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Southern Pines, NC

910-992-8225

Foundation Equine Clinic is an equine exclusive veterinary practice serving Southern Pines, NC, Aberdeen NC, Pinehurst NC, Raeford NC, Vass NC, Sanford NC and surrounding areas. The practice is dedicated to preventive care and dentistry, and values all types of horses and their owners. If you are looking for a horse vet or equine dentist in the sandhills of NC, please give us a call! 

Those aren't "old horse teeth!"  That's EOTRH- a painful condition of equine incisors.

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Those aren't "old horse teeth!" That's EOTRH- a painful condition of equine incisors.

Lisa Kivett


“He’s just got ‘old horse teeth’ doc!”

That’s usually the response from the horse owner or farm manager when I bring up the subject of an older horse’s diseased incisors. Yes, older horses have changes in the size, shape and orientation of their teeth, but broken incisors, “laid over” teeth, loose front teeth, and gingivitis are not a normal finding in an older horse. In fact, these are signs of a serious, debilitating, painful disorder called “Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH).”


 
This horse has multiple symptoms of EOTRH. The red arrow points to a broken lower incisor and the green arrow points to severe gingival erosion. Both orange arrows point to thickened areas of the jaw.

This horse has multiple symptoms of EOTRH. The red arrow points to a broken lower incisor and the green arrow points to severe gingival erosion. Both orange arrows point to thickened areas of the jaw.

 

I know, it’s an awful name. I can barely spit it out myself and I sound like a pompous know-it-all when I do. Unfortunately, we’re unlikely to give it a newer, catchier name any time soon (gone are the days of naming diseases after fabulous descriptive terminology like “trench mouth,” “pizzle rot,” or “bog spavin”). Regardless of the tongue-twisting name, it’s extremely important that horse owners know the signs of this disease. Allowing horses to suffer for years with this condition is simply unacceptable.

EOTRH is a newly recognized disease; it was only first identified in 2004. Since then, the veterinary profession has become increasingly aware of it. The condition involves proliferation (out-of-control growth) of the outer covering of equine teeth, called cementum (this is the “hypercementosis” part). In addition, many horses also have destruction of the internal structure of the teeth (the “resorption” part). As the disease progresses, the front teeth can become loose and crooked, or break off due to weakness and infection. In addition, the bone of the jaw can become infected.

This is a severely-affected horse. Note the large, broken, infected incisor. Feed is actually collecting within the rotted remnant of the tooth. This horse was in tremendous pain.

This is a severely-affected horse. Note the large, broken, infected incisor. Feed is actually collecting within the rotted remnant of the tooth. This horse was in tremendous pain.

Another severely affected horse. The blue arrow points to a broken, "laid over" tooth and the red arrow points to a tooth with hypercementosis (note the bulging and amount of exposed tooth).

Another severely affected horse. The blue arrow points to a broken, "laid over" tooth and the red arrow points to a tooth with hypercementosis (note the bulging and amount of exposed tooth).

This condition is obviously painful, and one of the first signs of the disease may be the horse’s refusal to bite a carrot or treat. Other early signs include drooling, decreased appetite, or abnormal behavior at the water trough (rinsing the mouth, dunking the muzzle, etc). Tapping on the teeth may produce a painful response. To diagnose EOTRH, we need to take radiographs (X-rays). Radiographs of affected teeth show bulbous root structures and dark spots inside the teeth, which indicate resorption.

 
X-ray of a horse with EOTRH. The green arrows point to bulbous roots (hypercementosis) and the red arrow points to a tooth with both hypercementosis and resorption (the black area inside the tooth).

X-ray of a horse with EOTRH. The green arrows point to bulbous roots (hypercementosis) and the red arrow points to a tooth with both hypercementosis and resorption (the black area inside the tooth).

 

At this point, we don’t really know what causes EOTRH. It’s still very new, so research is ongoing. In 2013, Arizona researchers published a study that offered some insight into risk factors for the disease. Management conditions, endocrine diseases and certain previous dental procedures were identified as some of the possible contributors. Excessive dentistry (categorized as prior treatment by a lay floater [unlicensed, non-veterinarian] or incisor reduction) increased the odds for development of EOTRH by five times*. Horses with a history of periodontal disease were also five times more likely to develop the condition. Horses who were fed alfalfa and did not receive turnout (which is more common in western states than here in the Southeast) were twice as likely to have EOTRH. EOTRH was also more common in horses with Equine Cushing’s and Equine Metabolic Syndrome (insulin resistance). It’s way too early to fully understand how these risk factors actually predispose the horse to developing EOTRH, but new information will surely become available in the coming years.

A good example of a resorptive lesion. The surface of the tooth is not intact, and the appearance is a little like a cavity. There is often feed material or hair stuck in the lesion.

A good example of a resorptive lesion. The surface of the tooth is not intact, and the appearance is a little like a cavity. There is often feed material or hair stuck in the lesion.

The blue arrow points to pinpoint draining tracts (they look like tiny dots) and the green arrow points to an affected corner incisor. The red arrow points to a severely affected, broken tooth with visible resorption.

The blue arrow points to pinpoint draining tracts (they look like tiny dots) and the green arrow points to an affected corner incisor. The red arrow points to a severely affected, broken tooth with visible resorption.

So what do we do about EOTRH? Unfortunately, there are few treatment options. If the horse is in pain, removal of the affected teeth will restore his comfort. Unfortunately, many horse owners are uncomfortable with the idea of extracting some of the horse’s teeth, especially in cases where all of the incisors are affected. Horse owners seem to have a strong emotional response to the idea of a horse without front teeth, and often feel that the horse is better left with the diseased teeth (and the pain). This attitude is frustrating to veterinarians, since the horse should not be allowed to suffer. It’s important to note that horses without incisors are able to graze and live a normal life, and it’s unfair to allow the animal to be in constant dental pain.

This horse had his incisors extracted six months prior to this photo being taken. The owners were thrilled with the horse's brighter attitude and could tell that he was in much less pain than before the procedure. The best part? He at three flakes of hay the night after the removal! He was more comfortable immediately after the extractions than he had been for quite some time! 

This horse had his incisors extracted six months prior to this photo being taken. The owners were thrilled with the horse's brighter attitude and could tell that he was in much less pain than before the procedure. The best part? He at three flakes of hay the night after the removal! He was more comfortable immediately after the extractions than he had been for quite some time! 

Another aged Thoroughbred gelding, two years after incisor removal! This horse grazes normally (well, almost normally) and lives a happy life! 

Another aged Thoroughbred gelding, two years after incisor removal! This horse grazes normally (well, almost normally) and lives a happy life! 

This is the same horse from the image above. He's fat and happy, but his tongue does hang out a bit! This is common in horses that have all their incisors removed. 

This is the same horse from the image above. He's fat and happy, but his tongue does hang out a bit! This is common in horses that have all their incisors removed. 

If your horse has any symptoms of EOTRH, have your veterinarian evaluate him for this condition. Also, please be open to removal of diseased teeth! Your old friend has likely earned the right to be comfortable as he ages, so don’t deny him that.

 

- Lisa Kivett, DVM, MS, DACVIM

Foundation Equine Mobile Medicine and Dentistry, Southern Pines NC

 

* Please read comment below for more information regarding the statement that lay dentistry increases the odds for EOTRH.