Oral Examination of Equidae

I. Introduction

The goal of dentistry is to preserve functional dentition in order to promote the general health, longevity, and productivity of horses. Practitioners must understand the current standard of care for equine oral examination because a complete examination is the basis for an accurate diagnosis and appropriate treatment. A general physical examination is performed on all patients to determine the patient’s health condition and to rule out concurrent systemic disease. Extraoral examination of the head and maxillofacial structures determines if dental disease has extended regionally. Oral examination determines the condition of the oral cavity and dentition. To ensure a consistent examination protocol and to meet the requirements of legal documentation, all abnormal or questionable examination findings should be recorded on a dental chart.

II. Materials and methods

Frequency of Oral Examination

Horses that appear healthy should be examined at six- to 12-month intervals, starting at their newborn examination. Congenital problems should be detected as early as possible so that appropriate treatment and monitoring will have the greatest positive effect. The dentition and surrounding tissues of young horses (less than five years) are going through dramatic changes, so it is important to evaluate them frequently. Six-month intervals are appropriate if findings are normal at each successive examination. Normal adult horses (greater than five years) might only need annual examinations, provided no pathologies are found.

Any horse showing clinical signs that might be related to dental issues should be examined as soon as possible. The list of possible extraoral clinical signs is extensive and varies based on individual patient and management factors. The extraoral clinical signs commonly associated with dental disease are usually indicative of advanced disease and include: weight loss, dysmastication (quidding), halitosis, hypersalivation (Fig. 1), facial swelling, purulent nasal discharge, bitting problems, and behavioral changes.
 

Dental disease might be the cause of, exacerbated by, or concurrent with systemic disease.¹ Periodontal disease, for instance, may contribute to bacterial infections in areas of inflammation such as diseased heart valves, liver, or kidneys via anachoresis². Even if the secondary conditions are treated successfully, they are likely to reoccur if the underlying primary dental disease is not found and treated successfully. Conversely, primary conditions such as equine Cushing’s disease or equine metabolic syndrome may contribute to the severity of dental disease (Fig. 2). Since patients must be sedated and restrained to safely perform an accurate oral examination, they should be assessed for anesthetic risk factors and treated for any concomitant diseases before performing any elective procedures.

III. Instrumentation

The instrumentation required to perform a comprehensive oral examination includes: a light source (head lamp^a and/or speculum light^b), a full mouth speculum^c, a large dose syringe^d, or water source for irrigation of the oral cavity, a dental mirror^e, a periodontal probe^f,g, a dental explorer^h, lingual and buccal retractorsⁱ, and a dental halter^j or head stand (Fig. 3). Additional equipment that might be useful for further evaluation of the oral cavity and surrounding structures include radiographic equipment^k, sinoscopy equipment^l,m and a digital camera (Fig. 4). Many instruments are available in multiple sizes and styles. Practitioners are encouraged to familiarize themselves with the various styles of each instrument to determine which provides best function and form for the task as well as the individual using it.
 

IV. Execution of the examination

Examination Stages

Oral examination is preceded by a general physical examination and extraoral (head) examination. Physical examination has been described elsewhere.  [...]