*1 – Horse Dentistry – Frequently Asked Questions

Note: The information here was updated in September 2022 but little was changed because the information is timeless. Doc T

FAQ – General questions about dentistry in horses

FAQ – Dental issues of horses

Does my horse need dentistry?

According to research, the horse chews between 10,000 and 40,000 times a day. Therefore, the hardness of the enamel varies between horses. In addition, the movement of the jaw and the tongue also varies between horses. These two factors will affect how rapidly the sharp enamel edges reform. I have seen edges last one year, and I have also seen them last one month. The average is six months.

However, there is a more important determinant of when to re-float the horse. It is the perception of pain by the horse. In other words, there are some tough horses and some wimps.

For most horses, somewhere between 6 and 12 months, the need to float the teeth moves from a preventive procedure to a corrective one. The only one who can determine when it is time to float the teeth is the horse. It is up to the rider to feel when the horse is due or to schedule floating before that point is reached. Prevention is the preferred situation because when your horse starts to have a bit or chewing problem, it may be a while before you can get your vet or dentist to respond.

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Why dentistry is an important part of a veterinary practice.

As a veterinary student, my mentor told me about the importance of dentistry in horses in 1983. I believed him. After nearly three decades, his words are still true. On this day, I will again witness the horse’s gratefulness once his pain is gone.

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Expectations between the client and the vet or dentist.

What does this have to do with equine dentistry? Well, it pertains to dentists, vets, farriers, and the feed delivery guy. Why? Because we can’t live without you, and you can’t live without us. We are partners. It is time to respect each other and watch the great things that can happen.

Remember, you can only change yourself. So if the vet arrives on your farm grumpy, so what? He’ll be gone soon.

“Buddha And The Jerk”

Remember Buddha, the guy sitting cross-legged way up on top of the mountain? Once a bad-mouthed jerk of a guy heard about him and thought he could mess up his day. So he climbed the mountain.

“Hey Buddha, you got a minute?” Then he laced into him with all the insults he could think of. Finally, after a while, Buddha said, “May I ask you a question? If you offer me a gift and I refuse it, who does that gift belong to?”

The man said, “It would be mine!”

Buddha replied, “So if you offer me insults and I don’t accept them, who do they belong to?”

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How often should dentistry be performed on horses?

It’s Not How Sharp The Teeth Are; It Is The Horse’s Threshold Of Pain

The frequency of floating a horse is variable and is related to the individual horse. Often, we think of prevention on a mechanical device, like how often you change the oil in a car’s engine.

A horse is a living thing and not a machine. The threshold of pain determines how frequently you need to float. In other words, how they perceive the sharp points against their cheeks and tongue.

Other determinants are genetics, age, and discipline. Some horses’ teeth are softer or decay more easily. Older horses have harder enamel and erupt less. Certain disciplines require more bit contact while others don’t need a bit.

The least determinant of the frequency of floating should be the cost because the benefit of preventing pain inside the horse’s mouth is well worth the little annual cost you spend getting it done. Plus, this one preventive act may help decrease other costs such as lost hay and grain (spilled or not eaten due to pain), lost training time (horse is more compliant and willing to learn), and decreased vet bills (a more comfortable horse is usually more healthy).

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The purpose of floating teeth (basic dentistry)

Removing Pain

Removal of the source of pain from the mouth of the horse is the primary purpose of equine dentistry. Most problems or pathology of the horse mouth are secondary to pain. Over my decades of floating, I observed the alignment of the teeth after about two years of dental care. It is as if they were wearing braces. In addition, often pathology, including local gum infections, resolves once the jaw and the tongue are allowed to move pain-free.


We know that horse teeth erupt (not grow) throughout life. We know that excessive tissue or hard enamel points develop from unopposed wear, and those sharp edges can dig into the horse’s tongue or cheek and create pain. The purpose of floating a horse’s teeth is to remove all those sharp points and make the horse comfortable.
The bottom line is removing all sources of pain. Some other dentists today think the purpose of floating horse teeth is to get proper alignment and lateral excursion, among other things. But I find that a horse chews a lot in a day. It has been documented that they chew between 10,000 and 40,000 times a day. The purpose, then, is to let the horse chew comfortably and chew into the pattern they are supposed to have.

I believe that any change in a horse’s mouth primarily occurred because there was pain. The horse will find its own “groove” and start chewing comfortably by eliminating the pain. Most of those problems in the mouth will disappear, including abnormally shaped incisors, waves, and gum disease. Most of these, if not too advanced, will be alleviated if you consistently float the horse, remove all sources of pain, and let the horse chew comfortably.

Removing the cause of oral pain is the primary purpose; from that, all the secondary things will follow. But if you don’t go after the primary reason but only after all the secondary things, then the order is off, and, in my opinion, dentistry won’t work.

With the removal of pain, the horse will show comfort on the bit and comfort while eating. But, more importantly, you will see it in the long term, as the horse’s teeth change position over many years, becoming aligned inside the horse’s mouth as if they were wearing braces. This is because the teeth are no longer causing pain and limiting the movement of the jaw.

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Are your horse’s teeth floated well?

Are you willing to reach in a horse’s mouth?

There is no effective way to determine that your horse has been floated well, which is why so many bad equine dentists exist. Modern equine dentists use a light and a jacked open mouth to show you an issue, but using sight is not a complete way to evaluate the mouth.

The Horse Will Tell You

The best way to determine if a job is well done is to listen to your horse. How does he respond to the floating process? Without pain medication, the horse will often demonstrate relief right there. After floating, does the horse carry the head and neck with symmetry when ridden and does he accept contact from the bit without resistance?

There are other reasons for a horse to have difficulty with the bit, and if a thorough floating doesn’t solve the bit issues, then you need to look else ware. For this strategy to work, you must have confidence in your dentist.

