Pull The Tooth!

This week a horse owner from over a thousand miles away called me after I had gone to bed with an urgent tone in her voice. She has an 8 year old warmblood dressage horse with a lump on her jaw for 4 days. Her vet came out and took x-rays and then pronounced that a tooth needed to be pulled. This horrified the owner and she was seeking out another opinion.

Wait a minute – I need to hit my head against the wall again.

Ahh – that’s better.

This poor owner had been scared by a vet with good intentions, but with only the knowledge of what she had been taught at vet school. While the glamor of performing surgery appeals to surgeons, it is not always in the best interest of the horse.

I just need to remind everyone (again) that we are talking about HORSES and not HUMANS. The teeth are very different. Yet only for emotional reasons we automatically think that if there is a tooth problem, we need to pull the tooth. It’s like Tom Hanks’ character in the movie “Cast Away.” If you didn’t see it, he becomes stranded on a tropical island with a toothache. His only relief from his agony is to knock out his own tooth using a rock and a skate blade. He passes out from the pain for a few days. If this doesn’t make sense to you, then go see the movie. It is a gruesome but memorable scene.

We all can relate to a painful tooth. We all have been to a dentist where they either drill out the abscess or they extract the tooth. We all want relief from the intense pain.

But the horse rarely exhibits pain from an infection near or in the tooth. In fact, they keep eating, as was this mare according to the caller. So why pull the tooth when a less invasive path could be tried?

There have been only a few instances in my three decades as a dentist where pulling the tooth actually helped. They were associated with malformed teeth or disintegrating teeth in young horses. Here the tooth was actually the cause of the infection. Extracting it then is an obvious choice. But realize that extractions have some serious and bizarre after-effects. Just ask the horse owner whose horse had a hole from the mouth to the sinus for several years after extraction.  That horse needed a liquid diet for years until the hole finally closed.

I have plenty of stories where mandibular lumps have resolved with long term antibiotics alone. I also have stories where owners have had a tooth removed plus antibiotics and the problem resolve as well. So which way would you go?
Antibiotics alone? Pull the tooth and antibiotics?

There is no doubt that pulling the tooth resolves the issue quickly. But is it the right thing to do for the horse? If the horse is not bothered by the swelling and continues to chew unaffected by it, then why extract a tooth? I believe they extract the tooth because of the owner’s desire to correct something that they have associated human feelings to, maybe a painful tooth issue they have had themselves.

What is an abscess? It is the body’s way of walling off something bad (foreign object, bacteria) and pushing it to the outside. It is a natural process we have all seen when we watch the ugly zit form on our face or a splinter gets under our skin. To me, it is an absolutely gorgeous event to watch. The body identifying a bad thing, walling it off, and kicking it out of the body. It’s perfect.

Why, then, do we not believe in its good intentions? Cover the effects of the bacteria spilling out of the abscess with antibiotics, but allow time for the abscess to do its job. With teeth, this can take 6 to 8 weeks.

In the 31 years of working with horse teeth, almost all the infected teeth resolve on their own with time and antibiotics. The few that did not were extracted, but well before they were given enough time to resolve on their own. They were extracted because the owner wanted immediate results and they went to a surgeon very willing to do the extraction.

There is one horse in my practice – a Belgian – who resists every attempt to work on her broken and abscessed tooth.  The owners couldn’t send the horse in for anesthesia and surgery plus Belgians are difficult to anesthetize.  The result is that we did nothing.  While it took a few years, the abscess resolved on its own and the horse never skipped a meal because it was never in any pain from the problem.

This owner who called me that night decided to try long term antibiotics. She was willing to let the horse resolve this abscess on her own and I was pleased with her decision. But then something happened. She became tired of hot packing the jaw every day and the other vet put pressure on her saying that the visiting specialist vet who could do the extraction had limited time in the area and would be there in a few days. The owner decided after only a week of antibiotics to have the tooth extracted from her horse.

This is cheek tooth #409 or 408 extracted from a 7 year old Hanovarian mare.  There was a history of swelling followed eventually by drainage.  A few antibiotics were used and finally SMZ pills were settled on.  The owner tried this therapy for less than a month before she was talked into extraction.  I never saw this horse.  I believe that if she had waited several more months, this mare could have resolved this abscess, but owners do not want to wait or give antibiotics this long.

This is cheek tooth #409 or 408 extracted from a 7 year old Hanovarian mare. There was a history of swelling followed eventually by drainage. A few antibiotics were used and finally SMZ pills were settled on. The owner tried this therapy for less than a month before she was talked into extraction. I never saw this horse. I believe that if she had waited several more months, this mare could have resolved this abscess, but owners do not want to wait or give antibiotics this long.

When she let me know about her change in treatment, she acknowledged to me that the horse was showing no discharge from the lump (a sign that the infection was resolving) nor was the filly having problems on the bit or chewing. The only reason she gave was that she was tired of going to the barn and hot packing the jaw.

I wasn’t surprised. People want the convenience and not the trouble when it comes to nursing care. The tooth was pulled and the abscess resolved because now there was a giant hole for drainage and the horse remained on antibiotics for 2 more weeks.

In over 62,000 floats that I have done I have seen the need in maybe 3 horses for extraction. Yet in the past decade the cry of “Pull The Tooth!” seems to become common. But just because we can do a procedure, is it always in the best interest of the horse?

Back to Travels With Doc T

Comments 106

  1. Hi there. I also have a 7 yo KWPN mare with a hard lower jaw swelling which came up overnight last week. I suspect an abscess and have hot packed twice a day for the last 4 days to see if I can initiate drainage. Nothing is draining at present so have requested a vet visit. She is eating comfortably, has an alert demeanor and doesn’t object to the mass being manipulated. However, she and a chum took to chewing a fence last month, so a splinter needs to be ruled out.

    If it is indeed a tooth root abscess, I would follow the antibiotic avenue for as long as possible to avoid extraction. I have also heard of a process of endodontic therapy where the tooth was preserved successfully which sounds promising.

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      I apologize Penny for not responding to you. Apparently I missed the notification! Please let us know what was discovered over the last 4 months. Usually a tooth root swelling develops over several days and not overnight so I agree that it might be a splinter or trauma. The advantage we have with swellings is that we have time. They are not life threatening and usually don’t affect the horse’s ability to chew.

      I agree that if it is a tooth root abscess to try long term antibiotics. If you end up trying any other therapy I certainly would be interested in the outcome. Thanks, Doc T

  2. I have a 19 yr old Dutch Warm blood/ Irish TB. He has exhibited a thick yellowish discharge from the nose mostly one side on and off since Aug. Antibiotics were prescribed and discharge lessened. No other symptoms by the way. X rays of sinuses and scoping of guttural pouches were negative of any abnormalities. A small darkened area did seem apparent over one tooth. The vet has recommended extraction of the tooth but I would like to research other possible treatments. Can an antibiotic be injected directly into the infection site?

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      Thanks Brenda – I cannot offer advice over the internet about your horse because I have not seen your horse. I can say that tooth extraction is permanent and I feel that all other options should be tried before extraction. Seek out another opinion if you are not comfortable with what has been advised. This could include sending the radiographs to a radiologist at a university. In answering your question, there are other options out there. But the most important thing is to get an accurate diagnosis. Sometimes another radiograph taken of the same tooth will no longer have a dark spot.

  3. Hi – I took my 19yr old mate to an equine dentist last week after her having bad smelling white discharge from right nostril- &yes there is an infection. A golf ball size and it is starting to grow bone around it. She has been on antibiotics for 3weeks now. She is booked in to get tooth removed at end of jan. she is on noradine granules. Should I continue to try them for longer? She appears to be in good form, but over the pass fees days is slower at eating and doesn’t seem excited for her food. Still eats meal.

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      Thanks for your comment and I can understand your concern. Your veterinarian may need to take several X-rays to monitor how effective the antibiotic is working. Based on this will determine if you should continue on them. I am unfamiliar with Noradine but it may be the reason why your horse is backing off of her feed. You should ask your vet about this. Remember that there is a difference between a horse having difficulty chewing (tooth related and hungry) versus a horse not wanting to eat (not hungry). Let us all know what happens.

  4. Hi there!
    I’ve been worried for almost a week now. My 12 year old mare broke a back molar in many pieces last week and could barely eat. She chewed with wide eyes, spit out her hay and salivated profusely. The vet came two days after I noticed this strange behavior and began looking at her teeth and next thing I knew, The tooth was out. Her gums were raw from the sharp teeth rubbing so I presume he felt this was the only option… She is now on an antibiotic for 2 weeks and I am rinsing out her mouth with salt water every day. Even then , he told me there is risk of a root infection which would then lead to my mare needing surgery….. What do you think the odds are that she needs this !?
    Sincerely,
    A stressed out owner!

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      Thanks for this great example Alexandra of a common event in horse teeth. It is common for a cheek tooth to develop decay that over time progresses down the tooth and eventually splits it causing a section to break off. This section can often lean into the cheek or tongue which causes the discomfort you saw in your horse. Removing this fractured piece is the only solution and it is what I have done for many years. Your vet probably did not remove the whole tooth but only this fractured piece which can be fairly large. While a tooth root abscess is always possible, I have found in my practice it is uncommon. What your vet has asked you to do (antibiotics and mouth flush) is reasonable. Have him / her keep an eye on things but there is no need to stress out! Tooth fractures are very common. Add a reply here in 2 weeks as a follow up. Thanks again.

  5. My 18 y/o gelding just recently was diagnosed with a sinus infection. After x-rays the vet didn’t see any thing wrong with his teeth and there was no mass. But behind the teeth that are connected to the sinus, the roots were very blurred, as if they weren’t there. Would it be a good idea to pull them? She sent the x-rays to a specialist and they recommend that I do but his performance is still the same as normal and he doesn’t seem to be in any pain and loves food as much as ever! The only problem is that the thick green discharge irritates him. He is on antibiotics but she said they rarely work and if they do the infection would most likely come back. What do you recommend?

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      Thanks Nikki for this comment. This is an example of a horse owner placed in a position of making a choice without enough information and it can be frustrating. The horse is otherwise healthy and acting normally, yet there is a nasal discharge that one vet says isn’t from a tooth and another says it is. The recommendation is to pull the tooth, yet you are not sure.

      A thick green discharge is interesting. Is there food in it? If so, then that is coming from the mouth through a direct path. Pulling the tooth may make that hole larger and the discharge worse. If there is no food, then why is it green? Usually a tooth root abscess is cream colored.

      There is never a rush on these things. You have 3 options: 1) 30 to 60 days of antibiotics (your vet will work with you on this). This usually eliminates the discharge. If it returns then you can either try the antibiotic route again or extract the tooth. Maybe by then a more definitive diagnosis can be made (identifying the exact tooth and cause). In addition, you can have a sinus flush performed on your sedated horse to help flush the pus out of the sinus. 2) Do nothing and follow its development with future exams and x-rays. 3) Go to a university for another opinion.

      Remember that a tooth extraction has its complications especially if there is a tract for food to enter the sinus. I remember a surgeon that told me once that he extracted a tooth only to find that the tooth was OK and the infection had gone up the side of the tooth. And I know of another where the tooth was extracted and for the next 2 years there was food passing from the mouth into the nose. The bottom line is that you need more information before extracting. This comes over time and trying things. Until you have an accurate diagnosis, avoid surgery. Abscesses are inherently a good thing and is a natural process. Yes it can smell but the horse is expressing the bad thing to the outside. Abscesses almost always resolve even though they can be messy and smelly. Oh, and one last thing. Float the teeth so that the tongue can clean the area on the inside of the mouth.

