It might be an understatement to say that I’ve always found extracting equine teeth to be somewhat daunting. (I won’t use the ‘It’s like pulling teeth’ cliché.) I’ll admit that whenever presented with a complaint of weight loss, I would say something along the lines of “Well, it could be lots of things other than the teeth,” and press for full physical and bloodwork with the vigor of a used car salesman--all the while chanting in my head, “Please not the teeth. Please let me find something else.”

For veterinarians with patience, skill, training, and luck with inanimate objects, equine dentistry can be tremendously rewarding. However, it also carries risk of complications or secondary injury to the horse or, as a legendary black eye on my part once bore testimony, to the practitioner. Coordination is also a useful attribute in equine dental extractions, I’ve found.

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For veterinarians with patience, skill, training, and luck with inanimate objects, equine dentistry can be tremendously rewarding. However, it also carries risk of complications or secondary injury to the horse or, as a legendary black eye on my part once bore testimony, to the practitioner.
Photo by Anne M. Eberhardt

I went into this morning’s session on dental extractions highly caffeinated and expecting to learn that I had been doing it all wrong. It turns out that I didn’t need the caffeine, and that the answer was that I was doing some of it all wrong, and some of it exactly right.

Drs. Jennifer Rawlinson, Jack Easley, and Edward Earley took us through the extraction process from the initial exam and considerations, into post-operative care, and even gave us a look at our worst nightmares – when things don’t go according to the plan. Strangely, they didn’t show any slides of a veterinarian whacking herself on the cheekbone with molar forceps. That may be a rare complication.

Dr. Rawlinson’s presentation on considerations in extraction perhaps gave the best take-homes for both owner and practitioner: not every tooth with pathology is suitable for extraction, not every horse can handle extraction (at least maybe not right then), not every veterinarian is equipped to extract every tooth (see above), and not every owner can invest the money and time required not only for the procedure but for the lifetime follow-up.

It turns out that my neurotic insistence on a complete workup before extraction was the right approach. When discussing signs of dental disease, Dr. Rawlinson commented that if a horse presents for weight loss due to suspected dental disease, it’s a good idea to do a full physical exam and bloodwork first since you don't want to miss other diseases. In fact, according to Dr. Rawlinson, the most common sign of dental disease is nothing. That’s right, a large amount of dental pathology in the horse produces no obvious outward signs. So, you know that tendency to wait to have a horse’s mouth examined until something looks wrong? Yeah, don’t do that.

Dr. Rawlinson’s presentation on regional anesthesia made me realize how much harder I had made my own life by wimping out on nerve blocks and sedation techniques, and how much harder it may have been on my patients. Some of the nerve blocks she presented looked pretty intimidating, but like any medical procedure they can be learned, and they reduce the overall sedative need.

Owners may not always like the cost of X rays, but the cases presented this morning reinforced the idea that no one should go anywhere near a tooth with intent to extract without a good set of radiographs. Horse teeth not only erupt throughout their lives, but that angle of eruption changes (you don’t want to be pulling a tooth in the wrong direction), and the roots of many teeth go deep. Also, X-rays will show the badness that is hiding beneath the surface. If a tooth is fractured or there’s weird pathology at the root, the veterinarian needs to be aware before surgery. Tooth fragments left in the socket can lead to infection and recurrent draining tracts and fistulae.

Ultimately, each of the speakers made it quite clear that the decision whether to extract a tooth has just as much to do with the humans as with the horse. The veterinarian needs to be comfortable with his or her skills, diagnosis, equipment/resources, assistants, and available time. The owner needs to be comfortable with costs, understand that the procedure may not go according to plan and that other costs may arise, and that the horse will require follow-up every six months for life to keep the opposing teeth from overgrowing. With all of that in mind, the overall goal for extraction, said Dr. Rawlinson, “is to keep the horse functional and comfortable.”