Aside from having the horse tell you, other options include word-of-mouth testimonials. For example, if you have many horses and all respond but the one you are concerned with, then that one horse may have an issue outside the mouth.

Using Horsemanship Dentistry, it is common to see horses show gratefulness before the float is completed. Also, it is common for owners to tell me later that the bit issues have been resolved. These are sure signs that your equine dentist has done their job.

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Why should dentistry be performed on my horse?

A Horse Chews 10,000 To 40,000 Times Per Day

Horse teeth continually erupt, but as they wear against each other and the tongue strops teeth into razor-sharp edges, painful ulcers develop in the associated soft tissue. Many horses object to this pain. The result is poor bit performance and disuse of the tooth, leading to local tooth disease and premature loss.

I make one mistake in this video in the beginning. I accidentally say “grow” instead of “erupt,” as I correctly say later. I apologize, but the horse’s teeth are fully developed by five years of age. They do not grow like their hooves or your fingernail. Instead, they erupt a little over time until they have no more material coming out. See the explanation below.

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Why I do not use power equipment to float horses.

Horsemanship versus Auto Mechanic

Power tools (air or electric) used in equine dentistry can be effective when used by trained equine dentists. What I don’t like about them is the immobilization of the horse for the procedure. Over drugging, mouth jacking, and the head suspension goes against every fiber of horsemanship I know. It is not in the horse’s best interest and turns the art of the horsemanship approach to equine dentistry into the auto mechanics approach.

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Abscesses in horse teeth

Abscesses Of Horse Teeth Are Rare

An abscess in a horse tooth is very rare. More commonly are infected draining tracts along the tooth: long-term antibiotics and diligent floating resolve most cases with surgery as a last resort.

Abscesses can occur within the tooth or along the side, penetrating down to the tip of the root. While tooth removal has been the traditional and effective treatment, I have found a less dramatic solution. My reasoning is simple. As we look at the total horse population, if tooth abscesses were common and problematic in horses, wouldn’t we see draining pus from the nostrils, face, or jaw everywhere? But they are not. They are usually self-limiting, AND I rarely, if ever, see a horse show pain from it.

Find And Treat The Cause

The question is, what caused the abscess in the first place? If a tooth has a genetic defect, removal is usually the result. However, in most cases, I find that the tooth has become unhealthy, allowing a disease process to occur. So how does it become unhealthy? If every tooth needs stimulation to remain solid in the jaw, the lack of stimulation allows ever-present bacteria to infiltrate the opportunity area.

Prevention Is The Key

Two things are necessary for tooth stimulation. First, the tooth needs to have pressure applied to it. Second, the tongue must push it around and clean up the attachment area. If pain is present, the horse will avoid chewing in that area. He will pack food to prevent the sore cheek from touching the sharp tooth. In addition, the tongue will avoid these sharp areas. The result is a lack of stimulation with subsequent disease formation.

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Broken teeth (cheek tooth fractures) in horses

All Sizes Of Tooth Fractures Are Common

As a horse dentist, I commonly find broken teeth during an equine dental exam. They are usually incidental findings. On occasion, though, a small chip hangs at the gum attachment and irritates the opposing cheek creating pain and a training issue. On the other hand, I have found horses with the tooth split down the middle like you would split a log for the fireplace. And these horses display no indication that there is something wrong. Either way, the fracture site is a source of impacted feed and local infection and an area with razor-sharp edges. Often, removing the piece requires pain medication by a veterinarian.

It is interesting to note that while tooth fractures are obvious to see, feel and sometimes smell, they were not in my veterinary textbooks in the 1980s. Could tooth fractures be a new disease in horses? If tooth decay of the pulp chambers is the cause, could this decay be a result of feeding high starch diets as it is in humans? In 1932, researchers found oatmeal to cause dental decay in children. Something to think about: prevention is better than disease and treatment.

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Caps and cap remnants in young horse teeth

24 Caps In 2 Years

Caps are what humans call baby teeth and are named deciduous teeth because they fall off like the leaves of a deciduous tree. They sit like a cap on your head over the permanent tooth erupting below it. Their location includes over the incisor teeth (also known as the nippers directly behind the lips – 6 on top and six on the bottom) and the premolars (the first three cheek teeth counting from the front to the back – top and bottom, both sides = 12 teeth). These caps jettison the mouth between the ages of 2 and 1/2 until almost five.

Hanging Caps, Broken Caps, Cap Remnants All Can Cause Discomfort

Often, the break away from the mouth is uneventful. However, on occasion, two problems can occur. First, during maturation, the tooth loosens but does not come off. The telltale sign is a foul odor from the young horse’s mouth. The second is an attachment of the cap breaking off, leaving a hard piece between the permanent tooth and the gum (like a kernel of popcorn stuck between your tooth and gum). This can become a source of localized infection and pain requiring removal. Again, they are discovered easily with fingers rather than with eyes.

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Cavities in horse teeth

These Are HORSE Teeth, Not HUMAN Teeth

Cavities occur in horses, but they usually resolve by self-repair with the removal of starch/grain, or a piece of tooth breaks off with no harm to the horse (see tooth fractures).

Some equine dentists “filling” horse cavities say that the horse will live on average five additional years because of the treatment. This fabrication is just a play on your emotions based on your fear of cavities in your mouth.

Just as a reminder, these are HORSE teeth and not HUMAN teeth. They are completely different. Since 1983 I have not had one horse come to me with a complaint of a cavity-causing him not to eat or causing any other issue.

Decay of one or more of the pulp chambers of a tooth will eventually cause a fracture of a part of that tooth. Think of a wedge splitting a log into firewood. The upper 9’s are the most commonly affected.

In 2013 at the AAEP meeting, speakers mentioned that the dental acrylics used to repair these decaying areas are ineffective. They usually fall out. Remember that horse teeth continually erupt with chewing and ware.

