Equine Dentistry: Exam and Treatment. Dr. Chris Blevins Equine Field Service Clinician
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1 Equine Dentistry: Exam and Treatment Dr. Chris Blevins Equine Field Service Clinician
2
3 Outline Know historical dental questions to ask Know all aspects of dental exam (general, oral soft and hard tissue) What dental equipment is needed Know sedation used for dentistry Know nerve block locations Know dental recommendations based on age (also eruption bumps) Know treatment for sharp points, overgrowth/malocclusion, diastema, wolf teeth and incisors Know information on EOTRH
4 Dental Exam A Brief Look Visual and digital exam Pocket flashlight History Wellness Exam Prepurchase Exam Age Problems
5 Dental Exam 5 Components Extra Oral Findings Occlusion Oral Soft Tissue Periodontal Status Endodontic Status
6 Dental Exam History: Oral, dental, and GI areas Whole body (cardio., resp., renal, liver, neuro., arthritis, pregnancy status) Effects restraint/sedation protocols Insured Showing/Racing Prohibited substances
7 Dental Exam History? Gained or loss weight Temperament/stable habits changed In training problems (What bit do you use?) Eating or drinking changes
8 Dental Exam Exam/Observation Dropping any food Body Condition Score Fecal examination (particle size) Physical Examination Blood Work
9 Dental Exam Complete oral exam Hard tissue Teeth Osseous structures Soft tissue Lips Cheeks Tongue Palate Gingiva Oral mucosa Salivary glands
10 Dental Exam Cheek Teeth Pulp Number System dutoit et al. 2008
11 Dental Exam Soft Tissue Under Tongue
12 Dental Exam Equipment Oral speculum Light source Basket retractor Dental Mirror Horse Stocks Dental halter or Head stand Bucket disinfectant/dose syringe
13 Dental Exam Protect Yourself Eye Protection Prevent Fog over Chlorhex Solution to dry on goggles Exam Gloves Ear Protection Surgery Mask
14 Dental Exam Get comfortable
15 Rinse Mouth
16
17 Dental Cart Water Resistant
18 Dental Exam Stubbs Speculum McPherson Speculum CAPPS Full Mouth Spec Alumispec (X Spec) cappsmanufacturing.com Gunther Speculum equinedentalinstruments.com hospodarintl.com/products.htm Conrad Speculum
19 Dental Exam Equipment Chemical restraint α-2 agonists Xylazine: mg/kg Detomidine: mg/kg CRI (Detomidine 0.02 mg/kg/hour) Butorphanol 0.01 mg/kg (with α-2 agonists Nerve blocks
20 Dental Exam Extra Help Lidocaine Oral Gel Sensitive tongue
21 Dental Exam Chemical Restraint Affinity Score (how well bind to intended receptor) High score-specific for receptor Low score-may lead to more side effects Xylazine = 160 Detomidine = 260 Romifidine = 340
22 Dental Exam Xylazine (Rompun) 1.1 mg/kg IV - shorter duration, more cardio effect Detomidine (Dormosedan) mg/kg IV - cost, Butorphanol + Detomidine (horse push forward)
23 Dental Exam Romifidine (Sedivet) mg/kg IV - Head does not drop as other Alpha-2 s Butorphanol (Torbugesic) mg/kg - Hyper-excitability, secreted in mammary gland, controlled substance
24 Dental Exam There are no safe anesthetic agents, there are no safe anesthetic procedures, there are only safe anesthetist. Dr. Robert Moors Smith
25 Dental Exam Nerve Blocks Infraorbital n. Mental n. Mandibular Alveolar n.
26 Nerve Blocks Dental Exam Maxillary n. (pterygopalatine fossa)
27 Dental Exam Equipment Oral full mouth speculum 15 min. intervals Check for soft tissue pinching Rinse with head down
28 Dental Exam Foals Normal bite Conformation defects Brachynathism (parrot mouth)
29 Dental Exam Young: 1-5 years Bi-annual exam 24 deciduous teeth erupt and shed 36 to 44 permanent teeth erupt
30 Dental Exam Young Eruption bumps (2.5-4 years) Normal tooth crown/root development Abnormal-heat, pain and/or draining tract
31 Dental Exam Middle age: 5-15 years Annual exam Forage diet Problems Geriatric age: >15 years Bi-annual exam Wear-out/loose teeth Make minor changes Dental Diet
32 Study at KSU VHC From at KSU VHC About 1,500 equine dental records gathered for retrospective information Age range from 2 38 years of age Multiple factors evaluated
33 Treatment Four Levels of Equine Dental Care 1. Prophylaxis 2. Performance Dentistry 3. Corrective Dentistry 4. Advanced Dentistry
34 Treatment Four Levels of Equine Dental Care 1. Prophylaxis Floating: odontoplastic (tooth reshaping) Sharp points Buccal side maxillary cheek teeth Lingual side mandibular cheek teeth Hand float and/or Power equipment Caution-power equipment Don t be over aggressive!!!
