Diastema's - Vet recommends PTS

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kitface

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Hi all

My horse has been suffering with diastemas for the last year and I have had them cleaned out, antibiotics, painkillers etc every 6-8 weeks since finding them, at a cost of up to £250 each time. My horse is very sensitive and reacts by throwing her head around even under sedation so heavy that she is nearly falling over. Last week the vet took x-rays in preparation for widening and packing to try and resolve the problem. The x-rays showed the last two cheek teeth were angled sharply forward and he felt due to this he would not be able to widen the diastema as he would inevitably expose the pulp. On the other side he found it to be much worse than expected and my horse has some enamel erosion and periodontal disease affecting the gum. She is excluded for all dental work on her insurance, and the vet said even if they did the work (under GA) he felt it would likely be many months of follow ups and more GA and sedation in the future, and that the amount of pain and the cost would outweigh any potential improvement ie the risk of it not working outweighed the benefit of attempting the surgery. I now have to decide whether to give it a try or have her PTS, at age 10.

Does anyone have any experience of diastemas of this severity, I have read all the posts on here and the outcomes all seem favourable but no-one has mentioned angled teeth?

Thanks for reading on!
 
It sounds rather drastic to pts would the teeth not be best removed at least to give her a chance, a livery recently had two teeth angling towards each other where a tooth had been removed in between, the vet got the dentist in to deal with it, like yours it was ulcerated and causing headshaking.

Sorry cant really advise but it may be worth consulting a dentist for more advice, our vet did not want to act alone and he is an equine vet.
The cost for the dentist with vet attending was not too bad, less than £300 in total for the one side.
 
Hi

Thanks for your reply, sorry should have made it clear, a registered EDT has been dealing with her alongside the vet the whole time and was in attendance, along with another vet from the same practice. Yes I was wondering about asking for removal, they were talking about possible complications with them growing back together again. ince she is fat and relatively happy in her field it is a much harder decision than if she was at the end of her life, or dropping weight but she does quid all the time and holds her head low, I can tell that she is in pain despite being on Danilon.
 
i haven't got experience with diastemas, but have recently gone through a very poor dental prognosis. my last resort was to take my mare to Chris Pearce (Barn Equine) to treat following a number of discussions. He is an EDT and equine vet, specialised in dental treatment. worth a phone call if nothing else??
 
You need to get a 2nd opinion & a CT scan done this is the only conclusive way you can find out whats going on inside your horses mouth.

Ive recently been through this with my 5yo he had numerous x-rays but he was reffered to Rainbow Equine for a CT scan, X-rays are not great for teeth & jaw area.
We found through the CT scan that the horse actually had a huge retained cap which had caused the Diastema, the vets at Rainbow equine managed to remove the cap. My horse has erruption cysts on his left jaw due to all this & they will take around 2 years the resolve.
The cap wasnt able to be seen by eye or through the many x-rays.

I would not be even thinking of PTS over an issue such as this i would be asking to be reffered.
 
kitface said:
Hi all

My horse has been suffering with diastemas for the last year and I have had them cleaned out, antibiotics, painkillers etc every 6-8 weeks since finding them, at a cost of up to £250 each time. My horse is very sensitive and reacts by throwing her head around even under sedation so heavy that she is nearly falling over. Last week the vet took x-rays in preparation for widening and packing to try and resolve the problem. The x-rays showed the last two cheek teeth were angled sharply forward and he felt due to this he would not be able to widen the diastema as he would inevitably expose the pulp. On the other side he found it to be much worse than expected and my horse has some enamel erosion and periodontal disease affecting the gum. She is excluded for all dental work on her insurance, and the vet said even if they did the work (under GA) he felt it would likely be many months of follow ups and more GA and sedation in the future, and that the amount of pain and the cost would outweigh any potential improvement ie the risk of it not working outweighed the benefit of attempting the surgery. I now have to decide whether to give it a try or have her PTS, at age 10.

Does anyone have any experience of diastemas of this severity, I have read all the posts on here and the outcomes all seem favourable but no-one has mentioned angled teeth?

Thanks for reading on!
Click to expand...

