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  Discussion on Long term tooth root infection - leading to acute respiratory attack?
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New Member:
wilde

Posted on Tuesday, Jun 12, 2007 - 8:45 am:

My 20yr old cob mare has had a chronic tooth root infection,excessive salivation & mouth odeur. We have been treating with potassium iodide for 4 months &painkiller. Stopped iodide approx 2 months ago as mare refused to eat anymore,changed painkiller to danolone from bute as not so bitter. Last night I went to catch her to bring her in and heard violent coughing, she had a discharge coming from one nostril - yellow & her breathing was very laboured. It was not a choke as she could swallow. Mucus appeared to be coming out of mouth when she was coughing.Vet came & administered anti-inflam & anti biotic, he feels there is no connection to the root infection but that this was an acute lower airway attack caused by an allergic reaction to something in the field. She is out today and appears ok, breathing is slightly noisy but much more relaxed. I would welcome any information & thoughts. Apologies for length of post, I am new to this! is there a limit on length of posts!
Member:
frances

Posted on Tuesday, Jun 12, 2007 - 9:35 am:

Hi Rebecca, no worries - we have mammoth posts on here at times - yours is just a mini one!
Moderator:
DrO

Posted on Tuesday, Jun 12, 2007 - 11:45 am:

Welcome Rebessa,
I agree with your vet, infected tooth roots can create a sinusitis but I have never seen one that lead to a lower respiratory disease.

Concerning posts length, as LL states there are no limits and your post is certainly not considered long. I believe short succinct posts are more likely to get responded to in a timely manner and accurately responded to.
DrO
Member:
paul303

Posted on Wednesday, Jun 13, 2007 - 1:01 am:

Is there a reason that the tooth has not been removed? 4 months is a long time to have to tolerate an active infection. Even if it has nothing to do with her respiratory troubles, the tooth infection is a constant drag on her immune system. As long as she is on antibiotics and anti-inflamatories anyway, now might be a good time to eliminate a constant source of infection. If the affected tooth is in the upper jaw, perhaps some bacteria has found it's way into a sinus cavity. At any rate, a chronically infected tooth needs to come out - it won't heal and it will remain a constant source of pain.
Member:
mitma

Posted on Wednesday, Jun 13, 2007 - 1:45 am:

Greetings Rebecca,
Sorry for you and your mare... as many on HA know, I have been BATTLING a tooth root infection problem in one of my mares that resulted in a mandibular abscess, the need for surgery, problems postop, and the story is not over yet! But, I agree with Lee... why has the tooth not been removed yet or had something done to it??? BTW, is the involved tooth an upper or lower one??? Dr. O may elaborate, but there are tooth sparing treatment possibilities, such as endodontic therapy (a root canal), something called periapical curretage (basically, trying to clean out the root and give the infection a pathway out for drainage), as well as the obvious tooth removal. Either way, don't delay... my experience has taught me that long term, untreated dental issues can lead to serious medical problems that put your horse at risk, as well as your wallet!!! Good Luck!
Martha
New Member:
wilde

Posted on Wednesday, Jun 13, 2007 - 9:27 am:

Many thanks for your replies regarding my mare. The vet prescribed her potassium iodide to try & kill the bacterial infection.She has on the lower jaw an infection on the same tooth either side of her mouth. He has always been unwilling to remove both teeth & roots as he says the success rate is extremely poor, and that her age is against her, which I can understand. She has a painkiller every other day on which she looks well. I would not at this stage feel confident in putting her through radical root treatment for what is given a poor prognosis.The teeth themselves look ok, you would not be able to tell anything is wrong until you look at her xrays.But if this respiratory attack has any connection to this I will have to rethink, as I will if the painkiller does not appear to be keeping her pain free, which it does at the moment. Thanks again for your advice.
Rebecca
Re
Member:
paul303

Posted on Wednesday, Jun 13, 2007 - 10:16 am:

It's hard to know what he means by the success rate being poor, without seeing the x-rays. Are the affected teeth molars? If the concern is that her chewing will be compromised, she should actually be better able to manage without the painful teeth ( I had a 38yr old gelding that lost all his molars by his early 30's and his front teeth barely touched - he remained fat and healthy ). If the concern is that the infection will spread if the teeth are fooled with - well, if the teeth are the source of the infection, and you remove them and do a course of antibiotics, you should have a much better chance of controlling the spread. As for the age factor, it seems much more logical to treat chronic infection aggressively since elderly equines may have compromised immune systems.

As for Martha ( above ), she should know. She's our current "Queen" of tooth and jaw infection.
Member:
dwinans

Posted on Wednesday, Jun 13, 2007 - 6:18 pm:

Rebecca,

I went through a teeth root infection a few years ago with my gelding. I understood from my vet also that extraction can become very complicated. We battled it for months with antibiotics before we did the periapical curretage. He spent a couple days in the hospital and they flushed out the area with antibiotics a couple of times per day. It took about 6 months after that for his nose to be completely dry. It was a very long process but I found the periapical curretage to be pretty non-invasive. I know the root canal can be pretty major and that was our next step but I lucked out with the periapical curretage. The periapical curretage is performed standing while they have to be down for the root canal and extraction which I'm sure is really scary for a senior equine.

Good luck!
Member:
mitma

Posted on Thursday, Jun 14, 2007 - 11:02 am:

Rebecca,

As Lee points out, many factors will impact the success rate... depending on which specific teeth are involved, etc... If you want to read about my mare's ongoing NIGHTMARE, see my post entitled PREGNANT MARE WITH SUBMANDIBULAR ABSCESS under the HA section on horse diseases, swellings/abscesses, how to diagnose them... My mare underwent repulsion of the affected tooth, her third mandibular premolar, which is basically "knocking it out from below" after making an incision in the submandibular region; that approach was necessary as the tooth had broken off at the gum line (another consequence of long term root infection, etc...) and it required general anesthesia. The long term infection had damaged her jaw bone (basically the infection chewed away the bone), so the affected area was debrided ("scrubbed" really well) and had to be "replaced" with a type of bone cement, similar to that used in human oral and orthopedic surgery. I know that you are faced with a significant decision, but you might want to contact your local vet school (if you have one) for some further thoughts. Because my mare has had a complicated course with her surgery, no doubt due to the fact that her condition was severe when diagnosed and had been totally ignored before I got her (she is an ex-PMU mare), I have been in contact with some academic facilities (looking into things like hyperbaric oxygen therapy) and I have found that academic equine surgeons have been more than willing to take my phone calls/emails and respond accordingly. Good Luck!
Martha
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