Cheek teeth dental disorders

Dr Nicole du Toit BVSc MSc CertEP PhD Dipl EVDC (equine) Dipl

AVDC (equine)

Tulbagh Equine Dentistry

www.facebook.com/EquineVetDentistry

Introduction

– Wear disorders develop due to the hypsodont nature of equid teeth

– Any one abnormality will result in another if not treated

– ‘Normal’ age related wear changes

Sharp enamel points

– Develop due to anisognathia and masticatory action

– Buccal aspect maxillary cheek teeth

– Lingual aspect mandibular cheek teeth

– Often associated with buccal ulcers

– Do not float occlusal surface

Overgrown teeth

– Misaligned cheek teeth rows e.g. maxillary prognathism

– Most commonly upper 06s and Lower 11s

– Opposite missing or displaced teeth

– Mild, subtle bilateral overgrowths associated with eruption ‘dominance’?

Treatment of overgrown teeth

– Mild overgrowths can be floated/rasped level

– Severe overgrowths need to be floated 2-3 mm at 6-8 week intervals to avoid pulpar exposure

– If you see pink you are already in the pulp horn!

Exaggerated transverse ridges

– Transverse ridges normal

– More pronounced in younger horses

– Exaggerated

• May inhibit normal masticatory action
• May cause diastemata/ interdental periodontal disease

Displaced teeth

– Young horses: developmental

– Older horses: acquired

– Often bilateral

– May be associated with:

• Diastemata
• Cheek or tongue ulceration

– Mild cases: float edges smooth

– Severe cases: extraction – can be tricky

– Don’t forget potential opposing overgrowths

Wave mouth

– Uneven occlusal surface in rostro-caudal plane due to adjacent teeth worn and overgrown

– Float overgrown teeth only to normal crown height and NOT to level of worn teeth

– If severe need to do in stages

– Older horses unlikely to completely resolve

Worn teeth

– Age related

– Decreased enamel

– Reduced reserve crown

– If entire cheek teeth row or mouth – smooth mouth

– Manage opposing overgrowths

– If severe: Dietary management

Shear mouth

– Rare, any age

– Possibly related to tilted palate

– Horses only able to eat on opposing side

– Long term management – regular floating

Step mouth

– Opposite missing or displaced tooth

– Inhibits normal rostro-caudal mandibular movement

– Floating of overgrown tooth

Broken mouth

– Severe uneven occlusal surface due to multiple overgrown, worn and sharp teeth

Diastemata

– Abnormal space/ food impaction interdental space

– Most painful condition

– Periodontal pockets

– Most commonly involves caudal cheek teeth

– Important to use dental mirror not too miss them

– Very painful periodontal pockets

• Flush out food
• Antibiotic gel and packing material – conservative treatment

– Reduce oclussal surface of opposing teeth

• Reduce action of impacting food into diastemata

– Tooth extraction

• Associated tooth

– Burring to enlarge interdental space

Infundibular caries

– Most common in 09s

– Incomplete cementum formation

• Infundibular hypoplasia

– Advanced caries may lead to tooth fracture

– Burring and filling with dental material

• Reasonable success

Supernumerary cheek teeth

– Extra tooth/teeth

– Malocclusion, overgrowths and periodontal disease

Bit seats/rostral profiling

– Practice with no scientific evidence

– Risk of pulp exposure

– Loss of masticatory ability of front four teeth

– Owner education!!!

Canine rasping

– Danger of pulp exposure

– Justified to prevent tongue laceration or handler comfort

– Mild floating of sharp edges acceptable

Cheek teeth fractures

– Taylor and Dixon 2007

– Prevalence of 0.4%

– 39% not associated with clinical signs

– Quidding, halitosis, bitting and behavioural problems

Results

– 133 Maxillary cheek teeth

– 09s and 10s most common (46% of all farctured cheek teeth)

– 49 Mandibular cheek teeth

– Lateral slab fractures most common (48% maxillary and 57% mandibular cheek teeth fractures)

Results

(Dacre, Kempson and Dixon 2007)

– Teeth extracted at University of Edinburgh

– Maxillary 09s (64%)

– Mandibular 08s and 09s (80%)

– 30/35 involved pulp horns

– 5/35 coalescing infundibular caries

Fracture patterns

– Group 1: Maxillary slab fractues – throught pulp horns 1 & 2

– Group 2: Maxillary infundibular saggital fractures (through rostral and caudal infundibulae)

– Group 3: Miscellaneous maxillary fractures

– Group 4: Mandibular buccal slab fractures – through pulp hornes 4 & 5

– Group 5: Miscellaneous mandibular fractures

Treatment

(Taylor & Dixon 2007)

– Removal of loose fragment

– Floating sharp edges

– Tooth extraction

– 81% no clinical signs at follow up (half of these had no clinical signs at initial examination)

Dixon, Barakzai, Collins & Yates 2007

– Conservative – removal of fragments

– Extraction if apical infections

Aetiology

– Pulp horns are weakest anatomical area:

• Predisposed by pulp infections
• Reduced secondary dentine formation (25%)
• Pulp death/ pulpitis secondary to fracture

– Apical infections

• predisposing or secondary to fracture

– Severe infundibular caries

• weakens tooth

Conclusion

– All fractures through pulp cavities or infundibulae

– Predisposed by anatomical weakness

– All at risk for developing apical infection

– Conservative treatment successful unless apical infection