I am going through all this at the moment same issue an angled tooth my horse is only six and has just has them widened again the third time.
The difference is my vet has referred him to professor DIxon at Edinburgh university who is a expert in horse dentistry .
Has your vet looked at removing the angled tooth that is what mine will have if what they have done does not work .
Also has he said to keep the horse at grass as it makes a huge difference to the healing if they only eating grass.
I would be seeking the opinion of a vet that only does tooth work and will recommend professor Dixon ( I don't know where you are) if it's not too far from you.
Tooth removal would better than PTS even if it meant extra dentals every year.
I think mine will end up with the tooth removes eventually .
 
Thanks for all the replies, it sounds like a second opinion is in order... is a CT scan expensive, I only have a few £k in my savings and she is excluded for her teeth. I am in Yorkshire so Edinburgh is a bit far but Rainbow is nearby so I could try there
 
kitface said:
Thanks for all the replies, it sounds like a second opinion is in order... is a CT scan expensive, I only have a few £k in my savings and she is excluded for her teeth. I am in Yorkshire so Edinburgh is a bit far but Rainbow is nearby so I could try there
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Mine is not insured my CT scan was £450 plus vat but they did a deal with me so I did not pay the full cost but I would think a scan is essential if you want to go on.
You need specialist advice fast.
 
Mine was more than Goldenstar's but less than 1k.

I would highly recommend Rainbow Equine though they where excellent, they are a 4hr journey for me in the lorry. So your lucky having them close, they can also fit people in quite quickly.
 
Ring your referral practice and ask to speak to the dental specialist about whether it is worth seeing him. I would guess removal is an option, but this is a v. tough procedure with a 10yr old as the teeth roots are still long and there is a risk fo jaw fracture. However, as it is a case of two bad teeth, I would be far more tempted to do this than pts..
 
I have an Arab mare that has Diastema . I was told by my EDT to syringe her mouth out after every feed. I use a weak solution of listerine and a 50ml (bladder tipped one) syringe. I have been dealing with this for over 2years now and have just had her teeth done (I have hers done every 6 months)

It is worth trying that as it will keep the mouth fresh.

We can always know when she needs extra mouth washes.

I also make the feed very wet so that it goes down well.

The angle and shape of an Arabs jaw makes it more likely to have problems ,so yes I have had this mare with angled teeth.

I don't know why you need them packed. Just good oral Health would work.
 
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paulineh said:
I have an Arab mare that has Diastema . I was told by my EDT to syringe her mouth out after every feed. I use a weak solution of listerine and a 50ml (bladder tipped one) syringe. I have been dealing with this for over 2years now and have just had her teeth done (I have hers done every 6 months)

It is worth trying that as it will keep the mouth fresh.

We can always know when she needs extra mouth washes.

I also make the feed very wet so that it goes down well.

The angle and shape of an Arabs jaw makes it more likely to have problems ,so yes I have had this mare with angled teeth.

I don't know why you need them packed. Just good oral Health would work.
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Packing is used when the Diastemas are very deep , if the bone in the jaw is involved getting rid of them is not as straight forward as you think . I had the masterclass including being show skulls of horses with nasty cases.
At Edinburgh they where confident that they could remove the tooth from my six year old said it would take four hours standing under deep sedation but it's not something that I would what done by anyone except specialists in the field.
 
Ring pete ramzan at rossdales Newmarket or as mentioned chris pearce,diastima widening can expose pulps but I've seen pete do it with very small tools and with the help of a endoscope he can follow the enamel folds do therefore not going near a pulp,,,PTs sounds like someone who isn't willing to refer....
 
Kitface I just wondered how you are getting on .
My vet returned to my six yo today we put a gag on had a good look Diastemas appear healed no food packed in them no smell .
You might not remember but that's the third time they have been widened since September twice by my own vet and this last time at Edinburgh vet school where they have been less conservative than my vet was as she was afraid she might expose the pulps.
The horse is in work and seems good fingers crossed we have swopped to using a micklem multibridle as this puts no pressure on the angled tooth ( which irritatingly is just where the noseband lies. )
The plan is to turn him out ASAP ( some hope at the moment) and just bring him for work hopefully I can get him out for six months and that will help .
I am going to get him checked every eight weeks or so and definatly when he comes in the autumn.
I think I am winning now I know I am not though with this but at least It seems positive and I can always have the tooth removed in the future.
I hope you have positive news too, post if you can be bothered.
 
