Dental Disease: What the Research Says
Evidence from 27 peer-reviewed studies
7 Cohort Study
6 Case Report
14 Expert Opinion
What Professionals Should Know
- •Horses with periodontal disease undergoing tooth extraction will show a measurable systemic inflammatory response; anticipate this and monitor for systemic effects rather than expecting straightforward local healing
- •Routine cheek tooth extractions in dentally healthy horses produce minimal systemic inflammation, suggesting simple extractions are relatively low-risk systemically
- •Presence of periodontal disease should elevate concern about potential systemic consequences of dental pathology beyond local effects
- •Implement early and frequent oral examinations in miniature horses as preventive care, starting when young, to identify and manage dental disease before progression
- •Monitor body condition score and head conformation in miniature horses, as higher BCS and wider head structure correlate with increased malocclusion risk
- •Recognize that age is a significant risk factor for dental disease in miniatures—older horses require more frequent dental examinations and interventions
- •Full-mouth radiographs reveal significant disease in horses that appear normal on visual and tactile oral examination alone—consider this a standard diagnostic tool, not optional
- •Targeted radiography based on clinical signs alone will miss ~21% of radiographic abnormalities; full-mouth surveys provide superior diagnostic coverage
- •Approximately 1 in 5 horses undergoing routine dental care have radiographic findings that could impact treatment planning and long-term oral health outcomes
- •Over half of working horses in this population experienced colic annually — dental health surveillance should be a priority, as severe dental disease carries nearly 7-fold increased risk
- •Monitor dietary changes seasonally; ground corn in dry season increased colic risk while rice bran in green season was protective, suggesting forage quality and feed composition matter significantly
- •Stereotypic behaviours and recent deworming were associated with colic history; reconsider blanket anthelmintic protocols and investigate underlying causes of stereotypies
- •Do not assume that occlusal fissures in cheek teeth indicate tooth compromise or are causally related to dental disease—they are common incidental findings
- •Fissure location and direction are inconsistent with causing slab fractures in most cases, suggesting they may be a normal variation rather than pathological
- •When investigating dental problems in horses, look for other signs of disease rather than relying on fissure presence as a diagnostic indicator
- •Regular dental examinations and treatment in donkeys are critical preventive health measures that reduce systemic disease risk and improve welfare outcomes
- •Early intervention in dental disorders prevents cascade effects where one dental problem promotes development of multiple other abnormalities
- •Donkeys presenting with weight loss, poor condition, or colic history should receive comprehensive dental evaluation as dental disease is a significant contributing factor
- •Do not rely on radiography alone to rule out dental disease in horses—it will miss approximately half of cases; combine it with scintigraphy for accurate diagnosis
- •Scintigraphy is essential for identifying which specific tooth is diseased and determining the nature of the pathology, complementing radiographic interpretation of anatomical detail
- •Use a density ratio threshold of ≥1.5 on scintigraphic imaging to minimize both false positives and false negatives when evaluating suspected dental disease
- •Nearly 1 in 5 horses in this population had dental disease—implement regular oral examinations and endoscopic screening as part of preventive health programs, especially in older horses (7+ years)
- •Molar rasping dramatically improved chewing efficiency and feed intake in affected horses; routine floating should be standard practice to prevent secondary weight loss and malnutrition
- •Watch for behavioral signs of dental disease: difficulty finishing feed, excessive salivation, and poor body condition—these warrant prompt endoscopic examination to identify pathology early
- •Current facial expression-based pain scales are not reliable for assessing dental pain in your horses—clinicians should not rely on these tools alone for dental pain evaluation
- •EOTRH and periodontal disease appear to cause more noticeable pain responses than other dental conditions, so heightened vigilance for these specific conditions is warranted
- •Improved assessment methods for dental pain are needed; until these are developed, combine multiple clinical signs and owner observations rather than relying on any single pain metric
- •When interpreting equine paranasal sinus CT scans, look specifically for a hyperattenuating cystic wall in the periphery of the lesion—this is the most reliable CT feature distinguishing cysts from other sinus pathologies
- •Do not rely on measuring attenuation values within the lesion contents to differentiate cysts from other conditions; the cystic wall appearance is more diagnostically useful
- •Expect to see concurrent bone changes and dental abnormalities in horses with paranasal sinus cysts, which may influence surgical planning
