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Discussion on Dental surgery today
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Member:
dsmith6
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Posted on Friday, Jun 5, 2009 - 9:19 am:
Hi, my horse is having dental surgery today. I noticed he was having a hard time eating so we took him to the clinic yesterday. On his top teeth, second molar from the very back he had a chipped tooth, causing a hole where grain, hay, grass was getting stuck. My vet dug out a large wad of it. My vet also discovered the chip was causing an ulcer on his tongue. He could not pull the tooth, did a radiograph and determined he did not have an infection... yet. He recommended doing surgery to remove the tooth, cut a hole in his sinus' and remove the tooth that way. I asked the vet if there was anyway possible to remove the tooth w/out surgery and he said no. We agreed and he is having surgery today. My vet made it sound that this surgery was pretty standard- is this true? Has anyone else had this type of surgery done or heard of it being done to remove a back tooth? The vet also said he needs to stay at the clinic for 7-10 days for sinus flushes to prevent infection. Any input/comments on this would be very appreciated. Thanks
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Moderator:
DrO
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Posted on Friday, Jun 5, 2009 - 10:32 am:
Hello Danielle,
The procedure is called trephining and is a standard surgery. In the past few years techniques for removing cheek teeth have been developed that do not require trephining but do require some specialized equipment. Is is not easy and may require several days to get the tooth loose enough to remove chiefly because the veterinarian just wears out after an hour of manipulating the tooth and the horse will only tolerate so much activity before he gets tired of it despite heavy sedation.
There are also other procedures that may be useful. The horses condition of trapping food between the teeth is called diastemata and recently some have gone in and enlarged the space by burring away the tooth surface on each side so that the food does not become trapped. The decision to do this in your case depends on whether the chipped tooth looks healthy enough to not develop infection. If the chip is large enough to expose the softer parts of the tooth and in particular the central canal removal may be the best choice. For more on this see Diseases of Horses » Colic, Diarrhea, GI Tract » Mouth, Esophagus, and Liver » Disorders of the Mouth and Teeth
DrO
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Member:
paul303
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Posted on Friday, Jun 5, 2009 - 8:47 pm:
I hope the surgery goes OK. After 40 years in human dentistry, I can see all sides.
1. A tooth that becomes infected or COULD become
infected, is nothing to fool around with.
2. A tooth that has contact with the sinus, is
tricky to deal with.
3. The 7 to 10 days to flush the sinus sounds
exactly right ( with no complications ).
4. I do not think that you would be able to
perform a proper flush at home, or catch a
post - op infection early enough.
5. It is much easier to obtain a good result
before the onset of an infection.
Dr.O is right, going in with high speed drills and opening the space, so that the food that gets into that space cannot become trapped, is a viable solution. But only if the operator is well skilled and understands the consequences of overheating the tooth structure during the procedure. Hope your horse did well today, Danielle, and please give us some follow-up.
Thanks
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Member:
dsmith6
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Posted on Saturday, Jun 6, 2009 - 9:19 am:
Thank you Dr. O and Lee for the wonderful feedback. Had quite a shock yesterday- they did not have to do surgery. They put him under anesthesia and on the operating table. With him being completely still on the table, they were able to get a real good look in his mouth. The tooth was not as bad as they originally thought. There is a crack in the tooth which caused a "spike" to develop. The crack is where food was getting built up, and the spike was causing the ulcer on the tongue. They did a power float and was able to even up that tooth to eliminate the crack and the spike. He had severe hooks on the very back molars causing him pain so they were able to fix those as well. So, saved a lot of money and my horse can come home today. I am hoping this is the reason why he has DrOpped weight over the past month. would the condition of his teeth as severe as this cause a DrOp in his weight?
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Member:
canter
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Posted on Saturday, Jun 6, 2009 - 10:28 am:
Glad it went well, Danielle and glad it was far less of a procedure (and expense) than initially thought. Those are the wonderful type of surprises!
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Member:
paul303
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Posted on Saturday, Jun 6, 2009 - 11:22 pm:
I'm so relieved to hear that it's over, with minimal work required. Certainly, the severe pain of ulcerated tissue could have an adverse affect on the ability to chew and process the food for swallowing. But, you'll be able to judge this for yourself once you get him home. Give those sores a little time to heal and see how he does. Again, glad it turned out well.
