Incisor pulled, now what?

[texsuze]

Took my 25 y.o. retiree to the vet this morning for his annual dental check-up/teeth float and he ended up having an incisor pulled. This front tooth had been just a bit wonky-looking for some time, actually, and I was always told to "keep an eye on it". During the float, my vet inspected it further, took an x-ray, and saw that the tooth had lost the interior (infundibulum?) material. Also, roots were absent, just granulation tissue there. The tooth was slightly loose (but not 'string-tied-to-the-doorknob' loose) so decision was made to go ahead and pull. Yuk.

My poor old guy. Since he is allergic to chlorhexidine, vet wants me to flush the gum cavity daily with saline. He feels it will heal well, since there are no residual roots, and granulation tissue is already present.

I need some hand-holding about post-pull care. Anyone care to share how they managed the aftercare of a pulled tooth? How long did it take your horse to recover completely? Any residual problems? Thanks in advance.

[Quelah]

Mine, or rather my horses, have always been molars, so no real aftercare of significance to be done on my part. It's been so long I'm trying to remember. Maybe we put them on ABs for a while? Always been older horses and tooth ready to go. When I had my own wisdom teeth out at the ripe old age of 35, totally not a big deal. Healed beautifully, never in any pain, no infection.

I think if the doc does a good job and leaves no tooth behind, it really heals well. Fingers crossed for your oldster

[Srhorselady]

Since no root not likely to be a major issue. My horses love to have their mouth's washed out with a syringe of warm salt water usually twice daily after tooth procedures for 2 to 3 days. I syringe 3 to 5 syringes on eac side. They all like it and one will even rinse her own mouth in the bucket of leftover warm salty water. I've had at least Three?broken teeth removed in elderly horses and a couple just left when they seemed firm. Usually Banamine for 24 hours and the salt washes. The only problem tooth was a firmly attached broken molar that they eventually had to go through the jaw to get. She had an exposed nerve so it had to be done. The Vet put in a sort of temporary cap inside the hole and the mouth healed well. We had some healing problems with the external opening and did use antibiotics but all turned out well eventually. Yours doesn't sound like it should be too much of a problem. However, any horse with a missing tooth MUST be dental checked regularly or you can have future problems.

[musical comedy]

My horse had one incisor pulled (due to looseness) a long time ago (probably 10 years). I do not recall treating with anything.

[texsuze]

Thanks for the feedback. I asked about AB but vet said the saline wash should be all that is necessary at this point. My oldster does not like the saline flushes--rolls his eyes back into his head, makes weird faces, etc.
I think a lot of what is taking place right now is adjusting to the sensitivity of the missing tooth, plus, the discomfort of the speculum and side gags required to do his dental work. It's hard enough for me to keep my mouth open for teeth cleaning, but I get to take more breaks in the action.

I've always had good, annual dental work performed on my guy(s) for years, so hopefully this will be the one and only time a tooth requires pulling. Fingers crossed. Last night he got some unsweetened applesauce as a treat

[VBOpie]

Did the vet mention anything about a condition called EORTH? Kind of sounds like you are describing. My retired horse has it.

[texsuze]

VBO, what is EORTH? I'm embarrassed to say I've not heard of it?

[VBOpie]

Texsuze,

Sorry I didn't respond sooner - just saw your question. EORTH is the acronym for Equine Odontoclastic Tooth Resorption and Hypercementosis. A Google search will give you lots on information. There are two schools of treatment - one says all teeth should be pulled because EORTH seems to spread (albeit slowly); the other said only pull teeth as needed. I've opted for the second. So far, in about two years, my guy has lost two teeth - with one on the watch.

[texsuze]

VBO, thanks, I'll be googling this condition. Vet didn't mention it during our visit. This incisor had been "suspect" for a few years now. No telling how long it was sitting there minus the roots, since we'd never had dental x-rays. Hope your guy's tooth loss is able to be managed successfully. Thanks for the info.

[VBOpie]

After you Google, please let me know if you think you might be dealing with this. It would be nice to have someone to compare notes with.

[texsuze]

VBO,
wow, lots of information to process there. My guy does some drooling (probably Pavlov response...), and does stand in the shade of the trees, gazing into his water trough, starting about 3 hours before he gets brought back to the barn--both of these 'behaviors' being mentioned in some of the literature. He doesn't appear to be in any pain, can still eat fluffy hay (see my "Leaky Bum" thread), and grazes in his pastures. In terms of gum appearance, his look pretty normal, and, since we had a decent quality x-ray taken, there was no mention of tooth roots having abnormal appearance. I can't say, however, that my vet has true expertise with detailed equine dental work.

