Pull The Tooth! (blog)

Please read this first -This post has received a lot of comments. Before you post your question, please read all of the comments at the end to determine if it has already been asked.  Remember, I cannot give you direct advice….. see disclaimer.

This week a horse owner from over a thousand miles away called me after I had gone to bed with an urgent tone in her voice. She has an 8-year-old warmblood dressage horse with a lump on her jaw for 4 days. Her vet came out and took x-rays and then pronounced that a tooth needed to be pulled. This horrified the owner and she was seeking out another opinion.

Wait a minute – I need to hit my head against the wall again.

Ahh – that’s better.

This poor owner had been scared by a vet with good intentions, but with only the knowledge of what she had been taught at vet school. While the glamor of performing surgery appeals to surgeons, it is not always in the best interest of the horse.

I just need to remind everyone (again) that we are talking about HORSES and not HUMANS. The teeth are very different. Yet only for emotional reasons, we automatically think that if there is a tooth problem, we need to pull the tooth. It’s like Tom Hanks’ character in the movie “Cast Away.” If you didn’t see it, he becomes stranded on a tropical island with a toothache. His only relief from his agony is to knock out his own tooth using a rock and a skate blade. He passes out from the pain for a few days. If this doesn’t make sense to you, then go see the movie. It is a gruesome but memorable scene.

We all can relate to a painful tooth. We all have been to a dentist where they either drill out the abscess or they extract the tooth. We all want relief from the intense pain.

But the horse rarely exhibits pain from an infection near or in the tooth. In fact, they keep eating, as was this mare according to the caller. So why pull the tooth when a less invasive path could be tried?

There have been only a few instances in my three decades as a dentist where pulling the tooth actually helped. They were associated with malformed teeth or disintegrating teeth in young horses. Here the tooth was actually the cause of the infection. Extracting it then is an obvious choice. But realize that extractions have some serious and bizarre after-effects. Just ask the horse owner whose horse had a hole from the mouth to the sinus for several years after extraction.  That horse needed a liquid diet for years until the hole finally closed.

I have plenty of stories where mandibular lumps have been resolved with long-term antibiotics alone. I also have stories where owners have had a tooth removed plus antibiotics and the problem resolves as well. So which way would you go?

Antibiotics alone? Pull the tooth and antibiotics?

There is no doubt that pulling the tooth resolves the issue quickly. But is it the right thing to do for the horse? If the horse is not bothered by the swelling and continues to chew unaffected by it, then why extract a tooth? I believe they extract the tooth because of the owner’s desire to correct something that they have associated human feelings with, maybe a painful tooth issue they have had themselves.

What Is An Abscess?

An abscess is the body’s way of walling off something bad (foreign object, bacteria) and pushing it to the outside. It is a natural process we have all seen when we watch the ugly zit form on our face or a splinter gets under our skin. To me, it is an absolutely gorgeous event to watch. The body identifies a bad thing, walling it off, and kicking it out of the body. It’s perfect.

Why, then, do we not believe in its good intentions? Cover the effects of the bacteria spilling out of the abscess with antibiotics, but allow time for the abscess to do its job. With teeth, this can take 6 to 8 weeks.

In the years since 1983 of working with horse teeth, almost all the infected teeth resolve on their own with time and antibiotics. The few that did not were extracted, but well before they were given enough time to resolve on their own (a week or two). They were extracted because the owner wanted immediate results and they went to a surgeon very willing to do the extraction.

There is one horse in my practice – a Belgian – who resists every attempt to work on her broken and abscessed tooth with a smelly nasal discharge that needed daily cleaning.  The owners couldn’t send the horse in for anesthesia and surgery plus Belgians are difficult to anesthetize.  The result is that we did nothing.  While it took a few years, the abscess resolved on its own and the horse never skipped a meal because it was never in any pain from the problem.

Answer These Simple Questions

How many horses have you seen with a nasal discharge from a tooth root abscess? Very few I’d bet. And of those you have seen, how many showed difficulty in chewing? Probably none. If tooth root abscesses with drainage were such a problem, wouldn’t we see horses everywhere suffering from them? But we don’t because they are self-limiting because abscesses are the end stage of healing. The infection has been going on for YEARS!

