Diagnosing and Treating Cheek Tooth Apical Infection - What Is Available?

Apical disease is defined as an infection of the dental apex or inflammation and/or necrosis of the root end, usually involving the pulp. In the horse, this type of disease has several synonyms: apical osteitis, apical periodontitis, periapical abscess, dento- alveolar infection. This type of dental disease is typically seen in young horses with the median age of 5–7 years. Early identification of apical disease prior to osseous fistula and secondary effects on the surrounding tissues should be the goals.

Apical disease often extends to involve structures surrounding the tooth, i.e. periodontal ligament, alveolus, supporting bone, paranasal sinuses, nasolacrimal duct, infraorbital canal and/or nerve, and/or nasal cavity. The most common clinical presentation is a rostral maxillary swelling with a cutaneous sinus tract or less commonly, ipsilateral nasal discharge associated with infection of the maxillary rostral cheek teeth. The upper 06 and 07 have also been associated with purulent discharge from the ipsilateral nasolacrimal duct. A foul smelling unilateral nasal discharge associated with sinusitis can be seen with apical infection of the caudal 4 maxillary cheek teeth. Infections of the upper last premolar may cause facial swelling and discharge. Involvement of the infraorbital canal has been associated with apical infection of the upper 08s and 09s. Infections of the upper last premolar may cause facial swelling and discharge. Disruption of the infraorbital canal has been noted in conjunction with apically infected 08s and 09s. Mandibular enlargement with a sinus tract is seen with first 4 lower cheek teeth infections. The caudal lower molars usually cause enlargement and drainage under the muscles of mastication. In a case series of 41 horses with mandibular fistula, 31 cases were associated with apical cheek tooth infection. The remaining were due to trauma or infectious damage to the mandible or parotid duct (Bartmann and Bienert-Zeit 2010). [...]