Hi

I'm still deciding what to do to be honest, she has multiple diastemas with very deep pocketing in the last cheek teeth and will require a general aneasthetic to treat due to her disposition! Likely to be similar to your experience Goldenstar of having 2 or 3 treatments before it starts to improve, plus regular check ups ongoing and short forage instead of hay in winter - a massive cost as there is nowhere I can turn her out on grass in winter (I've looked!) so this would be all day AND all night. She has always been a very difficult girl, and has a number of illnesses plus broken leg, torn tendon and various other complaints related to her being mental and chucking herself around. Uninsured for her teeth, so all of this would be paid for by me for what is in monetary terms a horse which has no value ie not a star competition horse, in fact not even safe to hack. I am worried that she will remember the pain in her mouth or that she will throw me badly if it returns as she has already done this a few times for no apparant reason over the years (previous to teeth problems). Hence why vet thinks it might be a lot of pain for her to go through just to be a field pet at the end of it all, plus she is very stressy and has ulcers and this will probably have a big impact on her in terms of her stress levels. So still thinking about it! Thanks for all the replies though, they do give me some hope that there would be life after diastemas
 
Good luck and my best wishes to you whatever you decide she sounds like my grey mare who had a stream of unrelated serious and expensive injuries and illnesses from the moment I bought her finally she got laminitis while turned out while was I in hospital after a terrible fall ( everyone was under a great deal of stress) and although my groom caught it quickly when she came out of the stable after six weeks box rest she was lame behind it was bone spavins I called it a day and PTS she was a talented mare super flat work horse but not good to handle my groom said she was the love child of my little pony and roboraptor I did not want to breed from her.
It was hard but I did not regret it.
 
kitface said:
Hi

I'm still deciding what to do to be honest, she has multiple diastemas with very deep pocketing in the last cheek teeth and will require a general aneasthetic to treat due to her disposition! Likely to be similar to your experience Goldenstar of having 2 or 3 treatments before it starts to improve, plus regular check ups ongoing and short forage instead of hay in winter - a massive cost as there is nowhere I can turn her out on grass in winter (I've looked!) so this would be all day AND all night. She has always been a very difficult girl, and has a number of illnesses plus broken leg, torn tendon and various other complaints related to her being mental and chucking herself around. Uninsured for her teeth, so all of this would be paid for by me for what is in monetary terms a horse which has no value ie not a star competition horse, in fact not even safe to hack. I am worried that she will remember the pain in her mouth or that she will throw me badly if it returns as she has already done this a few times for no apparant reason over the years (previous to teeth problems). Hence why vet thinks it might be a lot of pain for her to go through just to be a field pet at the end of it all, plus she is very stressy and has ulcers and this will probably have a big impact on her in terms of her stress levels. So still thinking about it! Thanks for all the replies though, they do give me some hope that there would be life after diastemas
Click to expand...

I think in your scenario given the other factors not just teeth involved, whatever decision you reach will be the right one and you shouldnt beat yourself up whichever way you decide to go :-)
 
I have a mare who has had seven diastema widened. These are all on her lower jaw! For whatever reason, her upper teeth are unaffected. A very major difference between mine and yours is mine is 25. As your mares problems are due to dental conformational problems, it is my understanding (but do check this with your vet) that the procedure would have to be repeated again as the teeth erupt further. My mare is also exceptionally adn very unusually tolerant of dental procedures, to the extent that I have purchased a gag, mirror and irrigation pick and I clean out the gaps myself a few times a week and flush her mouth with mouthwash. I can do this unaided and without restraint!! If she wasn't as tolerant of this, I would have had her PTS a few years ago. She has had a tooth removed since the original diastema widening which has allowed the neighbouring tooth to move and cause another diastema to appear!! I use a pair of angled nose forceps to dislodge any particularly stubborn pieces of forage.

With regards to tooth removal, hers (lower) was fairly simple, 20 mins of wiggling and it was out. However, my younger mare (13) just had an upper tooth removed and it took two days standing and then a third day under GA and a bone flap cut in her face to remove the tooth by repulsion. She was on IV 3x daily painkillers for 10 days and stayed at vets for 2 weeks. She wasn't herself for about 6-8 weeks! I think I experienced the two extremes!