35 1. Prophylaxis 82% soft tissue abnormalities (ulcer/gingivitis) 78% buccal ulcers 30% lingual ulcers 8% gingivitis Gastrophilis (Bot Fly) larva Grass awns
36 Treatment Four Levels of Equine Dental Care 2. Performance Dentistry (Bit/Briddle) Dental Prophylaxis + Bit Seat Application + Canine Tooth Reduction + Wolf Tooth Extraction + Deciduous Tooth Management Marketing Tool-careful!!!
37 Wolf Teeth (P1) 10% of dental exams 73% maxillary wolf teeth (105, 205) Removal classified as Performance Dentistry
38 2. Performance Dentistry Wolf Teeth (1 st Premolar) Problems with trainingbits Brachyodont teetherupt 6-18 months Tx: extract/ *leave Local anesthetic Wolf teeth elevator
39 2. Performance Dentistry Wolf Teeth (1 st Premolar) Local Block (Mepivacaine) Palatine Ridges Loose gingiva (buccal side)
40 2. Performance Dentistry Wolf Teeth (1 st Premolar) Elevate/extract Periodontal Elevators Rongeurs
41 2. Performance Dentistry Deciduous teeth extractions? Yes-occupying same space/problem No-stage/time extraction Individual Complications- Apical cheek tooth abscess
42 Tooth Removal Patent infundibula Apical cheek tooth abscess Food packed into the area Sx removal of tooth
43 Treatment Four Levels of Equine Dental Care 3. Corrective Dentistry Class 1 Malocclusions (MAL1) of the Cheek Teeth normal mesiodistal tooth position but are spatially misoriented (extruded, intruded, rotated, tilted) Hooks, Ramps, Steps, and Waves Tx: occlusal adjustment (OA), crown reduction (CRR), odontoplasty (OD)
44 Cheek Teeth-Malocclusions 14% Hooks (106, 206)
45 Cheek Teeth-Malocclusions 21% Ramps (311, 411)
46 Cheek Teeth-Malocclusions 2% Fracture (109,209) 19.5% Cups (109, 209) 11% Cups (108, 208) 18.5% Steps (309, 409) 13.5% Steps (308, 408)
47 Cheek Teeth-Malocclusions Cup Step
48 3. Corrective Dentistry Odontoplasty Complications Heat damage 5-10 sec per tooth Water/rinse tooth and tool iatrogenic pulpitis Vital dentin exposure (pink tinge of tooth) Tx: vital pulpotomy
49 Treatment Cheek teeth Loose Missing/expired Smooth/cupped
50 Cheek Teeth-Diastema 4.5% Open Diastema ( and )
51 Treatment Cheek teeth-diastemata/periodontal dz Impaction of fibrous feed material Dental Mirror to see it! Clinical signs: halitosis, quidding, buccal food packing, weight loss, and infections (bone and sinuses)
52 Treatment Cheek teeth-diastemata/periodontal dz Oral exam: dental mirror, basket retractors Tx: +/- Widening Interdental Spaces Diastema burr attachment Caution: damage tooth/teeth
53 Treatment Cheek teeth-diastemata/periodontal dz Tx: Indirect treatments Dietary modifications Removal of Transverse Ridges Reducing Occlusal Pressure on Diastemata Extraction of Teeth Reduction of Overgrown Teeth Packing Diastemata with Plastic Impression Material
54 Treatment Long Standing procedures CRI Bag Drip Rate Sedate to desired plane of anesthesia 20 mg Detomidine in 250 ml saline 15 drop set put at 1 drop/1-2 seconds 10 drop set put at 1 drop/1-3 seconds (1 drop/2 sec) 1 bag will last minutes CRI syringe pump 20 mg Detomidine + 10 mg Butorphanol qs 60cc Saline Set at 30 cc/hour
55 Treatment Class 1 Malocclusions (MAL1) of the Incisors Smile bite Frown bite Diagonal bite Irregular bite 5% 5% 22% of the dental exams had incisor abnormalities 1% 0.2%
56 Treatment Incisor abnormalities Tx: Incisor reduction Sensitive while working ± resedate Dremel type grinding tools 1mm/tooth correction at a time
57 Treatment Incisor and Canine Teeth Equine Odontoclastic Tooth Resorption and Hypercemetosis (EOTRH) Aged (>15 years old) Tx: Staged Extractions Steszyk et al. 2008