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Member:
sodmonst
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Posted on Sunday, Jun 7, 2009 - 12:57 am:
I would say that his weight loss and tooth problems are almost certainly related. If you care enough to have this procedure done, I'll bet you worm him conscientiously, so then next likely culprit would be his teeth. As a survivor of several unpleasant dental surgeries, and an infection requiring a flushing schedule similar to what your vet described , I'm happy for both you and your horse.
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Member:
sodmonst
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Posted on Sunday, Jun 7, 2009 - 12:59 am:
BTW I do floss and brush ; unfortunately it didn't stop me from falling on my face and smashing up my teeth and palate. Maybe our helmets should have face guards
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Moderator:
DrO
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Posted on Sunday, Jun 7, 2009 - 10:12 am:
Hello Danielle
He DrOpped weight because his energy intake did not match his energy needs. Did you see clear evidence of difficulty chewing? I bring this up because if this is not clearly true then you should proactively increase the plane of nutrition at least till he gets back to a good (moderate to fleshy) condition.
DrO
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Member:
dsmith6
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Posted on Tuesday, Jun 9, 2009 - 9:02 pm:
Thank you for all the comments. Tucker was discharged and came home on Saturday night. The vet tech explained in more detail what they did: he had a "dental projection" which was toothlike, but not a tooth by the second to last molar. They thought it was a cracked tooth, but turned out to be this projection. It was like a bone spur growing straight out and caused the ulcer on his tongue. They removed it completely. Also, the tech explained that horses don't have gums inbetween their teeth, and he did. so they took a biopsy of this. They also took a biopsy of the front of his gums. All 3 samples were sent to UNH to test. They want to determine whether or not this will grow back from what I can understand. they finished with an extensive power float. He is on antibiotics for 10 days. He seems much more interested in his grain and hay, where before there were days that he did not eat all his grain and wasn't interested much in hay, mostly ate grass in the field. The vet discharged him saying to watch for tongue lolling and mouth odor, which he had and was doing before the procedure. He did the tongue lolling thing a little Saturday night, Monday and tonite. I am going to tell the vet tomorrow- but I can't imagine what is causing his tongue lolling- unless he is still sore?? Pretty anxious over what the vet is going to say- I've had 3 vet appts in one week- can't really afford another vet visit soon... would appreciate any feedback on this. thanks!!!
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Member:
paul303
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Posted on Wednesday, Jun 10, 2009 - 12:20 am:
Danielle
The description the vet tech gave sounds like an anomaly on the tooth itself. I know a very common one in humans is a projection from the front cusp of the first molar - the cusp by the palate. It is called the "Cusp of Carabelli" and can range in size from a nodule, to a rather large extra cusp. I know it occurs in dogs and cats, so I would be surprised if something like it did not occur in horses. It seems to have a genetic component. I suppose it could also be a supernumerary tooth, an extra tooth that is not completely developed, but this would not be attached to the molar and would be (mostly) easily removed.
I have to admit I'm mystified at the statement that horses don't have "gums" between their teeth.....If a horse loses a tooth, it's the "gums" that grow over the empty socket and the "jawbone" should fill in underneath that in time. Perhaps what they meant is that they found an overgrowth of the gum tissue, or, hypertrophied tissue. If it is generalized, then they would take byopsies. I would be very interested in their findings.
If the tongue lolling is lessening, I wouldn't get too troubled about it. After all, if you've ever chipped a tiny piece of tooth or lost a filling, it feels like the Grand Canyon in your mouth, and there is no way at all that you can keep your tongue out of that spot. If they did an extensive power float too, the poor boy needs some time to get used to it.
All you must do now is keep an eye on him for anything odd in his behaviour that might signal pain ( besides the tongue lolling ). If he's doing better with his food, that's wonderful. Good Luck!
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Moderator:
DrO
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Posted on Wednesday, Jun 10, 2009 - 5:05 pm:
Hello Danielle,
I too think it is a bit early to expect the ulcer to have healed so it may be still bothering. Can you describe the tongue lolling in a bit more detail?