I have found that about 1 in every 40 horses (or more) I see has a tooth fracture which causes no problem in the horse other than occasionally the tooth fragment creates a painful rubbing ulcer in the cheek or tongue. The tooth fragment is easily removed, and the sharp edges are smoothed.

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Equilibration and lateral excursion in equine dentistry

Based On Poor Science And Not Needed

“Equilibration” and “lateral excursion” are definitions used in modern equine dentistry to describe issues seen inside the horse’s mouth. These dentists evaluate the movement of the jaw and adjust this movement by filing off edges in a manner that aligns the jaw. However, I feel that three issues invalidate these procedures.

  1. First is that the primary cause is not directly addressed (the removal of pain); however, the sharp points are removed, so it is addressed secondarily. In other words, it is the removal of pain that the horse responds to, not the equilibration procedure.
  2. The second issue is that a horse chews 10,000 to 40,000 times a day, so all the work done by the equilibration process may be gone in a week or two as the horse equilibrates by himself.
  3. And third, if the jaw has been out of equilibration for a while, is it possible that correcting it in one procedure may injure the horse? We certainly would not abruptly change hoof angles without worrying about creating lameness.

So why do so many horses stop eating for days or weeks after being floated using these modern techniques? This happens so rarely in our practice, where our only focus is on eliminating oral pain.

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Flabby cheeks and how they affect horses

“Flabby Cheeks” Is A Major Cause Of Most Bit Problems In Horses

Excessive tissue lying in front of the bottom first cheek teeth can become extremely irritating to some horses. Here is where a picture is better than words (see below). Rounding the first cheek teeth is commonly called the bit seat. The purpose is to smooth out the edges to prevent the trapping of this excessive tissue. Flabby cheeks are actually, in some horses, the primary cause of bit pain.

For some reason, I get everyone’s attention when I say “flabby cheeks,” but its’ importance cannot be overstated.

“Flabby cheeks” is my description of excessive cheek tissue just behind the corners of the lips. In my experience, many of these horses are easy to float as long as I don’t go near the lower first cheek teeth. Unfortunately, I sometimes need to administer pain medication just to finish the float. These horses anticipated the pain and fought floating in this area. My goal is to round the front aspect of this tooth so that it can easily move out when the excessive tissue moves into this area without becoming trapped.

Another area where excessive tissue can become trapped and pinched by the teeth is the base of the tongue next to the last bottom cheek teeth. These horses are very sensitive and respond favorably to the smoothing of the inside area of the last bottom teeth. I call this “Flabby Tongue,” and it is less common than “Flabby Cheeks.”

“Flabby Cheeks” – This picture is an example of a severe “Flabby Cheeks” where the cheek tissue drapes over the lower left first cheek tooth. This horse had a sore that is underneath the skin.

“Flabby Cheeks” And The “Threshold Of Pain” – A Question About Bits

This request came to me last week –

“Watched the Bit Seat video and would like to request a topic for consideration – how bits work and what goes into selecting the right bit for the job. There’s got to be some science here, beyond just what feels right. Am particularly interested in how leverage really works on the horse’s mouth, how different bits fit into different mouths and associated categories of benefits and drawbacks. Heard the Stable Scoop interview with Myler and have watched that video series also. Concur that some but not all of that theory makes sense. I’ve worked with and watched trainers for many years and have been fortunate enough to know some very good, thoughtful ones. However, none has ever been able to give an answer to the “How does this bit work?” question in a “mechanical” sense.”

My response:

This subject is emotionally charged with horse owners today. A rift is developing between those that use bits and those that ride bit-less. This question only asks how a bit works. My response may surprise you in that I believe it is not how the bit works but how the horse RESPONDS to the bit.

This space does not allow for an in-depth response; however, it will allow me to introduce two ideas I feel have been lacking in the discussion.

About 1980, a study with fluoroscopy (a movie using x-rays) showed the position of the parts of the mouth viewed without a bit and then with several bits. The name of the veterinary journal was Vm/Sac, in case someone wanted to look it up. It showed that pressure was applied to the tongue, bars, and the roof of the mouth. I think you and I could have guessed that. There can’t be a single answer to the question “How does this bit work?” because horses, like people, are different. What works on one horse may not work on another. Therefore, this study did not consider the variety of mouths, the presence of excessive fat tissue, or the threshold of pain. Unfortunately, it started a bias against bits.

There are two considerations. First, too many people ride with their hands and not their seats. The hands and the bit should convey subtle cues. The second is very important but has not been adequately addressed. It is the threshold of pain for the horse. This is the most variable aspect regarding a horse’s response to the bit regardless of the bit’s action on the mouth. It needs to be factored into every horse when assessing bit response.

The cause of pain in the horse’s mouth needs to be addressed. Primary is the sharp edges of the first cheek teeth. But, more importantly, the excessive soft tissue in front of these teeth is pinched when the bit traps it. I call these “flabby cheeks,” and I have been trying to draw attention to this for years. While it is not an issue in every horse, in my experience, “flabby cheeks” affect about 1/3 to 1/2 of the horses I see.

From my perspective, the added mechanics of the bit, such as curb chains, long shanks, and twists, respond to the horse’s reaction to resistance, bracing, reluctance to turn, or reluctance to bend. I know that many horses show remarkable improvement after floating horses with bit issues, sometimes coupled with changing the bit to a smaller diameter.

Some “bit issues” are not in the bit at all. For example, I have seen horses with nuchal bursa inflammation and cervical pathology (both in the neck) that, once treated, resolve bolting and other severe “bit issues.” However, I have also seen horses ridden without a bit that resolves the issue.

