WWYD - Suggested Tooth Removal

[HollyWoozle]

Last week my 18 year old retired mare had her yearly tooth rasp by the vet. She has had her teeth rasped every year under sedation without issue - this time she required a second bout of sedation as she was chewing the gag, but no drama. One of her incisors (right at the front, upper) has been partly dead for as long as I can remember but has never caused any issues and other vets have never thought it was a problem.

Since her tooth rasp last year, the tooth appears to have hollowed out essentially. The vet who came (not seen her before) strongly advised that we have the tooth removed in case it splinters. He said they would normally have no issue removing an incisor like that at home, however she would need to go into the clinic to be put in stocks. She has not travelled in 11 years, has always been nervy/spooky/unpredictable (was retired young) and has a blind spot one side which doesn't help. I had promised myself I wouldn't ever send her away for anything as I think it would be very stressful for her and all involved. Options:

1) Leave it and hope it doesn't cause a problem by splitting. She has absolutely no problems eating, seems totally comfy in her mouth.

2) Get a second opinion from either a different vet practice or equine dentist (in that case would need vet too to sedate I think), in the hopes that they either agree to do the procedure at home or that it can be left alone, giving me peace of mind. The vet who came is as knowledgeable on dentistry as any they have already at our current practice.

3) Suck it up and send her off for it and just pray it all works out.

I understand the need for safety for the vet doing the work and the need to have her still to do a good job. I just don't know what to do for the best and I guess I am surprised that she would need to go to the clinic when others don't as she is not at all wild or unmanageable, doesn't move her feet or pull away or anything like that. Until this time she has always just had one dose of sedation to get her teeth rasped and no problems, but I appreciate extraction must be rather different.

I'm sorry for the length.

Edit: Removed the part saying tooth "totally black" as that isn't true, significant portion has been black as long as I can remember but the part of the tooth near the gum/root is not black.

 

[PapaverFollis]

What's the consequences if it splinters? And how likely is that to happen? If no other previous vet has thought it would be a problem I would get a second opinion of whether any intervention is necessary. If it isn't bothering her at the moment.

 

[HollyWoozle]

Thanks for your reply, @PapaverFollis. The vet in question seemed very concerned about the possibility of it splintering - I raised my concerns about not wanting to travel her and so on and he said that I would then need to keep a very close eye on it over the next few months (to what end, I'm not sure). Although it's right at the front it's hard for me to study too closely, but I can get a glance to check it's still in tact. If it splinters then there is the possibility of it allowing infection in and I think that's the main issue, along with the possibility of it causing her pain and preventing her from eating.

I guess the concern is if it cracked and got infected then would likely require even more substantial treatment than if we removed it to prevent that.

The vet is very experienced and knowledgeable but new to our practice and wasn't overly forthcoming with details/options. I am feeling inclined to leave it at the moment but equally I don't want her to end up in pain or with a nasty infection of course!

 

[milliepops]

He said they would normally have no issue removing an incisor like that at home, however she would need to go into the clinic to be put in stocks. .

this is the bit I don't understand.

why would it normally be OK but not in this case?

 

[HollyWoozle]

I suppose the implication was because she is difficult somehow and don't get me wrong, she can and has been difficult in her time, but it surprised me. She stood like a statue for him to sedate her and put the gag on but she was chewing the gag a lot and it made it tricky to do the work, so he gave her another round of sedation to settle her and carried on and that was fine. At no point did she ever do anything which appeared dangerous or at all unmanageable, but equally I have never had a horse which required an extraction... I guess they need them to be totally still? She does sometimes move her head a bit as if to put it down off the stand but I'm talking pretty slowly and maybe someone could help me hold her?

 

[teddypops]

My oldest pony had a broken tooth which came out in bits over time. It didn’t bother her and no one ever suggested removing it. If I was you I would just keep an eye on it for now.

 

[PapaverFollis]

That was my next question. If intervention is indeed necessary why is it not possible for your mare to have it done at home if this is how it is usually done?

 

[HollyWoozle]

Answered this (above) just before I saw your post.

 

[PapaverFollis]

Cross-postedabove...

I would also get second opinion on whether travelling and stocks are necessary given her age and lack of travel prowess.

 

[milliepops]

Hmm. yeah I think a bit more understanding is needed about why it can't be done at home. i think for incisors they have to make an incision around the tooth and therefore there will be stitches etc involved which may be something to do with it? you'd want your patient to be pretty still then.

 

[HollyWoozle]

Thank you.

Here is a video of her before she had second lot of sedation: https://streamable.com/jh4deu

I can completely understand that it’s not practical to work on her like that (vet had just walked to car to get more sedatives) but was no issue after next lot. I guess now I think about it her mouth has to be held open another way for them to extract a front tooth, since it can’t be accessed when she has the gag on? So maybe vet felt that wouldn’t be possible, which I suppose is fair enough.
I should’ve asked more questions but he seemed adamant they wouldn’t do it at home.