This owner who called me that night decided to try long-term antibiotics. She was willing to let the horse resolve this abscess on her own and I was pleased with her decision. But then something happened. She became tired of hot packing the jaw every day and the other vet put pressure on her saying that the visiting specialist vet who could do the extraction had limited time in the area and would be there in a few days. The owner decided after only a week of antibiotics to have the tooth extracted from her horse.

This is the upper cheek tooth extracted from the horse in this story. There was a history of swelling followed eventually by drainage. A few antibiotics were used and finally, SMZ pills were settled on. The owner tried this therapy for a few weeks before she was talked into extraction. I never saw this horse. I believe that if she had waited several months, this mare could have resolved this abscess, but the owners do not want to wait or give antibiotics this long.

When she let me know about her change in treatment, she acknowledged to me that the horse was showing no discharge from the lump (a sign that the infection was resolving) nor was the filly having problems on the bit or chewing. The only reason she gave was that she was tired of going to the barn and hot packing the jaw.

I wasn’t surprised. People want convenience and not trouble when it comes to nursing care. The tooth was pulled and the abscess resolved because now there was a giant hole for drainage and the horse remained on antibiotics for 2 more weeks.

In over 67,000 floats that I have done, I have seen the need for maybe 3 horses for extraction. Yet in the past decade the cry of “Pull The Tooth!” seems to become common. But just because we can do a procedure, is it always in the best interest of the horse?

Cheek tooth fractures are common. Removal of the fractured piece is the correct thing to do and can be done in the stall with light pain medication.
This is often confused with “Pulling the tooth” which is what this post is all about. Many of the comments below are about cheek tooth fractures which is a different subject.

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Responses

  1. Typically how long should you wait to use a bit after a tooth extraction? Horse had an infected tooth root and needed to be extracted. Recovery is now 3ish months in. Vet said we can use bitless or his regular bridle with a light hand. Is there any worry using a bit at this stage or am I being too cautious.

  2. Hello Dr. Tucker! Thank you for all the information you provide! I’m curious about wolf teeth. I didn’t see them mentioned in your post or the comments. My understanding is that it is almost standard practice to pull wolf teeth because of the possibility they will interfere with a bit. It also sounds like they don’t have a specific function and they aren’t typically difficult to pull. Are there complications from pulling wolf teeth? Are there any legitimate reasons not to pull them? If they will be pulled, is it better to do it as soon as possible or wait to see if they will cause problems with the bit?

    My last young horse didn’t have wolf teeth, so it was never something I had to think about. My current yearling does have wolf teeth, though. The dentist has recommended they be pulled sometime within the next year or so. He is a dentist I trust who has been working with hand tools only on my horses for almost 20 years. So I’m asking to see if there are other perspectives and experiences that could give me more information before I commit to any particular action. Extraction seems extreme to me but I also don’t want to cause future problems by not taking care of it before training begins. Thanks for any information you would like to share.

    1. Wolf teeth are vestigial teeth meaning they are being phased out. They used to be permanent premolars. There can be up to 4 – 2 on each side on the top and 2 on each side on the bottom all placed in various positions next to or near the first cheek teeth. commonly there are only 2 located in the upper jaw. Some are born with them and I have seen them erupt through the gum as late as 16 years.

      To extract or not is between the owner and the vet or dentist. It is traditional to extract them although I have not been doing the extractions automatically. Usually the cause of bit issues are sharp points on the cheek teeth. However, if there are wolf teeth on the lower jaw and a bit is being used then I always remove them. I also remove them in any location if they are loose or broken. I usually do not extract blind wolf teeth – those that have not broken through the gum line and are not in a socket but rather are laying horizontally along the jaw bone.

      It is rare to have a complication from extracting wolf teeth though there have been some local infections. They just have never happened to me but I have seen them in other horses. I have no reason for these reactions.