Your question, “How Do Bits Work,” needs to be restated to “How should bits work?” Gently, quietly, and with a light touch, no matter what kind of bit is used. I advocate smoothing all tooth edges, becoming aware of a horse’s “flabby cheeks,” and using light hand pressure. With these adjustments, I feel that any bit, and at best the simplest of bits, will work on most horses.

Maybe this is not what you wanted to hear, but I am as frustrated as you are with what people say about this issue. The facts, from my perspective, are clear. Float well, respect your horse’s response to “flabby cheeks,” and lighten up on the hands to resolve most bit issues.

By the way, you mentioned the word “theory.” Did you know that most theories in the horse world are unproven, especially in equine dentistry? We all theorized without facts that the sun circled the earth until someone had enough facts to prove the theory of the earth circling the sun.[/cs_text]

“It is a capital mistake to theorize before one has data. Insensibly one begins to twist facts to suit theories, instead of theories to suit facts.” – “Sir Arthur Conan Doyle, Adventures Of Sherlock Holmes, A Scandal in Bohemia”

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Hooks (over-erupted teeth) in horses

Hooks Block Free Movement Of The Jaw

Horse teeth erupt throughout life, and the opposing tooth wears them down. If nothing is there to wear down this growth, it becomes excessive, which is called a “hook.” This video describes various types of hooks and what problems they cause in your horse. Removing these hooks is aggressive, but the results are worth it.

Hooks form when there is no opposing wear, but when the mouth is held shut with a nose band, and the head is flexed or turned, any hook will become a blockage to that head movement. The result is a flipping of the head or a resistance to turning to one side. Removing the hook(s) resolves this bit problem. But, again, it is not the fault of the bit but the teeth that are at the root of most bit problems.

As of 2020, I usually reduce hooks using medication and filing with more removal over subsequent floats. In addition, I rarely use compound hook cutters to avoid using antibiotics if a pulp chamber is exposed while cutting the tooth.

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Incisor reduction in horse dentistry

“A New Profit Center” Developed Without Science

Modern equine dentists have recently embraced the removal of material from the front teeth of a horse (nippers, incisors). Unfortunately, horses have died from this procedure because of bone infection secondary to tooth root/pulp exposure. There is no basis in good science for performing incisor reduction, and I will not do it until someone proves to me the necessity for it. The veterinary profession has moved away from routinely performing this procedure (AAEP and the BEVA at their meetings in 2003).

In my opinion, and now from others in the veterinary research community, the shape of the incisors is secondary to the movement of the jaw and tongue. These movements are affected by pain and avoidance of that pain caused by sharp structures (points) against the sensitive tissues of the mouth (cheeks, tongue).

A question posted on my YouTube site for this video:

“I have found some of your videos interesting but I wanted to discuss this incisor bit with you, purely for curiosity. If a horse doesn’t need “proper grinding” how is it that a horse who is over-floated can “starve” from lack of nutrition? Do you really believe proper mastication doesn’t increase digestion efficiency?

Also, I just wanted to point out that though “back teeth grind and your front teeth never touch” is it not also true that a horses front teeth are always in occlusion?? What have your results been with a horse who has incisor malocclusion? Have you looked into “camming?” When the lateral movement of the mandible takes place, and the horse’s incisors are in occlusion, BUT there is a slant, or a curvature, this HAS to separate the back teeth, and hence you would notice a larger temporal muscle on one side. This is PROOF of excessive use on one side due to incisors and so I am curious as to your results/thoughts.” – “Mack Horse” on March 21, 2013 on my YouTube page

My Response:

1) Over-floating can remove all points preventing the horse from getting a grip on the food, causing him not to form a swallowable bolus. This is why some horses have difficulty chewing after floating with quid formation. In the worst case, the horse cannot swallow anything, causing starvation.

2) The purpose of chewing is to form a swallowable bolus. Other chewing results include increasing exposed surface area for digestive enzymes and bacteria to work. Adding saliva lubricates as well as starts the breakdown of sugar. There is no study to prove that increased chewing causes improved digestion. An analysis of 17 horses with various teeth conditions were given the same feed. A sampling of digestive contents showed that digestion occurs in the digestive tract, and chewing was not a factor. As every horse owner knows, most of the manure in one barn looks the same. Condition of the colon has the most element of manure consistency, with horses on high grain diets having colonic ulcers causing loose and watery manure and whole grains passing undigested. So, to answer your question, no, “proper mastication” doesn’t increase digestion efficiency.

3) Incisor occlusion – the only time incisors occlude (and again, there is no study, only assumptions) is when they are biting something. Incisors are used as weapons in fighting. They are not used in sniping off the grass, as seen in parrot mouth horses (no occlusion) and horses without incisors (lost with EOTRH). All ruminants (cattle, deer, sheep, goats) never have upper incisors. With that in mind, what causes teeth to wear? Specifically incisors? Their enamel is different (seen in electron-microscopy) and softer than the cheek-teeth enamel (Dr. Paddy Dixon, personal communication 2003). I believe the tongue moving over the teeth causes the most wear. I also think the constant pressure of the tongue behind the incisors moves them forward in older horses (Please see all the images in the aging project post). Do they come into occlusion? Yes, and anywhere there is no opposition, an overgrowth occurs, such as the upper 3’s forming the seven-year hook. My statement was WHEN CHEWING; the incisors do not come into occlusion because the bolus of food prevents full closure of the mouth.

Again, for chewing, the incisors are not required. Why, then, are the incisors looked upon with such interest by horse dentists? Because it is a “profit center,” as expressed by the man who invented it in the 1980s (personal communication with another equine dentist who was told this directly). There is no science behind it, and several horses have died from the process as secondary, un-treatable osteomyelitis caused the horse to stop chewing from pain, leading to starvation. If the occlusion is necessary, why aren’t we filling in the over-worn teeth of cribbers or stall bar rubbers?

