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  Discussion on Periodonal steriod injection
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Member:
shogeboo

Posted on Wednesday, Apr 7, 2010 - 5:16 pm:

Hi Dr. O,

I have been treating my 21 yr old TWH gelding for a severe gum infection. He has been on Uniprym powder for 5 weeks and has 2 more weeks to go. The vet did a recheck yesterday and offered a periodontal steriod injection to the upper gums which remain tender to the touch with some slight bleeding. Have you ever heard of these? If so, do you recommend them? Are they of much benefit? I cannot seem to find much information on them or how they are used.

My horse is eating fine, the vet watched him eat. He is likely to need his upper incisors pulled but we have not done xrays yet. The injection was suggested as a way to help reduce inflammation and buy some time before considering pulling any teeth. No teeth are loose either. My horse also tested negative for Cushings and is a healthy weight, otherwise doing fine.

Thanks for any feedback on the suggested injections.
Moderator:
DrO

Posted on Friday, Apr 9, 2010 - 1:23 pm:

Hello Stephanie,
No I have not heard of such a treatment but if he feels he has the infection is covered with antibiotic yet the inflammation is still getting in the way of healing it seems a rational idea to me. The one concern is if the infection is not controlled and the steroid may worsen it.
DrO
New Member:
twhgirl

Posted on Tuesday, Oct 11, 2011 - 11:49 am:

I posted this about a year and a half ago (rejoined under a new user name)...Well, the periodontal disease in my now 22 yr old Walker has continued to progress. He had fractured incisors and root abcesses exposed. He was sent to the UW Veterinary Hospital where all of his top incisors were removed. He stayed overnight and was released the next day. Follow up care involves daily flushing with an oral solution (easier said than done), Uniprim, and bute. Was told he did need a special diet and in fact has been eating his hay without issue, but he is reluctant to eat his Senior Feed, which he really needs and that is where his meds are mixed in. We bought some molasses to mix in with his meds and the barn manager is going to start soaking his feed too, so hopefully that will encourage him. It's tough to do the after care as he is boarded, and I have to be out of town for work today- Friday. A friend is helping me with the flushing and my vet is stopping out tomorrow for a post op follow up and to DrOp off more antibiotic. He needs to return to UW on 10/21/11 to have his bottom incisors removed as well. I feel just awful that he has to go through all of this, and that I was unable to treat it or prevent it. The UW vet diagnosed it as "Equine Idiopathic Periodontitis"- basically really bad periodontal disease and they do not know what causes it. Any one else dealt with this or have any suggestions for improving Rambo's after-care?? Thanks!
Moderator:
DrO

Posted on Wednesday, Oct 12, 2011 - 6:23 pm:

Welcome Back Stephanie,
I have not heard of Equine Idiopathic Periodontitis such a condition nor does this appear to be a regularly occurring condition that is published. Neither have I ever seen such a horse. But I agree the name accurately describes the condition.

Is the feeling that there is a problem with the teeth, leading to secondary periodontal disease or that there is a problem is a primary periodontal disease leading to loss of the teeth. How about the canines and cheek teeth, any indication this condition is affecting them?

How are you currently doing the flush? I would look for a plastic wash bottle (like Nalgene's) with a delivery tube that runs to the bottom of the bottle so all you have to do is squeeze the bottle to deliver flush solution.
DrO
New Member:
twhgirl

Posted on Wednesday, Oct 12, 2011 - 7:44 pm:

Hi Dr O,
The vet at the UW who is treating this said the condition is relatively new in terms of diagnosis and treatment (about 2003), and only one published study/paper exists on it. The symptoms include foul breath, DrOoling, DrOpping food, and reddened, swollen gums with a pimple-like appearance.

