How to Examine an Treat Common Equine Dental Problems

Examination of the incisors, the bars or the premolars in the horse’s mouth is fairly easy and can be accomplished using a minimum of manipulation of the lips and lip commissures. Treatment of encountered pathologies in these regions is therefore mostly straightforward. Detecting dental problems in the back of the mouth on the other hand will require more skills and the use of specialized instruments to allow their proper identification and treatment. If performed with the correct intentions, examining a horse for possible dental problems should be done systematically and thoroughly.
A dental exam should be preferentially performed in a quiet and indoor surrounding to avoid unnecessary disturbance of the patient. This ‘examination room’ should be free of any obstacles, have a rough surface and provide the necessary utilities for water and electricity. The exam starts with a brief history of symptoms and other relevant information. After having observed the animal, careful palpation of head and neck may already attract our attention to one or more points of interest. These may include muscle atrophy, swollen and/or painful areas, and fistulous tracts. If possible, detailed inspection of the animal’s manure will allow detection of long fibers (> 1cm) and/or undigested grains indicating insufficient masticatory preparation of food.
For the next steps of our examination the horse should receive a sedative (α2-agonist ± opioied) which greatly facilitates the cooperation of the patient while manipulating its head and using different instruments. After thoroughly flushing the mouth to remove any food remnants, we’ll determine the horse’s age based on its mandibular incisors to help direct our attention to agerelated tooth problems and further inspect all incisors for any pathology. The range of motion of the lower jaw in relation to the upper jaw is determined both in the latero-lateral (lateral excursion) and in rostro-caudal (anterio-posterior movement) direction. The first is done by moving the mandible sideways while looking for (a)symmetry between left and right and measuring lateral excursion until separation of incisor teeth. Anterio-posterior movement is observed while flexing and extending the head and checking occlusion of the incisors. The bars are carefully palpated (eruption of canines, (blind) wolf teeth) before application of an appropriately sized full-mouth speculum to examine the deeper parts of the mouth.
Some specialized instruments/aids will greatly facilitate easy recognition of common dental abnormalities. Good illumination is a prerequisite to accomplish a good dental exam. It includes the use of a head lamp that preferentially positions the light source between the eyes. A dental mirror, cheek retractors and long dental picks or probes further complete the vet’s possibilities to fully examine the mouth. Inspection of the cheek teeth should be done from front to back looking for asymmetries, overgrowths, fractures, missing parts, discolorations of the occlusal surface and presence/absence of interproximal spaces residing food remnants. The soft tissues (tongue, cheek, gingiva) are carefully checked for the presence of lesions caused by the neighboring teeth. Then, careful palpation of the different teeth may further reveal/confirm the presence of suspected dental problems. Any diagnosed problem can be recorded on a dental record sheet (paper or computer-based). This will greatly enhance communication to the horse owner and allows evaluation of the evolution of a tooth problem on later occasions. 

Commonly encountered tooth problems in horses can be classified into developmental problems and abnormalities of wear. They are the kind of problems every equine practitioner should be aware of and should be able to treat in proper manner. [...]