4) My results with horses with incisor malocclusions – Any variance to a perfect horizontal occlusion is secondary to something causing the horse to chew unevenly. The number one reason I have seen for this is sharp points causing buccal ulcers and chronic pain. The horse chews in a way to avoid the pain, much like a human walks lopsided if one leg hurts. The second reason to cause uneven chewing is an over-erupted tooth such as 311 and 411 hooks. Every horse I have seen with uneven incisors has been in good body condition. One of my expressions is, “I have never seen a skinny parrot-mouthed horse.” The same is true for uneven incisors. Smoothing all sharp points of the cheek teeth always improves their chewing. Again, no study has involved just reducing the points, reducing just the over-erupted incisors, or both.

5) No, I have not looked into “camping” as my belief in its’ theory is doubtful.

6) “When the lateral movement of the mandible takes place, and the horse’s incisors are in occlusion, BUT there is a slant or a curvature, this HAS to separate the back teeth, and hence you would notice a larger temporal muscle on one side.” – This is classic “cart and horse” argument, which came first. Your statement requires that the over-eruption of the incisors causing the uneven bite is an active event that forces the jaw out of position. I believe the over-eruption is a passive event secondary to the horse’s chewing movement. Removing incisor growth doesn’t cause the teeth to become re-balanced. However, removing the pain caused by the cheek teeth will allow it to close correctly; over time, the incisors can self-correct. Nobody has taken the time to prove this. Regarding the asymmetry of the muscle, that can be caused by an altered chewing pattern caused by pain, not by incisor obstruction. Most horses select one side to chew their food (so do we humans), and in almost every horse, the soft tissue below the left temporomandibular joint (TMJ) is larger than the right and in some, it is also painful to pressure.

Finally, thank you for asking me my opinion on incisors in horses. I believe that horses have survived for many years without our interference. I also believe in doing what is in the horse’s best interest. Reducing incisors and balancing them is something I have looked at for three decades, and I am not convinced that it is the right thing to do. In a personal conversation with Dr. Paddy Dixon in Scotland (co-author of Equine Dentistry with Dr. Easly) in 2003, he said that the United Kingdom is moving away from recommending incisor reductions as they are secondary to a primary event in the cheek teeth area. In addition, they have caused the death of several horses. Later that year, the same thing was said by Dr. Lowder (Georgia Vet School) at the AAEP equine dentistry wet lab. That was enough for me to end the discussion on the subject.

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Jaw lumps (eruption bumps) in young horses

Every Action Has An Equal And Opposite Reaction

Hard, non-painful lumps located along the bottom edge of the jaw or on the face and seen in horses between 2 1/2 to 5 years of age are a common result of the eruption of permanent cheek teeth in the horse.

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Medication – why and when to use drugs in horse dentistry

Drugs Eliminate Horsemanship From The Equation

Medication should be given when the horse asks for them. The medicine allows the horse to cooperate with painful procedures, including wolf tooth extraction, fractured tooth removal, and occasionally routine floating.

If the horse needs pain relief, medicating the horse allows for completing the float, which is what you are paying for. This is the ethical use of medication in horses. With Horsemanship Dentistry, about 1 in 10 horses need medication. Half of those medicated are for procedures, while the other half are for routine floating. This means that one horse in every 20 needs medication to help them overcome their fear of the dentist. This is based on my yearly statistics of medication used over the last ten years.

The automatic use of medications for routine dentistry is unnecessary. These dentists were never taught how to perform dentistry without using medication. While being trained, they were taught that without drugs, only an incomplete float could be achieved with floating. I disprove this thought every day by using Horsemanship Dentistry.

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Medication – what types of drugs are used in horse dentistry

Pain Killers And Whiskey

The two types or classes of drugs I use in my equine dental practice are sedatives and analgesics (painkillers). Occasionally, I use an anxiolytic (removes anxiety) for scared horses. I do not use tranquilizers which are a completely different class and do not provide pain relief. In addition, two of the three drugs I use are controlled substances requiring a DEA license and my veterinary license. In other words, true painkillers can’t be bought and used by non-veterinary equine dentists.

When on a date, you have two choices. 1) take the time to build a relationship or 2) get drunk. Automatically sedating a horse without true painkillers is just getting the horse drunk to make the task easier. BUT… if you want to be on the date but have a whopping headache, then take pain medication to enjoy the date. This analogy is exactly why I only use pain medication when the horse requires it, but I never automatically “sedate” a horse.

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Nooks, crannies, swales on other unique features of horse teeth

Fun Definitions Of Things In Your Horse’s Mouth

These descriptions I’ve coined relate to some anatomical irregularities of a horse’s teeth. If they are not addressed, pain sources may continue in the horse’s mouth. I have never been a big fan of complicated words.

Every person that floats horse teeth needs to address everything that brings discomfort inside the mouth of the horse. It is not rocket science; however, it requires knowledge about the small things I talk about here.

Nooks and crannies (pictures below) describe very small pockets along the edge of the tooth where it should be smooth. Think of a serrated sharp-edged knife like a bread knife. The small, sharp edge of the teeth is like that knife. This edge is difficult to file because of these irregularities, which, by the way, are more pronounced in young horses. I call these prominent nooks and crannies.

The “crannies” are the dips between the ridges of the teeth. The “nooks” are the spaces between the teeth (ignore the arrow pointing to the cranny to the right.)

The swale is a low area or trough in many horses in the middle of the lower and upper jaws. Often confused with “Wave Mouth” or a “Ramp” of the last lower cheek tooth, it usually affects both chewing surfaces of the lower jaw and the outsides of the upper jaw. The teeth in this area are much sharper than any other tooth in the mouth. I suspect the movement of the tongue in positioning the food wears these areas more aggressively. Smoothing these areas requires extra effort and is often missed by inexperienced floaters. Remember, the goal is to remove all causes of discomfort.