  3. Wondering if anyone out there has been through a similar circumstance and what the outcome was. I have a 21 year old TBD with Cushings. He has been on Prascend for the past three years and then this spring things started to go south. He had a series of hood abscesses, and his top line seemed to vanish overnight. We have upped him from 1 to 1.5 Prascend tabs. The most serious thing we are dealing with is a tooth root abscess that seems to have gone into the sinus. He had the foul milky discharge from one nostril and was simply miserable with sneezing and eyes tearing. We did a 30 day course of SMZ which seemed to clear it up. However, after 4 days off, we could tell the discharge was starting back. We are now 2 weeks in to out second 30 day course of SMZ. What is the likely hood of this being healed due to his suppressed immune system. I do not believe that it would be in his best interest to try any surgery. I’m afraid that if this round doesn’t work, I may have to consider euthanasia as he won’t have any quality of life otherwise. Please share if you have been in a similar situation. Thanks so much.

    1. Kenley 0 Thanks for this report because it addresses so many points (and misconceptions). Let’s look at them in order,

      1) He has Cushing’s disease which is a sign of chronic protein deficiency. Hoof abscesses and a “sudden” loss of top line are also classic signs of protein loss. The reason for this is usually feeding carbohydrates (sugar, glucose, starch are all the same) every day of their lives. In addition, the immune system is adversely affected by lack of protein. You can read all about this in my nutrition blogs or you can enroll in the nutrition course.

      I also have the FAQ’s about nutrition in horses.

      2) An abscess is the body’s way of removing foreign material. The object is encapsulated (the definition of an abscess) and filled with defense cells to kill the foreign object. Then a soft spot is made whereby the puss (defense cells) and foreign object can be pushed to the outside (a draining abscess). It is a messy process with leakage which the SMZ pills (the antibiotic to the bacteria in the foreign object) kills. However the antibiotic cannot penetrate the abscess. It is only killing the leakage of the bacteria in the surrounding area yielding diminished drainage. But the abscess remains doing its job while the horse appears more comfortable.

      Extracting a tooth is like lancing an abscess. It just makes a big hole for the puss to drain. But the horse will eventually do the same only with a plug that blocks further entry of foreign objects. Eventually (usually 1 to 2 years) this will resolve on its own. Tooth extraction will resolve this quickly but only if there are no complications. While I have seen some really good results from cheek tooth extractions I have also seen some bad ones with more teeth extracted and a fistula created where all food eaten finds its way up into the sinus. The rate of complications, according to one vet school, is at least 50%. This is not reported but should be.

      Unfortunately, horse owners and vets all want this to resolve overnight with only antibiotics. In a lot of cases, this does occur when they are given for 30 to 60 days. Luckily SMZ antibiotic (either in the 1x or 2x per day formula) doesn’t appear to cause problems in horses. But what do we do when it does not resolve the smelly discharge? This usually indicates that the cause is larger than the time allowed for it to heal. You will have 2 choices. The first is to extract the affect tooth. Be sure you spend the money and go to a competent surgery where there is a good track record and they are forthright with their success / complication rates. I personally do not perform extractions and this is one of the reasons. The other is that I have never seen a horse with a chronic nasal discharge cause by a tooth root abscess suffer a demise. In fact the opposite is true.

      The other option is to wait and keep cleaning the discharge. Your horse is probably not “suffering” but is just annoyed. More likely you are “suffering” watching the horse sneeze while he otherwise shows no other signs of stress. And the tearing might be resolved with added protein in the diet and a nasolacrimal flush and fly control.

      Finally, euthanizing an animal is a very serious decision. To euthanize for a tooth tooth abscess in a horse that continues to eat and be a horse is not a good reason for euthanasia. If you either want to avoid surgery or you can’t afford surgery then turning the horse out 24/7 AND cleaning the discharge daily will probably give the same result – only it will take up to 2 years. I have seen this happen and again, I have NOT seen a sinus discharge from a tooth last forever in any horse. Have you? If so, please send the documentation here in a reply.

      Thanks for commenting here. Be sure to take your time in your decision and please, stop feeding grain and start feeding soybean meal to add the protein he needs to fight off this infection. Also realize that sinus abscesses and cheek tooth fractures were uncommon as little as 40 years ago. My belief is that grain is causing the decay that starts the tooth root abscess process. In humans in 1932 they discovered that the oatmeal children were eating was the cause of increased cavity formation. The sugar of starch disrupts the normal bacteria living in the mouth (microbiota) and this disruption (dysbiosis) is the cause of all ulcerations in the gut and, I believe, of the teeth.