  6. Hi 🙂 My horse has a tooth infection and has had white smelly discharge on and off for a year. Our vet/dentist is hesitant to extract it due to high complication rate ( it’s the last upper molar), our regular vet thinks we should just do nothing and eventually it will resolve on its own. It seems to go away with metronidazole but apparently this can’t be used for long periods? IM penicillin post sinus flap surgery to remove pus also cleared it up for awhile but it seems to come back.Sulprim doesn’t seem to have an effect but perhaps we didn’t use it for long enough. Is there a particular antibiotic you would recommend that can be used for a long course? Thanks so much.

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      Hi Anna – Thanks for reaching out around the globe to ask me about this. It is important that you know that I cannot give advice specific to your horse. What I can tell you is some of the experiences I have had.

      It is always important to have an accurate diagnosis before a treatment is applied. However, in cases similar to yours, the cause is often not found. If the “white smelly” discharge is coming from the nostril, it could be coming from several sources. In my experience, trimethoprim-sulfa antibiotics usually reduces or eliminates this within a few days if it is tooth related. I often treat these for 30 to 60 days with no side effects. In most cases the issue resolves as the horse heals the problem and the abscess does its job. But if the tooth is split from the crown to the root apex, then tooth removal may be your only option. If the smelly nasal discharge is coming from a local cancer, then pulling a tooth won’t do a thing. So a good diagnosis needs to be made.

      The good news is that there is no rush in these matters if it is tooth related. I have had 1 draft horse that was impossible to work inside the mouth and the only solution was to anesthetize her. There were risks to this so the owners elected to do nothing other than long term antibiotics and sinus flushes. After a year of treatments with little effect on the nasal discharge, the owners stopped all treatments. A year or maybe a little more, I asked about the mare. They reported that the nasal discharge had completely stopped. And the mare never went off of her feed or lost weight.

      The bottom line is that I have never seen a horse suffer in any way or even die from an infected tooth. If they never self-resolved, then we would see dozens if not hundreds of cases every year of horses with this condition. But we don’t and because of this, other than the mess you have to clean up every day, I usually don’t worry too much about them. Unfortunately, few horse owners are willing to do nothing with a wait and see approach.

      Talk with your vet about this. Schedule several check-ups for the future over the next year and follow this case together. What works for a lot of people is to write a time line starting on the day you first noticed this. Be sure to include all treatments (time, dose, frequency) and their results. This helps with long and protracted cases. It can also be sent to me a year from now as a form of documenting what works and doesn’t work for others to learn from. Interested?

      Thanks again, Doc T

  7. Thank you so much for that, I really appreciate the advice. We’ve scoped and done X-rays- it seems that the last upper molar is fractured. Being a young horse there is little tooth to grab onto to remove it and our dentist has said the surgery would have a high rate of complications. We had a sinus flap surgery done last year as vet seemed to originally think it was a tumor- but it helped remove the pus in the sinus and after the flush and a month of antibiotics the discharge went away for a few months and I resumed riding. We had a lot of trouble after the sinus flap surgery-somehow the infection went to the other sinus and ended up with catheters in both sides of his head… The wound also got infected and there was also infection due to sequestration of bone fragments post surgery. He had IM penicillin and then a procaine reaction, resulting in multiple injuries. It turned out to be a huge ordeal with months in the stable. I would really like to avoid any more surgery if possible. It’s great to know there won’t be long term damage from leaving it alone- would it be best to spell him in a big paddock for a year to see how he goes? I’ve been riding lightly with metronidazole for flare ups but not sure if this is a good idea. Sulprim doesn’t seem to work but perhaps I didn’t give it enough time. He is acting normal, eating well and has good energy. I really appreciate your help with this.

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      Anna – Please accept my apology, but your comments are the reason veterinarians (or doctors or plumbers or auto mechanics) can’t help without first seeing the problem, getting a detailed and chronological history (time line), and consulting with the other professionals who have seen the horse.

      After reading your comment I become confused. For instance: 1) What to you mean too little tooth in a young horse? Young horses have the most tooth of any aged horse. 2) Fracture of the last upper cheek tooth is uncommon but does occur. It is the hardest to remove orally especially because of its length in the smallest space in the mouth. 3) A sinus flap would be a good approach to the removal of a split upper last molar but they do have a high rate of complications. However, the least of the complications are wound infections and bone fragment sequestrations. 4) Tumors in the head are rare especially in a young horse but not unheard of. If a tumor was not visualized at surgery, then was the cause actually determined then? When was the diagnosis of fracture made? 5) Sinus infections, in my mind, don’t travel to the other side of the head. A bilateral smelly nasal discharge from the sinuses indicates 2 problems, one on each side of the head, and the causes need to be determined.

      Based on your story, I suggest you have a long and detailed discussion with your vet(s) and bring your time line along so that you can get a better understanding as to why these things are occurring with your horse. If after that you are still without answers, seek out another opinion from a vet who can visit your horse (or that you can take your horse to).

      It is always interesting to me how the horse continues to eat as this process develops. Some of the questions that need answering are these: 1) Why does metronidazole work but sulprim (is this trimethoprim 160mg and sulfamethoxazole 800mg?) not work when it is usually effective on dental disease? 2) Are these bilateral fractures? While common in the upper 9’s they are usually in horses around 10 years old and up. 3) Is there a plan (conservative or aggressive) that can be developed that is in the best interest of the horse based on the evidence? 4) What other diagnostic information is necessary to get the missing pieces?

      I started this with an apology and I end it with one too. I cannot help you because I am not there, but I can help you in suggesting the creation of a detailed time line and then approaching the professionals available to you. In my experience, most medical things are simple. When they are not, then a team approach to solving the mystery is necessary. Gather your evidence and assemble your team. Please let all of us know via this post how your horse and you make out in this interesting case.

  8. Im so sorry for the confusion, and of course I realise you cannot give answers specific to my case 🙂
    The way I understood it ( and perhaps I am completely incorrect here) is that most of the tooth is within the gum- there is little in the mouth to actually grab hold of so the vet wanted to give it time to “grow out”?
    I’m not sure what you meant about the complications but we had a sinus flap surgery done, pus removed and it got extremely infected. The vet assured us it wouldn’t happen but it did. We didn’t entirely understand why it was done, partly to remove pus and partly exploratory to see if there was anything else that it could have been? But after it was done and nothing was found there the vet and dentist decided it was the tooth based on the original X-rays. As for the infection on the other side, post sinus flap surgery he developed discharge and an abscess near the wound edge on the originally unaffected side of his face and we xrayed his skull- he had developed a new horizontal skull fracture allowing the infection to move along to the other side. Apparently the vet hadn’t seen that happen before so I suppose we are very unlucky. Antibiotics and flushed cleared that up quickly. That is the way I understood it so apologies if that is incorrect.
    The horse is 13 so could very well have bilateral fractures but I don’t believe the X-rays showed anything. I’m terrified of more surgery after the mess we had following what was promised to be a simple procedure.

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      Thanks for the clarification. It sounds like you are frustrated with the care he has received. While difficult, the only way to resolve this is to talk with the vets involved.

      I will tell you this – there is NO surgery that can’t have complications even when everything is done correctly. This is a fact that EVERY surgeon goes in knowing. I used to joke with the owner before anesthetizing a horse with this comment. “Did you leave your horse the instruction manual on anesthesia and the surgery last night for him to read?” There is nothing worse than a successful surgery and the horse dies in recovery. I had to face this myself when I was anesthetized. There are no guarantees and I tried to forget this point as my lights went out.

      This said, please remember that abscesses are a beautiful way our bodies remove a problem and expel it to the outside. If you are seeing pus, then the abscess is working. If given time, the abscess will resolve the issue, though it may take years if reinfection occurs from a bone fragment. If the abscess is enclosed (hoof abscess) then it can become very painful. If it is deep inside, such as my son’s abscess within his spinal cord last year, then it can be life threatening.

      The ethical and legal answer is that you need to talk with the vets who have seen your horse and have a vested interest in the outcome. All I can offer you is that as long as the horse is showing no discomfort and is chewing and swallowing, then you have some time to think about this. All dental issues are slow to form and slow to heal. As long as pus is draining, your horse’s body is working at resolving the issue. Surgery may speed up the process.

  9. Hello, I have a 23 year old Appendix Quarter, between my sister and I we have had in our family 18 years no previous dental problems have kept up with dental checks(floating) with our regular vet, same vet for 15 years. Recently through a neighboring farm a veterinarian equine dentist was coming to do dental checks on their horses as my 2 were due I took mine over. The veterinarian dentist took one look at my 23 year old gelding and said uh oh looks like EOTRH. As said before up to this point no real problems , ate fine, weight is great but was showing some receding gums. The dentist proceeded with full set of X-rays and full blood panel. Blood was good but X-rays did show moderate amounts of EOTRH and cementin. Horse has not exhibited any signs of pain no problems quidding or eating. This dentist advised removal of all incisors, canines and possible 4-8 molars. Said getting rid of teeth would get rid of the (pain causing) disease.he immediately wanted to schedule the first of the two procedures it would take For all the extractions . Now I would do anything for my animals to keep them pain free as possible including pulling all their teeth but he isn’t showing any pain. I consulted my regular vet who came out and looked at him, who while agrees with probable diagnosis says putting my horse through such traumatic procedures is uncalled for and the risks involved too great, I definitely tend to agree with my regular vet, I hope this older guy is not just being stoic and is really in a lot pain. Any thoughts or advice on follow up.
    Thank you

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      Hi Laurie – EOTRH has been around for a while. I used to call it “ugly teeth of old horses” and the worse thing that happened was the horse could no longer bite a carrot before the incisors fell out. It wasn’t until a few years ago that vets started to radiograph these teeth that they gave it the name condensed as EOTRH (Equine Odontoclastic Tooth Resorption and Hypercementosis for anyone interested). I have documented several of these cases and have found the following:

      1) Some horses become very painful and extraction of the diseased teeth eliminates the pain. These horses are very uncomfortable and have difficulty biting grass and hay. The incisors at this point are easily removed with IV analgesia (not local nerve blocks) and extraction using my fingers (they are that loose) or forceps.

      2) The teeth affected are the incisors and canines. I have not seen a case yet involving the cheek teeth. There is research suggesting that EOTRH is only seen in geldings though a veterinarian in AZ has documented it in a mare (I wonder if this mare has canines as a small percent do).

      3) Removing all the incisors has no effect on the horse’s ability to harvest grass or hay into the mouth.

      4) As a conservative vet, unless there is compelling reasons to do otherwise, I always wait to pull any teeth in a horse. Too many complications can occur from extraction of teeth that are not bothering a horse.

      Frankly, your horse has about another 7 years of life. This is a slowly progressive disease. But the bottom line is always this – talk with both vets involved with the case and then listen to your gut feelings – and always do what is in the best interest of the horse.

      This link may not be good in a little bit, especially if I forget to redirect it after migrating to a new domain. If it doesn’t work, go to HorsemanshipDentistrySchool.com and look there. But for now, you may find this post interesting. It is in the Public Library of my dentistry school. I will also have it soon on my other website TheHorsesAdvocate.com which will become free very soon.
      http://equinedentistryschoolonline.com/eotrh/

      Thanks for commenting and good luck – Doc T

  10. Thank you so much, the general consensus amongst my regular dentist , a board cert. Equine surgeon my vet consulted with and now yourself, is to put tooth extractions on hold until and only if they become necessary. The risks are too great complications of infection etc.and the trauma involved in extracting some 20+ teeth over 2 surgeries would in all likelihood compromise this horses quality of life. Right now he is happy and by all appearances pain free (as my dad always says “don’t go borrowing trouble!”)We will be increasing his dental exams to every 3-4 months. I will repost any compelling changes, again thank you so much!