Hooks occur when a tooth has no opposing tooth to wear the tooth down to the level of the surrounding teeth. The common cause is an overbite, easily seen by parting the lips to determine if the incisors are lined up or not. A parrot mouth only affects the incisors but does not affect the cheek teeth or cause hooks. An overbite will shift all the teeth so that hooks will form on the 1st upper cheek teeth – even on the caps – and after six years of age, on the last lower cheek teeth.

The lower hooks on the last cheek tooth can prevent the mouth from fully and comfortably closing, just like trying to close a door with a rock or shavings on the hinge side. Tight bridle nose bands preventing the mouth from opening accentuates the problem, especially when drawing the head down (collecting). The horse usually resists and can even violently flip his head up.

Old horse tooth occurs in horses older than 17. At this age, the first lower cheek teeth run out of the normal hard tooth material. Instead, the softer material is exposed to continual tongue movement. Like the old barbers who sharpened their razors on a leather strop (stropping the razor), the tongue sharpens these teeth to a razor’s edge. Often in very old horses, these are the only teeth that need attention.

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Older horse dentistry

Prevention Is Better Than Fixing In Older Horses

Some issues are unique to horses 20 to 25 years old and older. Most of them could be avoided by starting a dental care program early in life. Often management changes are required to maintain their weight. Very old horses that have not received dental care in the past sometimes are harmed by the floating process. The dentist must take care to be conservative and perform several light floats to get their teeth back into shape.

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Points – what are they, and how do they form

1 = Smooth, 2 = Slight 3 = Ready To Float, 4 = Overdue, 5 = Sharp As A Rip Saw

Points are the sharp edges created on the edge of the chewing surface that can develop sores (ulcers) on the cheeks and the tongue. Removal of this excess hard enamel is the process of floating the horse. The rasp “floats” over the wave-like sharp edges until the surface becomes smooth.

Eruption, Not Growth.

Have you ever used a mechanical pencil? They were popular a while back and were handy because you never needed a pencil sharpener. The middle of the plastic pencil handle had a tube you would fill with a core of graphite about 2 1/2 inches (65 mm) long. As you wrote with it, the exposed graphite would be used up. Then a simple button click on the top or side of the tube, and a 1/8 inch (3 mm) of new graphite would appear.

The mechanical pencil is a good example of the eruption of horse teeth.

Think of the tooth in the horse as the graphite core you place in a mechanical pencil. Remember, horse teeth are not like our teeth, nor are they like the teeth in your dog or cat. No, they are not like shark teeth, either. While they use similar materials, the horse developed teeth to work with their continuous eating and chewing lifestyle. Horses do not continually grow teeth, as many people believe. The teeth are fully developed by five years of age. A small portion is exposed above the gum line, while the remaining larger portion is held in reserve below the gum line. As their teeth wear from use, it is replaced with tooth material held in reserve, just like the lead is clicked out in the mechanical pencil. When all of the reserve tooth is used, there is no more tooth left to be held in the gum, and it falls out, just like the pencil running out of graphite.

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Power equipment used in horse dentistry

Are Power Tools More Effective Than Hand Floating Horses?

This video describes the difference between power tool floating and hand-floating. You may be surprised by what I say. Power tools are actually not a problem. I prefer not to associate with the application of poor scientific theories and lack of horsemanship in the technique used. In addition, the new business of power floating has taken an attitude that their way is the only way to float. Specifically, they say that hand floating is not good. Here is my response.

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Quidding and spilling grain

Pain, Bad Hay, Or A Slob?

Quidding is the balling up of hay in the mouth (the quid) and spitting the bolus onto the ground. Spilling grain is exactly what it sounds like. Several reasons cause these issues:

  1. The most common cause is the horse’s inability to move the tongue to position the food freely. But, again, pain is the root cause.
  2. Another reason is that the hay tastes bad. But, again, this is associated with the non-structural carbohydrate content of the hay.
  3. There could be a loose or broken tooth. Chipped teeth are very common. We see about one horse daily with a chipped tooth and a razor-sharp edge.
  4. Of course, your horse could be a slob. But, unfortunately, I won’t be able to help with that.

Quidding – A Question From A Horse Owner

The Question:
“Hi, I live in the United Kingdom and came across your website. I want to pick your brains. I have an 11 year old quarter horse who has just recently started quidding. He has had his teeth floated and a couple of tiny gaps have been noticed on him. The gaps have been flush and a putty/paste has been put in the gaps. After all of that he has started quidding again. Rather than keep having his teeth flushed and paste put in the gaps, is there a more permanent solution to this problem that you know of? Many Thanks, Natalie”

My answer:
Thanks for the question, Natalie. First off, I cannot from here tell you why your horse is quidding. Your vet can only do this.

In my experience, horses refuse to fully chew their hay and expel the partially chewed mass (a “quid”) because they are uncomfortable swallowing it. There are two associated events: 1) the hay has stalks, thick stems, too fine a stem, awns, or prickers, and 2) the horse has something preventing his tongue from moving the hay into position for complete chewing. The second part arises from pain in moving the tongue efficiently throughout the mouth. Causes for this pain include one or more sharp points (including one overlooked in a recent float), a chipped or broken tooth, or a cut tongue. I have also found foreign bodies as a cause of quidding; for example, a wire buried in the base of the tongue or sticks across the roof of the mouth.

If you have faith in your dentist, experiment with the hay you are feeding him. For example, try feeding chopped hay with or without soaking it in water. Find what he likes and continue approaching the quidding as a management issue.

If you feel it is a dental issue, check for any slight or profound malodor from the mouth. Ask your vet to check for any chipped or broken teeth. Use medication if necessary for the examination. Also, check for any cheek ulcers (usually associated with a sharp point), a cut in the mouth, including the tongue, or a foreign body.

