equine dentistry overview - dr.marty langhofer

Equine DentistryEquine Dentistry

ByBy Dr. Marty Langhofer DVM.Dr. Marty Langhofer DVM.

PATDPATD

Equine Dental Equine Dental ExaminationExamination

Tooth IdentificationTooth Identification

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

Biomechanics of ChewingBiomechanics of Chewing

15 Degree Angles15 Degree Angles

Malocclusions & Malocclusions & PathologyPathology

Foxtails \ Foreign BodiesFoxtails \ Foreign Bodies

Dental EquipmentDental Equipment

Power GrindersPower Grinders Extraction ToolsExtraction Tools

Hand FloatsHand Floats SpeculumSpeculum

Equine Equine StocksStocks

Mouth SpeculumMouth Speculum

Veterinary Dental Products – Flexi-Float

TreatmentsTreatments

Dental IdentificationDental Identification

Bit SeatingBit Seating

Placement and MechanicsPlacement and Mechanics

Three Point BalanceThree Point Balance

Nerve Blocks / Analgesics Nerve Blocks / Analgesics

Nerves and Blood VesselsNerves and Blood Vessels


Wolf TeethWolf Teeth

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

Dental AnalgesiaDental Analgesia

Equine Dental CapsEquine Dental Caps

Retained CapsRetained Caps

Decidvous TeethDecidvous Teeth

Equine Dental CapsEquine Dental Caps

At what age do caps fall At what age do caps fall off horses teeth?off horses teeth? (A)(A) 6 months, 12 months, 6 months, 12 months,

18 months18 months (B)(B) 24 months, 24 months,

28months, 30 months28months, 30 months (C)(C) 3 years, 4 years, 3 years, 4 years,

5 years5 years (D)(D) 2 years 8 2 years 8

months, 2 years months, 2 years 10 months, 3 10 months, 3 years 8 months years 8 months (also depends (also depends on breed of on breed of horse)horse)

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

Dental Cavities and Dental Cavities and FillingsFillings

Dental ExtractionsDental Extractions

Extraction TechniqueExtraction Technique

Periosteal elevatorsPeriosteal elevators Tooth spreaders-allow clot to begin formingTooth spreaders-allow clot to begin forming Apply extractors-rock, rock, rock side to sideApply extractors-rock, rock, rock side to side Wait, wait, waitWait, wait, wait Resume rocking then wait, wait, waitResume rocking then wait, wait, wait Resume rocking then wait, wait, waitResume rocking then wait, wait, wait Dental fulcrumDental fulcrum

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

AlternativeAlternative Flush alveoli socket daily with Chlorhexidine gluconate dilute solutionFlush alveoli socket daily with Chlorhexidine gluconate dilute solution Then seal with Bio-cellThen seal with Bio-cell

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

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

Electrocautery Electrocautery

Daily dental packsDaily dental packs

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

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

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

Dental hemostatic powder/pasteDental hemostatic powder/paste

Problems with ClottingProblems with Clotting

Salivary enzymesSalivary enzymes Clot dislodgment with tongue/chewing motionsClot dislodgment with tongue/chewing motions Bleeding disordersBleeding disorders Liver or kidney diseaseLiver or kidney disease DrugsDrugs

Aspirin-platelet interferenceAspirin-platelet interference Antibiotics-decreased Vitamin K productionAntibiotics-decreased Vitamin K production AnticoagulantsAnticoagulants Alcohol/mycotoxins-causes hepatopathyAlcohol/mycotoxins-causes hepatopathy

HypertensionHypertension

Healing Process of Healing Process of ExtractionExtraction ExtractionExtraction Blood flow from alveolar bone and gingivaBlood flow from alveolar bone and gingiva Blood clot formationBlood clot formation

Forms barrier to debris, food, irritants, bacteriaForms barrier to debris, food, irritants, bacteria Forms a supporting structure for granulation tissue Forms a supporting structure for granulation tissue

Local tissue damage from extraction siteLocal tissue damage from extraction site Evokes an inflammatory reaction Evokes an inflammatory reaction local expansion local expansion

of blood vesselsof blood vessels WBC’s and fibroblasts invade the connective tissue WBC’s and fibroblasts invade the connective tissue

at the alveolus until granulation tissue is formedat the alveolus until granulation tissue is formed Leukocytes digest the blood clot as granulation Leukocytes digest the blood clot as granulation

tissue is formedtissue is formed

Healing Process of Healing Process of ExtractionExtraction Bone is layed down by osteoblastsBone is layed down by osteoblasts Coarse, trabecular, and compact bone is Coarse, trabecular, and compact bone is

used in bone remodelingused in bone remodeling

After ExtractionAfter Extraction

Pain medication (bone)Pain medication (bone) AugenalAugenal BenzocaineBenzocaine NSAIDS such as phenylbutazone and banamineNSAIDS such as phenylbutazone and banamine