DrO
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Member:
dsmith6
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Posted on Wednesday, Jun 10, 2009 - 9:27 pm:
Hi all, spoke with the vet today. It was consistent w/ Dr. O's comment, he recommended to wait 2 weeks to give the ulcer and irritation in the mouth time to heal in which he should stop with his tongue lolling. The tongue lolling is like what we would do to get something stuck out of our teeth instead he sticks out his tongue after rubbing it across his teeth. (hope that helps, hard to describe). he does this sometimes after he eats his grain and/or hay. I'm concerned with another comment the vet made today... I asked the vet what the biopsy is going to tell us. He said to determine whether or not Tucker has gum disease (like gingivitis) or if the areas biopsied are malignant.I looked at the vet report again for clarification "Surgical findings include: defect in the interdental spacing on the mesial side of the last lower right molar, a sharp dental consistency projection at the third upper right molar with ulceration and food impaction associated and a third upper left premolar deformed due to wear. Biopsy samples taken from the ulcerated areas of the anterior and posterior tongue, the interdental space and the hard projection was sent to UNH for histopath". Very upsetting to think of malignancy. Just to provide a little more background on Tucker (I have posted about him before) he has severe osteoarthiritis in his stifles (meniscus is pushed out of stifle completely). I feed him bute and recovery eq for his pain and inflammation in addition to surpass 2x a day, he has been doing well with this. Tucker has had stomach ulcers. We treated him a full month on ulcerguard, 1 tube a day. We re-scoped his stomach after a months treatment and he still had minor ulcers. They had improved greatly but still not clean. The vet explained that the ulcers were not bad and did not seem to resemble what they would look like if they were malignant. At the time we scoped him, we discovered he wasnt eatting well and sour odor from his mouth. Then 2 days after the scope we had this teeth procedure done (last Friday). The vet had me swtich to equioxx instead of bute,assuming the bute was the cause of stomach ulcers. Also we are going to do another 2 weeks of ulcerguard combined with rentidine. So my question is, what is the chance that this irritation in his mouth is malignant? Does this description fit the description of malignancy? Or do you think these biopsied areas are due to irritation of this projection and everything else he had going on in his mouth. thanks again for any comments/opinions you may have on this.
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Member:
dsmith6
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Posted on Wednesday, Jun 10, 2009 - 9:33 pm:
sorry, I mis-spelled the medication, it is ranitidine.
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Member:
paul303
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Posted on Thursday, Jun 11, 2009 - 1:58 am:
Yeah, I sympathize with the ulcer thing, going through a bit of that myself right now.
The report talks of the third lower right molar being out of alignment (resulting in the diastemata condition Dr.O spoke of). Might be a slight chance that the opposing tooth, "the third UPPER right molar" with the "dental consistency projection" is related to that, it's hard to say without seeing it...but teeth are designed to mesh and work together - upper and lower against each other. When there is an aberration in the lower, sooner or later, the opposing upper will adjust due to the force that mastication exerts, and vice versa. It sounds as though there IS an overgrowth of tissue, again, hard to say without seeing, in which case it's certainly reasonable to biopsy it. But gums are very vascular, and can sometimes have overblown reactions to conditions such as a long standing food impaction. At any rate, it's always wiser to biopsy than to guess.
Keep watching his behaviour. How's he handling his food now? Is he eating any more? Give Tucker some time, it took awhile to get this way. You've been through quite a bit with him, haven't you? If I were you, I'd relax right now...stressing won't do any good. You've done everything right. Please let us know how he's doing.
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Moderator:
DrO
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Posted on Thursday, Jun 11, 2009 - 7:11 am:
From the information we have chance of malignancy low. I commented on the ulcer treatment in your other post Danielle.