As I understand this disease, it's more of a condition that affects the gums, and ultimately leads to pain, inflammation and utlimately, loosening of the teeth, and the only real treatment that works is extraction. Other treatment is what we have already tried, the Uniprim and injections, but they typically only buy some time as the disease progresses. There is some thought that older horses are 'outliving' their teeth and that is a contributing factor. This condition can affect horses of any age, but does occur more often in horses in late teens and early 20s. To my knowledge, my horse does not have any affect on his canine or cheek teeth, but yes, it can progress there as well if left untreated for too long.

I am doing the flush with a large flusher the hospital provided and I forgot what the solution is- it's blue and I dilute it with water. It's hard to do as Rambo does not want his mouth touch and I have had to pinch/twitch his muzzle so I can actually get in there to flush it. Although horses do not use the incisors to chew, Rambo has been reluctant to eat his equine senior which he usually gobbles down, so we have been wetting it down for now until his mouth heals. Of course, next week is round 2 for the bottom incisors so no rest for this poor boy until he is done with that.

The vet told me horses usually do really well after extraction and many times, have a new lease on life with no chronic dental pain.

If you come across the published article on this condition I would love to read it!
Moderator:
DrO

Posted on Saturday, Oct 15, 2011 - 9:49 am:

I ran a search in PubMed for Equine Periodontitis and it did not show up so this morning I looked at a few review articles on equine dental disorder surveys, and several texts I have on equine dentistry and do not find the article. If he has a reference and assuming I have access I would be glad to publish what I can.
DrO
New Member:
twhgirl

Posted on Tuesday, Oct 25, 2011 - 9:09 pm:

Well, an update on my horse following his bottom incisor extractions on 10/21. For the extraction of the tops, they kept him overnight, which I felt good about. For the bottoms, he was released the same day. I was a little leery taking him home but he seemed okay. The following day though, he was obviously in a lot of pain and was depressed, not eating or drinking. I was originally prescribed 1 gm bute twice a day. I gave him 2 gm at once and he seemed to perk up a bit. I went out later to check on him (I board and live 20 min away) and he was in his stall, not eating, very depressed, to top it all of, he was looking at his sides, and stomping. He obviously had a colic starting on top of everything. I felt awful and really questioned the entire decision to remove all this horse's incisor teeth. It was a Sat night, but I called the vet and he was tubed with water and electrolytes as a precaution, and give IV pain meds. The following day he was much improved and eating again, drinking, pooping, etc. His pain management post operatively was upped to 2 gm bute twice daily for 4 days and then reduce to 1 gm twice daily. This poor horse...I now have him on UlcerGuard as a preventative, as well as Pro Bios since the colic episode, along with his bute and antibiotics. Plus, I have to do oral flushing too. He is a good sport and seems better now. He is 4 days post op right now and there was some slight bleeding when I flushed him tonight and dabbed to try and get the hay and grass out of his gums. His spirits are better and he seems perfectly normal in every other way, even snatching at grass with what, I don't know, but he manages somehow. He has really amazed me. The vet surgeon at UW advised his canines may need to be removed in the future too...not sure about that. I do not know if I can put him or me through this yet again.
Moderator:
DrO

Posted on Sunday, Oct 30, 2011 - 12:34 pm:

Hello Stephanie,
Thanks for the update and sorry to hear you and your horse are going through so much trouble. Once this heals and a diet established, there may be sunnier days ahead.
DrO
Member:
kriseyc

Posted on Thursday, Nov 3, 2011 - 8:40 pm:

Hi Stephanie, Was reading your post and was just curious how your boy is doing. Well I hope!
Thanks
IKE
Member:
twhgirl

Posted on Thursday, Nov 3, 2011 - 9:05 pm:

Hi Dr O and IKE,

Thanks for the well wishes. Rambo is doing really well! We are at the tail end of the oral flushing which is really a pain in the you know what. We are done with bute and tomorrow is the last day of antibiotics. He is eating his Equine Senior and hay without problem. After the colic ordeal he bounced back well. I am anxious to ride him in another week or so, as my vet said that a lot of horses with chronic oral pain get a new lease on life once the teeth are out and the pain is gone. Maybe I should dust my helmet off :-)
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