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  11. Hi! I have a warm blood yearling who has had a snotty nose for 6 months. Sulprim cleared it up for a couple of weeks but then it came back. I have had further consultations as the nasal discharge (on one side only) suddenly became smelly. Examination of the teeth from the mouth showed nothing obvious neither did scopes of xrays. I was under CT that they saw the root of the number 9 molar was damaged and casing the infection and nasal discharge.
    The Equine hospital is now considering options of whether to do the bone flap surgery to flush the sinus and “patch” or “fill” or “cap” the root. They say that dong this might keep the tooth there but it may need to be extracted down the track. My question is should you just extract the tooth so that the horse only has one surgery rather than “patching” and then maybe having to extract the tooth in a few years?

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      Thanks Anne – I am glad to hear that keeping the tooth is becoming an option at some surgeries. I am also impressed with the ability of CT to see these small causes. Too bad it isn’t available to the majority of horse owners because it is such a valuable diagnostic tool.

      What makes this case interesting is that it is in a yearling. The formation of the cheek teeth has not finalized yet and presents thoughts and decisions that might not be the same as for an adult (older than 5 years in teeth discussions).

      I am glad to hear that Sulprim cleared this up. In my experience the length of therapy is important to it’s permanent success and usually is 30 to 60 days with tooth root infections. You should discuss this with your vet first, but I have had no adverse effects on this long term administration of trimethoprim and sulfa in adult horses. However, I have not done long term therapy in growing horses.

      A sinus flush can be performed in a sedated horse with the puncture of the sinus using a 14 gauge needle. This can be repeated often and should be done in conjunction with systemic antibiotics.

      Finally, I have seen one adult horse resolve a tooth caused nasal discharge over two years time after the therapies above did not work.

      To answer the question you asked required the above perspectives. It did not mention “filling, patching or capping” because I think this is a new and novel approach to a problem we don’t really understand thoroughly. If it is a deformed tooth, will this procedure actually help? You should ask your surgeon if this is experimental or find out the data for similar procedures performed in other young horses with not fully developed cheek teeth. Remember, the tooth is still developing AND the tooth is NOT a human, cat, dog, etc so extrapolation from procedures done on other species may not be accurate. The other consideration to removal of the tooth is potential damage to the adjacent developing teeth.

      I prefer conservative approaches to everything and you have time to decide on the course taken. Talk this one out with your vets involved. I cannot give you direct advice, but I can give guidelines that help you discuss things. Consider long term antibiotics and if necessary, repeated until this horse becomes older. If it is a deformed tooth, then the tooth should be removed, but waiting until the cap is naturally expelled first might be beneficial for the horse. Lots of issues in young horses. The most important consideration is always the horse: is he affected by this tooth? chewing well? maintaining weight and growth? What about taking serial CT scans over a period of time to create a better picture of what is happening over time rather than basing a decision on a snap shot of a moment?

      PLEASE keep us all informed here with follow up posts so we can ALL learn through your documentation. I suggest you develop a time line book for this that starts at the first sign of the problem. When all is resolved, send that to me for posting. I would be glad to post it here and in The Horse’s Advocate web site. Thanks, Doc T

      1. Hi Doc T
        It’s not good news. After lots of consultations across Australia and the USA, the vets have decided that there is no option but to extract the tooth. They feel that the evidence from the CT scan shows that the damage is too great and the sinus is very impacted and is already causing deformity (The yearling has a bump on the left side of his forehead between the eyes).
        When I queried a bout a more conservative approach – wait and see – they are advising against this because of the severity of the sinus infection and the already apparent distortion of the sinus cavities. They feel the extract of the tooth is in the long term best interest of the horse.

        It sounds like an awful operation – they are proposing to do a bone flap to get to the tooth and to drain the sinus – and long post op care. I feel so sorry for the horse as he is so well mannered with a lovely nature and is taking all the prodding and poking in his stride. Regards Anne

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          Thanks Anne for the update. Please keep all of us informed.

          You need to trust the vets because they have more information to base their decision on. Sinus flap surgeries have been around for a long time and their success rate is high.

          The most interesting thing about your horse is the age. Because he is a yearling, it is a good assumption that there is a developmental problem with the tooth and that this will continue and destroy the sinus. Removing the cause will logically work. If he was a 10 to 20 year old, then a more conservative approach might be considered.

          I know you feel sorry, but if parts don’t develop correctly (teeth, limbs, heart) then there are consequences in the health and longevity of the animal or human. You should be happy and grateful that we have options today that have not been available to our parents and grandparents for conditions like this. I know I am. The problem today is knowing when to step in with these new options. I thing your vets are correct in their decision because of the advanced condition in such a young horse.

          Again, please keep us posted and send some pictures along too to my email address. Doc T

  12. Hi Doc T

    I have a 12 year old horse that presented a month ago with unilateral yellow/green thick discharge, mixed with a thin orange discharge from her left nostril. No smell and no other symptoms. Vet came out and scoped her and did an oral exam. Everything seemed fine, so was decided to treat her for a primary sinus infection. She was given a penicillin shot which lasted for 10 days. No change. Now she is on Sulfa Trim. It’s been a week and no change. My vet said the horse will have to be on antibiotics for 30 days. If not better, than they will do x rays to check for tooth root abscess and do a possible sinus flush. My question is how long does the horse have to be on antibiotics before I see a change in discharge? The full 30 days, or would I have seen a difference by now if the antibiotics were going to work? Thank you.

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      Hi Jeannine – Usually an appropriate antibiotic will become effective quickly. However, antibiotics don’t penetrate abscesses. They only work on the bacteria that leaks out providing pain relief from the swelling. So if the abscess continues to drain, that doesn’t mean that the antibiotic isn’t working.

      There is time for you to make decisions. Your vet’s plan of waiting 30 days before taking X-rays is valid, and if he / she expands this to 60 days, in my experience, that’s OK too because long term antibiotics will help many of these horses overcome tooth root abscesses.

      As you may know, I cannot advise you specifically on the treatment of your horse. I can say that in my experience, long term antibiotics have helped horses overcome abscesses but they never “cure” an abscess. An abscess is a beautiful process that has a visually disgusting face. Don’t be discouraged as this abscess evolves. As long as your horse is doing well and is not affected by the disease, then you have time.

      Thanks for contacting me about your horse. Doc T

      1. Thanks for responding.

        My horse has no discomfort and is behaving normally. I think my plan at this point is to go the 30 days, then do the x rays and see if it even shows anything obvious. I have read so so many horror stories about tooth extractions, that unless she has a damaged tooth, extraction will be a last resort. As long as my vet is on board, I’ll probably continue the antibiotics another month and if still no change, try the sinus lavage first. I just hate putting my horse through all this if this is something that may just resolve itself eventually, and from what I’ve read here and other places, they often do.

  13. We did a routine float on one of my polo mares yesterday, 15+- year old TB. lower right jaw 2cd molar from the back cocked at a crazy angle toward the cheek, nice ulcer on cheek, slab fracture visible. Probing showed nasty black stinky mass of feed down deep. Vet recommended extracting,it moved easily laterally with finger pressure. Took about 10 minutes to extract. decayed feed all the way down between branches at root. Was searching web for after care ( week of uniprim) and saw this thread and curious about your comments. Thanks!

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      Hi Bob – This type of sagittal cheek tooth fracture is a very common occurrence in horses and in my experience is seen in about 1 horse in every 40 to 50 I see. The most common tooth is #209 which is the 1st upper left molar but I have seen every cheek tooth fracture. The most common direction of the fracture is front to back (sagittal) with the fractured piece leaning either into or away from the cheek, but the fracture can also go from left to right (transverse) or flat across (coronal).

      Your horse had the most common fracture in a very common tooth with a common outcome. It is caused by decay working its way down the core and like a wedge in a log, eventually split the tooth. When enough pressure occurred sideways in the split, the tooth fractured off at right angles to the split and your horse was left with a fractured piece of cheek tooth loosely attached with gum tissue. Feed acted like a wedge driving the fractured tooth into the cheek causing the ulcer. It also created a bad mix of odors from decay and fermentation.

      The treatment is removal of the fractured piece and filing smooth the edges (as well as the rest of the mouth) allowing the tongue to freely clean the area and distribute saliva with antibodies. I rarely follow up with antibiotics because this process has been going on for a very long time (years) and is usually an incidental finding during routine floating. There is no other follow up care. I have never had one become worse or need any other further care, and I have extracted hundreds of these fractured pieces.

      And just to be clear, extracting a fractured piece is NOT extracting a whole tooth. The remaining tooth piece is healthy and in my experience will never need extraction.

      Finally, I have a student in my dentistry school from Hawaii. This explanation is part of her training. Through the school, my goal is to bring my experience to every part of the world so you will never need to worry about your horse’s teeth. Thank you so much for this comment. Doc T

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      Thanks for the picture Bob. It looks like the tooth was split right down the middle. Nice job by your vet and I agree with using antibiotics anytime there is a lot of fresh red tissue on the extracted tooth.

  14. Thanks. Covergirl is on a week of uniprim and seems happy and normal. She is on good pasture comes in once a day for a scoop of feed with her meds. There is no external swelling at the site and pressing the area firmly with fingers gets no reaction. I have no plans to inspect inside visually unless I see a problem. Thanks !

  15. Hi Doc T,
    Hoping you can help me! I have a 25 year old Appendix QH mare. She seemed to be doing just fine up until we had her teeth floated a week an a half ago. The only abnormal thing we noticed during the dental were a couple of pointy bumps on the tip of her tongue (my vet thought maybe from foxtail in the hay). I wasn’t out over the weekend but early the next week I noticed she was dropping feed and trying to eat hay and grass but just quidding it up and spitting it out. She became dehydrated and ended up having an episode of colic by the end of the week so we hauled her to an emergency clinic that night to get that under control. The vet there examined her mouth and thought she saw a slight pocket in her back right second to last molar. We didn’t take xrays then and decided to start a course of Moxycyline. I do see some swelling in her right jaw but she’s still eating soupy mashes and now she’s advanced to dry senior and dyno sport. The only thing not back to normal is the way she eats hay and grass. I’m tempted to wait it out as I’ve seen you suggest in previous responses but I’m getting some pressure to get xrays taken and possibly scope her throat. She’s 25 years old so I’m not inclined to go the surgical route and there isn’t any kind of nasty discharge coming out of the nostril, just a white/clear liquid at times. I guess my question is would you continue to wait? I’m really worried about her but I also don’t want to start doing a bunch of diagnostics until we give the Moxy a chance to work. It’ll be 10 days on Monday which is when my vet is suggested we do a follow up, is that even enough time to tell?

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      Hi Katie – what an awful experience for your horse, you and the vet who floated her. But I need to remind you that I cannot offer advice about your horse because I have not seen it.

      However, I might add that I have seen some horses that just become inflamed from the vibration of the floating process. These horses do better with an anti-inflammatory such as Banamine®. Basically, their teeth hurt which will prevent them from eating anything and may lead to colic. I have never seen a “slight pocket” cause a problem like you describe. Also, in my experience, I have seen horses unable to eat hay and quid (ball it up) after floating, but never grass.

      Please reply here with an update so we may all learn from this. If it is pain from the floating process, It is truly rare and is no one’s fault. Also, if it is pain related, then this is the one time I wait till there is a problem before I work on the teeth and I pre-medicate with Banamine about 1 hour before the work, I sedate with pain relievers for the work, and I follow up with Banamine as needed. I have 1 horse in my practice that this is the standard procedure for her.

