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Juvenile Equine Dental Case Study

By Jon M.Gleche, DVM, FAVD EQ, Diplomate AVDC EQ

Article Archives LinkJuvenile Equine Dental Case Study

Juvenile Equine Dental Case Study

Dentistry is an important part of the equine veterinary practice, both for patient wellbeing and practice profitability. Horses under 5 years old should have complete dental/oral examinations at least twice a year and may need more frequent examination if pathology necessitates. There are numerous developmental events occurring in juveniles under five years old. Each one has the potential to become pathologic. The following case highlights the importance of designing a practice dentistry program that includes thorough examination of these young horses.

Case Study:

A horse owner calls for consultation regarding a bump on her young mare’s gum. She describes a small raised area under the upper lip over the left maxillary incisors. She is certain this is new and was not there a week ago. She proceeds to describe a very active, playful Arabian mare who is turned out on pasture with 3 other horses of varying ages. Although you explain the limitations of a phone consultation, she declines a physical examination and states she will text you a picture for your review. You review the picture and of course it is tiny, grainy, out of focus and underexposed. You remind her of the benefits of a physical examination and she declines, stating she will place the mare on phenylbutazone and call if she does not improve. She further states, “in my experience this is almost certainly trauma”. The initial treatment plan (TP) is to follow up with a phone call in one week. On follow up in one week there is no change. Since the horse is due for a routine dental the owner agrees to have you examine the mare.

Chief Complaint:

Presented for routine dental examination, any indicated dentistry and to evaluate a small bump under her upper lip that is suspected to have been a result of trauma.

History:

Current owner purchased this mare about 22 months ago as a halter show horse. She is current on vaccinations and not on any medications. To this owner’s knowledge she has not had a prior dental examination. There is no history of performance issues. Mastication and deglutition are within normal limits (WNL) for grain and forage per history. The owner estimates she currently spends about eight to ten hours a day chewing/grazing.

Physical Examination (PX):

The owner presents a 28-month-old, bay, Arabian, mare, in good flesh (body condition score of 5). On physical examination the mare appears to be in good health, bright alert and reactive, with normal vitals. Extra oral examination is WNL. The mare is sedated and standard dental function tests are performed and found to be WNL. Function tests are followed by a complete intra oral examination.

Intra oral examination:

Age appropriate mixed dentition appears to be present. Sharp enamel points are present on the buccal/vestibular aspect of the maxillary cheek teeth and on the lingual aspect of the mandibular cheek teeth. Mild abnormal transverse ridges present on the maxillary and mandibular cheek teeth. All other intra oral anatomy appears WNL except the presence of a small mass located apical to the clinical crowns of the 101, 201-02 incisors (Fig. 1). The mass is a very firm boney consistency with no pitting edema or discoloration of the overlying gingiva or mucosa, non-painful, and dorsoventrally ovoid. It is covered by attached gingiva and mucosa and it is difficult to palpate the dorsal extent of the mass deep to the vestibular mucosa over the incisive bone. There are two small bruised areas of attached gingiva occlusal to the mass (Figs. 1-2).

Figure 1

Diagnostics & Treatment:

TP consisted of a routine float/ odontoplasty (FLT/ODY) and radiography (RADs) of the mass (Fig. 3). Based on PX and RADs a tentative rule out list was formulated (Fig. 4). After consultation with the owner the patient was tentatively scheduled for biopsy of the mass, however due to financial constraints the mass was not biopsied until 4 weeks post initial examination. At that time the mass had increased in size by approximately 20 percent. During biopsy the mass was noted to be extremely hard/dense almost impenetrable with the bone biopsy instrument. Three sites were sampled and the biopsy report stated: “A form of odontoma is the primary concern for this mass, but this is difficult to confirm due to marked fragmentation and crush artifact of the specimens and poor cellular detail. There is no evidence of cementoma in these sections and no overt malignant features.”

Further TP recommendations were to surgically remove the mass. Financial constraints delayed the scheduled surgical treatment. At 3 weeks post biopsy the owner complained of swelling and possible infection at the mass’s location. On examination there was a pinpoint area of scant serous drainage over the mass centrally and again the mass had increased in size and remained a bony consistency on palpation. Culture results yielded “mixed environmental species”. Due to the increasing size of the mass and the draining tract the owner consented to surgical treatment and a standing, partial rostral incisivectomy/maxillectomy was scheduled to remove the mass (Fig. 5). Post-operative dissection and further analysis of the mass confirmed a complex odontoma with complete surgical margins (Fig. 6-7). After care consisted of antibiotics, NSAIDS, and soft diet with rechecks at two weeks, three weeks (Fig 8), three months and six months post operatively. Radiographic follow up was scheduled at the six month recheck and was WNL. Healing was uneventful with excellent results to date. In this case of complex odontoma with the complete surgical excision, the long-term prognosis is good.

Figure 2

Discussion:

Compound and complex odontomas are odontogenic tumors occurring in both young and old horses with a predilection for horses under 5 years of age. Complex odontomas consist of all the standard dental elements found in a normal tooth but they are arranged in a disorganized manner within the mass.

Compound odontomas consist of all standard dental elements organized in “tooth like” structures called denticles within the mass. Both are surrounded by a layer of bone in a cyst like structure that may thin dramatically as the mass within enlarges. These masses are associated with the incisive bone and apical regions of the maxillary cheek teeth.

Because this mass was concealed by the labia it could have easily gone undiagnosed for an extended period of time. Early diagnosis and treatment increase the odds of a good treatment outcome. This is just one of numerous examples highlighting the need for thorough biannual oral examinations of horses less than five years of age.

Take-home points:

Age appropriate frequency of dental/oral examinations can dramatically improve patient wellbeing and practice revenue. Horses under the age of five experience numerous ongoing developmental events. Origins of dental/oral defects may be congenital, developmental, traumatic, infectious or iatrogenic. Often, they are subtle and can progress to serious pathology without early detection and treatment by a trained professional.

Bio:

Dr. Jon Gieche received his Doctorate in Veterinary Medicine from Michigan State University College of Veterinary Medicine in 1986. In 1991, Dr. Gieche founded Kettle Moraine Equine Hospital and Regional Equine Dental Center, a state-of-the-art full service equine hospital and ambulatory practice specializing in Equine Dentistry in Wisconsin. In February 2013, Dr. Gieche achieved Equine Fellowship status in the Academy of Veterinary Dentistry (AVD). He is one of only eight AVD-EQ Fellows in North America. In 2016, Dr. Gieche achieved diplomate status in the American Veterinary Dental College, (Board Certification in Equine Dentistry). Currently Dr. Gieche is one of ten board certified equine dentists in the United States and one of fifteen in the world. His extensive knowledge of Equine Dentistry has given him the opportunity to instruct veterinarians and veterinary students via lectures and hands-on wet labs both nationally and internationally.

Dr. Gieche designed and built Kettle Moraine Equine Hospital and Regional Equine Dental Center (KMEH-REDC), and his mobile veterinary unit, specifically to provide state-of-the-art equine care. KMEH-REDC's facility includes a fully padded surgery suite with padded induction gate and an inflatable surgical table, reducing risks associated with surgery and anesthesia. During standing procedures patients are handled in KMEH’s spacious in-house treatment area or our safe secure padded stocks. KMEH-REDC’s mission is to bring the highest quality care to their referral, in-house and ambulatory patients