- •Septic sialoadenitis should be suspected in older horses presenting with salivary gland swelling and inappetence; ultrasound effectively differentiates parotid from mandibular involvement
- •Dental disease is a primary risk factor—perform thorough oral examination and address underlying dental abnormalities in all suspected cases
- •Treat empirically for anaerobic infection (Fusobacterium species) in all cases until culture results available; prognosis is good (>80%) with appropriate antimicrobial therapy
- •Understanding normal occlusal angles for different cheek tooth positions provides baseline reference values for detecting abnormal wear patterns that may indicate dental disease
- •The significant difference between mandibular and maxillary occlusal angles is normal anatomy; recognize that rostral and caudal cheek teeth have distinctly different angles requiring position-specific assessment
- •Occlusal angle changes are subtle in dental disease (except at Triadan 06), so clinical evaluation should not rely solely on angle measurement but incorporate other diagnostic methods
- •Consider supernumerary cheek teeth in differential diagnoses of severe dental disease cases, though it is uncommon
- •Mild clinical signs can often be managed conservatively with diastema management and overgrowth reduction before resorting to extraction
- •Horses with severe clinical signs from supernumerary cheek teeth typically require extraction; major facial flap surgery may be needed in complex cases
- •Early identification of inflammatory markers and bacterial involvement may enable earlier diagnosis and intervention in horses showing signs of EOTRH
- •Understanding the inflammation-infection link could inform preventive management strategies and targeted therapeutic approaches for affected horses
- •Practitioners should recognize EOTRH as a significant dental disease with systemic health implications requiring prompt veterinary attention
- •Implement routine dental examinations and preventive care protocols as part of regular horse health management
- •Learn to recognize clinical signs of dental problems early to prevent progression and maintain performance
- •Understanding equine dental anatomy helps identify anatomical variations and predisposing factors for dental disease
- •Routine dental examinations should be a standard practice for all privately owned horses, as 95% prevalence suggests dental disorders are nearly universal in this population
- •Incisor and cheek teeth disorders occur with equal frequency; practitioners should give equal attention to all tooth groups rather than focusing primarily on molars
- •Different tooth types present different pathologies (incisors show curvatures/calculus; cheek teeth show enamel points/caries), suggesting targeted treatment and prevention strategies may vary by location
- •CT is now a standard diagnostic tool for equine head problems — consider it early for dental, sinus, and ear diseases where traditional imaging fails to provide complete information
- •Request multiplanar reconstructions (not just transverse images) from your imaging provider to fully understand spatial relationships and treatment planning
- •CT cannot reliably assess neurologic structures; use MRI if brain or spinal cord disease is suspected alongside head signs
- •Education and training programs targeting horse owner knowledge and experience can improve husbandry practices and ultimately horse welfare
- •Farriers, veterinarians, and equine professionals should prioritize owner education on parasite control, hoof care, and dental care as these are key areas where knowledge gaps exist
- •Understanding that owner attitudes drive management behaviour can help practitioners tailor their communication and recommendations to different owner experience levels
- •Understanding the history of equine dentistry helps contextualize why traditional practices (like floating) focused on enamel points, while modern approaches demand comprehensive oral diagnosis
- •Current best practice requires detailed examination and specific diagnosis of dental pathology rather than treating all horses with the same standard procedures
- •Equine dental care has progressed significantly in the last few decades—staying current with research-based approaches is essential for optimal patient outcomes
- •Implement routine sedated dental examinations as preventative care rather than waiting for clinical signs—early detection prevents costly advanced disease
- •Modern equipment and sedation protocols make advanced dental procedures feasible in standing horses, reducing risks associated with general anaesthesia
- •Develop client education programs emphasizing proactive oral health management; the industry must shift from treating problems to preventing them through regular professional examination
- •Owner perspectives on choosing between veterinary and equine dentist providers may inform how dental services are marketed and delivered
- •Individual case narratives can highlight practical considerations in dental care delivery but should not replace evidence-based guidelines
- •The equine TMJ appears well-adapted to biomechanical loading, with distinct tissue composition reflecting different stress patterns across dorsal and ventral compartments