My gelding has had very good quality annual power floats, save for one year when my dressage trainer recommended someone who turned out to be really lousy. I'm hoping the annual dentals are not now resulting in issues. I guess I'll need to be on the watch, for the time being. Can't say that I'd consider him an EORTH candidate, but I will bring this up to the vet if anything changes.

VBO, how old is your retiree? How are you assessing his quality of life after tooth removal? Are you taking things as they come, or do you have a plan for how many procedures your retiree can handle? Since my guy turns 25 this month, I tend to be over-analytical WRT quality of life, what might be expected on any medical intervention, pros vs cons, etc. Thanks for alerting me to this condition.

[VBOpie]

Hi, Texsuze

Lad is 20. He is doing great at this point. You'd never know he has had any teeth pulled. He is still able to eat carrots, etc. There is another tooth that is loose - when #3 is pulled that may change things. The extractions have not caused him any problems, at all, so I'm very optimistic as far as this not affecting him in the long term. Of course, these teeth are definitely ready to come out when they are extracted. When you do an extraction, you can take a look and see that it is EOTRH. The roots have a very "fossilized" (for lack of a better description) to them. I am going to have teeth extracted as needed. I've heard that some horses get depressed when all their teeth are pulled at once - and QoL for my horse is something that is important to me, too.

[AmityBee]

Texsuze,

Sorry I didn't respond sooner - just saw your question. EORTH is the acronym for Equine Odontoclastic Tooth Resorption and Hypercementosis. A Google search will give you lots on information. There are two schools of treatment - one says all teeth should be pulled because EORTH seems to spread (albeit slowly); the other said only pull teeth as needed. I've opted for the second. So far, in about two years, my guy has lost two teeth - with one on the watch.

How timely. My good friend's pony was diagnosed with cushings and EOTRH about two years ago as well. She also opted for the "pull teeth as needed" option at first and had three teeth removed over time.

After the last check-up about 3 months ago it turned out that the situation became so bad within a short amount of time, that there was a lot of involvement of the yawbone now as well. The vet wasn't sure if the pony could be saved even if all incisors would be pulled immediately.

Long story short, pony it well now. All theeth were pulled within 6 weeks (first top, then bottom) pony is in much better shape now without them. No issues with eating at all (turn out, hay).

I guess taking all incisors out at once right after the diagnosis would have been the less expensive, less painfull and less stressful route for everybody involved, but as always, hindsight's 20/20...

[VBOpie]

Texsuze,

The vet wasn't sure if the pony could be saved even if all incisors would be pulled immediately.

Why was the pony at the point where the vet felt that the pony couldn't be saved? Because of inability to eat??

[texsuze]

Wow, interesting again. Still can't believe I hadn't heard of this condition before. One of my guy's lower teeth is a bit dark where it is in contact with another tooth, but I don't know if that is a precursor to EOTRH. I'll continue to watch and maybe see if getting annual dental x-rays along with floating would be beneficial, since it has only been about 4 months since his incisor was removed. My plan is to go back to my "dental vet" early next year for dentals and input.

[AmityBee]

Texsuze,

The vet wasn't sure if the pony could be saved even if all incisors would be pulled immediately.

Why was the pony at the point where the vet felt that the pony couldn't be saved? Because of inability to eat??

Interestingly enough, no. Pony ate fine. He just seemed a little off, lazy, "depressed" if you will.

EOTRH does two things, there is either the hypercementosis part, where material builds up, causing inflamation and pain, or the resorption of tooth material. Resorption was what was happening to my friends pony. The first x-rays looked so bad, that the vet thought the bone material of the yaw might be too damaged already to hold up during the extraction. If the bone "crumbles" away during the extraction, there isn't really anything you can do anymore. BUT, it turned out that it wasn't as bad as it looked. Pony is toothless now but doing well.

[AmityBee]

*Attention! Gory pictures ahead!*


If anyone is interested. We took pictures of the whole ordeal. Looking back, I think the top incisors were pulled in early august, the bottom about 6 weeks later. No stitches, just tamponade (which didn't really stay in) and rinsing with water...

The pony went to the vet clinic for about 3 days each time (came home on day two after surgery).

Top incisors out: (some time in the first week after surgery, sans tamponade. It's quite a big hole.)

P1030755.JPG (218.99 KiB) Viewed 16970 times

Probably 3-4 weeks later: (all healed up) You can see that he only has four of his bottom incisors left anyway, two were pulled because of the EOTRH already.