      Thanks for telling us about her and sorry for the delay in my reply. Doc T

  16. Hello! I have a 9 year old gelding who developed a bump on the side of his face over 6 months ago. It never seemed to bother him so we were waiting to see if it would go away on its own. A couple of weeks ago, after riding him, the bump enlarged and he seemed irritated or in pain when we touched the bump. The vet performed a visual examination and said that the tooth will most likely need to be pulled due to a potential root infection but that it is a very complex and long process to pull a tooth on a younger horse. I’m concerned now after reading your article because in my mind, if this is something that can resolve without pulling the tooth, I’m willing to try another approach. I worry about the consequences and long term effects of having a large hole in his mouth if we have his tooth pulled. Right now we have him on antibiotics that we’re top dressing in his grain but I have not heard of hot packing. What exactly does hot packing mean and how is it performed? Do we need to pack antibiotics inside his mouth? Our next step is x-rays to determine the extent and location of the infection.

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      Angela – Thanks for sending me this case, but for legal reasons, I cannot advise you specifically on your horse because I have not examined him. I will say that “lumps” on the face can be from a number of things and that before extracting any cheek tooth, an accurate diagnosis must be made. Trauma and tumors can also cause enlargements of the flat bones of the head. In the cases I have seen where a tooth infection has caused a lump on the face, there is usually no pain. It would be interesting to observe if the swelling is all bone or if there is also soft tissue edema involved. Also of interest is the response to antibiotics. Be sure that he is actually getting the antibiotics into his body which can be a problem when “top-dressed.” Finally, as far as “hot-packing” or applying a hot compress over the facial swelling, that would be up to your veterinarian to advise. Let us all know the outcome of the radiographs and what treatment you and your vet decided upon so we all can learn. Thanks, Doc T

  17. Hi Dr Tucker,
    I am interested in hearing your input on my case. On April 16th, my mare came in from the field with a big, ugly burst abscess hole in her face, a few inches below the eye. Gross and oozing pus, we (barn owner and I) figured the worst must be over since it burst and was draining nicely, so we just cleaned it and drained it as best we could, flushing the cavity with sterile saline solution twice a day. But it got worse – the area got swollen and she started resisting having it messed with. So vet was called, x-rays were taken – they shows what looked like a “once-infected tooth root”, and a tract all the way from the tooth to the sinus and to the abscess exit point. Vet also went in and examined her teeth from inside, he said he couldn’t see any indication of an “active” infection of the tooth/tooth root, that part looked healed over and, by all accounts, fine. But her sinus cavity was full of pus and gunk, so we decided on the hole drilling and catheter installation surgery. It went extremely well, everything flushed out nicely, no complications or issues, and catheter stayed in for 8 days before being removed. Within 36 hours of the procedure, the flush was coming out her nose crystal clear (my barn owner was diligently flushing 2x/day, and the original abscess hole/exit point was getting smaller – though still draining a bit of pus). Catheter came out on the 8th day, we continued to drain the (now extremely small) hole of the original abscess, and up until yesterday my barn owner was only able to get a tiny drop of pus out of the hole, followed by a small bit of blood – the pocket was almost gone and the hole was trying to close/heal.
    As of today, however, my barn owner was not able to drain the hole, it was fully closed up, and she texted me to tell me the mare’s face was swollen – there was a hard, swollen area between the original hole and the hole the vet drilled (now stitched up). She was also very much NOT pleased when my barn owner tried to gently palp the area. Obviously the infection is still present – this whole time my mare has been on Enrofloxacin and Metronidazole. My vet initially recommended she go to the large animal clinic 2 hours away to have the bone-flap surgery and possibly have the tooth removed, but the more we talked about it, the more I became skeptical. Then I found this webpage. I called her back and asked if there was any harm in trying to maintain the rx’s for a while since my mare is eating well, not running a fever and not dropping weight, and she said “absolutely not, there is no urgency at this point in time”, and she is supportive of a wait-and-see-for-a-bit approach. She also suggested the equine dentist (who will be in the area next week) have a look at her in-clinic (so no exorbitant call fee), and I’ve agreed to trailer her there for him to have a thorough look inside her mouth and give me his opinion on whether the tooth really needs to come out or not – they have the x-rays at the clinic so he can have a look at those as well if necessary.
    Also worthy of note – discharge was always unilateral, never smelly.

    What are your thoughts based on all this..? Are there any complications that could arise from NOT aggressively treating this soon, or..? I read somewhere that if the infection spreads to the mucus membranes/lining, that it could begin to affect the bone..?! That sounds bad!

    Thank you!

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      Thanks Lianne for this thorough description of your case (with the exception of how old she is) – organized and descriptive. Kudos!! Also kudos for you discussing this with your vet and to your vet for allowing you to have an opinion and agreeing to wait.

      Abscesses are not like a pus filled balloon but more like a pus filled sponge with dozens of small cells that at some point coalesce into a a large cell that erupts to the outside. However, all the small cells are still there. In fact as you press and clean the area, you move some of the bacteria into new areas which either expands the original abscess or causes seeding of the surrounding tissue causing small abscesses around the original site or at some other points of the body.

      Because of the spreading, the only thing to do with a draining abscess is to hot pack the area but never apply pressure.

      I have learned a lot about Staph infections. I got an infection that affected only the skin that took about two years to come under control by my immune system. Every time I pressed the abscess, several more would pop up in the surrounding area. My son expressed an abscess at the base of his neck and then dove 90 feet underwater. The pressure drove the bacteria into his spinal canal where it set up a life threatening abscess almost killing him.

      As I have stated many times before, I love abscesses because it is the body’s ingenious way of kicking out the bacteria. However, when we interfere, perpetuation and serious complications can occur. The lessons I have learned over time is to leave a draining abscess alone except for cleaning the area and hot packing to increase the circulation to bring in more blood for healing.

      This is a lengthy process now and patience will help. Adding the long term antibiotics helps in killing the seeping bacteria but is not very effective in penetrating an abscess.

      Pulling teeth is often done to remove the cause (which I disagree with), but in your case, I think your horse is well beyond that and according to your vet’s exam, has healed the original source. In other words, when the abscess occurred on April 16th, the infection was on its last legs. The rupture of the abscess was the last step.

      I think that with the help of your vet, you just need to be patient and to keep the systemic antibiotics working for maybe 30 or more days (well beyond when it stops draining). Remember to be gentle with it and give some pain medication if necessary for the expanding new abscess. Hot compresses without pressing the abscess helps but adding pressure to express an abscess is not only painful, but actually is counterproductive.

      As always, you must listen to your vet in any decisions you make with your mare. This discussion is only to make you aware of the process of abscess formation and how to effectively resolve them.

      1. Thank you!! Sorry about the age omission – my mare is a May 2006 model. 😉
        I went out this weekend with a kettle of boiling water, mixed in some Epsom salts, and once it was cooled enough for me to be able to touch it without scalding my fingers, I dunked a towel in the water and held it on my mare’s face until it cooled off, dunked again, repeat process, etc. until the water became tepid and was no longer useful. She REALLY seems to enjoy being “hot packed” – she gets dopey-eyed and stands perfectly still, even if half the towel covers her eye, she doesn’t move. She area that has “swelled up” is only about 4 x 4cm across, and very hard.. it almost feels like bone, even though i know that’s impossible. It has not gotten worse since Friday, and so far no discharge, no temp, nothing. She’s now on Uniprim and Metronidazole, she gobbles up all of it in her feed no issues.
        I also lunged her lightly after the hot packing, with the intent to get circulation flowing and help the “cleansing”, if need be. She snorted and blew a lot, was very relaxed.

        My concern now is, how long do I wait before assuming this is “resolved”? This mare is my prized broodmare – I am now terrified of putting her in foal and having this “flare up” again.. 🙁

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          Thanks for the update. Please be patient because the bone is affected in this swelling and will remodel over the next few months. Your vet will give you more information on this, but I can’t see this interfering with your breeding plans. Please keep us all updated with the progress. And remember, just because it “looks good” doesn’t mean you can stop the antibiotics. I have seen infections return if the antibiotics are stopped too soon. But how long should you go? There is no rule but just be patient and work with your vet on this. The infection is exiting the body and you are helping in the imprecise process.

          1. Hey Geoff,
            Just following up on this with an update for you & your readers.
            So my mare saw the Equine Dentist on May 12th – two weeks ago today. What a revelation that was… I really should’ve had her done by him much sooner (as in, 4 years ago). He first pointed out how one eye socket was higher than the other, and once he was in her mouth he noted that the two sides of her jaw were very different/uneven – she develops crazy waves on the right side of jaw, on the bottom mainly, and it was exerting an enormous amount of pressure on the corresponding upper molar, preventing it from erupting – hence, the pocket/abscess/infection and sinus involvement. My poor sweetie!! He fixed her up, even adjusted her atlas for me, and within 10 minutes of him being done, the hard, swollen bump on her face had receded by about 50%.
            Two weeks have gone by, and as of yesterday she is off antibiotics – she was on them for 5 weeks. Absolutely no change or discharge of any kind, the bump is still there but not as pronounced as it was pre-dentist visit. I even rode her on the weekend and I noticed a definite improvement in her acceptance of contact from what I remember (she was leased out in 2014-2015, i just got her back last fall).
            Plan is to breed her end of June or so. Fingers crossed the infection doesn’t resurface!

            The Dentist also recommended she be done again in 6 months by him – he’ll be back in my area in the fall. I will definitely make that happen. I am very lucky that my regular vet is one of the best in the area in terms of dental work, she shadows this Dentist every time he comes to the area and he is very confident in her ability to maintain his work with my mare in future years. 🙂

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            Thanks Lianne for the update. If everyone knew the importance of having the oral pain removed from their horses the world would become a better place for them. It is time now for more veterinarians to realize this and to get good answers for great sources. It is why I started the HorsemanshipDentistrySchool.com so that people, especially equine veterinarians, can learn.

            I agree with the every 6 month floating. “If you horse is chewing then the teeth need doing.” Remember, at 25,000 chews per day, he will chew about 4.5 MILLION chews in 6 months. Doc T

  18. My 22 yo Arabian gelding (has PPID, on pergolide) fractured his lower incisor (bottom left, outside incisor) about 2-2.5 years ago now. It fractured down the middle, with the front part in tact, back half broke off. X-rays showed some inflamation, but an otherwise in tact tooth/root, besides the half that was gone and a few splinters, which my vet removed. 30 days of SMZs and it tightened back up and had been fine since, until recently. Loosened more than ever and gums are not happy around it. The fractured back part has ruptured through now, and the deepest/lowest point of the fracture has mostly erupted. They want to do more x-rays and extract now. They had warned me originally there can be destabilization of the lower jaw, so were trying to be conservative before. With it being more loose now, I guess they feel it’s too loose and unstable to keep it. He is eating well, though, won’t bite a carrot the way he used to, indicating there’s at least a tad of discomfort. He also doesn’t love having it palpated but not too upset, as he was somewhat right after the fragment removal. But also never stopped eating then either. How risky is pulling a incisor? It is fractured enough I understand the recommendation. Will do an x ray either way. I just want to make best and most informed decision for him. Appreciate any thoughts.