AntimicrobialsAntimicrobials Iodofoam packing gauzeIodofoam packing gauze Aluyjel (Septodont)-a fibrous productAluyjel (Septodont)-a fibrous product Biotene oral gel (A/cell)-enzyme that releases iodine and Biotene oral gel (A/cell)-enzyme that releases iodine and

lactoferrinlactoferrin Calcium sulfate (plaster of paris) antibiotic plugsCalcium sulfate (plaster of paris) antibiotic plugs

SMZ-TMPSMZ-TMP MetronidazoleMetronidazole AmikacinAmikacin

Complications with Complications with ExtractionsExtractions 50% of extractions have complications50% of extractions have complications X-Rays should be taken before ALL extractionsX-Rays should be taken before ALL extractions Improper extraction toolsImproper extraction tools

Dental ElevationsDental Elevations Extraction ToolsExtraction Tools

Molar, incisor, canine, wolf teeth-long thin blade screw Molar, incisor, canine, wolf teeth-long thin blade screw driver, trephines (Michelle and Mallet) and assorted dental driver, trephines (Michelle and Mallet) and assorted dental punchespunches

Strong peridental supporting structuresStrong peridental supporting structures

Complications with Complications with ExtractionsExtractions Abnormal root morphology-divergent, hooked, Abnormal root morphology-divergent, hooked,

locked, ankylosed, germinated, misshaped, locked, ankylosed, germinated, misshaped, tumors of the toothtumors of the tooth

Hypercementotic teethHypercementotic teeth Teeth that are weakened (eg-dental decay that Teeth that are weakened (eg-dental decay that

has been repaired)has been repaired) Teeth with abfraction or deep cariesTeeth with abfraction or deep caries Desiccated teeth or brittle teeth associated with Desiccated teeth or brittle teeth associated with

endodonic treatmentendodonic treatment Patients with inflammatory disorders Patients with inflammatory disorders

associated with alveolar bone disease or associated with alveolar bone disease or Cushing’s diseaseCushing’s disease

Complications with Complications with ExtractionsExtractions

Patients with limited opening or trismus (lock jaw)Patients with limited opening or trismus (lock jaw) Oro-sinal fistulaOro-sinal fistula Broken off root tipsBroken off root tips Fractured boneFractured bone Invasion into sphenoid bone-possible bacterial Invasion into sphenoid bone-possible bacterial

meningioencephalitismeningioencephalitis Sepsis systemicallySepsis systemically Dry socket or non-healing socketDry socket or non-healing socket SinusitisSinusitis PainPain BleedingBleeding

Factors causing a Dry or Factors causing a Dry or Non-Healing ExtractionNon-Healing Extraction Exzyme fibrinolytic productionExzyme fibrinolytic production Alveolar infectionAlveolar infection

Especially anaerobes, but can be aerobesEspecially anaerobes, but can be aerobes StreptococcusStreptococcus FusospiralFusospiral TreponemaTreponema BacteroidsBacteroids

Immunocompromised patientImmunocompromised patient Systemic diseaseSystemic disease

Treatment of a Non-Treatment of a Non-Healing SiteHealing Site

Betadine flushBetadine flush Chlorhexidine gluconateChlorhexidine gluconate Antibiotic tablets or calcium sulfate antibiotic plugs –Antibiotic tablets or calcium sulfate antibiotic plugs – SMZ/TMP + metronidazole SMZ/TMP + metronidazole Tetracycline PO or IVTetracycline PO or IV ClindamycinClindamycin

Mix capsule with calcium sulfate or gelfoam (drug of choice for Mix capsule with calcium sulfate or gelfoam (drug of choice for anaerobes) anaerobes)

Soak gauze with Clindamycin mixure and fill in alveolar socketSoak gauze with Clindamycin mixure and fill in alveolar socket Open caspules and place in alveolar socketOpen caspules and place in alveolar socket

Look for systemic diseaseLook for systemic disease

EndodonticsEndodontics

Periodontal diseasePeriodontal disease

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

IncidenceIncidence

40 % prevalence in 3 to 5 year olds40 % prevalence in 3 to 5 year olds Eruption of permanent dentitionEruption of permanent dentition

Decreased incidence in 5 to 10 year olds.Decreased incidence in 5 to 10 year olds.

60 % in horses > 1560 % in horses > 15

Anatomy and FunctionAnatomy and Function Teeth are attached to the alveolus by bundles of Teeth are attached to the alveolus by bundles of

connective tissue.connective tissue. Periodontal membrane or ligamentPeriodontal membrane or ligament Collagen fibers attach cement covering to the boneCollagen fibers attach cement covering to the bone

Embedded portions known as sharpey’s fibersEmbedded 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 FunctionAnatomy and Function

Gingiva attached to periosteum with Gingiva attached to periosteum with dense fibrous CT.dense fibrous CT.

Portion of the gingiva adjacent to the Portion of the gingiva adjacent to the tooth is the gingival sulcus.tooth is the gingival sulcus.

This adheres to the tooth by surface This adheres to the tooth by surface tension.tension.