As for diet management, horses can live quite successfully on speedibeet and high fibre nuts as a complete diet. This would completely elimiate the possibility of anything getting wedged in the diastemas. Bizarrely, this is a cheaper option than short chop forages! I often do this for a while to allow any particularly bad spells to heal up a bit - even keeping her off grass. I also sourced some very soft hay (haylage worked too) and used a garden shredder (bosh reconditioned unit off ebay £70 paid for itself in 3 weeks!!) to make my own chaff. This is quite successfully eaten! I use a garden weed sprayer (never used for weedkiller!!) to spray chlorhexidene mouthwash into her mouth to kill off bacteria (you can do this without a gag).

So to summarise my waffling, you can see the amount of effort I go to to keep my girl happy, but she's given me 18 years and she allows (and even seems to assist with the correct positioning of her head!!) me to do all this and seems grateful! I am completely certain that if I wasn't able to go to these lengths, she wouldn't be here anymore. I wonder if any of this has helped you? I hope so! My vet is continually surprised when I tell him what I do and how!! So is your horse worth all that? Don't worry if you think she isn't.

On another note, I wonder if your vet just doesn't have the facilities and or experience to really deal with this? To say this needs a GA is utterly bonkers. eg my vet would have a constant drip sedation plus a nerve block is used to numb the whole side of the head. The horse is also in stocks and the head is hoisted by an overhead pulley to keep it up. There is no way with all this your horse would still protest. I'd bet a lot that she is is excruciating pain and this is why she is protesting. Does your vet not perform the nerve block?

Sorry this is so rambling!! Hope it can be of some help.
 
sounds daft but ask your refferal vets when their next CPD day is if it involves scanning etc

mine had a scope for free as it was cpd day!

just a thought to save some money and a way forward?
 
Hi,

I know I'm a bit late, just seen this!

I bought a 6yo mare who turned out to have this. She had extremely bad gum disease, we thought get the operation and she'll be fine. She had it done, and began to work again she was coming on great, then I noticed a change in her behaviour, so we had them checked and turns out they were bad again. I mean I would rather have this done than get her PTS. However, I was falling off quite regulary as she wouldn't show any signs until I was on her back, therefore this knocks my confidence and you have to build it back up every few months.. She has now come down with a jaw infection on the bone which resulted in more bad behaviour a few weeks after surgery. If you choose to get surgery done, please keep on top of it, other wise things can turn v. dangerous!! I also had the choice of getting teeth out, but because there tightly packed there was a chance of him getting the wrong tooth out, breaking her jaw, or the tooth shattering in the mouth. As she isn't the easiest of horses to operate on (Vets words) she would have to go to a specialist up in Edinburgh. The vet told me she was born with teeth like this and it's just unfortunate, we guess the previous owners sold her because of this problem. My vet specialises in teeth and he explained to us that it is a very painful situation. The summer is fine, however the winter becomes a problem for me, sometimes she can manage her haylage sometimes she can't, so she also has grassnuts - sloppy!

Let me know how you were getting on.
 
kitface said:
Hi

I'm still deciding what to do to be honest, she has multiple diastemas with very deep pocketing in the last cheek teeth and will require a general aneasthetic to treat due to her disposition! Likely to be similar to your experience Goldenstar of having 2 or 3 treatments before it starts to improve, plus regular check ups ongoing and short forage instead of hay in winter - a massive cost as there is nowhere I can turn her out on grass in winter (I've looked!) so this would be all day AND all night. She has always been a very difficult girl, and has a number of illnesses plus broken leg, torn tendon and various other complaints related to her being mental and chucking herself around. Uninsured for her teeth, so all of this would be paid for by me for what is in monetary terms a horse which has no value ie not a star competition horse, in fact not even safe to hack. I am worried that she will remember the pain in her mouth or that she will throw me badly if it returns as she has already done this a few times for no apparant reason over the years (previous to teeth problems). Hence why vet thinks it might be a lot of pain for her to go through just to be a field pet at the end of it all, plus she is very stressy and has ulcers and this will probably have a big impact on her in terms of her stress levels. So still thinking about it! Thanks for all the replies though, they do give me some hope that there would be life after diastemas
Click to expand...