  4. I would urge everyone here to listen to the do not hurry to extract an infected tooth. I was told by my veterinarian and the specialized dental surgeon and sinus surgeon that this was the only way to go. I am devastated. I go to a small animal vet who bucked the tide and did not do dental cleanings on cats and dogs every year. Why did I listen to them? They did 2 sinus flaps. The discharge had disappeared from SMZ in the 2 weeks before surgery. They said it went well. They removed packing in 2 weeks at barn and then food started to go up in hole. He went to hospital for recheck All good reports, except they cultured Klebsibella bacteria but said the antibiotic microbeads in wound would address that . 2 days later slight discharge and original smell. They left me janging and said just to keep on SMZ and instructed barn vet to keep cleaning out fistula. She did once and was coming back the next week. I started free lunging. He was active and beautiful She came for second clean out and when he came out of sedation he had tremors. Next day fever on and off The hospital still did not react to the signs I was telling them he had. They insisted fever had nothing to do with sinus surgery. They ignored the symptoms I told them about (later proving to be neurological). 6 days later after trying an antibiotic for what they thought might be a systemic infection, my vet wanted him at hospital. They took 2 days to look for this “other” cause of fever. They flushed out sinus again. They were ready to send him home, now hoping after flush he would not have fever. I pushed them to look for cause. I asked them about sinus infection to brain. Oh no, they said so rare. Well he died from bacterial menigitis. i feel like I sent my beautiful horse who before surgery never exhibited pain to his death.

    1. Joan – I think I’m speaking for everyone reading your comment how sorry we all are for your loss. Thank you for sharing your story. Doc T

  5. Hello Dr. T,
    Please for give me for sounding ignorant about horses, as I am fairly new to them ( I’ve only owned them for 5 years). I have a 20 year old gelding whom I’ve owned for 4 years now. When I first received him, a vet thought that he had EORTH because of the way his front teeth looked. My horse has billy bob teeth (gaps all over the place). The vet asked what does he do when I feed him a carrot, well I don’t give treats to my horses, so I did not know. The vet proceeded with floating his teeth. When I got home I gave him a carrot and he bit it off with his front teeth and ate it just fine. Fast forward to this spring ( 2020), I took my 20 year old gelding in to have his teeth floated and a new vet performed an exam and we both observed bleeding and puss from around the gum tissue. The affected area was tissue around a molar and a premolar on the left maxillary. X-rays were taken and black areas around the affected teeth were observed. She recommended that I have those teeth extracted before the infection spreads to the other teeth. My gelding right now, eats fine and is holding his weight. I scheduled the appointment to have his two teeth extracted and then that evening I started having second thoughts. He was just started on Enrofloxin ( April 10, 2020). I called my trainer and she recommended getting a second opinion but liked the wait and see approach to what the antibiotic will do. My vet said antibiotics will not work and his condition will get worse and worse. He has no bumps on his face, no drainage and no obvious other issues. He is a tough horse though. How will I know if the course of antibiotics will work? Will the gums stop bleeding? Will the pus go away? His teeth will still have gaps ( gaps even between his premolars and molars) there is nothing we can do about that as he is too old for braces 🙂

    Thank you for your thoughts.

  6. Hi I have an 8 y.o. miniature mare who had yearly floats, then last fall overnight the right side of the front of her face was swollen. Vet came out we sedated her and did a good oral exam and found nothing she got injections of Excede and the swelling went away for weeks but then overnight came back again so we did a whole bottle of doxycycline ( over a month of antibiotics) and again it went down, but during that episode she had discharge from right nostril and right eye, not alot but some. Then weeks later overnight swollen again, I pressed on it and discharge from nose again and it went away, it came back again but then went down and two weeks ago it appeared again but all the hair fell out of the lump, It had a small hole and I tried to flush it. The small hole is there and puss is draining daily. I’ve spoken with the vet and she is coming out to do x-rays but she is talking pulling the tooth. Are we not using the right antibiotic? The mare is in foal so was hoping to not pull tooth until after she foals, if at all. Now that it has erupted from the front of her face and is draining, could we try even longer term antibiotics or am I better off pulling the tooth? Thanks

    1. I’m sorry but I cannot comment on a specific case. The X-rays may help. There are many causes to rule out. Remember, if an abscess is draining then it is doing its job whether it is pretty or not.