If the sulcus develops periodontal If the sulcus develops periodontal disease it is called a perio(dontal) pocket.disease it is called a perio(dontal) pocket.

Signs of periodontal diseaseSigns of periodontal diseasefour categoriesfour categories 1 local gingivitis with hyperemia and 1 local gingivitis with hyperemia and

edemaedema Erosion of gingival margin 5mm and Erosion of gingival margin 5mm and

periodontal pocketperiodontal pocket Periodontitis with gum lossPeriodontitis with gum loss Gross periodontal pocketing, lysis of Gross periodontal pocketing, lysis of

alveolar bone, loosening of bone supportalveolar bone, loosening of bone support

EtiologyEtiology

MultifactoralMultifactoral Abnormalities of wear (malocclusions).Abnormalities of wear (malocclusions). Tooth eruptionTooth eruption Plaque deposition (salivary glycoproteins + Plaque deposition (salivary glycoproteins +

bacteria + inorganic minerals from feed.bacteria + inorganic minerals from feed. Chronic oral bleedingChronic oral bleeding

tartar, perio, ulcers all secondary to tartar, perio, ulcers all secondary to exaggerated ridgesexaggerated ridges

5 yr QH

Pathology of PeriodontitisPathology of Periodontitis

HyperemiaTooth loss

Plaque build up

Edema

Loss of supporttissue

Bone loss

inflammation

TreatmentTreatment

Eliminate the malocclusion Eliminate the malocclusion Remove tartarRemove tartar Eliminate or minimize the pocketEliminate or minimize the pocket Eliminate or reduce occlusion at siteEliminate or reduce occlusion at site Open up space between teeth if Open up space between teeth if

pocketing involves entire spacepocketing involves entire space ExtractionExtraction

TreatmentTreatment PowerfloatPowerfloat

Grind off the side of affected tooth with wheelGrind off the side of affected tooth with wheel Flush mouth twice daily chlorhezidineFlush mouth twice daily chlorhezidine CheapCheap

Air abrasion Clean pocket with bicarbonate of soda

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

Identification of Pulp Identification of Pulp Cavities and MeasurmentsCavities and Measurments #1 Pulp cavity measurements are 5-7mm #1 Pulp cavity measurements are 5-7mm

from the interdigital edge of opposing from the interdigital edge of opposing teeth (Dr. Rugby- West Virginia, USA)teeth (Dr. Rugby- West Virginia, USA)

Tartar removalTartar removal

Buccal perio pocketsBuccal perio pockets107/8 8/9 207/8 8/9107/8 8/9 207/8 8/9

Perio pocket 406/7Perio pocket 406/7

Perio pocketPerio pocket

Thru and thru perio Thru and thru perio pocketpocket Food material packed between two teeth Food material packed between two teeth

from medial to lateral sidesfrom medial to lateral sides Gingival erosion and odorGingival erosion and odor Visible crevice between teeth (usually)Visible crevice between teeth (usually) Tooth may be looseTooth may be loose

Perio pocketsPerio pockets

•Food packed between206/7 7/8 8/9•All teeth firm

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

Powerfloat burrsPowerfloat burrs

Diastema treatmentDiastema treatment

Diastema TreatmentDiastema Treatment

Perio pocket after openingPerio pocket after opening

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

Advanced perioAdvanced perio


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

26 year old mare26 year old mare5 perio diastemata5 perio diastemata

106/107 107/108 burred open106/107 107/108 burred openimmediate post treatmentimmediate post treatment

Two months laterTwo months later

Perio pocket 207/8Perio pocket 207/8

Two months post Two months post treatmenttreatment

Exaggerated ridge probably Exaggerated ridge probably contributed to this perio pocketcontributed to this perio pocket

Diastema burringDiastema burring

The treatment has been criticized as The treatment has been criticized as potentially damaging to;potentially damaging to;

the periodontal ligamentthe periodontal ligament gum tissuegum tissue tooth tooth possibly opening a pulp cavity from the possibly opening a pulp cavity from the

side. side.

Diastema burringDiastema burring

The burr does not remove any tooth below the The burr does not remove any tooth below the level of the top of alveolar bone.level of the top of alveolar bone.

The pulp cavity does not extend above the The pulp cavity does not extend above the level of alveolar bone.level of alveolar bone.

There is already loss of interproximal tooth There is already loss of interproximal tooth material, (cementum); the burr removes only material, (cementum); the burr removes only 1-2 mm more from each tooth. 1-2 mm more from each tooth.

Regeneration of healthy gum and solidification Regeneration of healthy gum and solidification of the tooth within the alveolus occurs within of the tooth within the alveolus occurs within weeks.weeks.


•Chlorhexidine soln

•Flush mouth twice daily for 7 10 days

•Oral antibiotics +/-

equine dentistry overview - dr.marty langhofer

Documents

years months

months years

months cc

common diseases

dental cavities

months18 months bb

years5 years dd

horses teeth