Infected Canines

Case History:

A 25-year-old QH gelding in poor condition, with no history of previous dentistry, was referred to the wet lab for dental evaluation. There was an incisor missing on both the upper and lower arcades and the lower canines were slightly mobile. An oral speculum was not used on this horse for examination due to the condition of the incisors. Intraoral radiographs were taken of both the upper and lower incisor arcades for evaluation.

Evaluation:

The 102 is missing but I’m not sure which lower incisor is missing due to drifting and deformation. I believe it is the 402 from the shape of the teeth shown in the intraoral radiographs. The reason for these missing teeth is unknown but the most common reasons are trauma or genetics. All of the teeth are stable except the lower canines, however there is a lot of alveolar bone loss and hypercementation around all of the incisors. It is common to see increased production of cementum in geriatric horses to help stabilize these expired teeth, but several of these incisors have excessive cementation, alveolar bone loss, and recession of gingiva, which will likely lead to a breakdown of periodontal attachment and necessitate removal.

The lower canines show a modeling effect along with hypercementation in the radiograph, which is an indication of infection. Also, these lower canines are not stable and have severe alveolar bone loss and recession of gingiva. The most common reasons for infected canines are pulp exposure from excessive reduction, periodontal disease started by excessive calculus buildup around the tooth, and hypercementation syndrome which occurs in older horses.

Treatment:

Canines are used for fighting and have no mastication function. However, we do not routinely remove these teeth because they normally do not interfere with performance and have a long curved root deep into the mandible, which makes them difficult to extract. In this case there is severe infection, and the horse is probably experiencing oral discomfort. Due to the extent of the periodontal disease, extraction is the best option. Elevation should be done with a thin incisor elevator to break down the periodontal attachments as deep as possible into the alveolus. After elevation, patient force was applied with forceps and the canines were successfully removed. However, removal of alveolar bone on the labial side is often necessary in order to extract canines that are firmly attached.

Aftercare:

The alveolus is examined for any fractures or loose fragments of tooth or bone which should be removed. Damaged gingiva should be removed or sutured, if viable, to obtain a smooth healing surface. To allow the area to drain and granulate, the alveolus is not filled with any packing material. Daily flushing is necessary to remove any feed material from the alveolus until it is completely granulated. Antibiotics may be of benefit along with anti-inflammatory therapy. Debridement and flushing daily with large quantities of water is adequate in most cases.

B.W Fletcher

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