      I always find it amazing that when I receive cases like this there is never any mention of how the horse is doing. I’ll bet he is eating without a problem and is bright and active.

  7. When the vet came out to float my 4 year old geldings teeth, 2 of his permanent incisors hadn’t pushed out his baby teeth and he was quidding. The vet pulled his baby teeth. When I look in his mouth I see that the 2 baby teeth weren’t pulled only broken off. Now he has broken baby teeth rupturing thru his lower gums. Is this normal? He still quids but now only small marble shaped pieces. I think this is normal until his permanent teeth move forward and fill in the gaps.

    1. -lease ask the veterinarian who worked on your horse these questions.

      In my experience quids are not caused by incisor teeth but from the cheek teeth. Often it can occur after floating when the pain causing sharp points are gone.

  8. Thank you for all the helpful information here, it has been very useful in considering what to do with my 16yo boy with a fractured incisor.

    I’d be very interested to hear what you think is the best course of action for him as I am a little confused with where to go next. My gelding, Noogs, had a fractured incisor and its been that way for over a year. I have nothing to suggest when he did it or what happened but a past horse dentist suggested it had long been cracked and merely broke one day. Because of this, his normal demeanour, incredible ease of maintaining weight and apparent happiness I hadn’t considered extraction and just watched it for redness and swelling/pain symptoms instead.
    Nothing changed, but I moved locations with him and had to get a different dentist who took some photos and referred me to her collegue who is a vet and wants to extract the tooth. My concerns are that basically the entire procedure to me seems like a lot of discomfort, I’d worry about his sedation and nerve block, how we could keep the socket clean, the pain following the surgery when his favourite activity (eating) isn’t so comfortable, as well as things like increasing his chances of developing EOTRH by damaging surrounding soft tissues. I have spoken to this vet, and he argues the tooth is ‘mobile’ within the socket, that is actually cracked into quarters and only the exposed 1/4 came out, leaving the root mobile and resulting in the pulp dying but no visible discolouration in the remaining tooth. The dentist could not get a probe into the blackened pulp area, suggesting maybe it had sealed. I understand the tooth is a risk for packing feed and creating infection, this is probably dumb as, but do horse fillings exist and could that maybe work? I enquired whether we could reduce the tooth down but my vet argues the lateral movement of the adjacent teeth would still allow that mobility and pain in the tooth.

    All I want to do is the best for my boy, he means a lot to me. If it’s genuinely mobile and causing pain on lateral movement and mastication then I understand, and just want to help him be comfortable but I’m worried that with the information I have I may wind up doing the opposite. I’m probably biased too in that ive had a fused erupted canine removed recently which was a horrible pain, but I also know horses display pain in different ways and perhaps it is actually the best mode of action, I just honestly don’t know.

    Am I being at all rational in my reasoning here, or should I just cough up the 2k and get it out asap? Also, do you think perhaps xrays would give a better indication of whether there in any mobility in the injured tooth?

    1. I cannot respond directly to a case I have not seen myself.

      What I live by is simply that 1) most people have time to make a decision because the worst thing to happen is the loss of the tooth naturally and 2) if the horse is eating and showing no discomfort then you have time.

      No one has a cause for EOTRH but your suggestion that it is caused by damage to the surround tissue is unfounded by all. My theory is that EOTRH is an auto-immune disease of the bone (as suggested by Dr Dixon) and that removing the cause of the auto-immunity reaction is helpful. See my blog on this in my dentistry blogs nearby.

      I apologize in not being able to give you direct advice on your horse. I believe that horses don’t need their incisors for anything other than biting you! Parrot mouth horses with no occlusion are usually fat. So weather he keeps or looses a front tooth is really not as important as if he is in pain or not.