- •The mandibular fossa bears minimal compressive load while other articular surfaces are specialized for load-bearing, suggesting the TMJ may be resilient to dental-related biomechanical overload
- •Understanding normal TMJ histology provides a baseline for identifying pathological changes and evaluating claims that dental problems routinely cause TMJ disorders
- •Horse owners have substantial knowledge gaps about dental disease and treatment—this represents an opportunity for veterinarians to provide education and build trust through professional communication
- •Word-of-mouth is currently the primary information source for owners; creating accessible, reliable educational materials and leveraging professional networks could improve informed decision-making about dental care
- •Owners strongly prefer dental work to be performed by specialists; marketing your advanced training or referring to specialists can improve client satisfaction and outcomes
- •Use CT imaging when detailed assessment of dental anatomy and pathology is needed, as it provides clearer visualization of individual teeth and surrounding structures than radiography alone
- •Consider scintigraphy for suspected early periapical infections before radiographic changes become evident, improving diagnostic sensitivity
- •For complicated cases involving supernumerary or dysplastic teeth, combine imaging modalities (CT and scintigraphy) rather than relying on conventional radiography alone
- •Ensure your equine dental care provider has advanced, evidence-based training in equine dentistry beyond basic veterinary qualification
- •Request diagnosis and treatment plans based on current scientific literature and established dental principles, not tradition alone
- •Recognize that properly trained equine dental specialists can deliver safer, more effective care with reduced injury risk to both horse and practitioner
- •Scintigraphy offers diagnostic capability beyond bone imaging for investigating soft tissue, organ, and vascular disease when conventional imaging is inconclusive
- •Clinicians should request well-validated non-skeletal scintigraphic protocols and be cautious interpreting results from techniques lacking prospective validation studies
- •Economic and clinical value of non-skeletal scintigraphy varies by technique; seek evidence-based guidance before committing to these investigations
- •Clinical presentation of equine apical infections varies by location: expect facial swelling with rostral maxillary lesions but nasal discharge with caudal maxillary lesions
- •Oral extraction offers superior long-term outcomes compared to medical treatment, apical curettage, or repulsion in most cases
- •Caudal maxillary apical infections complicated by sinusitis are challenging to treat and warrant aggressive early intervention or referral
Key Research Findings
Horses with periodontal disease showed significantly elevated serum amyloid A (SAA) at 24h (median 135 mg/L vs 27.5 mg/L, p=0.004) and 48h (median 264 mg/L vs 0 mg/L, p=0.043) post-extraction compared to horses without periodontal disease
Simple extraction of non-fractured cheek teeth without periodontal disease did not produce remarkable systemic SAA elevation
Periodontal disease appears to drive a local inflammatory response that translates to detectable systemic inflammation when diseased tissues are mechanically disturbed
Crown elongation, oral mucosal ulceration, diastemata, class 1 malocclusion and hypodontia were the most common dental diseases in miniature horses
Older miniature horses had significantly higher prevalence of dental disease, diastemata and crown elongations
Horses with high body condition scores had increased likelihood of class 1 malocclusion
Miniature horses with wider heads showed higher prevalence of dental disease and class 1 malocclusions
20% of horses (50/248) had radiographic signs of disease with no corresponding oral examination findings
46% of horses (113/248) had oral examination findings warranting radiography
21% of horses with indication for targeted radiography (24/113) had additional disease missed by targeted approach alone
Full-mouth radiography detected clinically occult dental disease in approximately 1 in 5 horses
12-month prevalence of colic was 54.6% in this working horse population in Egypt
Severe dental disease increased colic risk 6.8-fold (OR 6.8, P<0.001)
Stereotypic behaviour, ground corn feeding, and recent anthelmintic use were associated with increased colic risk
Rice bran feeding in green season and geophagia/coprophagia were protective factors against colic
Evidence Base
Effect of Simple Oral Dental Extraction on Systemic Serum Amyloid A Concentrations in Horses
A. Sidwell, Marco Duz, A. Khan et al. (2024) — Veterinary Medicine and Science
Cohort Study
The prevalence and risk factors of dental disease found in 100 miniature horses.
Tinsley Tracy, Fogle Callie, Means Elaine et al. (2023) — Frontiers in veterinary science
Cohort Study
Diagnostic value of full-mouth radiography in horses.
Bishop Ian Tyler (2022) — Frontiers in veterinary science
Cohort Study
Colic in a working horse population in Egypt: Prevalence and risk factors.
Salem S E, Scantlebury C E, Ezzat E et al. (2017) — Equine veterinary journal
Cohort Study
Occlusal fissures of the equine cheek tooth: prevalence, location and association with disease in 91 horses referred for dental investigation.