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      Hi Amanda. Ask your vet if he / she sees any EOTRH of the incisors. To see more of this, go to TheHorsesAdvocate.com and enroll – it costs nothing. Once logged in, go to the dentistry section and look at the posts on incisor decay and fractures and incisor EOTRH. For me, older horses with EOTRH get decay of the incisors with subsequent fractures like you describe. The key evidence you gave was simply that he doesn’t like to bite carrots. This is common with horses affected with EOTRH and indicates that more than one incisor is involved. X-rays of the lower jaw will show the changes to the teeth and the bone. There is no treatment and extracting this incisor won’t help the horse bite a carrot if other teeth are involved. PPID is not a part of this, but being a 22 year old gelding is classic. Please reply back if you go ahead with more X-rays or any other news you would like to share here. Thanks – Doc T

  19. Hello Doc T!! I just found your site and sooooo thankful that I did 🙂 I have a 31yr old Morgan mare that has a left sided, thick nasal discharge ( creme colored and very smelly). Had rads done to rule out tumor vs tooth. It was determined to be a tooth root abscess. My vet gave me 2 weeks of Baytril and told me if the infection continued she would need to be brought to the clinic and the tooth “tapped” out. I am Vet Tech who is conservative and also always research issues to try and get a good understanding of the problem. We need to be the best advocate for them. I just wanted to say Thank You for taking the time to help us. My gelding stands as a healthy, happy senior today due to people like you who share knowledge. Diagnosed with Atlantal Bursitis that did not resolve with surgical debridement, I was told to euthanize him due to the non resolving infection. They admitted due to lack of experience in this rare case they had nothing left to offer, but would do what ever I wanted to try. It was through researching out here that I came up with a plan for him. He stands above the ground today and not below because people like you share your knowledge and experience. Just wanted to express my gratitude. THANK YOU 🙂

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      You are very welcome and thank you for taking the time to comment.
      Nuchal bursitis is mor common than people think and can cause unprovoked riding behavior such as unstoppable bolting. An ultrasound guided injection into the bursa of antiinflammatory agents can give you a “new horse” in a day.
      A 31 year old horse with a “tooth root abscess” probably has an end stage tooth that can be extracted relatively easily by pulling on it. No need to do a flap and “tap it out.” Often they come out with my fingers.
      Good luck and thanks again. Remember to send people to the school page: HorsemanshipDentistrySchool.com if they want to learn more.

  20. I agree with this too. I recently purchased an old horse I owned back. I only broke her in last Feb and sold her on to get a phone call 9 months later to say she rears vertical abd she’s to be pts if I don’t buy her back,I would nerve see a 4 yr old pts so got her hime abd firstly 2 Wolf teeth were removed the dentist said she also had a 108 fracture so I contacted my local dental surgeon to be told if it doesn’t bother her leave it. Yet my dentist insists it is removed who is right this fracture happened 4 months ago nobinfection ride everyday eating with novproblem

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      Hi Anon from across the pond! Fractured cheek teeth are common. We see one in every 50 horses and sometimes 2 fractures in 1 horse. This come from decay into the pulp chamber which splits the tooth like a wedge going into a log to make fire wood. As the tooth wedges wider from the decay and packed feed material, the bottom usually breaks leaving a fractured piece. It is a good idea to remove these because of local infection from the fermenting trapped feed. Removing the piece also allows the tongue to get in and clean the area with the now large hole. Interestingly, most horses will never show their owners any sign of discomfort. But if you carefully smell the inside of the mouth on these horses, you will sniff the tell tale odor of decay. It stinks! Doc T

  21. Hi Dr. T. I wrote a while back about my horse and her unilateral discharge. After a 30 day course of antibiotics, the discharge didn’t go away. My vet came and xrayed and saw nothing in the sinus. She said she thought tooth root infection. My vet does not believe in pulling the tooth if the horse has no other symptoms due to scary complications , so decided on a wait and see basis. She felt the infection would either resolve, or the root of the tooth would die and the tooth would be loose enough to pull. That was a couple months ago. The discharge has never resolved and in the last week, the discharge has become bilateral. Still no smell or any other symptoms. My question is have you ever seen bilateral discharge with a tooth root abcess?

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      Jeannine – I thought I had answered this but apparently it never was posted! So sorry.

      No I have never seen a sinus infection become bilateral. I agree with your vet that there are complications when a cheek tooth is extracted and the wait-and-see approach usually is a good approach. However, there is no diagnosis and without one, a plan is difficult to make. You need to talk with your vet and find a way to accurately diagnose the cause and make a sound plan from this even if you need to be referred to a hospital with advanced diagnostics. If this is a tooth root abscess, it should have responded to a broad spectrum antibiotic. Because of this, there may be something else causing the discharge.

      While it is impossible for me to diagnose this from afar, I am grateful for you reaching out to us with this case so we can all learn. Please let us know what you do / did and the results. There will be someone else out there with a similar issue – and I am very curious too. Thanks, Doc T

  22. Hi, interested on your view for removing teeth fractured in bottom of mandible. 3yo TB got kicked in jaw with adult (not yet errupted) tooth smashed at base still has juvenile tooth as cap so no food getting in to cause infection. He does have a hole draining blood to the outside of jaw. Currently awaiting referal to dental specialist, but found your site, interesting. Have xray but cant post picture.

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      Jennie – Thanks for finding me. Trauma to the mandible with blood draining from a hole should be X-rayed to look for a hematoma and a fracture of the mandible. A dental expert may advise differently from a veterinary surgeon so listen to both. The horse can still chew with a fractured mandible and since you didn’t mention it, I assume he is chewing. Please work on the trauma to the mandible first before extracting any teeth. Extraction of horse teeth has complications without trauma and more with trauma. In addition, the tooth may be salvaged in the healing process so allow time to discover which way it chooses.

      Feel free to email me any pictures and I will add it to this comment. Also keep us informed with the outcome of this. Thanks, Doc T

  23. Hi Dr. T.

    Just an update. My vet had me start my horse on another 30 day SMZ course. By day 3, the green discharge turned into just a clear liquid with an occasional white glob mixed with blood (looked very orange). I’m on day 28 now and there is still occasional trickling of clear discharge only when she sneezes. No more thick discharge. We are hoping that her issue is resolving, thought my vet has stressed that chronic sinusitis can be difficult to fully treat. My vet also recommended to try an antihistamine, but I haven’t given it to her at this point since the antibiotics seem to be helping.

    Unfortunately where I live (long island, NY), diagnostics at a clinic would be extremely expensive, so we are trying the conservative route right now since my horse has no other symptoms. Wish us luck!

    Thank you for your continued advice.

  24. Hello Dr T.
    After reading these questions and answers on this page i thought, i too, should ask!
    I have a 7 year old Quarter horse gelding that has a slab fracture on his 309. He has shown signs of extra saliva during eating his grain, whole oats, and head tilting. His teeth were floated 2 years ago and the signs prompted me to get him checked again. My dentist found the broken tooth. I did take him to get an X-ray. He dosent have any reaction to the tooth not the out side of his mouth. she was able to take the tooth out of enclusion (so it dosent rub anywhere) and he didnt react any. THere isnt any draining, swelling but some bad smells. How serious is this tooth being broken? This has gone on for 2 weeks now since we found the tooth. My i Please have your advice!
    Thank you

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      Hi Renee and thanks for your question. Cheek tooth fractures are very common in horses and the 4th one back (# 109, 209, 309, and 409) are the common teeth affected. No one has concluded why it is predominately in these teeth.

      A slab fracture usually means sagittal (X axis) but the other 2 directions of the axises (Y, and Z) include transverse and coronal. With sagittal, the fragment can be thin or up to half the tooth. The displaced tooth tilts into the cheek creating an ulcer (rub) on the cheek or into the tongue altering its movement. Either way can cause increased saliva, drooling, head tilting, excessive tongue movement, spilling of feed and difficulty chewing. In some it is only an incidental finding with no unwanted chewing behavior but in others it can be quite dramatic.

      The creation of a cheek tooth fragment is similar to splitting a log using a wedge with a simple exception that the split usually does not go the length of the tooth. A fracture starts with decay of one or more pulp chambers of the tooth. The decay and packing of food over a long period of time wedges into the tooth creating a fissure and the pressure from this splits off a section. At some point after enough force has been applied by the decay, the piece snaps off at right angles to the fissure, usually near the gum line. On occasion the fissure can go completely down the root of the tooth splitting it in half but this is rare. Interestingly, the mirror opposite tooth (#409 in your case) often fractures in the future.

      There are no complications except when it is an upper cheek tooth on the palate side. Removal of this piece can tear the palatine artery which is a very bloody mess. If you think of the fracture as nature’s way of creating a big hole for the decay to escape, then you will have the right idea. The fractured piece should be removed and is easily done with an IV injection of sedatives (xylazine, NOT detomidine !!!!) and potent pain medication (butorphanol) and using fracture forceps. I see fractures in at least 1 or 2 in every 100 horses floated and I remove them on the spot. Not removing the fractured piece only aggravates the horse and allows the decay and the packing of food to continue. There is no reason not to remove the fractured piece. The remaining healthy tooth never becomes a problem with the one exception that there are more fractured pieces that remain. These will become a problem later but can be addressed later. I can remember only a few cheek teeth that have crumbled into multiple pieces that later caused a pathway into a sinus.

      My final note I hope is not taken as a reprimand by you. Horses chew 25,000 times a day (“Motivation for hay: Effects of a pelleted diet on behavior and physiology of horses” Jamie B. Elia a, Hollis N. Erb b, Katherine Albro Houpt b, September 2010). This is 9 million chews a year and 18 million chews in the 2 years you did not have the teeth floated. Unfortunately, most horse owners wait until there is a problem to call a dentist as you stated. While there is obviously a structural problem with some horses teeth that causes the decay and subsequent fractures, I find that horses that are regularly maintained with the removal of the painful sharp points every 6 months (prevention before they become painful enough to alter the movement of the jaw and tongue) allows the horse to maintain the health of the teeth (distribution of saliva, positive pressure from unobstructed occlusion) and prevents decay and gum infections.

      Please have your vet remove the fractured piece and then remove all sharp points through floating every 6 months for the next 2 years. After this, if your budget requires it, reduce the frequency to every 9 to 12 months. Your vet / dentist will see the improvement even though, in the maintenance / prevention mode, you will not. Just because you can’t see a problem doesn’t mean it doesn’t exist.

      Thanks again for your question. I think it will help a lot of others. Doc T

  25. Hello, I am interested in your opinion on my 6 yr TB mare. She developed a lump on her lower jaw about 6 months after I purchased her. I had her teeth floated last Sept 2015 and her lower jaw was not straight. i.e it deviated from a straight line, so the back half was straight then it took a jog to the outside and then straight again.
    The lump remained with no drainage and no issues. Now this year April 2016 when her teeth were floated her jaw was pretty much back in alignment again. About 2 months later the jaw swelling started to enlarge and slight drainage. She was prescribed Uniprim for 2 weeks. The drainage stopped after the 3 rd day and all looked well. However about 3 weeks ago the entire jaw swelled again quite large (golf ball size). After a few days it started draining again (whitish). My Vet xrayed and she has a tooth fracture in the molar, it is not loose but split. Recommended it be extracted. The swelling is now really hard, still draining. Mare is back on Uniprim as I await on the Vet’s further direction as to whether they can extract tooth with mare standing or if she needs to have surgery.

    What are your thoughts? Is it possible for this to resolve on its own with time? Should a fractured tooth always be extracted?

    1. Post
      Author

      Hi Irene – as you probably already know from reading my other replies, I cannot make a comment on your horse directly because I have not seen it. What you decide to do is between you and your vet.

      In my experience I usually look at the horse to determine if she can chew normally. If she can and there is no problem in eating, then there is usually no rush to perform an extraction. If the Uniprim worked immediately then I usually continue for 30 to 60 days. It is common in my experience for the horse to return to swelling and / or discharge when the antibiotic is stopped after 2 weeks. I have had horses with hard swellings on the mandible resolve their problems with this long term treatment without needing to move to extraction.

      X-rays of the jaw are often hard to assess. I have seen x-rays showing definitively a root abscess that 1 week later had move to another tooth. In reality, what looked like an abscess of a root was really an abscess near a root but unfortunately it is almost impossible to get 2 views to make a 3-D position location. I had another horse that went in for a last lower cheek tooth extraction (not my decision) where the surgeon afterwards said to me that the tooth was perfectly normal but the infection was along the side of the tooth. This horse would have probably resolved this infection with long term antibiotics.