P1050823.JPG (206.67 KiB) Viewed 16970 times

[AmityBee]

The bottom teeth:

On day three or four after surgery, part of the tamponade is still in:

P1060101.JPG (233.99 KiB) Viewed 16970 times

Healing nicely:

P1060157.JPG (208.19 KiB) Viewed 16970 times

And the final result: (taken about a week ago):

P1060206.JPG (223.57 KiB) Viewed 16970 times

[VBOpie]

AmityBee

Thanks for sharing the pictures. The pony's procedure was definitely more intense than what my guy has been through. Lad is due for a dental check next month, so we'll see if there are any other candidates for extraction.

[Tarlo Farm]

Had a molar pulled in one of my old guys about two years ago. No aftercare, everything was fine.

[highoctane]

Reviving a somewhat older thread just to chime in...I'll start a new thread about my 23yo (24 in March) boy, who's scheduled now to have most, if not all, his incisors pulled on 2/20/17 due to EOTRH. It's become evident that it's time to yank. He was doing fine, ie not showing signs of pain, up to about a month ago. I finally got some radiographs done, and, like icebergs, the true damage is evident under the surface. Oww.

I'll start a new thread about EOTRH, as I have come to believe that it's MUCH more common that I was initially led to think.

[texsuze]

Yowza, HiO! So sorry about your oldster's dental problems. A few questions, if you don't mind:

Were you already monitoring him for a suspected problem?
What were his final symptoms which prompted radiographs?
Did his gums/teeth look suspect?
Did your vet already have a good understanding about EOTRH or was this a learning curve for him/her?
Is there any other condition/disease/syndrome which looks or presents similar to EOTRH?

Thanks for sharing what you can, and jingles for a successful surgery.

[highoctane]

Yowza, HiO! So sorry about your oldster's dental problems. A few questions, if you don't mind:

Were you already monitoring him for a suspected problem?
Yes. He was diagnosed 5 years (!) ago, and since he was showing no signs of pain, we have been monitoring him since. My vet told me that EOTRH can go either way - more resorption than hypercementosis or the other way around...and Hi-Oc seemed to be lucking out with just the hypercementosis part. I should note that he has been floated every 6 months since I bought him 16 years ago.

What were his final symptoms which prompted radiographs?
Well, he stopped really drinking when it got cold, has been picky about his hay lately, and the real kicker - he used to not mind me looking at his teeth/gums...now it's a struggle with him really making it obvious that he doesn't like having his mouth fiddled with. His gums have a spotted/mottled red pattern indicating some sort of infection. So it must be painful . I've been riding him bitless for well over 10 years, and most recently he "lost" the ability to turn right. He's also lost quite a bit of weight, which I'm tacking up to dealing with the chronic tooth pain.

Did his gums/teeth look suspect?
Now they do, yes. Then, I just thought that's what his teeth looked like (I don't make a practice of looking at others' lol ). Also, they didn't look as alarmingly bad as they do now. It all started out with a hole in his upper gum where we'd thought he'd poked himself with a bit of hay. Turns out this is an infection draining tract called a fistula, a common sign of EOTRH and a sign that the tooth root is being resorbed. This has never healed over, and he has about 4 now in total. His teeth - mostly the "outside" incisors - started having a calcified/overgrowth look that the gum receded from. This is the hypercementosis part, where his system is trying to compensate for the loss of tooth root by laying down very weak cementum.

Did your vet already have a good understanding about EOTRH or was this a learning curve for him/her?
My vet knew right away that's what it was. I had no clue. The syndrome has only had a name since 2004(?)...and what I was initially told was a bit rare, is turning out not to be. It seems everyone I know either has/had a horse with EOTRH, or they know of someone who does. The surgeon that's doing his extractions has done quite a few surgeries due to EOTRH; two just this year alone.

Is there any other condition/disease/syndrome which looks or presents similar to EOTRH?
Not sure, but the vet that did the radiographs (not my regular vet, but one that could take them asap) was hoping it was just "plain old periodontal disease". My research of periodontal disease says that the gums recede - as in humans - but the hypercementosis is definitive for EOTRH. Whether they are related or not is for someone way smarter than me to decide.

Thanks for sharing what you can, and jingles for a successful surgery.
Thank you!! I'll work on getting that other thread up tonight.

[Josette]

http://www.thehorse.com/ask-the-vet/387 ... 02-13-2017

[piedmontfields]

Texsuze, please update as healing commences! I have heard very similar advice re-post tooth pull care from other vets.

FYI, today, I used a vet who is very old school about teeth floating and care. Good horsemanship and no sedation (for my mare's float). Nice to see!