and gingiva Blood clot formation  Forms barrier to debris, food, irritants, bacteria  Forms a supporting structure for granulation tissue

 Local tissue damage from extraction site  Evokes an inflammatory reaction local expansion of blood vessels  WBC’s and fibroblasts invade the connective tissue at the alveolus until granulation tissue is formed  Leukocytes digest the blood clot as granulation tissue is formed

Healing Process of Extraction  Bone is layed down by osteoblasts  Coarse, trabecular, and compact bone is used in bone remodeling

After Extraction  Pain medication (bone)

 Augenal  Benzocaine  NSAIDS such as phenylbutazone and banamine

 Antimicrobials

 Iodofoam packing gauze  Aluyjel (Septodont)-a fibrous product  Biotene oral gel (A/cell)-enzyme that releases iodine and lactoferrin  Calcium sulfate (plaster of paris) antibiotic plugs   

SMZ-TMP Metronidazole Amikacin

Complications with Extractions   

50% of extractions have complications X-Rays should be taken before ALL extractions Improper extraction tools  Dental Elevations  Extraction Tools  Molar, incisor, canine, wolf teeth-long thin blade screw driver, trephines (Michelle and Mallet) and assorted dental punches

 Strong peridental supporting structures

Complications with Extractions  Abnormal root morphology-divergent, hooked, locked, ankylosed, germinated, misshaped, tumors of the tooth  Hypercementotic teeth  Teeth that are weakened (eg-dental decay that has been repaired)  Teeth with abfraction or deep caries  Desiccated teeth or brittle teeth associated with endodonic treatment  Patients with inflammatory disorders associated with alveolar bone disease or Cushing’s disease

Complications with Extractions          

Patients with limited opening or trismus (lock jaw) Oro-sinal fistula Broken off root tips Fractured bone Invasion into sphenoid bone-possible bacterial meningioencephalitis Sepsis systemically Dry socket or non-healing socket Sinusitis Pain Bleeding

Factors causing a Dry or Non-Healing Extraction  Exzyme fibrinolytic production  Alveolar infection     

Especially anaerobes, but can be aerobes Streptococcus Fusospiral Treponema Bacteroids

 Immunocompromised patient  Systemic disease

Treatment of a NonHealing Site      

Betadine flush Chlorhexidine gluconate Antibiotic tablets or calcium sulfate antibiotic plugs – SMZ/TMP + metronidazole Tetracycline PO or IV Clindamycin  Mix capsule with calcium sulfate or gelfoam (drug of choice for anaerobes)  Soak gauze with Clindamycin mixure and fill in alveolar socket  Open caspules and place in alveolar socket

 Look for systemic disease

Endodontics

Periodontal disease  Presence of disease and loss of tissue structures around the tooth.

Incidence  40 % prevalence in 3 to 5 year olds  Eruption of permanent dentition

 Decreased incidence in 5 to 10 year olds.  60 % in horses > 15

Anatomy and Function  Teeth are attached to the alveolus by bundles of connective tissue.  Periodontal membrane or ligament  Collagen fibers attach cement covering to the bone  Embedded portions known as sharpey’s fibers

 Fiber transfer occlusal forces to longitudinal forces along the tooth  Supports the nerves and blood vessels from occlusal forces  Tooth suspended in the alveolus but has slight movement

Anatomy and Function  Gingiva attached to periosteum with dense fibrous CT.  Portion of the gingiva adjacent to the tooth is the gingival sulcus.  This adheres to the tooth by surface tension.  If the sulcus develops periodontal disease it is called a perio(dontal) pocket.

Signs of periodontal disease four categories  1 local gingivitis with hyperemia and edema  Erosion of gingival margin 5mm and periodontal pocket  Periodontitis with gum loss  Gross periodontal pocketing, lysis of alveolar bone, loosening of bone support

Etiology  Multifactoral   

Abnormalities of wear (malocclusions).

Tooth eruption Plaque deposition (salivary glycoproteins + bacteria + inorganic minerals from feed.  Chronic oral bleeding

tartar, perio, ulcers all secondary to exaggerated ridges

5 yr QH

Pathology of Periodontitis inflammation

Plaque build up

Tooth loss

Hyperemia Edema

Bone loss Loss of support tissue

Treatment     

Eliminate the malocclusion Remove tartar Eliminate or minimize the pocket Eliminate or reduce occlusion at site Open up space between teeth if pocketing involves entire space  Extraction

Treatment  Powerfloat   

Grind off the side of affected tooth with wheel Flush mouth twice daily chlorhezidine Cheap

 Air abrasion  Clean pocket with bicarbonate of soda

 Fill with doxyrobe gel (pfizer-pharmacia)  Apply impression material  Expensive

Identification of Pulp Cavities and Measurments  #1 Pulp cavity measurements are 5-7mm from the interdigital edge of opposing teeth (Dr. Rugby- West Virginia, USA)

Tartar removal

Buccal perio pockets 107/8 8/9 207/8 8/9

Buccal perio pockets 107/8 8/9 207/8 8/9

Perio pocket 406/7

Perio pocket

Thru and thru perio pocket

 Food material packed between two teeth from medial to lateral sides  Gingival erosion and odor  Visible crevice between teeth (usually)  Tooth may be loose

Perio pockets

•Food packed between 206/7 7/8 8/9 •All teeth firm

Advanced perio •Food packed either side of 207 •Tooth loose •Should be extracted •Minimal gum attachment •Food frequently packed above & under the attached gum

Powerfloat burrs

Diastema treatment

Diastema Treatment

Perio pocket after opening •Minimal bleeding •Local not used •Pack w/ metronidazole tabs •Flushed twice daily with chlorhexidine •Healing in 10-14 days

Advanced perio

Diastema treatment

•Low speed to prevent heat buildup •Remove gloves—apply chlorhexidine 5% teat dip full strength to area

Diastema treatment

26 year old mare 5 perio diastemata

106/107 107/108 burred open immediate post treatment

Two months later

Perio pocket 207/8

Two months post treatment

Exaggerated ridge probably contributed to this perio pocket

Diastema burring  The treatment has been criticized as potentially damaging to;  the periodontal ligament  gum tissue  tooth  possibly opening a pulp cavity from the side.

Diastema burring  The burr does not remove any tooth below the level of the top of alveolar bone.  The pulp cavity does not extend above the level of alveolar bone.  There is already loss of interproximal tooth material, (cementum); the burr removes only 1-2 mm more from each tooth.  Regeneration of healthy gum and solidification of the tooth within the alveolus occurs within weeks.

Diastema treatment •Chlorhexidine soln •Flush mouth twice daily for 7 10 days •Oral antibiotics +/-