If the gaps between the teeth have sharp edges, this will cause the horse to quid. Often the horse wants to clean the space using the tongue, which strops the edges, creating a sharp edge quickly. These are frustrating due to their recurrence. Filling the space is temporary. Some dentists widen the gap with a Dremel® tool to help the feed fall out. I use my files to smooth the edges and round off the entry. Even with these approaches, you may need to combine dentistry with feed modification to find hay and grain so that the tongue can easily clean out of the gap.

My final thought about quidding is to differentiate it from a horse that doesn’t want to eat or doesn’t like what is being fed. Many hays taste bad (low sugar, foreign substance, etc.). Horses will turn away from this even if they are hungry. This also applies to moldy grain. The major difference is clear. Either the horse won’t eat or wants to eat but can’t.

Have the sharp edges removed if he wants to eat and spits out the hay. If that doesn’t work, management changes must take place, usually for the rest of the horse’s life.

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Sedation horse dentistry

Drugs Are Being Used Today To Replace Horsemanship

In modern equine dentistry, many terms from human dentistry are now being used in the horse field, and sedation dentistry is one of them. Its use in equine dentistry primarily plays on your fears of the human dentist based on your prior experiences.

Drugs Given By A Non-Veterinarian Is Not Logical And Illegal

The method of sedation equine dentistry applies the use of sedation to every horse. However, its use is for the operator’s benefit only because the popular drug used (detomidine) has poor pain relieving characteristics inside the mouth of the horse. The best pain relieving medication (butorphenol) is a controlled substance and can only be used by a vet. Non-veterinary equine dentists are breaking the law if they carry and administer any drug labeled “use by or on the order of a veterinarian.” They violate federal law if they possess a controlled substance. For a vet to be involved, there must be a valid Patient-Client-Veterinarian relationship described in the law.

In my practice, over the past year, the need to use drugs in a horse is about 1 in 10 horses.

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Speculum use in horse dentistry

The Mouth Jack

A speculum is a device that holds open a body cavity. The type used in equine dentistry varies.

A full mouth speculum places two metal plates between the nipper teeth, and a lever is used to hold open the mouth against the hinges of the device located on either side of the cheek. I have one horse in my practice whose lower jaw was fractured by another equine dentist’s prolonged use of this type of speculum.

Another type is the wedge speculum. This style places a solid object (metal or rubber) between the cheek teeth on one side of the mouth. These can be difficult to leave in place, and some styles can cause tooth fractures.

At an AAEP conference where participants discussed a topic, the moderator set up the discussion for the speculum. Soon, one person said he had a stainless steel bolt fail to send the broken bolt past his head like a bullet. Two other veterinarians exclaimed, “Me too!” The group erupted into a chaotic conversation, which ended when the developer of the most expensive speculum spoke up. He said, “It’s not if a speculum fails; it’s when. This is why we recommend replacing the speculum every three years.” What! The pressure to break an aircraft-grade aluminum speculum is also applied to the bones and joints of the horse.

The Hand And Arm Is A Speculum By Definition

For some reason, the use of my hand and arm as a speculum is not looked upon by other dentists as a valid speculum. So here I give the reasons why I find it to be perfect.

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The importance of the tongue

Pain Prevents The Tongue In The Horse From Moving Freely

If you have ever had a sore on your tongue or have bitten it, you know how difficult it becomes to move it around the mouth. Without this movement, three important effects are removed.

  1. Thoroughly cleaning debris from the mouth.
  2. Stimulating the tooth to strengthen its attachment in the mouth.
  3. Positioning food within the mouth for a good bolus formation.

The Importance Of The Tongue Is Completely Overlooked

In every discussion, article, and text about equine dentistry, there is no mention of the tongue except for gruesome laceration stories. The tongue’s importance in consuming food and the overall maintenance of the health of the teeth is never mentioned.

The reason for this is simple. When talking about horse teeth or equine dentistry, everyone focuses on the teeth as they do in human dentistry. But in reality, the association of the teeth and the soft tissue around the teeth interacting with the horse’s perception of pain causes disease or abnormalities.

Has your horse’s ability to chew hay or carrots changed? Is he leaving behind the long stems or coarse hay that would normally be eaten? How about carrots or treats? Does it look like it is difficult to position? Chances are, the tongue is pressing against sharp points, and the horse is saying it’s just not worth it. After spitting out the food, he seeks out softer things like grass or smaller items like moist grain.

Do Horses Need The Teeth To Maintain Their Weight?

As for digestion, an interesting study was recently completed where 17 horses with varying dental care were given the same feed. Afterward, ingesta was sampled from the stomach, intestines and feces. Given the same meal and environment but given 17 horses in different dental care, the result (feces) was the same. If you have mucked stalls for any time, you already know these results.

This concludes that as long as the food gets swallowed, digestion starts in the stomach. This makes sense. The mouth, teeth, tongue, and saliva take the raw food and make a bolus that the animal feels comfortable swallowing. The saliva may add digestive enzymes and pH buffers, but it is also a lubricant.

The role of the tongue is to help position the food between the teeth, to switch the forming bolus from side to side, and pass the bolus back to the larynx, where the esophagus takes over in the swallowing process. Afterward, the tongue moves around into every corner of the mouth to clean out pockets of food left behind. So go ahead, try it in your mouth. Pretty amazing to think that you can place the tip of your tongue behind your last tooth.

Recognizing the importance of the tongue to feel safe in the mouth is the basis for my approach to dentistry. If someone else calls it “balancing the mouth,” “equilibration of the mouth,” “creating proper lateral excursion,” “advanced equine dentistry,” “proper dentistry,” or whatever else, it doesn’t matter. Because what they are doing is removing the pain and allowing the tongue to move freely. The horse improves on the bit and eats better because the pain is eliminated.