      As far as the crooked jaw that became straight after floating – I am suspicious that the jaw itself was not crooked but the teeth within the jaw were not in alignment. I often see horses that after about 2 years (4 floatings) have their teeth realign as if they were wearing orthodontic braces. This is because the horse now chews without restrictions from sharp points causing pain in the cheeks and tongue. This alignment can occur to a whole arcade or an individual tooth.

      In your mare’s case, an infection could have started in the area where this crooked tooth was. In addition, swellings of the mandible from infections commonly occur about 4 to 6 weeks after a change occurs within the mouth including the April 2016 floating. They DO NOT occur immediately which makes people think that the swelling is a separate event. In my experience when these swellings occur, the 30 to 60 days of trimethoprim – sulfa works every time.

      To summarize, talk with your vet about continuing the Uniprim for 30 to 60 days, perform repeated x-rays over this time, and monitor the progress. I would especially appreciate it if, after you and your vet decide together choose to follow this path, that you come back here with a detailed report with x-rays along with permission for me to use this material publicly so others can learn from your experience.

      Doc T

      1. Hi Doc T,
        There is a fracture in the tooth, it is north/south fracture and the tooth is still solid. Mare is given another week of uniprim (will be 3 weeks continuous) and previously had 2 weeks with a 3 week break in between. The swelling is down, still a bit of drainage. Mare is in excellent health, lots of dapples and a bit on the plump side so it has not affected her ability to eat so far. I prefer not to extract unless absolutely necessary, but my Vet suggested removing the portion of the tooth that is fractured even though it is firmly anchored. For now we have not reached a decision, but I am holding out for the best and your information/input has helped me deal with my anxiety. Thank you.

  26. Hello Dr. T,
    I have a 28 year old mare who upon dental exam/float 2 months ago was found to have a crack in a right lower molar. My vet is not convinced it goes all the way to the root and advises we wait and see if it just grinds down to whole solid tooth. I have changed her diet a bit to make chewing easier (chopped hay, soaked hay cubes etc. in addition to plenty of grass turnout) but notice that periodically while eating pelleted feed or alfalfa pellets she suddenly stops eating, walks away from her food and stays very, very still refusing even her favorite treat. I have checked for quids and rinsed her mouth but found nothing. Eventually, in 5-20 mins she returns to her food. I think she may be experiencing pain from that tooth. What do you think is going on? Should I have the vet come out again? Do cracked molars always need to be removed? Thanks for your thoughts.

    1. Post
      Author

      Mary – Without actually seeing your horse I would be uncomfortable giving you advice. You should ask your vet to come out and re-evaluate. If the vet needs some help from someone more familiar with cracked cheek teeth then make that happen. I agree that it seems like your horse is showing some pain not just in the reaction but in the fact that you have needed to change what he eats to be comfortable in chewing.

      Most cracked cheek teeth do not extend the length of the tooth. In a 28 year old horse, the tooth will never “grind down” to a solid tooth. It is always in the horse’s best interest to remove a fractured piece to eliminate pain, allow for comfortable chewing, allow for cleaning of the area, prevent trapping of food and prevent local infections.

      I hope this helps. Please come back with an update for all to see. Thanks, Doc T

      1. Hi again,

        Thanks for your response. I spoke to my vet again and he had the dental specialist vet look at her.That vet did not believe that her teeth were the problem. After further work ups and evaluation turns out she has ulcers. Been treated with Gastrogard and Ranitidine and she is dong very well without any more episodes of stillness or disruption in eating.

        1. Post
          Author

          Thanks Mary. Remember to prevent the ulcers in the first place by increasing hay intake and eliminating grain. Go to TheHorsesAdvocate.com/grain for more information.

  27. Hello,

    I have an 11 y/o QH gelding who has had small cavities in the upper first molars on both sides of his mouth for several years. They’ve stayed around 1/2″ deep for the past 4 years. Today, during his annual float, my vet found that one of the molars had fractured, leaving a very sharp edge on the molar. The fracture does not go below the gum line, but the decayed cavity definitely does, and is now much wider. Her initial suggestion was to have the molar removed, but when I wanted to be more conservative, she agreed to put him on doxycycline for a month, and then recommended X-rays to see how deep the cavity goes. I am extremely reluctant to have the tooth removed, since I know it will require anesthesia and leave a huge hole behind. There isn’t enough tooth left above the gum to grasp and remove that way. The horse shows no symptoms whatsoever. His last float was a year ago, so this fracture may have occurred anytime in the last year. I’m afraid that if the X-rays show significant decay in the root, that I’ll be under a lot of pressure to remove the tooth. What is your experience with cavities, and do you often recommend extraction for severe ones?

    Thanks!!

    1. Post
      Author

      Hi Joy – What you have described is a very common thing in horses (1 in 40 seen). The upper 4th cheek teeth are the ones mostly affected followed by the opposing lower cheek teeth, but I have seen every tooth split at some point. The decay acts like a wedge pushing the tooth apart until it snaps off, usually at the gum line, and it either falls out or is removed.

      These cheek tooth fractures are never a problem for the remaining tooth and almost every horse shows no signs of a problem – ever. Those that do show a problem are usually because of the pain associated with the tooth fragment displaced into the cheek or tongue or the remaining socket forms a razor’s edge.

      I usually find no need for antibiotics. The fermenting and decay odor self-resolves after the tongue is allowed into the new space, without interference from sharp edges, and cleans the area.

      In my career, cavities are an incidental finding with no effective course of treatment as in humans. The result of a cavity is either no damage to the tooth or it fractures and the fractured piece is removed without complications. Often the mirror image tooth also fractures at some point. There is one complication that may occur during removal and that is when the palatal side of the upper 4th cheek teeth fracture. There is a possibility that during removal, the palatine artery is damaged causing a bloody mess.

      It is a very rare day that I recommend extraction of any tooth in a horse.

      If your vet has any questions about this, please have him or her contact me through the contact form on this web site. Thanks, Doc T

  28. This is proving to be one of the most useful pages I’ve ever read. I have a 10 year old Welsh Part Bred mare with an unusual lower jaw root abscess. The vet did X-rays using a probe into the hole. This showed that the teeth, roots and jaw bone were perfect and the pus appears to be draining from between the two teeth. Could this be what some people call a Pus Pocket? She was given two weeks of antibiotics and the vet recommended that a visiting “Specialist” extracts the tooth. Which tooth? Who knows! They are after all perfect. When I asked this she said that there might be a link to one of the adjacent teeth. This sounds too much of s risk to me so I’ve turned the mare back out on the Welsh hills. She is contented, eating and if anything slightly overweight so I’m not really concerned but I do feel terribly guilty after the vet used the emotional black mail of “toothache”. Her jaw is draining constantly and is looking slightly worse today so I think I need to try different antibiotics and for longer. Thanks everyone for your comments on this, it really does help counteract the effects of emotional blackmail.

    1. Post
      Author

      Beth – I can’t thank you enough for your comment here. We are blatantly steeling the expression “Emotional Blackmail” from you. We have always called it the “Pull the tooth!” syndrome and the “Do Something!” syndrome.

      I have never seen a toothache in a horse and I challenge anyone to find a documented case of it.

      In my opinion, abscesses will continue to drain until the infection comes out – a beautiful process. Antibiotics often clear up the surrounding infection but the process is long taking 4 to 8 weeks.

      Please feel free to update this comment as your mare progresses. And while I’m here, I also want to thank all who have commented and brought to life this page and the awareness that the veterinary profession has done NO controlled studies to look at abscess drainage from the jaw and the optional treatments. All I have is 33 years of experience as a vet and 43 years with horses. I have yet to see a “toothache” or a horse that has suffered a catastrophe from any drainage from a jaw with the exception of a mandibular fracture or invasive cancer. For this reason, an accurate diagnosis is always recommended. But if nothing catastrophic is found, be patient.

      1. Thanks for your reply Geoff. This is a recurring issue which has flared up a few times over the years. This is the first course of antibiotics that she’s had. It never completely goes away, it just dries up leaving a tiny hole which occasionally forms a crust. I have a lot of respect for my vet and have spoken to my her since I first posted on this page and explained that I am going to let it run it’s course. In fairness, she was fine about it but I think she could see that I had made my mind up. I had considered breaking the mare in but am afraid that I may aggravate the situation if I do so. I have seen Welsh Mountain Ponies with the same problem, one of whom had a constant “drain” below his eye along his sinus, where the upper tooth was causing a problem. His tooth was left in situ with no problems other than looking unsightly. I really think that this may be a breeding problem in the smaller Welsh breeds as their heads are becoming smaller. I’m assuming that this at some point will affect the jaw and teeth.

        1. Post
          Author

          Thanks for the further details. I cannot comment on whether it will affect the jaw or teeth because there is no diagnosis. Please keep us all posted with updates.

  29. Thank you for this page! I recently bought a Norwegian Fyord this summer. When I purchased him the owner said he had his teeth floated last year. Sven is a 12 and absolutely perfect for me to learn on. Last week I had the dentist come out to float his teeth. Well welcome to the horse world he said to me. His teeth looked like they have never been floated. I was shown that is 209 is broken and can lead to problems with sinus infection and should be removed. The dentist has set up an appointment with a vet who specializes in these certain issues. I’m not sure if by having his teeth floated have I poked an angry bear for he is perfectly well right now. I have the appointment on Monday to get X-rays done and talk with the vet. After reading one of the previous post I’m wondering now if they can fill the tooth. This whole pulling the tooth through the sinus cavity scares the crap out of me. I am not a stable so I really don’t have anywhere to keep him in a clean environment. I guess all I can do is go in with a list of questions and concerns. Do you think if he is not showing any signs of sinus infection it is alright to not proceed with the surgery right now? Thank you for your time.

    1. Post
      Author

      209 is THE most common tooth to fracture and is very common. With sedation and analgesic drugs, the fractured piece can be extracted and the remaining healthy tooth remains in the mouth. There have been no complications I have seen from these extractions with one exception. If the fracture is sagittal with the fractured piece is on the palatal side, then on occasion it’s removal will tear a hole in the palatine artery. This is very bloody and has happened 3 times.

      Tooth fractures can occur even in horses whose teeth have been regularly cared for. It is unknown why the 9’s fracture more than any other tooth, but any cheek tooth can fracture as decay descends down 1 or more pulp chambers and splits the tooth like a wedge in a log. When it splits far enough, the distal edge snaps off and the piece disconnects from the main part of the tooth. Surprisingly, this is usually an incidental finding but these displaced pieces can also move into the cheek or tongue causing discomfort.

      Finally, it is rare that these fractures lead to a sinus infection. And these fractures are common being seen in one horse in every 40 or so.

  30. I hope you can help! I have an 18year Gelding Througbreed he has draining yellow from one nostil . He had bad teeth the last time the vet was here she put him on anitbolics and said get his teeth floated but since then we had them floated and he was fine. He doesn’t cough, but he will not open his mouth. I have spent hundreds of dollars on vet bills for him and everytime the vet comes it is always comes down to him having bad teeth. I will not pull any I just want help on getting them healthy, again his teeth have been floated and after the floating I have more problems with him and this yellow discharge from his nose. And after a course of anitbolics it goes away but comes right back………

    1. Post
      Author

      Thanks Tina – You want your horse to resolve this issue and you are frustrated because after spending money for answers, the issue remains. I find the one comment interesting and perplexing – “…but he will not open his mouth.” Are you saying he does not want to eat, can’t eat, or is his jaw broken and he is physically unable to open the mouth. Either one of these warrants a visit from your vet again.

      However, your vet has already said his teeth need floating but from your story, it appears that your dentist isn’t getting the job done. Your vet needs to inspect your horse right after the teeth are done – or better yet, be there to inspect the mouth while the dentist is there.

