This is an archived Horseadvice.com Discussion. The parent article and menus are available on the navigation menu below:
HorseAdvice.com » Diseases of Horses » Colic, Diarrhea, GI Tract » Mouth, Esophagus, and Liver » Disorders of the Mouth and Teeth »
  Discussion on Research Summary: Fractures of Teeth, Cause and Treatment
Author Message
Moderator:
DrO

Posted on Thursday, Oct 4, 2007 - 8:33 am:

Here is a interesting study that uncovers some surprising facts about cheek teeth fractres. It estimates the incidence of fractured cheek teeth in the population is as hign as one in 250 horses and over 1/3 are asymptomatic. Also of note that except in the case of infection of the deep parts of the tooth (apical infection) often more conservative treatment like rasping down the rough edges and removal of loose fragments resolves the clinical signs. Deep infection requires extraction.
DrO

Equine Vet J. 2007 Jul;39(4):310-8.
Equine idiopathic cheek teeth fractures. Part 1: Pathological studies on 35 fractured cheek teeth.

Dacre I, Kempsot S, Dixon PM.
Division of Veterinary Clinical Studies, The University of Edinburgh, Easter Bush Veterinary Centre, Midlothian EH25 9RG, UK.

REASONS FOR PERFORMING STUDY: There is little published information on the pathology of idiopathic fractures of cheek teeth (CT). OBJECTIVES: To perform pathological examinations on equine CT with idiopathic fractures in order to establish fracture patterns and to gain information on their aetiopathogenesis. HYPOTHESIS: Gross and histological examination of CT with idiopathic fractures, including measurements of dentinal thickness, will provide information on fracture patterns, and on the duration and aetiopathogenesis of these fractures. METHODS: Of 35 CT with idiopathic fractures that were examined to determine their fracture patterns, 20 underwent gross, histological and ultrastructural examinations, including dentinal thickness measurements, with the latter compared to dentinal measurements of dental age and Triadan position matched control CT, to help determine the duration of any pre-existing endodontic disease. RESULTS: The fracture planes involved the pulp chambers in 30 out of 35 CT examined, and ran through coalesced, carious infundibula in the other 5 (maxillary) CT. The maxillary CT, particularly the Triadan 09 position were preferentially affected. The most common fracture plane, which was termed a maxillary buccal slab fracture, occurred through the 2 lateral (1st and 2nd) pulp chambers of maxillary CT and usually involved only the clinical crown. Buccal slab fractures of mandibular CT (through 4th and 5th pulp chambers) and midline sagittal fractures through the infundibula (of maxillary CT) were the next most common fracture patterns. Reduced dentinal thickness (probably indicating prior pathological changes in the fractured CT) was present in 25% of fractured CT. CONCLUSIONS: Most idiopathic equine CT fractures involve the pulp chambers, especially those on the buccal aspect of both upper and lower CT. No predisposition to fracture was found in the majority of affected CT that appeared to have a normal endodontic appearance prior to development of fractures through their pulp chambers. The remaining idiopathic CT fractures were caused by advanced infundibular caries. POTENTIAL RELEVANCE: All CT with idiopathic fractures are all at risk of pulpar or even apical infection.

Equine Vet J. 2007 Jul;39(4):322-6.
Equine idiopathic cheek teeth fractures: part 2: a practice-based survey of 147 affected horses in Britain and Ireland.

Taylor L, Dixon PM.
Division of Veterinary Clinical Studies, The University of Edinburgh, Easter Bush Veterinary Centre, Midlothian, EH25 9RG, UK.

REASONS FOR PERFORMING STUDY: There is limited information on the prevalence of idiopathic cheek teeth (CT) fractures in the general equine population and on which CT are most commonly affected. OBJECTIVES: To obtain information on the prevalence of fracture patterns and clinical details of idiopathic CT fractures. METHODS: Details of cases with idiopathic CT fractures encountered were obtained via a questionnaire sent to suitably experienced veterinary practitioners and equine dental technicians (EDTs). RESULTS: Details of 147 horses that suffered a total of 182 idiopathic CT fractures; and median 0.4% (range 0.07-5.9%) of horses examined were diagnosed with such fractures; 133 maxillary CT and 49 mandibular CT fractures were found; maxillary Triadan 09s and 10s were preferentially fractured (46% of all fractured CT); fracture patterns included maxillary CT slab fractures (through 1st and 2nd pulp chambers) in 87 teeth (48% of all fractured CT), maxillary CT midline sagittal fractures (through the infundibula) in 31 CT; and various other types of maxillary CT fractures in 15 CT. In the mandibular CT, lateral slab fractures (through the 4th and 5th pulp chambers) were found in 28 CT and a variety of other fracture patterns in the other 21 mandibular CT. Clinical signs included quidding in 33% of cases, bitting and behavioural problems (29%) and halitosis (12%), however 39% of horses with idiopathic CT fractures were asymptomatic. Treatments included oral extraction of the smaller dental fragment in 37% of cases, extraction of the entire fractured tooth (9%); removal of sharp edges on the remaining part of fractured tooth (14%); reduction of height of the opposite tooth (4%); other surgical or endodontic treatments, or referral of case for further investigation and treatment (10%); or no specific treatment (39%). Following treatment, 81% of cases were reported to be asymptomatic, 6% had ongoing clinical problems and the outcome was unclear in 13% of cases. CONCLUSIONS: Idiopathic CT fractures are present in approximately 0.4% of horses and may variably cause none to severe clinical signs. Most idiopathic CT fractures respond well to treatment. POTENTIAL RELEVANCE: Understanding of the prevalence, clinical findings and treatment of idiopathic CT fractures will improve management of these disorders.