Ramzan P H L, Palmer L (2010) — Equine veterinary journal
Cohort Study
Clinical dental examinations of 357 donkeys in the UK. Part 2: epidemiological studies on the potential relationships between different dental disorders, and between dental disease and systemic disorders.
du Toit N, Burden F A, Dixon P M (2009) — Equine veterinary journal
Cohort Study
Comparison of radiography and scintigraphy in the diagnosis of dental disorders in the horse.
Weller R, Livesey L, Maierl J et al. (2001) — Equine veterinary journal
Cohort Study
A Prospective View of Oral and Dental Examination and Dental Diseases in Horses in İzmit and Karacabey Pension Hara of Turkey Jockey Club
Fatih Mehmet Derelli, G. Atalan, M. K. Yönez (2025) — Harran Üniversitesi Veteriner Fakültesi Dergisi
Case Report
Application of the horse grimace scale in horses with dental disease: Preliminary findings
A. Sidwell, Marco Duz, Bradley Hill et al. (2024) — The Veterinary Record
Case Report
Computed tomography characteristics of equine paranasal sinus cysts.
Ostrowska Justyna, Lindström Lisa, Tóth Tamás et al. (2020) — Equine veterinary journal
Case Report
Septic sialoadenitis in equids: a retrospective study of 18 cases (1998-2010).
Kilcoyne I, Watson J L, Spier S J et al. (2015) — Equine veterinary journal
Case Report
Occlusal angles of cheek teeth in normal horses and horses with dental disease.
Brown S L, Arkins S, Shaw D J et al. (2008) — The Veterinary record
Case Report
Supernumerary cheek teeth (n = 24): clinical features, diagnosis, treatment and outcome in 15 horses.
Quinn G C, Tremaine W H, Lane J G (2005) — Equine veterinary journal
Case Report
Inflammation and response to bacterial infection as potential drivers of equine odontoclastic tooth resorption and hypercementosis: A proteomics insight.
Jensen Anders, Clarke Emily J, Nugent Zoe et al. (2025) — Equine veterinary journal
Expert Opinion
Equine Dental Care
SallyAnne L. DeNotta, Brittany Justesen (2025) — EDIS
Expert Opinion
Malocclusions and Dental Diseases in Privately Owned Horses in the Mazovia Region of Poland.
Górski Kamil, Stefanik Elżbieta, Turek Bernard et al. (2022) — Animals : an open access journal from MDPI
Expert Opinion
The Role of Computed Tomography in Imaging Non-neurologic Disorders of the Head in Equine Patients.
Stieger-Vanegas Susanne M, Hanna Ashley L (2022) — Frontiers in veterinary science
Expert Opinion
The Human-Horse Relationship: Identifying the Antecedents of Horse Owner Attitudes towards Horse Husbandry and Management Behaviour.
Hemsworth Lauren M, Jongman Ellen C, Coleman Grahame J (2021) — Animals : an open access journal from MDPI
Expert Opinion
A Brief History of Equine Dental Practice.
J. Easley (2020) — The Veterinary clinics of North America. Equine practice
Expert Opinion
Recent developments in equine dentistry
Cj Pearce (2020) — New Zealand Veterinary Journal
Expert Opinion
Show 7 more references
Offering better equine dentistry services.
(2018) — The Veterinary record
Expert Opinion
Functional anatomy of the equine temporomandibular joint: Histological characteristics of the articular surfaces and underlining tissues.
Adams K, Schulz-Kornas E, Arzi B et al. (2018) — Veterinary journal (London, England : 1997)
Expert Opinion
Equine dentistry: Survey on Swiss horse owners
Schiesser E, Geyer H, Kummer M et al. (2017) — Schweiz Arch Tierheilkd
Expert Opinion
Computed tomography and scintigraphy for evaluation of dental disease in the horse
Barakzai S. Z., Barnett T. P. (2015) — Equine Veterinary Education
Expert Opinion
Essential Considerations for Equine Oral Examination, Diagnosis, and Treatment
R. Menzies, J. R. Lewis, A. Reiter et al. (2011) — Journal of Veterinary Dentistry
Expert Opinion
Non-skeletal scintigraphy of the horse: indications and validity.
Archer D C, Cotton J C, Boswell J C (2007) — Veterinary journal (London, England : 1997)
Expert Opinion
Equine dental disease part 4: a long-term study of 400 cases: apical infections of cheek teeth.
Dixon P M, Tremaine W H, Pickles K et al. (2000) — Equine veterinary journal
Expert Opinion