2 year old QH with swollen maxilla

Case Report:

A 2 year old gelding with a swelling on the right side of the maxilla was brought to the clinic for dental evaluation.  The swelling was firm with no signs of a drain tract.  The owner said he noticed the bump two months ago and that it had been getting bigger slowly.  There are some scraps on his head which happened during a recent trailer ride.

Oral examination revealed a missing 507 and the 107 was beginning to erupt. There was some odor coming from this area and feed was packing on the buccal side of the 107.

Two radiographs were taken, a lateral oblique and a dorsal ventral with the mandible offset.

Evaluation:  The enlargement on the right maxilla is due to an abscessed 107.  The lateral oblique radiograph shows a blunted root with some deformity.  The 507 is missing but the remaining deciduous teeth look normal.  The dorsal ventral radiograph shows a increased radiolucent area around the 107 which indicates a increased periodontal space due to bone loss.  The radiolucent areas within the tooth are indication of lack of development of the tooth which expected in a 2 year old horse.

Treatment options:  The only reasonable option in this case is extraction.  The root area is abscessed and is causing the maxilla enlargement.  The periodontal area is packing feed and is infected.  The tooth is dead and will not develop any further in this young horse.  The pain caused from these types of infection is substantial and will interfere with mastication and performance.

Oral extraction is preferred but the lack of a clinical crown makes this a difficult extraction.  However, this tooth was extracted using elevation with dental picks.  Surgical extraction is a reasonable option but requires surgical technique and instrumentation.  This type of surgical extraction can also be accomplished in a standing horse with sedation and local anesthesia.

Prognosis:  Removing a tooth from the arcade causes lack of integrity and drifting of teeth in the arcade.  The dental maintenance is always higher after an extraction because of lack of opposition which allows protuberances to develop.  The prognosis is good for resolving the infection and the maxilla enlargement. After care for this case should include a soft food diet for 4 weeks, twice daily flushes with large amounts of water, and antibiotics.

Discussion:  If a deciduous tooth is removed prematurely, the undeveloped permanent tooth is exposed and can become infected as in this case.  We do not know exactly what happened to the 507 but it was probably fractured or damaged, which caused premature shedding.

As our experience and techniques for oral extraction increases, we tend to prefer this method if applicable.  Surgical extraction of a 107 is not difficult and can be considered depending on the experience and ability of the practitioner.  The 107 does not communicate with Maxillary sinus which decreases the complications of this procedure.  Either approach should have a good outcome in this case.B.W Fletcher