Cheek Tooth Extraction - Horse
Introduction
Tooth extraction is the most common surgical procedure performed in the horse. However it should always be considered a last resort as there are considered to be both welfare issues and potential risks/complications associated with the procedure. The extraction of a cheek teeth is considerably more invasive that the removal of wolf teeth and caps and is considered to be a major operation which should be performed either under sedation or general anaesthetic. Ideally radiography should be performed to identify the affected tooth before any extraction.
Indications
There are numerous reasons for cheek tooth extraction, these include: fractured teeth, loose teeth, displaced teeth, peridontal disease, impaction, apical and periapical abcessation, infundibular necrosis, mandibular fractures, neoplasia and the removal of supernumarary teeth.
Techniques
With all extractions the entire tooth should always be removed. It is necessary to disrupt the periodontal ligament and alveolar margin in order to remove the tooth. Care should be taken not to damage the adjacent teeth. There are three commonly used techniques for cheek tooth extraction:
Oral Extraction
This technique is the least invasive (as the alveolus remains intact) and it can be performed under sedation. If the technique is unsuccessful subsequent surgical extraction may be required. It is ideal for use in elderly horses as the periodontal ligament is often already loose.
First, the gingival margin should be lifted using elevators. Secondly, molar spreaders should be placed between the extraction tooth and the surrounding teeth. Finally, forceps should be placed on the extraction tooth and gently rotated to loosen the surrounding attachments. This final step can take a very long time - particularly where the periodontal ligament is intact, but it should not be rushed as this could result in fracture of the extracted tooth.
Complications include tooth fracture and incomplete extraction.
Repulsion
This technique approaches the tooth from the apical margin and repulses the tooth back into the oral cavity.
Having accessed the apical surface the tooth either via a trephine hole or an osteoblastic flap, a punch and mallet are used to knock the tooth into the oral cavity.
This has more associated complications due to its invasive nature. These include incomplete extraction, sequestra formation, haemorrhage, fistula formation, slow healing and damage to adjacent teeth.
Buccotomy
This technique is most suited to the extraction of abnormally shaped teeth that cannot be removed by the above mentioned methods.
The tooth is accessed from the lateral surface of the skull and removed piece meal.
Complications include damage to surrounding structures such as salivary glands and nerves, incomplete extraction and sequestra formation.
Post-op Care
- Analgesics such as NSAIDs
- Antibiotics to prevent infection
- Placement of a plug in the gap left by the tooth - this needs removal or replacement post-op.
Most horses will need preventative dental care for the rest of their lives. This is because the tooth apposing the extracted tooth will not be exposed to as much wear as the other teeth, and is susceptible to overgrowth.
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References
Howarth, S (1995) Equine Dental Surgery In Practice 1995 17: 178-18
RVC staff (2009) Alimentary System - Part I RVC Intergrated BVetMed Course, Royal Veterinary College
Tremaine, H (1997) Equine Practice: Dental care in horses In Practice 1997;19:186-199
Verstraete, F. J. M. (1998) Self-Assessment Colour Review - Veterinary Dentistry Manson