In the past seven days, I have had three horses extremely affected by the pain in their mouth. They could not chew comfortably and had become selective in what hay they ate and their consumption of carrots. One had even lost weight over the last few months. However, the old chewing habits resumed within minutes after floating their mouths, and they all ate carrots without spilling. One even started to consume the long stem hay he had left since the morning.

Most of you know that as a horseman, I like to keep things simple because life in its natural state is simple. Complicating things may make someone feel better, but I would rather make the horse feel better.

There Is Little Written About The Horse Tongue

Some interesting cases this past week all involved old horses having difficulty chewing hay and grain and losing weight. They were all great examples of pain as it relates to the ability of the tongue to move within the mouth freely.

A review of all the veterinary texts I have offers no information regarding the tongue other than, on occasion, it can become cut in two. So I will tell you what I know about the tongue.

The tongue as a muscle is equal in importance to the heart and diaphragm. It is part of the swallowing process. The purpose of the tongue is to position the food between the teeth, help form a bolus that is the correct shape for swallowing, mix the food with the saliva for lubrication, and finally propel the bolus back to where swallowing takes place. Several studies have proven that if food can be swallowed, then a horse can thrive. Conversely, if efficient swallowing is prevented because the tongue is in pain and a bolus can’t be easily formed, the horse will lose weight from not swallowing the food.

The tongue must be free to move throughout the mouth to complete the bolus forming and mixing process. The one thing that consistently prevents this freedom was seen in the three old horses I saw—Razor sharp points in horses with low pain thresholds. After smoothing out the teeth and removing the sources of pain, all three horses ate without spilling grain within minutes.

But Wait… There’s More! The Horse Tongue Has Two Other Important Jobs

The first is to push the teeth, which causes the teeth to become more firmly attached to the tooth socket. In older horses, where the length of the reserve crown (the part of the tooth below the gum) becomes as short or shorter than the part above the gum, an unstimulated tooth becomes loose and starts to wiggle. This allows feed and bacteria to invade the socket causing the tooth to fall out eventually. In every old horse with loose teeth, the teeth become firm within the socket within six months of removing sharp pain-causing edges.

The second is to clean the gum-socket junction. Almost every case of gum disease I have come across in the horse has been resolved by first removing pain-causing points and allowing the tongue to clean the area. Sometimes, I add antibiotics and an oral flush with hydrogen peroxide (Peroxyl by Colgate).

One more thought I have about the tongue. In days long ago, men shaved using a straight steel blade that was sharpened by “stropping” the blade against a leather strap. The tongue acts like the leather strap stropping the teeth. This action causes two things. First, it sharpens the edges of the teeth into razors and wears a trough midway back along the bottom row of teeth. I call this the “swale.” Others describe the resulting formation of higher back bottom teeth as a ramp. This ramp is normal and does not affect the horse on the bit, but it should not be confused with a hook.

Have I seen a tongue cut and hanging by a thread? You bet. Did they have razor-sharp teeth? Unbelievably! Treatment? Float and give the tongue a safe place to heal, plus antibiotics. Outcome? Perfect reattachment.

So get the pain removed from your horse’s mouth and improve your horse’s dental health. Float them whether you use a bit or not.

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Ulcers of the cheeks and tongue

Cause – Rubbing Of Sharp Teeth Against The Soft Tissue

Have you ever bit the inside of your cheek? The sore you feel with your tongue is a cheek ulcer. These are not caused by stress but by trauma from the sharp tooth.

In the horse, cheek and tongue ulcers develop when the sharp points rub against the soft tissue and rub away the outer layers. Depending upon the horse’s threshold of pain, these ulcers may not be noticed by the horse or cause him to object violently to the bit.

The treatment is to remove the offending sharp edges; like your cheek, the ulcers will heal quickly.

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Young horse dentistry

The Teeth Of Horses Under Five Years Old Are Very Dynamic

Dental care in young horses should begin about 2 1/2 years of age or two weeks before introducing a bit into their mouths.

Teeth in horses younger than five years old are softer than older horses and go through very dynamic changes. When you start to float a young horse, it becomes a commitment to continue floating that horse every 3 to 4 months. In that short perio, new teeth erupt, floated caps ejected, and soft teeth become sharp again. Therefore, young horses need floating 3 to 4 times a year.

This paradigm replaces the old saying that only older horses need floating.


All front teeth (the incisors) and half of the cheek teeth (the premolars) start with baby teeth. These are called “caps” by horsemen and are deciduous, meaning they fall out and are replaced with permanent teeth. The total number of caps between 2 ½ years and five years of age is 24.

Wolf teeth

The number of teeth in the horse mouths is decreasing. The first premolar teeth are gradually disappearing on the top and bottom jaws. Most horses today have two very small teeth with sharp points, usually in front of the two upper cheek teeth and sometimes in front of the 1st two lower cheek teeth.

It has become traditional in the dentistry of horses to remove these vestigial teeth because some can cause pain when a bit is used in riding. These are called “wolf” teeth, and you can look up several reasons for this name. I like the one about the General who couldn’t control his horse many centuries ago. First premolar extractions resolved the rearing, but the troops were told that wolves had scared his horse. Whatever you want to believe is fine with me.

Sometimes these teeth don’t fully erupt. Instead of erupting perpendicular to the jaw, they go horizontally and parallel to the jaw. They never erupt but become encapsulated in fibrous tissue creating a lump. They are almost always non-painful and don’t bother the horse. However, horse owners find them and ask for their removal. They are called “Blind Wolf Teeth.”

Wolf teeth can also be found in front of the first lower cheek teeth on the lower jaw. I often find these in Thoroughbreds, Shetland Ponies, and Donkeys.

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