DrO
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Member:
dsmith6
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Posted on Wednesday, Jul 8, 2009 - 9:14 pm:
The test came back negative, non-malignant. so that was really great news! The spike was actually a fractured bone (my vet says) in his face which migrated out thru his mouth. He has been eating very well, big difference. Loves his grain and eats all his hay. But its been over 3 weeks and he has not gained really any weight. I have been taping him every week and no real gain. We just got new hay last week- so that is good. Waiting to hear back on what the vet wants me to do. I've poked around for other posts regarding weight gain. He's been on canola oil and going to start feeding some alfalfa cubes as a treat. He gets free hay (4 flakes 2x a day) and he eats it all. I also have a donkey too that shares the hay- I think I'm giving them enough. Not sure where to go from here. Any suggestions?? He is still on ulcerguard and ranitidine and just started him on 1/4 cup of aloe vera juice in his grain. He is still on equioxx 1000lb dose. For grain he gets 1 scoop (3 pints) of Vintage Senior AM & PM. I can't really afford another vet appt right now, so I'm hoping in communication with my vet and everyones help here, we can get him to gain some weight. Thanks!!!
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Member:
sodmonst
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Posted on Wednesday, Jul 8, 2009 - 10:41 pm:
From last October
Hi Danielle, As DrO says, he needed to consume more calories than he used. I did not want to give him a lot of grain, he's plenty zippy already. We came up with "Hairball's ration."
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Member:
sodmonst
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Posted on Wednesday, Jul 8, 2009 - 10:44 pm:
I am no feed expert, but will share what helped my old guy. The mushy aspect of my Hairball's ration might be helpful for your horse. With this ration, took in more calories than he burned, and gained what he needed.
Twice daily:
8 oz.calcium fortified rice bran meal
4 oz. flax meal
1# soaked beet pulp
2# soaked alfalfa pellets
1 oz. probiotic
He gets plenty of Bermuda grass hay to go with the mush meals. He gained weight slowly and steadily.
I wish that I had better pictures to compare, but you get the idea. My horse is 18 years old, and although he was not emaciated, he was thin. I wanted to put weight on him in a sane way, without grain. He has a ton of energy as it is.
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Member:
dsmith6
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Posted on Thursday, Jul 9, 2009 - 8:15 am:
Thank you for posting the pictures! this is great! Did your vet recommend this mixture or did you come up with it yourself? Still have not heard from my vet.... Tucker isn't really a fan of wet mashes but will try it. Where do you get beet pulp and probiotic? My vet explained he's not real thin, but could gain about 50 lbs.
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Moderator:
DrO
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Posted on Thursday, Jul 9, 2009 - 8:43 am:
Hello Danielle,
For putting weight on horses check out, Diseases of Horses » Colic, Diarrhea, GI Tract » Weight Loss in Horses » Overview of Chronic Weight Loss.
DrO
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Member:
sodmonst
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Posted on Thursday, Jul 9, 2009 - 9:48 pm:
Hi Danielle,
I came up with Hairball's ration after reading this site. I read DrO's information on feeding and management, including the Overview of Chronic Weight Loss and feeding the older horse. Then I read through members' discussions for a while. Following that, I stopped feeding oats and came up with the Hairball mush mix.
My objectives were:
1. Feed something he'd clean up so the donkeys couldn't eat it. (That's why alfalfa hay is not an option. It makes donkeys as fat as engorged wood ticks!
2. Feed the extras in a feeder too high for the donkeys. They get Bermuda hay only.
3. Balance calcium and phosphorous.
4. Have enough but not too much protein.
5. Have nice, long fiber forage make up the bulk of what he eats.
6. Add calories without adding too much hot carbohydrate.
7. Make sure that there were multiple sources of vitamins and minerals in the mix, thinking that this offered opportunities to cover what one lacked with another. For example, the bermuda hay is high in phosphorous. The beet pulp, fortified rice bran, and alfalfa pellets have lots of calcium.
I neglected to say that in consideration of his age, I do add a small dose of vitamins to his feed. There are a mineral salt lick and a plain salt lick in their enclosure.
I introduced this to him by offering about 1/8th of the current amount two times daily. When he started to like it and look for it, then I increased the amount each few days until feeding the current amount.
Most likely there was no need to come up with the "Hairball mush mix," but I love figuring things out and learned more about feed in the process.
