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Common diseases affecting the teeth
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Summary
The oral examination should result in clinical findings relating to a number of dental diseases and disorders and studies have shown the relative incidence of these[1-4]. These can be grouped into developmental, acquired, periodontal, endodontic, infundibular or other miscellaneous pathologies. The common diseases and disorders are listed below:
- Developmental or acquired disorders e.g. malocclusions such as ‘parrot mouth’, displaced teeth, supernumerary teeth
- Endodontic disease e.g. septic pulpitis and ‘apical abscesses’, fractures
- Infundibular disease, relating to hypoplasia of cementum and caries, fractures
- Periodontal disease, diastemata (abnormal spaces between teeth), peripheral caries
- Miscellaneous
- Traumatic damage e.g. incisor fractures
- Equine odontoclastic tooth resorption and hypercementosis (EOTRH) of the incisors
- Neoplasia
- Iatrogenic e.g. over-rasping of the tooth surfaces
In order to understand the diseases of the teeth, it is essential for practitioners to understand the detailed anatomy of the teeth and how this alters with age as well as the physiology of mastication and the process of ageing.
Developmental and acquired disorders
The balance of eruption vs attrition can be affected by displacements, fractures, maleruptions, malocclusions, dysplasias, supernumerary and supplemental teeth resulting in a lack of surface attrition and abnormally increased crown heights, commonly referred to as malocclusions, with often individual teeth or parts of teeth ‘overgrown’. Terms such as ramps, beaks, steps, waves, exaggerated transverse and others can often be collectively termed ‘focal overgrowths’ with the cause of the focal overgrowth documented. Common examples of focal overgrowth are malocclusions, fractured teeth, displaced teeth, supernumerary (extra) teeth, delayed eruption, uneven masticatory patterns (e.g. ‘shear’ mouth, sharp enamel points)
Endodontic disease - problems with the pulp (pulpitis)
Pulp tissue may become infected or severely inflamed through fracture, infundibular disease or through anachoresis – a region of idiopathic focal pulpitis, pulp necrosis and establishment of blood-borne bacteria within the pulp resulting in focal or widespread septic pulpitis. Once there has been pulpal death and infection, in general the tooth will require extraction or full endodontic (‘root-canal’) therapy due to an apical abscess. In young horses, with roots close to the bony surfaces of the head, facial swellings may occur. Other times the pulp death may go un-noticed for years and the tooth may fracture. Small surface secondary dentine lesions such as fissures, cracks or infractions of equine teeth are commonly identified oroscopically.
Infundibular disease –hypoplasia (IH) and caries (IC)
Some cheek teeth, notably the (maxillary) 09, 06 and 11 have been well documented to have areas, usually apically, that are devoid of the normal cement 'filling' that should be present throughout their whole length right up to the apical enamel reflection[6]. With occlusal wear, eventually these appear on the occlusal surface, and food material will enter these cavities with progressive decay, or ‘caries’. Results of this may be pulp infection, fracture of the teeth or premature loss of the infundibulum.
Periodontal disease, diastema and peripheral caries
Periodontal disease may have a number of causes and progress in variable ways depending on the anatomical arrangement of the teeth with each other. Trapped food causes gingival recession, peripheral cement caries and formation of a 'valve' diastema. Other cases with less perfect interproximal junctions may progress more quickly developing deep, severe periodontal pockets. Once again, horses will adapt their eating patterns to cope with the pain and disguise the problem, so it is up to us to find the developing disease before the overt clinical signs appear – often when things are really severe.
Figure 1: Food impaction, interproximal cemental caries and gingival recession – an early ‘valve’ diastema - treatment at this stage will prevent problems later.
Other pathologies and miscellaneous disorders
Pathologies that do not easily fall into the categories above include:
- Resorptive lesions including equine odontoclastic tooth resorption and hypercementosis (EOTRH) – an autoimmune disorder of incisor teeth in aged horses resulting in sub-gingival tooth resorption, excess cementum formation around the root and secondary infection
- Neoplasia of dental or surrounding structures
- Iatrogenic damae to teeth e.g. over-reduction of teeth with motorised instruments
Get access to all handy features included in the IVIS website
- Get unlimited access to books, proceedings and journals.
- Get access to a global catalogue of meetings, on-site and online courses, webinars and educational videos.
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[1] Dixon, P.M., Tremaine, W.H., Pickles, K., Kuhns, L., Hawe, C., McCann, J., McGorum, B., Railton, D.I. and Brammer, S. (1999) Equine dental disease part 1: a long-term study of 400 cases: disorders of incisor, canine and first premolar teeth. Equine Vet J 31, 369-377.
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