I've not had any experience with dental problems but reading through all of this I think that whatever you decide will be the right one. It sounds like a lot stress and pain for your horse to go through for an uncertain outcome.
I think it would be worth having a chat with a specialist and get their opinion and then you need to think about whether your horse could cope with the treatment. For example my collie had severe hip dysplasia and arthritis and while a bilateral hip replacement would fix the problem she wouldn't cope mentally with the surgery and recovery from it so I won't put her through that and instead manage her with medications even tho I know this means she's going to have a shorter life. Only you know your horse and what she can cope with, whatever you decide will be the right decision for the two of you {{{{{{hugs}}}}}}}
 
Depends how much pain your mare can take, I put my mare through a lot with her sweet itch, never again,she's at peace and I'm trying to get over my guilt for being selfish.
 
kitface said:
Hi all

My horse has been suffering with diastemas for the last year and I have had them cleaned out, antibiotics, painkillers etc every 6-8 weeks since finding them, at a cost of up to £250 each time. My horse is very sensitive and reacts by throwing her head around even under sedation so heavy that she is nearly falling over. Last week the vet took x-rays in preparation for widening and packing to try and resolve the problem. The x-rays showed the last two cheek teeth were angled sharply forward and he felt due to this he would not be able to widen the diastema as he would inevitably expose the pulp. On the other side he found it to be much worse than expected and my horse has some enamel erosion and periodontal disease affecting the gum. She is excluded for all dental work on her insurance, and the vet said even if they did the work (under GA) he felt it would likely be many months of follow ups and more GA and sedation in the future, and that the amount of pain and the cost would outweigh any potential improvement ie the risk of it not working outweighed the benefit of attempting the surgery. I now have to decide whether to give it a try or have her PTS, at age 10.

Does anyone have any experience of diastemas of this severity, I have read all the posts on here and the outcomes all seem favourable but no-one has mentioned angled teeth?

Thanks for reading on!
Click to expand...


I would find a VERY good rec dental guy ask his advice, they specialized in this . Dorian Harwood is an amazing guy around here but there are others too.

I would Not rush into PTS yet.

Keep us posted how many gaps are there? Can teeth be removed so the gap wont get clogged with food?

this might help
http://www.baedt.com/
 
OP I would consult an EDT (Equine Dental Technician). I might be talking out of my ar*e but from what I have seen of half done jobs by vets rasping teeth, and problems with vets snapping off the roots of wolf teeth and thus causing infection I would say that an EDT who is highly recommended would sort you out.
Here is a very good one I can thoroughly recommend.
Alex Jessett Warwks, West Midlands & surrounding area 07980 012041
 
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applecart14 said:
OP I would consult an EDT (Equine Dental Technician). I might be talking out of my ar*e but from what I have seen of half done jobs by vets rasping teeth, and problems with vets snapping off the roots of wolf teeth and thus causing infection I would say that an EDT who is highly recommended would sort you out.
Here is a very good one I can thoroughly recommend.
Alex Jessett Warwks, West Midlands & surrounding area 07980 012041
Click to expand...

Old thread (but would be interested in hearing an update if OP sees this).

Applecart, sounds like it has gone way beyond 'get an EDT to check ' ;)
 
Hi,

I have a mare who has be diagnosed with severe diastemas in all four quadrants and severe gum disease she has been to Bristol Langford Vets who have done some remedial work with her but have advised that moving forward with her with this condition will be very costly and will take considerable management.

To add to this she has recently recovered from a sacroilliac injury.

The vets have recommended PTS but she is healthy and happy at present, in fact due to retirement from competing she is now the fattest i have ever known her, I have had her 15 years (she is 18)

She had a few months out 24/7 after her surgery to help the mouth heal as much as possible but now she is stabled by night and out by day and in full work.

I wash her mouth out daily using a cattle drench gun (definately better that the hose pipe recommended by the vets!!) and i use a diluted soution of Corsodyl every few days or salt water to wash out her mouth and try to keep any infection at bay.

I have also recently ordred a speculum (horse gag) so that I can check her mouth for wadding and keep an eye on her gums etc.

She does have hayalage at the moment but i also use grass nuts in a ball (she wont eat any soaked feed in a bucket unless there are nuts in it!!) and also give lots of carrots etc as she isnt a greedy horse this is easier as if i can fill her up on other stuff she only eats about half net of hayalage over night.

Feel free to PM me if you want to chat further.

There is life after it but it is hard work.
 
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