(This blog’s header photo is of a horse that is moderately affected with EOTRH)
Every once in a while I become lost for words. My mind becomes numb and my jaw freezes. My eyelids slowly sweep moisture across my eyeballs as I try to bring things into focus. My open mouth dries as I breath slowly pretending I did not hear and see what I just did.
The text message did not change and the image sent with the text did not alter. I asked myself how this could happen? How can someone do this to the innocent horse dependent on our species to advocate for them. How could the veterinarian, bound to do no harm, support this procedure? How could a horse owner allow it?
Then I became mad in my helplessness and I wrote this blog.
The Text
Good morning… I have a question … we have a horse that came to us with developed EOTRH.. we discovered it a little over a month ago.. after 2 weeks of SMZ antibiotics there was only slight but not significant improvement..it was determined his top 6 incisors needed to be pulled and they were.. horse is doing well , on hay and we hand graze on taller grass.. he will not touch his soaked alfalfa cubes nor his senior feed( he is 17)..which is fine because I make sure he has hay 24/7 .. my question is… do his bottom teeth also need to be pulled? It just seems criminal to pull them as well.. not clear to me if they are as infected, but I will find out when vet comes to recheck.. but from my understanding for insurance reasons it needs to be done within a month of top teeth being pulled.. Is it normal to pull bottoms if you pull tops if there is not evidence of or little evidence of EOTRH? Can a horse do well with just bottom incisors? I tried googling but got no where. I am going to transition this horse and most others at the farm to the diet (my friend) has her horses on as per (your) recommendation .. but for now it bothers me that this poor horse in 3 weeks will have more teeth removed. Wondering what your thoughts are on this?
The text sent to me yesterday
I replied to this text with my obligatory line that interfering with someone else’s case without seeing the horse is unethical and not allowed. I encouraged her to have a conversation with her vet expressing her concerns.
Discussion
EOTRH is a progressive disease affecting the bones in the skull that hold the incisor and canine teeth in position. As the disease progresses, these teeth react by adding more structural material to keep them in position. Throughout the process of the horse saving the affected teeth, the gums become inflamed, enlarge to form a ridge and then withdraw from their normal position (recede). The incisor tooth roots become enlarged creating hard bulges under the gums. The incisor and canine teeth become dead with abscess formation occasionally causing rupture of some of these teeth.
Pain is not common in mildly and moderately affected horses. However as food is trapped in the pockets formed by the receding gums, the inflammation becomes painful. When the teeth become loose there can be pain seen as difficulty biting hay from a net or biting a carrot. Because the cheek teeth are rarely involved, the horse will continue to chew food normally.
The Cause And Treatment Of EOTRH
I have written about the cause of EOTRH in another blog here. My thought is that EOTRH was not in my veterinary text books at Cornell in the 1980’s. It is a new disease that is so obvious to our eyes that we cannot say that it existed before 1980 but we just didn’t notice it. Lift the lips and look to diagnose. You can see over 100 images of EOTRH at TheHorsesAdvocate.com to see what I have seen.
My guess is that EOTRH is an autoimmune disease (as per Dr Paddy Dixon at the AAEP meeting, December 2017) caused by a reaction to grains and grain byproducts. This is reasonable because these products were not readily available prior to 1980.
Mushrooms have been shown to neutralize plant lectins in human studies and lectins have been shown to be a major cause of all autoimmune diseases in humans (lupus, Crohn’s, rheumatoid arthritis, Hashimoto’s thyroiditis and others). Because of this, I have placed several horses with inflamed gums on the shredded mushrooms found in Equident®, a product specifically made for this disease. The results are consistently seen as reduced inflammation. More importantly, these owners have also removed grain and byproducts from the diet to prevent further inflammation. Neither of these actions will reverse the damage already done but they have demonstrated their ability to stop the advancement of EOTRH.
The Reason To Be Angry
I wrote this thought a while back in a blog: “But just because we can do a procedure, is it always in the best interest of the horse?” In this case, was there a need to pull all upper incisors? I don’t know because I was not there. Yet in the thousands of horses I visit each year, there are a lot of horses with moderate EOTRH that don’t need their teeth extracted. They live into their 30’s with their front teeth still in their heads and eating well. In fact there is only one horse with EOTRH affecting their ability to chew that I did remove all but 1 incisor (see this blog’s header and the images below). They wiggled with finger pressure and most of them came out with my fingers or forceps with only some IV pain medication. It took about 5 minutes and the horse went to chewing comfortably in less than a day.
My point of anger though only started with the extractions of the horse in this text. It deepened as I re-read the text and gleaned more. He was only 17 years old which isn’t “old.” Why was he on a senior feed? I have been looking for YEARS to find senior feeds for squirrels, for birds, for people and I have not found them. My conclusion is that “senior feeds” for horses is only a marketing gimmick to get horse owners to purchase the unwanted byproducts of the human food industry. Just look at the ingredient label. And when should a horse be considered a “senior?”
The ingredients of one brand of senior feed listed on the internet is below. Purina and Nutrena no longer list the ingredients on their web sites which adds to their cover up and confusion. Red are inflammatory ingredients and blue are unnecessary ingredients if the digestive tract is not inflamed. Green are the only ingredients needed and can be purchased individually.
