Catch Equine Dental Disease Early: Learn the Signs of EOTRH

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Catch Equine Dental Disease Early: Learn the Signs of EOTRH

As horses age, they are at higher risk of developing dental disease. The most common disease horse owners need to be aware of is Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH). This process occurs in older horses when their body resorbs the bone and tissue surrounding the incisor (and occasionally canine) roots. As a horse loses more and more of his dental papillae (the gums between each incisor), feed accumulates and gives the green light for infection in the gingival (gum) pockets. This can destroy the periodontal ligament, which helps hold each tooth in place, as well as the alveolar bone that surrounds the tooth root. 

This process of inflammation and infection can also affect the tooth’s center (the pulp), and eventually cementum, the enamel-like material that covers the horse’s tooth, starts growing near the gumline. Researchers believe that cementum proliferation is the body’s way of trying to stabilize the tooth as the normal structures deteriorate. As EOTRH progresses, the part of the gumline only gets worse and the support structures continue to diminish. The weakened areas of the teeth can even fracture. The entire process is very painful and can lead to changes in the horse’s ability or desire to eat.

No one knows why EOTRH occurs. This isn’t a new disease and has probably been with horses throughout history, but it seems to be more common at this time. Some researchers blame age-related changes in the mouth, such as natural loss of a tooth’s reserve crown (the portion of the tooth hidden by the gum). Dental trauma and not enough time spent chewing could also be responsible.

Risk Factors for Equine Dental Disease

  • EOTRH most commonly occurs in horses older than 15.
  • Thoroughbreds, Warmbloods, and Arabians tend to be more predisposed to EOTRH than other breeds.
  • Stallions might be more susceptible than mares or geldings.
  • Horses with limited pasture access or those that consume food that does not require a lot of chewing, such as horses on alfalfa-based diets.
  • Horses with endocrine conditions such as equine metabolic syndrome (EMS) or Cushing’s disease are 50 percent more likely to develop EOTRH than healthy horses. Veterinarians believe the high circulating levels of insulin and glucose seen in horses with EMS might be associated with periodontal disease. Additionally, horses with Cushing’s disease are known to have impaired immune function, making them more susceptible to infection.  


Symptoms of EOTRH

EOTRH takes years to develop into its highly destructive and most painful stages. Changes to the teeth and the pain horses exhibit can be quite subtle in the early stages. Horse owners usually associate these signs with their horse getting older and becoming a little grumpy. Annual oral exams from a veterinarian can help identify EOTRH early.

Early symptoms of EOTRH are often related to incisor pain and may include:

  • Your horse being unable or unwilling to grasp hard treats, such as apples or carrots
  • The animal trying to use his lips instead of his teeth to grasp hay and grass
  • Spending an abnormal amount of time mouthing at the water bucket
  • A “smiling” behavior, pulling the lips back at both rest and work
  • Headshaking
  • Resistance to the bit
  • Hypersalivation
  • Poor appetite
  • Weight loss
  • Resistance to having the mouth handled or their teeth examined  

Once the resorption process has begun, you might notice the physical signs in the mouth, such as:

  • Loss of the dental papilla (gums between incisors)
  • Teeth that appear bulbous and discolored near the root
  • Gum lines that appear to be receding
  • Tissue surrounding the top of the teeth becoming enlarged and inflamed
  • If the tooth roots are infected, you might also notice small red dots above the gum line
  • Loose teeth due to loss of root structure


How is EOTRH Diagnosed?

Owner recognition is the first step toward an EOTRH diagnosis, because it’s likely you will notice your horse’s subtle behavior and eating pattern changes before others do. Your veterinarian can confirm an EOTRH diagnosis based on both a physical examination of the teeth and by doing some X-Rays. X-Rays are essential to revealing the destructive process hidden beneath the gum line. By using these images, your veterinarian will be able to check the roots of the upper and lower incisors as well as the canines. They will also look for loss of the periodontal ligament space, changes in the bone surrounding the tooth roots, and any evidence of a bone infection or fractured teeth.  

EOTRH Treatment

Unfortunately, there is little you can do to slow EOTRH progression once it has started. In mild cases, horses benefit from having a veterinary dentist address the early stages of periodontal disease. You can also keep the incisors free of feed material by flushing the mouth with water daily or even brushing the teeth.

Once radiographic changes and pain occur, however, most practitioners recommend that they extract the affected teeth. Removing the teeth relieves the horse of the pain associated with each tooth and might even prevent the process from expanding to nearby incisors. Most equine practitioners are experienced in dental care and capable of removing loose incisors.

If the disease is advanced and your horse requires complete removal of the incisors, he might need to be referred to a veterinary dentist or surgeon, because the retrieval of all infected material, fractured tooth shards, or severely resorbed teeth can be very technically challenging. After surgery, horses receive a course of pain management and antibiotics. Most veterinarians recommend taking serial radiographs to ensure they completely removed affected teeth and to monitor the remaining incisors’ progress.  

Nutritionally, these horses typically receive a soaked pelleted feed for the first few days after surgery but can quickly transition to soaked hay or a hay stretcher (a complete pelleted feed that serves as a forage alternative). Horses learn to use their lips and their tongue to grasp grass and hay, and because incisors were never intended to grind food in the first place, these horses are still able to eat hard feed. Some older horses might benefit from a senior feed to help them maintain a normal daily caloric intake.  

Schedule An Annual Dental Exam for Your Horse

An annual dental exam from a qualified equine veterinarian is one of the best ways to detect dental problems early and help avoid EOTRH. Carolina Equine Hospital offers complete dental services. Complete our online form or call 336-349-4080  to schedule an exam for your horse.