58 Treatment EOTRH Treponema and Tannerella sp isolated (Sykora et al, 2013) SURGICAL EXTRACTION OF INCISOR AND CANINE TEETH IN THE HORSE J. Rawlinson, DVM, DACVD Veterinary Dental Forum 2013 Radiographs, Nerve Block, Local anethetic, and CRI sedation
59 Treatment Four Levels of Equine Dental Care 4. Advanced Dentistry Oral Surgery Periodontics Orthodontics Endodontics
60 Treatment Parrot mouth (Brachynathism) Orthodontics 2-8 months rapid (up to 19 months) Maxillary/incisor plate and wire Allow mandible to catch up
61 Cheek Teeth Extraction Radiographs Sedation/Blocks Elevation Coronectomy Extraction
62 Minimally Invasive Buccotomy MINIMALLY INVASIVE APPROACHES TO CHEEK TOOTH EXTRACTION Jack Easley, DVM, MS, DABVP (Equine) Equine Veterinary Practice, Shelbyville, KY 2012 ACVS Proceedings
63 Records and Education Standards: Exam and Treatment Record keeping Dental charting Client involvement/education Follow-up Client compliance
64 Date: Equine Dental Evaluation and Maintenance Form Owner: Horse: Breed: Color: Age: Sex: BCS: /9 History: Problem: Sedation: Comments: Dr. Chris Blevins
65 Records and Education Oral/Dental Charting Periodontal Disease Index 0 Normal 1 Local gingivitis with hyperemia and edema: no attachment loss (probe depth <5 mm) 2 Early periodontal disease (<25% attachment loss) 3 Moderate periodontal disease (<50% attachment or bone loss) 4 Advanced periodontal disease (>50% attachment or bone loss)
66 Records and Education Oral/Dental Charting Tooth Mobility Index 0 Normal with no crown mobility 1 First distinguishable sign of movement (up to 0.5 mm) 2 Movement of the crown (up to 3 mm) 3 Movement (>3 mm in any direction)
67 Records and Education Oral/Dental Charting Grading of infundibular caries Grade 0 Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 No visible caries Caries of the infundibular cementum Caries of infundibular cementum and surrounding enamel Caries of infundibular cementum, enamel, and dentin Splitting of the tooth as a result of caries Loss of tooth due to caries
68 Records and Education Computerized Dental Charting Edward T. Earley, DVM Laptop (80 GB) Digital camera Software Compact printer/scanner/copier
69 Computerized Dental Charting
70 Computerized Dental Charting
71 Dental Endo Exam + Records
72 Records and Education Client Education Go over Patient Dental Exam and Treatment Newsletters Workshops Purina HOW Clinic Publications: already out there!
73 photostock.uwb.pl/.../640/horse_smile_640.jpg Thank you!
74 References: Baker, GJ and Easley, J, ed. Equine Dentistry 2 nd edition. Elservier Saunders Budras, KD, Sack, WO, Rock, S. Anatomy of the Horse 3 rd edition. Schlutersche GmbH and Co Dixon, PM. Cheek Teeth Diastemata and Impactions. Focus On Dentistry AAEP. 2006: Du Toit N, Kempson SA, Dixon PM. Donkey dental anatomy. Part 1: Gross and computed axial tomography examinations. Vet J : Earley, ET. Computerized Dental Charting. Focus On Dentistry AAEP. 2006: Easley J, Dixon PM, and Schumacher J ed. Equine Dentistry 3 rd edition. Elservier Saunders Scrutchfield, WL. Wolf Teeth: How to Safely and Effectively Extract and Is It Necessary. Focus On Dentistry AAEP. 2006: Staszyk, C., Bienert, A., Kreutzer, R., Wohlsein, P. and Simhofer, H. Equine odontoclastic tooth resorption and herpercementosis. Vet J :
75 Case 3 year old, Black, Morgan, Gelding Lumps under jaw (periodic purulent nasal discharge) Issues while riding (throws head around when turning to left and right) Owners request pull wolf teeth and caps What do you want to do?
76 Make your own exam form Make your own exam form (Choose one below) Fill out by hand Computerized Both
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