Periodontal Disease: What the Research Says
Evidence from 25 peer-reviewed studies
What Professionals Should Know
- •Routine prophylactic antimicrobials may not be necessary for all standing cheek tooth extractions; reserve them for horses with concurrent diseases or high-risk cases
- •Mandibular extractions, dental infections, and extractions of multiple teeth carry higher complication risk and warrant closer monitoring
- •Document cases without antimicrobials to build evidence-based protocols that reduce unnecessary antimicrobial use while maintaining safety
- •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
- •Diastema widening is an effective treatment for cheek teeth diastemata with severe periodontitis, with 72.6% showing complete remission, but owners should expect that 50.5% will have permanent improvement while 22% may require re-treatment
- •Clinical improvement can be delayed; reassess cases at 4+ weeks post-procedure as some horses show delayed response to treatment
- •This is an invasive procedure requiring trained personnel; improper technique can cause iatrogenic pulpar exposure, so refer to specialists for advanced cases rather than attempting in-practice
- •Poor dental health alone is not a risk factor for large colon impaction in horses—other factors should be investigated in impaction cases
- •Dental disease severity does not reliably predict faecal particle size distribution in horses with impaction
- •Routine dental care remains important for overall health but may not prevent large colon impaction
- •Donkey owners and veterinarians must recognize that dental disease is extremely prevalent in donkey populations (>80%) and increases significantly with age, necessitating routine dental examinations as standard care
- •Enamel overgrowths occur at high frequency but most do not cause soft tissue damage, yet their high prevalence in forage-fed donkeys suggests multifactorial etiology beyond feed type that warrants further investigation
- •Routine dental care should be implemented for welfare reasons and breed preservation, as the current situation shows <5% of donkeys receive any dental attention despite the burden of disease
- •Dental disease is extremely common in donkeys; expect to find problems in 7 out of 10 animals examined
- •Start prophylactic dental examinations and treatment protocols from age 15 years, as this is when most significant deterioration begins
- •Multiple concurrent dental disorders are typical in older donkeys, requiring comprehensive rather than spot-treatment approaches
- •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
- •Expect significant dental disease in older donkeys (especially >25 years); routine oral examinations should be standard practice regardless of presenting complaint
- •Cheek teeth diastemata with periodontal disease is the dominant problem in aged donkeys—early intervention and preventive care may reduce progression
- •Poor dental health directly impacts welfare and quality of life; prophylactic treatments and monitoring protocols should be established for aged donkey populations
- •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
- •PPID-positive horses aged 15+ years should receive enhanced periodontal monitoring and preventive care as part of their management protocol
- •Dental disease in older horses may be a secondary manifestation of PPID rather than an isolated problem; address the underlying endocrine disorder
- •Consider periodontal health as part of comprehensive geriatric PPID assessment and management strategy
- •Screen geriatric horses (>15 years) for PPID before undertaking major dental treatment, as PPID impairs wound healing and immune function
- •Expect increased periodontal disease risk in PPID-positive horses; proactive oral hygiene and monitoring become more critical in these patients
- •Recognize macroscopic gingival changes (irregular texture, bulky appearance, deep sulci) as potential clinical markers of PPID in older horses during routine examinations
- •TMJ abnormalities are more common in older horses; consider age-related screening in geriatric patients with mastication issues
- •Infundibular disease appears linked to TMJ changes—investigate TMJ status in horses presenting with infundibular pathology
- •Periodontal disease alone may not drive TMJ pathology; focus diagnostic workup accordingly when assessing mastication problems
- •EOTRH is a painful progressive condition in older horses affecting multiple teeth; early recognition based on characteristic patterns of canine and incisor involvement is important for diagnosis and treatment planning
- •Diagnosis requires integration of clinical history (number and location of affected teeth), gross examination of hard/soft tissue changes, and radiographic findings; histopathology can confirm but is not required for clinical diagnosis
- •The condition begins at the external tooth surface, so preventive strategies and management should focus on maintaining periodontal health and addressing any systemic factors contributing to inflammation
- •EOTRH should be recognized as a specific periodontal disease form in horses with potentially infectious etiology requiring targeted management
- •Identification of red complex bacteria in affected horses may guide treatment decisions and antimicrobial strategies for equine dental disease
- •Routine oral health assessment should include consideration of bacterial involvement in tooth resorption cases, not just mechanical or nutritional factors
- •Check the caudal cheek teeth (especially Triadan 09-11) and peripheral cementum during routine dental examinations in trotting horses on high-concentrate diets, as peripheral caries can progress to serious dental disease
- •Be alert to increased diastemata and periodontal disease adjacent to PC lesions, and consider dietary management (lower concentrate, different forage) as a preventive strategy
- •Recognize that peripheral caries frequently coexists with widespread infundibular caries; thorough imaging and examination of all maxillary teeth is warranted when PC is identified
- •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
- •Equine dental disease was historically underdiagnosed and undertreated due to limited veterinary training; modern practitioners should recognize that contemporary equine dentistry is now evidence-based with substantial scientific support.