 

[HollyWoozle]

Hmm. yeah I think a bit more understanding is needed about why it can't be done at home. i think for incisors they have to make an incision around the tooth and therefore there will be stitches etc involved which may be something to do with it? you'd want your patient to be pretty still then.

Ah that would make sense. I guess I would just have accepted it completely but it was the notion that they can do most at home which gave me some sense of hope!

I'll investigate second opinions and ask for more clarification on the procedure. Thanks for your answers.

 

[milliepops]

good plan
it may be different with just one tooth, i only know from what I looked into about EORTH which seems to necessitate removal of all incisors. fortunately my iffy one isn't at that point yet. but asking more Qs definitely sounds like a good move. if the vets were concerned enough about the tooth to mention it.

 

[PapaverFollis]

My question on seeing the video is what are stock going to achieve ? She's stood perfectly still. She's just quite perky and chomping because the vet hasn't given her enough sedation to start with. Her head isn't even moving, she actually looks pretty relaxed! Just having a good time chomping at the weird thing in her mouth.

 

[Red-1]

I would go for an equine dentist rather than a vet. I have found that vets are inclined to sedate whereas dentists seem to have better skills to work with the horse to have them stand still without sedation. I am talking with the same horse, with no behavioural issues, but who does not exactly enjoy the experience.

I think they learn that because sedation isn't immediately available.

As far as the video goes, that is normal behaviour when they loosen the gag. It feels weird, they try to spit it out.

The best dentists will give many mini breaks at precisely the right moment to train the horse into thinking that if they stand stock still then the horrid thing will end.

I am sure there are many, many excellent vet-dentists as well as many, many bad non vet dentists. I have just found that the non vet ones have learned to manage the natural behaviour without drugs and stocks.

I removed one horse from the vets once, when I had taken him for a vaccination (needed to get the date right and travelling was easier) and thought I would get the teeth done at the same time. The horse was always fine at home, but I understood using the stocks as they were there. The vet just rasped away, no break and in the end he was worried and cheesed off. I suggested a break, the vet wanted sedation. Nope, not happening, not when it is not necessary. I took him home and got the dentist to do it.

 

[PapaverFollis]

I use a vet and don't mind sedation but if the vet was concerned about your mare Hollywoozle, I dread to think what he'd have made of Granny horse!

 

[HollyWoozle]

My question on seeing the video is what are stock going to achieve ? She's stood perfectly still. She's just quite perky and chomping because the vet hasn't given her enough sedation to start with. Her head isn't even moving, she actually looks pretty relaxed! Just having a good time chomping at the weird thing in her mouth.

This is sort of what I thought too and then wondered if maybe I was just being naive! We have three others and I guess she chomped a bit more than they do but she only had one bout of sedation in previous times, so I guess he just didn't give her enough as you suggest. She didn't move her feet an inch the whole time.

@Red-1 - thank you for your thoughts too, much appreciated. Someone has directed me to a good equine dentist and I think I will contact him and try that.

I use a vet and don't mind sedation but if the vet was concerned about your mare Hollywoozle, I dread to think what he'd have made of Granny horse!

Haha, I figured there must be a lot worse out there! She did used to be somewhat of a maddo and headshy but I decided to retire her, keep her and love her until the end of her days and she is generally very relaxed and happy now. I feel a bit like I'm being precious about not just packing her off to the clinic but I'd rather make a fuss and not upset her if at all possible.

 

[milliepops]

i think tooth extraction is classed as surgery so you have to have a vet, or at least a vet-dentist?

 

[ownedbyaconnie]

My mare had her second from back molar removed last year at home with sedation and nerve blocks. Her tooth had fractured from root to tip and was rotten. It splintered as they pulled it out so they had to cut a hole through her cheek and chisel the remaining bits out.

She had a surgeon, vet and EDT present. Yours sounds a lot more simple, I’d be surprised if you couldn’t have it removed at home. Maybe speak to an EDT?

 

[HollyWoozle]

i think tooth extraction is classed as surgery so you have to have a vet, or at least a vet-dentist?

Ooh, that's good to know and seems confirmed by the next post:

My mare had her second from back molar removed last year at home with sedation and nerve blocks. Her tooth had fractured from root to tip and was rotten. It splintered as they pulled it out so they had to cut a hole through her cheek and chisel the remaining bits out.

She had a surgeon, vet and EDT present. Yours sounds a lot more simple, I’d be surprised if you couldn’t have it removed at home. Maybe speak to an EDT?

Thank you, this is really encouraging! I will enquire and am pleased to hear it got sorted for your mare.

 

[HollyWoozle]

Here's a pic I snapped whilst she was still sedated - hard to see but the tooth is sort of hollow and actually you can see that the neighbouring tooth is starting to blacken, but I don't think that side will be an issue since I don't think she has too many years left (lots of melanomas).

 

[laura_nash]

I'd want to be clearer what the possible negatives are if it does splinter and the likelihood they would occur. I'm another whose horse had a damaged tooth that eventually broke off without causing any issues.