Equine Vet J. 2007 Jul;39(4):327-32.
Equine idiopathic cheek teeth fractures: part 3: a hospital-based survey of 68 referred horses (1999-2005).

Dixon PM, Barakzai SZ, Collins NM, Yates J.
Division of Veterinary Clinical Studies, The University of Edinburgh, Easter Bush Veterinary Centre, Midlothian EH25 9RG, UK.

REASONS FOR PERFORMING STUDY: There is limited information available on the more serious sequellae of idiopathic cheek teeth (CT) fractures. OBJECTIVES: To obtain information on clinical and ancillary diagnostic findings in referred horses with idiopathic CT fractures. METHODS: Details of all horses suffering from idiopathic CT fractures referred to the Equine Hospital at the University of Edinburgh 1999-2005 were examined, and information concerning fracture patterns, clinical and ancillary diagnostic findings, treatments and long-term response to treatments were obtained and analysed. RESULTS: A total of 60 maxillary and 17 mandibular idiopathic CT fractures were diagnosed in 68 horses. Fracture patterns included maxillary CT lateral slab fractures (45%), maxillary CT midline sagittal fractures (16%) and various other patterns of maxillary CT fractures (17%). In the mandibular CT, lateral slab fractures were found (12%) and various other CT fracture patterns were present in 10%. The more centrally positioned CT (maxillary and mandibular Triadan 08s and 09) were preferentially fractured. Clinical signs included quidding in 47% of cases; bitting and behavioural problems (28%); signs of apical infection, including bony swellings and nasal discharge (21%); anorexia/weight loss (15%); halitosis (13%); and buccal food impaction (12%). The treatment of all cases was conservative whenever possible and included corrective rasping of the remaining tooth (46% of cases); oral extraction of the smaller and loose dental fragment (32%) and extraction of the entire fractured tooth by oral extraction (28%) or by repulsion (13%). Prophylactic treatment of adjacent, nonfractured CT with carious infundibula was possibly of value in preventing further midline sagittal maxillary CT fractures. CONCLUSIONS: Horses referred with idiopathic CT fractures frequently have clinical signs of apical infection of the fractured CT and these teeth require extraction, orally if possible. More conservative treatment of idiopathic CT fractures without signs of gross apical infection can resolve clinical signs in most cases. POTENTIAL RELEVANCE: In the absence of apical infection, extraction of only the loose dental fragments of CT with idiopathic fractures is usually successful.
Member:
lmiller

Posted on Monday, Jul 5, 2010 - 2:41 am:

Dear Dr. O,
About two years ago, my then 10YO Paint mare developed a sinus-like infection that we later found out was related to a fractured 209 molar. A 10-day course of SMZs remedied the infection, and up until 2 weeks ago the mare has been fine.

This latest episode began with quidding her hay and alfalfa, and her obvious difficulty chewing. Vet removed some sharp edges/floated teeth, and found half of 209 missing. The process of floating loosened the remaining fractured portions of that tooth. My vet decided to remove the fractured portions, but left the root in place. There was no sign of infection present.

She is now back to normal work, and seems pretty much fine. She shows no quidding, nasal discharge or signs of discomfort whatsoever. My vet is pretty conservative, and he indicated that she had a good chance of just being fine if no infection developed in this initial period. He also said this condition potentially could require surgery to remove the tooth root if something did develop.

Reading the stats on these reports, it looks like I have maybe a 50/50 shot. However, several lay people I've talked to seem to think it's really important that the root come out immediately, even though there currently are no symptoms or problems.

I guess my question/s is/are: Is it realistic to believe that this will heal and not cause future problems, or is it a matter of time before she'll require surgical extraction of the tooth root anyway? Is it important that the root come out now? Am happy to furnish more in depth info if you need it.

Thanks, Laurel
Moderator:
DrO

Posted on Thursday, Jul 8, 2010 - 7:18 am:

Hello LA,
It really takes a radiograph to make this decision as it is the only way to check for apical infection. So let's assume the worse and it is just a matter of time, what if that time frame is 10 years? Without symptoms, and if radiographs not a part of your goals, and considering the work and expense required to remove those roots, I think a wait and see attitude reasonable.

Removal once problems occur might be a bit easier with the roots looser but might not have quite as good as a prognosis as further damage to the alveolus (socket) might make a persistent infected track more likely.
DrO
Member:
lmiller

Posted on Thursday, Jul 8, 2010 - 9:14 pm:

Thanks. I check her every visit for bad breath, sensitivity, and of course unusual chewing habits. Meanwhile, I'll check on getting radiographs done. It seems like that might be a good idea, if not too costly.
Laurel
Member:
npo33901

Posted on Tuesday, Jul 13, 2010 - 7:49 am:

Removal of the remaining root may cause shifting of neighboring teeth .
Good to watch the tooth opposite the "missing" one . It may overgrow and will need rasping more often.
Home Page | Top of Page | Join Us!
Horseadvice.com is a BBB Accredited Business. Click for the BBB Business Review of this Horse Training in Stokesdale NC