- •The resurgence in equine dentistry research since 1993 has provided practitioners with validated diagnostic and treatment protocols that supersede historical practices, such as unjustified incisor reductions.
- •Regular dental examination and professional care are now recognized as essential preventive health measures for working and sport horses, supporting the case for routine dental assessment in equine practice.
- •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
- •Nanoparticles show promise as alternatives to antibiotics for managing equine digestive health and microbial control, but require extensive in vivo validation before commercial recommendation
- •Multiple nanoparticle types target different equine health issues (digestive efficiency, parasite control, environmental impact) and could potentially be combined in feed additive formulations
- •Current evidence is primarily theoretical and in vitro; equine practitioners should await peer-reviewed clinical trials before adopting nanoparticle-based feeds for their clients
- •When selecting materials for equine periodontal pocket filling, PeriCare® and Provicol® appear safer choices based on in vitro biocompatibility data, while Honigum and Calxyl® should be avoided until clinical validation is complete
- •Do not assume human dental materials are safe for equine periodontal therapy without species-specific testing—equine fibroblasts respond differently than human cells
- •Request clinical confirmation before widely adopting any dental filling material for equine periodontal disease, as in vitro results need practical validation in live horses
- •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
- •Understanding that excessive masticatory forces create stress concentrations in the PDL may explain why horses develop periapical disease and help guide preventive management strategies
- •Consider the biomechanical environment when evaluating horses with recurrent cheek tooth problems—excessive wear patterns or malocclusion may amplify PDL stress
- •Proper dental care and equilibration to optimize occlusal forces may reduce PDL strain and lower the risk of periapical inflammation
- •Perform thorough oral examination with full mouth speculum on all horses as many suffer from undiagnosed, painful dental disorders that compromise mastication and performance.
- •Address enamel points and other wear disorders promptly to prevent progression to severe conditions like shearmouth and widespread periodontal disease.
- •Suspect apical infection in horses with facial swelling or fistulae and obtain radiographs for diagnosis; prioritize oral extraction to minimize complications compared to alternative extraction methods.
- •Peripheral caries is a common oral condition in horses that warrants routine screening and clinical attention due to pain and pathological implications
- •Practitioners should assess horses presenting with periodontal disease for concurrent peripheral caries, as the conditions appear to be associated
- •Understanding the anatomical basis of these lesions may improve diagnostic accuracy and treatment planning for equine oral pathology
Key Research Findings
Complications occurred in 56 cases (18.4%), with 12.7% mild/transient and 5.6% severe requiring veterinary treatment
Antimicrobial use was associated with increased complication rates (OR 2.69; p=0.02), suggesting complications may prompt antimicrobial use rather than antimicrobials preventing complications
Concurrent diseases (OR 4.32; p=0.001), mandibular extractions (OR 2.20; p=0.018), warmer seasons (OR 1.97; p=0.04), and extraction reason (dental infection OR 6.37, fracture OR 3.90) were significant risk factors
Many horses (35.4%) did not receive antimicrobials without resulting in higher complication rates, challenging routine prophylactic use
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
72.6% of 202 horses treated for cheek teeth diastemata with diastema widening showed complete remission of clinical signs at mean 20.8 months follow-up
50.5% of cases achieved permanent remission while 22% experienced temporary remission of clinical signs
Common pre-treatment clinical signs included quidding (76.2%), weight loss (33.2%), bitting problems (20.1%), and halitosis (10.9%)
19% of cases required >4 weeks post-treatment for clinical improvement to manifest, and mean 1.5 treatments per case were necessary
Horses with large colon impaction did not have significantly worse oral pathology scores (P=0.2) or periodontal disease indices (P=0.3) compared to control horses
Faecal particle size estimates were significantly higher in control animals (P<0.001)
In horses with large colon impaction, faecal particle size estimates increased with increasing periodontal disease index (P=0.05)
No significant association was found between faecal particle size estimates and oral pathology scores in either group
Evidence Base
Possible association of short-term complications and antimicrobial use in standing equine cheek tooth extractions 2018-2022.