Soybean Hulls, Dehydrated Alfalfa Meal, Wheat Middlings, Corn Distillers Dried Grains, Wheat Flour, Soybean Meal, Ground Corn, Soybean Oil, Ground Beet Pulp, Cane Molasses, Rice Bran, Calcium Carbonate, Yeast Culture, Salt, Monocalcium Phosphate, Magnesium Oxide, Natural Flavor, DL-Methionine, Calcium Sulfate, L-Lysine, Vitamin E Supplement, Selenium Yeast, Yeast Extract, Zinc Amino Acid Complex, Manganese Amino Acid Complex, Zinc Sulfate, Manganese Sulfate, Copper Amino Acid Complex, Copper Sulfate, Biotin, Vitamin B12 Supplement, L-Ascorbyl-2-Polyphosphate (source of Vitamin C), Cobalt Glucoheptonate, Ferrous Sulfate, Stabilized Flaxseed, Algae Meal, Soy Lecithin, Dried Enterococcus Faecium Fermentation Product, Dried Lactobacillus Acidophilus Fermentation Product, Dried Aspergillus Niger Fermentation Extract, Dried Bacillus Subtilis Fermentation Extract, Dried Bacillus Subtilis Fermentation Product, Dried Bacillus Licheniformis Fermentation Product, Niacin Supplement, Calcium d-Pantothenate, Riboflavin Supplement, Vitamin A Supplement, Sodium Selenite, L-Threonine, Choline Chloride, Pyridoxine Hydrochloride, Thiamine Mononitrate, Calcium Iodate, Vitamin D3 Supplement, Folic Acid, Menadione Sodium Bisulfite Complex (Source of Vitamin K), Cobalt Carbonate, Natural Mixed Tocopherols, Citric Acid, Rosemary Extract.
Blue Seal website for their senior feed
My anger then hit a level I had not been to in a while when I read that the insurance company required the rest of the teeth be pulled within 30 days of the first set of extractions. What?!? In order to save money, the owner will need to decide quickly to extract the remaining teeth whether they need to come out or not. Where is the advocacy for the horse? Are we so blind to reason that we need to be faced with such a ridiculous decision?
Conclusions
I cannot reach SOME of my veterinary colleagues because they are too far down the path of “Whack-A-Mole” medicine. In fact they do “something” because the horse owner wants them to “DO Something!” One of the most common words I hear from horse owners is, “I just want what’s best for my horses.” Then they turn over the responsibility to experts without going through and confirming that what is happening is really the best for their horses.
In today’s world of marketing, how do we determine what is best? How can we agree when we can’t agree on politics, raising children, religion or almost anything else? I wrote about “Cognitive Laziness” in a recent blog where we just accept what we are told without understanding the information. You should read this and then ask yourself, is what you are doing for your horses really in their best interest?
Information today is abundant and is unfiltered and not refereed. It is usually agenda driven because why put in the effort of creating content if there is no reward? I become energized by texts like this one and from the decades of watching horses become more ill and lame. The reward for me is when I get the chance to balance the agenda driven words and actions with novel information based on almost 50 years of experience. Stoping horse owners in their tracks to look at things from a different perspective, having them try these ideas and then reporting back the positive improvements in their horses is my reward.
Read these and blogs from others. Avoid agenda driven information where they are trying to sell you something. What you will find is that simplicity works in most cases – that pulling teeth is a last resort.
There are a lot of veterinarians and horse owners who feel the same way I do and are serving the horses in a profoundly beneficial way. However when I see a case like this and realize the pressure being brought upon the horse owner by the insurance company to possibly make a very wrong decision, I worry. I become angry so I write blogs and I remake my website to be a source of information for horse owners so they never say as she did in the text, “I tried Googling but got no where.”
EOTRH horse 16 – with mandibular bone enlargement and receding gum line in a 24 year old horse. 
EOTRH horse 15 – Incisors not painful but #106 and 107 cheek teeth were painful when floating. Owner may take radiographs though EOTRH is rare in the cheek teeth. 
EOTRH of #103 – Associated lip ulcer is not painful and does not affect his eating. I filed smooth the edges. Because this tooth did not affect his chewing we decided to wait until further action was needed. 
A malformed #303 with receeding gum line in a 24 year old with suspected EOTRH (more evident in the upper incisors). Also necrosis of the pulp chambers of 301 and 401. 
2 necrotic holes on the labial surface of 203 of this 24 year old horse. Also, the gums are starting to receed along with the prominant bull nose shape of the upper incisors indicating the onset of EOTR-H (unconfirmed). 
EOTRH horse 6 – Taken 8 months after extraction of decayed and fractured 403- base of 402 exposed but firm in the mouth. All teeth firm with no bad smell or pain when filed with the small canine file. Cheek teeth not affected and in great shape in this 29 year old. 
EOTRH horse 13 – 5/1/1995 = 18yr 4mo – early EOTRH with gum recession, bulbous profile and stippled gums. 
EOTRH horse 11 – older horse with thickening of the gums with a cobblestone appearance. 
EOTRH horse 10 – 4/11/1993 = 20yr = W (partial) TB G – Receding gum line, bulbous incisors, thickening of the gum line. 
EOTRH horse 14 – 7/29/1986 = 27yr 3mo WB S – Early EOTRH and an underbite but only from the forward displacement of the lower left incisors. Note more receding gums on the lower left tongue side and upper left lip side than on the right.