I buy beet pulp shreds at the feed store. They come bagged. Whenever I buy a new bag, I weigh the portion because weight/volume varies. The probiotic is from Valley Vet, their own brand, Command Probiotic Pak. I don't know if it does any good or not, but am hesitant to stop using it because HB is doing well.
One last thing, it is not necessary to soak this; it just makes it easier to chew. Since your Tucker is recovering from a dental problem, he might learn to appreciate it if you start him off with a very small amount. It ends up moist, not soupy. Of course all of this would be worthless without regular worming.
Good luck with Tucker, you could probably accomplish the same or better with a commercially prepared food, but if you are a do-it-yourself-er, this works and is fun to mix up if you're not feeding a lot of horses.
Susie
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Member:
dsmith6
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Posted on Tuesday, Aug 4, 2009 - 10:44 pm:
Susie,
I'm referring to your earlier post of what you feed your horse. How do you measure the alfalfa and beet pulp, wet or dry? I've introduced beet pulp and alfalfa to his feed. I measure 1 lb of alfalfa, then soak it and mix in with his grain, and do the same with 1 cup of dry beet pulp, measure 1 cup dry, then soak it with the alfalfa. He loves it! Haven't seen any weight gain yet, but maybe I'm not feeding enough?? Thinking of increasing the beet pulp. what do you think?? thanks!!
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Member:
sodmonst
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Posted on Tuesday, Aug 4, 2009 - 11:36 pm:
Hi Danielle,
I do weigh the beet pulp and the alfalfa pellets before soaking them, just like you are doing. A pound of beet pulp is probably more than 1 cup, if you have a feed scale, you can weigh it. If not, I'll admit that in the past I've taken a baggie or two of feed to the grocery store and weighed it in the produce department
Anyway, you can feed more beet pulp and alfalfa pellets than you are. However I believe that feeding the rice bran and flax meal is what put the weight on old HairBall. Both are rich in fat, and add energy without the dangers associated with large grain rations or sweet feed.
The beet pulp and alfalfa pellets give bulk to the rice bran and flax meal. Without beet pulp, the rice bran and flax meal turn gummy and stick to his face and his teeth. I guess it would be like eating peanut butter without the bread.
These are only a couple of suppliers, there are many others.
rice bran: https://www.naturalglo.com
flax meal: https://www.buygpdirect.com (Omega Flax)
For plenty more information, oheck out the article here on HorseAdvice.com. You will find that beet pulp has lots of fiber, and is described in the section on forage. I copied part of what is in the article and pasted it here. The link to the full article is: https://www.horseadvice.com/horse/messages/3/5196.html
From: Overview of Horse and Equine Nutrition
by Robert N. Oglesby DVM
"Beet Pulp...an acceptable substitute for forages. Usually only available in the dried form, beet pulp contains 20% fiber so is a good substitute for forage. With a protein content of about 9% (and poorly digestible at that), a crude fiber content of about 20%, and a digestible energy of about 1 megacal per lb. it is similar to a good quality grass hay. However it is moderately high in calcium while low in phosphorous content, so phosphorous supplementation is recommended, see below. Also it is deficient in vitamins A and D so if fed as a significant percentage of the diet, general vitamin supplementation is recommended, ...more. Also consistent commercial availability is sometimes a problem.
"Usually fed at between 1/3 to 2/3 of the total diet by weight, it should be mixed with a 12% protein concentrate pellet or grain for maintenance. When fed as a significant percentage of the diet or in combination with other high calcium feeds, like alfalfa or lespedeza, in would be wise to supplement the phosphorous content. Adding 2.5 ozs of bran per 1 lb. of alfalfa / beet pulp fed should adjust the calcium / phosphorous to normal amounts and ratios with respect to these two feed stuffs. Good quality alfalfa would also help correct the vitamin deficiency of the beet pulp.
"The Golden Rule stresses the importance of forage:
The feeding program for maintenance of the average horse is quite simple and relatively inexpensive: good to excellent quality forage fed free choice, clean water, and a trace mineral salt block. When forage alone is not enough to provide all the nutrients needed, then we turn to concentrates."
Thank you for sharing your progress, Danielle. I'm looking forward to hearing how it goes.
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