 

[HollyWoozle]

Thanks @laura_nash. I've just booked for someone else to come out for a second opinion (have to wait a few weeks which is fine) - they are both a vet and an equine dentist so hopefully will be able to advise. I will ask more questions this time too!

 

[WandaMare]

I had a similar experience at the beginning of this year. I agonised about whether to travel my mare and decided to ask a vet I had known for longer to come out and confirm what was needed. He was shocked that the first vet had even suggested travelling my old horse. I wasn't too chuffed tbh especially I had literally been awake for few nights wondering what to do and worrying about her. Turned out the procedure was perfectly safe to do at home, and when it was done, it didn't even take much longer than the normal rasping...after all that worry!

Not saying yours is the same as I don't know but definitely worth getting another view.

 

[HollyWoozle]

I had a similar experience at the beginning of this year. I agonised about whether to travel my mare and decided to ask a vet I had known for longer to come out and confirm what was needed. He was shocked that the first vet had even suggested travelling my old horse. I wasn't too chuffed tbh especially I had literally been awake for few nights wondering what to do and worrying about her. Turned out the procedure was perfectly safe to do at home, and when it was done, it didn't even take much longer than the normal rasping...after all that worry!

Not saying yours is the same as I don't know but definitely worth getting another view.

Thank you very much, really helpful to hear these other experiences (and oddly comforting to know that I'm not the only one agonising about such things!). Will keep my fingers crossed for an easy resolution and really pleased that it all got sorted for your girl.

 

[asmp]

One of ours had to have a front incisor removed as the equine dentist said it was infected (he’d been booted in the mouth some time before and had chipped half off). We were told to go to the vets and it was done under local (but he is a young horse.) I’m sure if the dentist thought he could have done it he would have. I’m also pretty sure he had stitches.

 

[HollyWoozle]

To update this thread, I found an equine dentist who is also a qualified vet willing to come and have a look. I was originally recommended a particular dentist by a friend of mine and that dentist immediately referred me to this next chap. He has been to see my mare and is returning on 15th January to remove the tooth at home. It isn't without risk but I believe it is the best way forward for her and now I just have to cross my fingers and hope it all goes to plan!

Thanks again for all of your helpful responses.

 

[HollyWoozle]

A final update to this thread, just in case it's useful for anybody!

The dental specialist vet I mentioned before came today and removed the offending tooth at home. I am relieved to say it went as well as it possibly could and the tooth came out without too much difficulty and in one piece. I am absolutely delighted and so pleased for my mare that we were able to get the procedure done at home with minimal stress to her. A few hours later and she is back out in the field with her pals and grazing happily.

The tooth itself was much smaller than we expected (mare is 18) but no doubt that helped it to come out easier, so fortune was on our side today. I've attached a photo of it in case anybody is interested - as you can see, it's totally hollowed out. There are two small drainage holes to the side where the initial infection drained out by itself, presumably many years ago.

As a side note, I stopped riding this mare years ago as she was dangerous and unpredictable. The infection would've been painful at the time and perhaps that contributed to our difficulties - I wish now I had investigated further but you live and learn (she has never shown any pain to her mouth and never had difficulty eating). She has had regular tooth rasps but that tooth was always black and dead at the front and I was told not to worry about it, until November when they saw it had rotted out.

Think I will have some fizz tonight and mentally prepare myself for trying to flush out her mouth tomorrow, haha! Fingers crossed it heals up OK.

 

[milliepops]

glad you got it sorted good luck for the flushing!

 

[ownedbyaconnie]

A final update to this thread, just in case it's useful for anybody!

The dental specialist vet I mentioned before came today and removed the offending tooth at home. I am relieved to say it went as well as it possibly could and the tooth came out without too much difficulty and in one piece. I am absolutely delighted and so pleased for my mare that we were able to get the procedure done at home with minimal stress to her. A few hours later and she is back out in the field with her pals and grazing happily.

The tooth itself was much smaller than we expected (mare is 18) but no doubt that helped to come out easier, so fortune was on ours side today. I've attached a photo of it in case anybody is interested - as you can see, it's totally hollowed out. There are two small drainage holes to the side where the initial infection drained out by itself, presumably many years ago.

As a side note, I stopped riding this mare years ago as she was dangerous and unpredictable. The infection would've been painful at the time and perhaps that contributed to our difficulties - I wish now I had investigated further but you live and learn (she has never shown any pain to her mouth and never had difficulty eating). She has had regular tooth rasps but that tooth was always black and dead at the front and I was told not to worry about it, until November when they saw it had rotted out.

Think I will have some fizz tonight and mentally prepare myself for trying to flush out her mouth tomorrow, haha! Fingers crossed it heals up OK.

Yay glad to hear it came out quick and easy - my mares did not! Took 3 hours and enough sedation to wipe out an elephant.

I was told to flush daily especially as her tooth was right at the back, I didn't even manage it once! She was so traumatised from the experience she wouldn't let me near her mouth. Luckily it all healed up with no issues although my vet popped some putty type stuff in the wound which helped it heal and stop anything getting in.