I've been thinking about teeth this week - horses' teeth in particular. That's partly because my own horses are due for a dental check up, but also because there's been a report in one of my journals that really made me think how much dental work has moved on in the last ten or fifteen years! When I was training as a vet, an equine "tooth check" mainly involved grabbing the tongue, having a quick feel round, then rasping away at anything that felt sharp. If you were properly equipped, you'd use a gag (aka a dental speculum); if not, many vets were happy to work around the horse's tongue and teeth. Nowadays, that sort of cursory examination really isn't good enough in many cases. There are a lot of very well trained and experienced vets, as well as good equine dental technicians (EDTs) who would probably need a sit down if they saw some of the things that were commonplace not that long ago! We also have many more "paraprofessionals" now - EDTs who have a variety of qualifications, and there seem to be fewer quacks out there than there used to be. That said, if you're asking an EDT to do your horse's teeth, check out their qualification first: if something goes wrong, some insurance companies won't pay out if the EDT isn't registered with the BAEDT (British Association of Equine Dental Technicians). For a start, a proper tooth check up needs to include a clinical examination of the horse - is he losing weight? Are there any lumps or bumps on her head that might indicate a tooth root problem? How well are his intestines working to digest his food? It's also true that it is not possible to do a full mouth exam without a gag of some sort. If you're brave enough, yes you can feel the outside edges of the teeth by running your hand up, but anyone who thinks that holding a horse's tongue will stop them biting your fingers has either been very lucky, or hasn't tried it! A gag really is essential so you can examine the inner surfaces of the teeth, and also so you can have a look at the mouth. Although you can learn a lot from feeling, there are some conditions that are easier to detect and evaluate by sight, using a head lamp or a pen torch to have a good look around the mouth. Now, of course, we have to consider the horse himself. In my experience, about 1 in 3 horses aren't safe even to examine without some degree of sedation. Yes, you can often get away with it - but once you've put a gag in, you've effectively given the horse a lethal weapon. He doesn't have to turn his head that far or that fast to knock someone out, or worse. I've only had this happen once while I was working on a horse, but that's enough for me to be very certain I don't want anyone else to be injured. Of course, only a vet can legally prescribe sedatives to a horse, so in many cases, this is where EDTs have to call in backup. And please note, I've found that ACP (e.g. sedalin) barely takes the edge off a nervous horse; for dental work, injectable sedatives are preferable. Once the exam is complete, we need to decide what we're going to do with whatever we've found. Most horses, especially those who are seen regularly, will have a few sharp edges where the tooth has grown into sharp points as part of its daily wear pattern - remember, horses' teeth grow down from the roots constantly through life, and are worn away by the teeth opposite. If they don't line up properly side to side, we get sharp edges and points (usually on the outside, by the cheeks, at the top and the inside, by the tongue, at the bottom); if the misalignment is front to back, we get hooks (at the front of the first cheek teeth, usually on the top) and ramps (at the back of the last cheek teeth, usually on the bottom). All of these changes can make it painful or difficult to chew if they are allowed to continue, and sharp edges can cause mouth ulcers. I'm sure everyone knows how painful those can be! It's even worse if a tooth is missing - the opposite one will grow down into the gap. In severe cases, this can cause "tooth lock", where the horse is unable to open its mouth because the overgrown tooth has locked into the gap left by the missing one. If it’s just a matter of sharp edges, or small hooks, these can usually be fixed with a hand rasp; however, if they're large a power tool may be required. Power tools come in two forms - either a reciprocating power-float, or a rotary dremel are usually used; personally, I prefer a dremel because the blade is guarded so is less likely to damage the soft tissues of the cheeks and tongue. One important thing to remember about power tools is that altough they make the work easier, they do impose some problems of their own. Firstly, it’s very easy to take too much off - I remember once seeing a horse whose owner was very worried because she'd had "the tooth man" (who wasn't a vet or a qualified EDT) out and then the horse had been unable to eat afterwards. On closer examination, he had managed to power float the teeth as smooth as billiard balls so the mare was no longer able to grind any food. She had to live on porridge and mashes for several months, until the teeth wore in and the grinding ridges reappeared. The second issue is that power tools often generate a lot of heat, and if left applied to the tooth for too long can actually kill the tooth so that it rots and needs to be removed. Some tools have a built in water spray for cooling; otherwise, I only leave the cutting surface on the tooth for a matter of seconds, remove it, apply water if needed, then do a bit more. Now, once again we need to consider sedation; the more you need to do, the more likely it is that you will need sedation, and personally, I almost always sedate horses if I'm going to use power tools like a dremel. I didn't always follow this rule, until one day a very calm pony I was working on jumped forward and swallowed the running dremel. Fortunately, all was well in this case, because as I felt the dremel vanish down the pony's gullet I managed to cut the power, and then retrieve it before it was all gone, but it certainly made me think twice before working on unsedated patients! In addition, even a quiet power tool makes vibrations that the horse will feel through the bone of his skull. My experience is that it's a very rare horse that will stand perfectly still and allow you to do a proper job, rather than rush through and say "that's fine" just before you think the horse is going to start throwing himself around the stable! There are a number of other problems we come across on regular check ups as well. One of the commonest is misaligned arcades, where one tooth grows out at an odd angle - often straight sideways into the cheek. These require very careful treatment, and often need seeing on a very reglar basis (I had one which needed seeing every 6 weeks a one point). Another major problem I've seen is where there's a really painful tooth, but nothing obvious on examination. These are often due to tooth root abscesses. Unfortunately, a horse with an abscess like this can't usually be fixed with a simple course of antibiotics; we need X-rays to see exactly which tooth is involved and how badly, and often we need to remove the tooth. If it’s already pretty wobbly, this can sometimes be done in the field under deep sedation, although it tends to be a lot of physical work to rock it and work it out of its socket. If it isn't wobbly yet, it usually means the horse needs to come into a hospital facility and have the tooth removed surgically. This can frequently be done under sedation, but occasionally a general anaesthetic is required. You can find information about other tooth problems that horses can suffer from here: http://www.baedt.com/?c=5386 That said, the vast majority of dental problems I've seen can be managed at home, with a good examination, sedation if needed, and then appropriate treatment with either hand or, occasionally, powered tools. Will I be sedating my horses? One, definitely yes - I have no wish to fight with a 17hh stroppy eventer! The little pony, on the other hand, I'll see how she feels about it; if I can get away without, I certainly will, but with her there are no guarantees... If you are worried about your horse's teeth, talk to your vet or check out any symptoms with our Interactive Horse Symptom Guide to see what to do next.