Schnierer Marlies, Nekouei Omid, Huber Lisa Christina et al. (2025) — Equine veterinary journal
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
A long-term study on the clinical effects of mechanical widening of cheek teeth diastemata for treatment of periodontitis in 202 horses (2008-2011).
Dixon P M, Ceen S, Barnett T et al. (2014) — Equine veterinary journal
Hospital-based study of dental pathology and faecal particle size distribution in horses with large colon impaction.
Gunnarsdottir Helga, Van der Stede Yves, De Vlamynck Caroline et al. (2014) — Veterinary journal (London, England : 1997)
A clinical survey on the prevalence and types of cheek teeth disorders present in 400 Zamorano-Leonés and 400 Mirandês donkeys (Equus asinus).
Rodrigues J B, Dixon P M, Bastos E et al. (2013) — The Veterinary record
Clinical dental examinations of 357 donkeys in the UK. Part 1: prevalence of dental disorders.
du Toit N, Burden F A, Dixon P M (2009) — Equine veterinary journal
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
Post mortem survey of dental disorders in 349 donkeys from an aged population (2005-2006). Part 1: prevalence of specific dental disorders.
Du Toit N, Gallagher J, Burden F A et al. (2008) — Equine veterinary journal
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
Periodontal structures in horses with pituitary pars intermedia dysfunction: A histological evaluation.
Zapf Anne Maria, Fey Kerstin, Büttner Kathrin et al. (2023) — Frontiers in veterinary science
The Gingiva of Horses With Pituitary Pars Intermedia Dysfunction: A Macroscopic Anatomical Evaluation.
Nitzsche Anne Maria, Fey Kerstin, Büttner Kathrin et al. (2021) — Frontiers in veterinary science
The association between oral examination findings and computed tomographic appearance of the equine temporomandibular joint.
Carmalt J L, Simhofer H, Bienert-Zeit A et al. (2017) — Equine veterinary journal
Equine Odontoclastic Tooth Resorption and Hypercementosis: Histopathologic Features.
Smedley R C, Earley E T, Galloway S S et al. (2015) — Veterinary pathology
Isolation of Treponema and Tannerella spp. from equine odontoclastic tooth resorption and hypercementosis related periodontal disease.
Sykora S, Pieber K, Simhofer H et al. (2014) — Equine veterinary journal
Post mortem survey of peripheral dental caries in 510 Swedish horses.
Gere I, Dixon P M (2010) — Equine veterinary journal
Equine Dental Care
SallyAnne L. DeNotta, Brittany Justesen (2025) — EDIS
Equine dental disease – no longer a neglected field of study
P. M. Dixon (2021) — Equine Veterinary Education
A Brief History of Equine Dental Practice.
J. Easley (2020) — The Veterinary clinics of North America. Equine practice
Recent developments in equine dentistry
Cj Pearce (2020) — New Zealand Veterinary Journal
Nanoparticles in Equine Nutrition: Mechanism of Action and Application as Feed Additives.
Adegbeye Moyosore J, Elghandour Mona M M Y, Barbabosa-Pliego Alberto et al. (2019) — Journal of equine veterinary science
Show 5 more references
Influence of dental materials on cells of the equine periodontium.
Ringeisen H, Pöschke A, Krähling B et al. (2018) — Equine veterinary journal
Computed tomography and scintigraphy for evaluation of dental disease in the horse
Barakzai S. Z., Barnett T. P. (2015) — Equine Veterinary Education
Periodontal biomechanics: finite element simulations of closing stroke and power stroke in equine cheek teeth.
Cordes Vanessa, Lüpke Matthias, Gardemin Moritz et al. (2012) — BMC veterinary research
A review of equine dental disorders.
Dixon P M, Dacre I (2005) — Veterinary journal (London, England : 1997)
Peripheral caries and disease of the periodontium in Western Australian horses: An epidemiological, anatomical and histopathological assessment.
Jackson K, Kelty E, Staszyk C et al. (2019) — Equine veterinary journal