      Either your dentist isn’t resolving the problem you vet says is in there or your vet has the wrong diagnosis. It’s time to get the two together and resolve this or find another opinion. I hope this helps you and others to realize that the mouth of the horse is often misunderstood even by the professionals responsible for its care. Talk about frustrating….

  31. Hello! I have a 24 year old arabian and he has had the classic bad breath and one runny nose for a week. Had the vet out today and his teeth looked fine, couldn’t find any cracked or loose. No bumps and eats fine. She wants him on antibiotics for a month and then if it doesn’t clear we will take him to a vet to do xrays. My question is will 30 days be long enough to clear it or should I go to 60 days just to be sure? This site is great thank you!

    1. Post
      Author
  32. I have a horse with a hole in his canine. He is 21 and over the last year has lost a ton of weight. Blood work is all clean.Doc #1 says after seeing radiographs we will only be chasing the infection and that even though there is risk involved, the tooth should come out and that the issue will most definitely fester into other problems and could lead to having to put him down. Doc #2 says try antibiotics first. Thoughts?

    1. Post
      Author

      A hole in a canine is usually EOTRH. Radiographs will prove it as it involves not just the tooth but the bone it is in. This usually involves the incisors as well. The decay has already occurred and antibiotics usually are ineffective. Extraction will work but is unnecessary because time will allow the decay to do the same thing. In every case, horses usually feel no pain with canine decay. Please discuss this with your vet because they are the ones who know you and your horse. Please let them know that they can contact me if they want more information.

  33. Hi!
    I have a 27 year old Dutch-thoroughbred mare who has had an ongoing jaw abscess in the lower right jaw. It started more than a year ago- vet came and cleaned out the hole. She was on antibiotics for 3 weeks and improved but did not heal. A couple of months later she had another 4 week round of antibiotics and improved again, but again it never healed all the way. She had no meds through the summer or fall, but her jaw is oozing with more intensity. But she is still eating well ( not on any medication) . Should I request that my vet prescribe something for her? Should I be concerned that this long running infection might invade her jaw bone? The teeth in the jaw are solid- it is the hole that was
    left after an extraction 2 years ago that the problem stems from. Anyway, I am willing to wait, as long as I have some positive feedback to do so.
    Thanks!

    1. Post
      Author

      Your vet can radiograph or MRI the abscess to determine the cause of the drainage. Only after getting an accurate diagnosis can a course of action be established. In my experience, drainage will continue until the cause is removed by the draining process. It is relevant that the horse continues to chew without difficulty. Please consult your vet to discuss this case as I have not seen it. Thanks

      1. Thank you for your input. My mare had X-rays last week and it shows there is an abscess around the whole root of 408 (409 was the tooth that was missing and I thought had an abscess in the vacant hole but I was mistaken). The tooth though is not budging. She has been off antibiotics for 3 weeks and the drainage continues although it seems to have lessened. I continue to soak the drain hole and rinse her mouth several times a week (when I go to the barn as she is boarded out). She is on a great mash mixture to try and keep her weight on as she really cannot chew the hay very well and quids it quite a bit. She actually seemed to quid less when she was on the antibiotics but the vet said her teeth are not the greatest and her quidding is not because of the abscess. She has had her teeth consistently maintained so I guess it is just a natural decline of their condition. The vet said that as long as the tooth is there then so the abscess will be there. But I wonder if by removing the tooth we will just create an even bigger area in her jaw where she can’t grind since there will be a two tooth gap. Is there a chance that the tooth will loosen to the point that it could be removed without surgery? The drainage and treating it are not an issue for me. The vet said it could just keep draining until she dies and also said she has never seen it compromise the jaw bone (which has not happened in this case). So, is this what you have referred to about letting the abscess heal itself? Can it possibly heal and the tooth actually not be lost?
        I appreciate any input.

        1. Post
          Author

          Without being your vet, I can’t advise or predict how this will turn out over time in your horse. This said, I still love an abscess because it means that the horse is removing from the body the problem. In my experience, these eventually stop draining without the horse developing adverse issues. It could be that the missing tooth and the sharp edges that form from the horse focusing his attention on the gap may be the source of quidding, but it could also be the coarseness of the hay. Experiment with different forages such as chopped hay or soaked hay cubes to see if this helps with the quidding.

          I always recommend 30 to 60 days of antibiotics for these cases and you said he quidded less while on them. Ask you vet if he or she is willing to try another 30 to 45 days. In the case of the horse that the owners did not perform the extraction and the draining abscess eventually dried up, they tried two 60 days periods of antibiotics. Each time it resolved but then the draining started again about a week after ending the treatment. Don’t be surprised if this happens to your horse. But if you don’t want to extract the second tooth, I can say that you will have a lot of time to think about this and even change your mind with no problems for your horse.

          Please keep us updated. Doc T

  34. I have a 20 year old mare with a yellow smelly discharge from her left nostril which the vet has diagnosed as sinusitis caused by what what she has identified as a slab fracture in an upper tooth (3 from the back) there is a pustule evident on the inside of that tooth which is visible. The vet has initially put her onto 10days of Noradine antibiotic and some Bute as antinflammatory / pain killer, she has suggested that we have her ex -rayed with a view to the tooth being removed, I am loath to go down this route as I have seen the results of this invasive surgery in the past. The cost in both time and money are also a very big issue for me now that we are both retired, is 10 days enough time for the antibiotic to do its work or would I be wrong to suggest a longer period for antibiotics, I am also aware of the negative affects on the digestive system of long term antibiotics. At the moment, apart from the smelly snotty nose, there are no other symptoms or sign of distress, however this has only been going on for approx 3 weeks.

    1. Post
      Author

      Gill – fractures of the cheek teeth are common. Until the cause is removed, the discharge will continue. Removing the fractured piece is fairly easy and can be done at the farm with mile analgesia in most horses. Covering with a broad spectrum antibiotic after the extraction is important. Please consult your vet to find someone with experience to extract the fractured part of the cheek tooth. The remaining healthy part can usually be left in but that is up to your vet.

  35. Hi i have a 10 year old horse, who had a veterinary on visit last year. He told me she needed a tooth extraction of one of her upper teeth on the left side. After this everything went fine, but i had a bad feeling about the surgery. Ended with a horse now in january having a inflammation in her left nosetril, my vet says its linked to it, but she had another surgery now where the cleanse her nose with water and a electrical pump.. Then they Will but her on antibiotics again, i have No idea if she Will get any better. If this doesnt work then he told me to put her down was the only option. Due you have any advice?

    1. Post
      Author

      Yikes!!! As long as she is not showing difficulties in chewing then be patient. I wouldn’t euthanize a horse that is eating and not showing discomfort in chewing but only having a nasal discharge. There must be more to this story that you are not telling us such as cancer in the sinus.

      For all reading this, know that extracting cheek teeth in horses can have unplanned consequences. Please discuss thoroughly with your vet before extractions to understand these complications.

  36. I currently have a retired 21yo QH gelding with a (now) diagnosed tooth root abscess. He never showed any sign of discomfort or came off of feed. We just noticed the lump on his face by chance. We are too late in noticing, as the infection has already gone through the bone. I would love to send you the radiograph and get your opinion. Extraction may be a possibility, however the damage has already been done to his bone, so the options there seem slim.

    Thank you!

    1. Post
      Author

      Sorry but I can’t look at radiographs of a case I have not seen because I am not a board certified radiologist. However, the bone swelling is not “damaged.” The abscess is finding a way out and you are not “too late in noticing” and your options are not “slim.” Abscessation is a process that evolves over time and is natural. Nothing is being damaged and there is no need for a doom and gloom outlook. Consider 30 to 60 days of broad spectrum antibiotics to see if this resolves things. As always, discuss this with your vet. In my opinion cheek tooth extractions are a last attempt to resolve things and should not be considered a first thing to do. As always, as long as the horse is chewing without discomfort, then you have time.

  37. In the case of a lower jaw tooth abscess with a draining fistula, how long do you go before extraction? 6 months on and off antibiotics and still no better. Not really causing an issue, other than tender when abscess flairs up, it drains for a few days then heals for about a month then flairs up again and so the cycle goes on. How long do you continue like this before deciding to remove the cause and can leaving it cause any long term damage? Many thanks

    1. Post
      Author

      Thanks Karen for the question. Are you sure it is a tooth? This could also be a sequestrum from traumatic damage to the mandible which I have seen. While 3 different vet clinics diagnosed a tooth root abscess, and the final vet clinic (a vet school) extracted the overlying tooth, the area continued to drain. It wasn’t until an MRI done at a 4th clinic that the bone sequestrum was identified and removed ending the drainage. This is a true story that occurred to my client.

      Like your horse, her horse had no discomfort and it was only a management problem. Remember that drainage occurs when the body wants to eliminate something from the body and is natural and good but can take a long time. We seem to want to rush things, jump in and fix it. In my experience, waiting has no adverse affects to the horse. What you want to do is between you and your vet, but in your question you state: “How long do you continue like this before deciding to remove the cause…” An accurate cause MUST be determined BEFORE you can remove it. In these cases, finding that cause can be difficult, expensive and unavailable for many.

      Please keep us posted. Doc T

  38. The molar (107) is my horse extracted yesterday. It is winter time, we only have cold water available or a hot water boiler (for tea for example). The dentist said cleaning with flowing water, but the horse is a sensitive one, and does not really accept the water hose, Which I can imagine. We have tried several options, without any luck. Does anyone know a good alternative to keep the hole of the extracted molar clean?

    1. Post
      Author

      In my experience it is impossible to keep the extraction hole clean. As soon as the horse returns to eating, the hole is filled again. The good news is that granulation tissue will fill the hole in just a few days. The bad news is that in some extractions, the hole never completely fills. Some vets will fill the socket with a plug. While this seems to work, I’m not sure there are any statistics that show the outcome is improved by doing this. The bottom line is that I wouldn’t worry about the hole. I will add though that I try to avoid extraction of any cheek tooth if at all possible. The one we left alone (upper cheek tooth with chronic nasal draining of a foul smelling fluid) self resolved in about 2 years without extraction.

      Hope this helps – Doc T

  39. Hi!

    My 23 year old gelding has recently had a problem with grass getting compacted between his upper incisors and lip, he let’s me brush it off if he doesn’t manage to dislodge it himself. I’m suspecting this is EOTRH as he also has very slight gaps between his incisors? I also noticed a couple of weeks ago that he started eating funny. He takes a bite then stretches his neck and head out while chewing. It may just be a coincidence but he only does it when the bucket is on the floor and never with hay or grass. I looked in his mouth and it appears his lower right canine is broken and there’s quite a deep hole down into the gum. I’ve been cleaning it out daily ever since i noticed it and i can stick a cotton swap socked in warm salt water into the hole without him showing any real discomfort but it does smell a bit. I’m worried that it will become infected if it hasn’t already

    Your opinion and any advice on this would be much appreciated and as i know when the vet comes up in a couple of weeks the first thing she will say is “It needs to come out right now!” and a canine extraction is the last thing i want after reading so many horror stories and especially when my boy doesn’t seem bothered by it at all.

    1. Post
      Author

      Hi Shaz
      As always I am not advising you on your horse because I have not seen him.
      Whenever a horse doesn’t clean a part of his mouth such as the area between the teeth and lip it is usually caused by pain or a physical blockage preventing the horse from getting the tongue in this area. Removing the blockage or removing ALL the pain producing points or conditions (a broken tooth) will allow horses to move the tongue thoroughly within the oral cavity. Also, if the chewing behavior suddenly changes such as head / neck stretching, a cause such as a broken tooth needs to be considered. Broken cheek teeth are very common and are almost always easily addressed in a medicated horse in their stall.

