Equine oral anatomy poses unique challenges for managing dental disease. Dental extraction is indicated for the following common equine dental diseases.
• Tooth fracture (when the pulp is directly exposed, infected, and/or necrotic)
• Tooth Resorption (Equine Odontoclastic Tooth Resorption and Hypercementosis—EOTRH)
• Periodontal disease (when infection under the gumline results in severe bone loss around the tooth)
• Severe Caries/Decay (which expose the pulp to the bacteria of the mouth)
• Periapical Abscess (which is usually secondary to one of the first three diseases listed, but which can also develop as a result of blood-borne infection)
There are multiple techniques which are utilized to extract teeth. They are listed below in order of increasing
invasiveness/risk of complications:
• Standard, non-surgical oral extraction
• Coronectomy and/or sectioning with oral extraction
• Minimally invasive transbuccal extraction (limited availability of equipment and procedural training)
• Surgical Buccotomy with transcortical osteotomy
Patient assessment, which guides technique selection and follow up, includes physical exam, oral exam, and radiographic evaluation. Additional procedures for evaluation may be indicated prior to initiating an extraction procedure or to manage an intra- or post-operative complication including
• Computed tomography (CT)
• Endoscopy
• Histopathology/cytology (microscopic tissue/cellular examination)
• Microbiology (culture/sensitivity)
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Using appropriate technique, risk of complications can be largely minimized. Yet, inherent risk cannot be altogether eliminated as variations in anatomy exist and long-standing pathology can alter and/or obscure normal anatomy. Surgical complications following extraction of equine teeth may involve injury to and/or infection.
Examples of potential complications following cheek tooth extractions in horses are
• Alveolar plug displacement
• Sequestrum (dead bone)
• Oronasal fistula (communication between the mouth and nasal cavity)
• Oroantral fistula (communication between the mouth and paranasal sinuses)
• Refractory Sinusitis
• Palatine artery laceration
• Facial nerve injury
• Jaw fracture
• Reactions to local anesthetic injections
• Reactions to pain medications or antibiotics (GI ulcers, colitis, compromised kidney function)
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