      EOTRH starts with receding gums from the incisors as well as decaying canines. These affected teeth may also cause pain and prevent the tongue from moving. Please become a member of TheHorsesAdvocate.com (free) and then explore the pictures and articles in the dentistry section for more information.

      Doc T

  40. Hello Doc T,

    I sold a horse subject to a two week trial which ends tomorrow April 29th, during this trial the buyer decided she wanted to do a pre-purchase exam. Below are the findings. I wonder if you would actually recommend to extract the tooth or if you would leave it be and just do more frequent floats? I am extremely concerned. The lady is trying to convince me to drop the price significantly. I feel that it might just be best if I go pick him up but it is a 14 hour drive round trip. I wonder if you would advise to PULL THE TOOTH based on the findings.

    Significant dental abnormalities are identified requiring additional intervention. There is a chronically fractured cheek tooth (109), with at
    least 2 fragments remaining and a large portion of the crown missing, the sharp fragment in his cheek has chronically lacerated the
    cheek and produced a large callous. A second fragment is visible adjacent to the palate. The majority of the space previously occupied
    by the tooth is packed deeply with malodorous fermented, bloody feed. There is overeruptuion of the apposing tooth in the lower arcade
    into the void created by this partly missing tooth. The estimated duration of this problem is considered several months, greater than a
    few weeks. Palliative measures were taken to improve oral comfort until definitive measures are taken

    Recommended medical care for this problem, in the very near future, includes,radiography and extraction of remaining fragments.
    Without radiographs it is uncertain how much of the tooth remains deep in the socket. Extraction may be complicated dependent on
    how many fragments remain and how accesible they are. A standing oral extraction would be the preferred route, more complicated
    problems could require general anesthesia and/or sinus surgery. The prognosis for this problem with appropriate medical care is
    guarded to good, however, complications prior to resolution of the problem are not uncommon. An investment in this medical care will
    be necessary.

    There are other occlusal dental abnormalities of the cheek teeth, that have been initially addressed. Additionally, the incisors have a
    slant conformation and early signs suggestive of EOTRH, (enlarged bulging roots, irritated gingiva and few small fistulae). EOTRH is
    typically a slowly progressive, destructive, and proliferative condition effecting the incisor and canine teeth of horses.. No intervention for
    this problem at this time is recommended. IF this problem is progressive, it MAY result in dental pain requiring extractions of the
    effected incisor teeth. Extraction is the only treatment available for this condition, it is not being recommended at this time, but may be
    necessary later in this horse’s life.

    Sincerely,
    Tanya

    1. Post
      Author

      Tanya –
      The veterinarian’s report is thorough and accurate. Removal of the fractured piece of cheek tooth is usually not complicated with a good prognosis. I remove fractured pieces weekly. I recommend to follow the advice of extraction of the fractured piece. This is NOT a full tooth extraction.

      EOTRH has been around for ages but is being recognized now due to radiographs of the underlying bone and hence a very long name has been assigned. This is a progressive disease without a known cause. Most live their whole lives without complications (other than being ugly) but a few end up losing their incisors and / or their canines. Please become a member of TheHorsesAdvocate.com and visit the dentistry section with the topic EOTRH to see plenty of pictures. You will also see plenty of fractured pieces of cheek teeth.

      As far as dropping the sale price, in my experience, after removing the displaced fractured piece that is interfering with the tongue or cheek, the horse actually goes better – possibly providing a better riding experience.

      Good luck and let us all know what happens. Doc T

  41. Hi Doc T,

    First of all i’d like to say what an informative page this is and i wish i knew about it sooner!

    So here’s my problem that i could use a bit of advice on. My Gelding had a piece of his fractured canine tooth removed 2 weeks ago. The root is still intact but there’s still a mighty hole. The vet told me to pack it with cotton wool to stop feed material from getting in there and to change it every couple of days. So that’s what i’ve been doing. But today there was white pus coming out of the hole and he was very sensitive in having it cleaned out, it was bleeding a fair bit too. Do you think packing the hole would have caused this? Or maybe the root of the canine was already infected and the whole thing should have come out? Should i continue to pack it or let the pus drain out while running the risk of feed getting stuck in the hole instead?

    Many thanks for reading,

    Luana

    1. Post
      Author

      Thanks Luana for finding this page. There are 2 causes for a canine fracture: trauma and EOTRH. This sounds more like the decay found in the necrotic EOTRH. Please discuss this with your vet but the pus is probably coming from the decay.

      In my experience, packing in the mouth is not necessary as the cleaning action of the tongue along with the antibodies in the saliva and granulation tissue formation prevents any infection within the dirty mouth.

      1. Thanks Doc T for the reply, i really appreciate it!

        I’ve since had the vet out again and she’s adamant that it’s a root abscess which erupted once that broken fragment was removed. She’s given me a course of antibiotics for my gelding but said it’s highly unlikely that the hole will close up and that he’s going to keep getting infections unless the whole canine is removed. In your experience is this always necessary? What would be the worst case scenario if i didn’t have the tooth pulled?

        1. Post
          Author

          Thanks for the update. As always, the attending vet has the only advice you should listen to.
          It has been 9 days since your last comment. Please bring us all up to speed with a report of what the antibiotics and time have done for your horse. Also let us know if you elected to remove the canine or had an X-ray taken to confirm a diagnosis. Thanks from all of the horse owners following this and me.

          1. Hi Doc T! I’m always checking this page now for new posts, it’s helpful to get a second opinion sometimes and to read about problems other people may be having with their horse’s teeth and what worked or didn’t work for them.

            As for an update on my horse, the antibiotics seem to have kicked in and he’s alot less tender around his canine. I’m still cleaning and packing the hole as instructed by my vet but there is little to no pus at all coming from the hole that runs along the side of the remaining piece of canine. I am yet to have xrays done but that will be the next step if the pus returns after he’s finished his course of antibiotics. As for having the rest of the canine removed, i may be called a bad owner by many for not wanting it pulled and although age shouldn’t matter he’ll be 24 years old soon and i’d rather let the tooth ‘rot out’ unless i know the infection will spread and become serious if i don’t have the remaining tooth removed. So long as he’s happy to eat, not dropping too much weight and let’s me mess around with his mouth then I have no problems with cleaning out the hole on a daily basis.

          2. Post
            Author

            Thanks Luana. Obviously you are NOT a “bad owner” because you are seeking advice for the best interest of your horse. For this I thank you. Stay in touch over time so we can all learn. Doc T

  42. Hello – I’ve just been told I need my 7 year old mare’s teeth checked based on the fact she has “Enlarged Temporalis muscles.” Truth be told i haven’t had her teeth seen to since she was 4 years old because my current vet won’t even inspect inside the mouth without the horse being heavily sedated. My mare had a bout of colic after the first sedation which is why i’ve put off having her teeth looked at for so long.
    As far as i can remember she’s always had raised muscles on the forehead so if it’s a problem caused by the teeth then she’s had it for quite a while and that really concerns me. I’ve noticed myself as well that she has little hooks on her last upper incisors on either side. I’ve read that this is a common occurrence in 7 year olds and the hooks smooth out on their own most of the time without intervention once the horse reaches 8 or 9 – Is this a correct assumption or do you think that the hooks on the incisors and the enlarged temporalis muscles are linked and i need her teeth done asap?

    I’ve tried looking on the internet about the enlarged muscles but i can’t find any information on it. I would be so grateful if you could explain to me what they might mean and if you’ve encountered them in your line of work before.
    I’d like to find a vet or dentist that will do her teeth without sedation before i have her floated again but that seems like a rare treasure nowadays.

    Thanks in advance.

    1. Post
      Author

      Hi Emma – I have not seen an association either in my practice or in the literature associating the over-development of the temporalis muscles and the need for the teeth to be floated. Let’s look at this in another way.

      The horse chews on average 25,000 times a day (K Houpt, VMD of Cornell University) so this means your horse has chewed and licked into sharpness his teeth 9 million times every year. Add to this that the enamel of the cheek teeth are softer and sharpen more quickly when young and we all can be confident that your horse has very sharp edges. Each horse is an individual but for almost all horses, between 6 and 12 months the teeth become sharp enough to bother them with floating causing relief from oral pain. It is that simple. The most important factor is the horse’s individual threshold of pain.

      The hook on the upper corner incisor is called the 7 year hook which can also appear at 11 years. Or it may never appear at all. Contrary to others, it does not prevent the horse from moving the jaw but is created by the movement of the jaw. A lot of people get this backwards.

      For more information please go to: https://www.horsemanshipdentistry.com/does-my-horse-need-equine-dentistry/

      To find a horsemanship dentist in your state go to: https://www.horsemanshipdentistry.com/find-equine-dentists/

      To send someone from your area to the school go to: https://horsemanshipdentistryschool.com/info

  43. Doc T,

    I have just found out my horse has a broken upper molar. The dentist did not tell me a number tooth. He suggested take her to get it punched out barbecue he was scared if he messed with it, it would break off and make things worse. The only symptom my horse has is ear sensitivity one one side. She is not dropping food, fat as a butter ball, and seems happy. When he unpacked the tooth from all of the crud that surrounded it , it smelt very BAD! It is definitely infected. I have called every vet I know to get an opinion. Most say take her to get it punched, but one finally said treat with antibiotics and see what happens. Maybe it will cure the infection and it can be pulled. What would you suggest?

    1. Post
      Author

      Hi Shannon
      The smell is the digestion and fermentation of the packed food which may cause a local infection (usually painful) but your horse does not have an infection that systemic antibiotics will help.

      If the tooth is fractured into 2 or more pieces, the fractured off pieces need to be removed. This is usually done orally. I don’t advocate for extraction of a whole tooth because abscesses usually resolve on their own or with the help of long term antibiotics.

      Sometimes the fracture will go the length of the tooth. These pieces are difficult to remove. I have had one horse where the fracture went the full length of the tooth and would not budge. We waited two years before the piece matured to become loose enough to extract. During this time the horse gave no indication there was anything wrong with that tooth. 10 years later this warmblood mare is doing fine with absolutely no problems in the mouth.

      If you would like to have your dentist or veterinarian contact me to discuss this case that would be fine. Until then I cannot advise you on what to do with your horse. Doc T

  44. Hey Doc T, it’s me again! I had to make another post because I was unable to reply to the previous posts i made, sorry for the inconvenience. I just wanted to share my latest update and again, ask you for some advice because I’ve been left with 3 choices by a new vet i got in contact with.
    Since my last reply I’ve had xrays done and it’s been concluded that my boy has a root canal infection which hasn’t yet reached the root. Part of the canal is exposed due to the hole and broken fragment that was previously removed and that’s why the infection keeps reoccurring.

    The vet gave me 3 choices:
    1.) Extract the canine – He said that due to the fact the root itself is currently healthy extraction could prove to be quite difficult as the canine’s have the longest roots which don’t constantly erupt and I would need to get it surgically removed.
    2.) Continue with long term antibiotics
    3.) Leave it alone and see if the tooth becomes easier to extract overtime – I was quite surprised by this option because even though i’d prefer not to pull the tooth I don’t want the infection to take hold and possibly cause bigger problems.

    I know you can’t really comment because you haven’t seen my horse but based on the information I’ve given what would you suggest?

    1. Post
      Author

      This new vet has all the correct options. You need to discuss it with him or her and agree with the course. If s/he wants to consult that is OK. Have them call me.

      I agree that canine extractions are problematic and difficult.

      Long term antibiotics do work as long as the source of infection is removed (sequestrum).

      Wait and see is a viable option because nothing moves that fast in the mouth. Unless it is something we don’t expect (cancer, EOTRH – both would have been seen on X-ray) then I have not seen a local tooth infection move to the bone. Though it is possible, it is not likely in my experience.

      Looking forward to the future updates. Please include photos. Doc T

I look forward to reading your comment! Doc T