      1. Thanks so much for your help, if I’m really honest basically I want to have proof its causing him discomfort first because I certainly cant justify the whole thing otherwise. This has helped me get a level head back before rushing into anything, thanks again.

  9. Hi there , hope you can help our 10yr old boy has a lump come up under his eye with a puncture spot in the middle which was oozing now has stopped this is for around 3 weeks. He has dentist every 6 month and has had dentist in middle of this episode no signs of anything there he has no symptoms at all but our vet thinks that it’s tooth abscess and wants to x ray and then extract but I m IMG_2381.jpeg
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    1. Thanks Melissa but I cannot comment on a specific case. Also the images you attached did not come through.

      Abscesses of the upper teeth can cause a draining tract through the face bone expressing themselves to the outside (drain). An abscess is a natural process or removing a source of infection to the outside. It can be disconcerting to the owner but the horse thinks nothing of it. The vet and the owner often want to “do something” to improve it.

      Please do your research as to the complications of extracting a tooth for this condition. My client had an upper cheek tooth removed for the same presentation at a university and the drainage didn’t stop. They extracted an adjacent tooth and still it took a year for the drainage to stop. This is when the university said that there was a 30 to 70% complication rate (sounds like 50% to me) with these types of extractions. Maybe your vet has a better track record but you need to ask him/her 1) what are the complications after extraction and 2) what is their experience in leaving these alone and letting the abscess run its course.

      Come back and tell us the answers and then what you decided to do. Then come back again with the results of your actions. This will be very helpful to all who read these comments.

  10. I have a 14 year old mare who developed a boney lump on her face spring of last year. After a few months she had a nasal discharge from one nostril, not smelly and didn’t bother her really. The vet prescribed oral antibiotics which soon cleared it up but the lump kept getting bigger. We had x-rays done last July which showed that the root on the upper left, 3rd from front tooth was rotting. After discussion with the vet it was decided to leave it to rot some more to make extraction easier. This meant we could ride her as usual through the summer and deal with it in the winter. The lump on her face continued to grow, reaching around 3 inches diameter and raised by about 1 inch. It still didn’t bother her for eating or riding but by December the discharge was back and smelly this time. The vet came out and tried to extract the tooth orally in January 2019. After wiggling at it for about an hour the crown of the tooth came off, leaving the root behind in the yaw. On examination the vet decided that it had just been sitting there, trapped by the surrounding teeth and that the root had rotted off some time earlier as it was not a fresh break. He now says that the remaining root is fused to the jaw bone which is causing the boney lump. He says it might be possible to extract it by punching it out from the front of the face after cutting a flap in the bone but he is not confident this would work due to the fusion to the jaw bone. He thinks there is only one vet in Scotland who could possibly try this procedure! Also he feels there would be a high risk of complications like sinus infection. We are not insured and this procedure would be very expensive, even if we were I don’t think it is worth the risk as we would probably just be swapping one problem for another.

    At the moment she is still doing light schooling and hacking but does have a fairly constant small trickle of cream coloured gunk out of her nostril. Twice this has flared up into a really horrible sewage smelling discharge which we have treated with oral antibiotics. Given the cost of the antibiotics these have been short 14 day courses and have cleared things up but the discharge comes back after around 3 weeks. The last time I just left it to see what would happen, as although the smell was upsetting to us humans it didn’t seem to bother her. Sure enough it cleared up on it’s own back to the small trickle. What I would like to know is what the long term outlook is for her? Will the root rot away completely and the discharge stop? Will the infection spread to the jaw bone? Or is this going to keep happening until one day the antibiotics stop working as we’ve created a superbug and there will be nothing we can do for her? (This is what the vet suggested might happen!) The vet is the “horse expert” of our local practice but I don’t get the impression that they do huge amounts of horse work, mainly farm animals and small pets so I’m looking for any advice or experiences on similar cases?

    1. Thanks Lesley for this good account of your horse’s troubles. First of all you vet is doing an excellent job of approaching this and communicating with you. Secondly it is important for everyone reading this to notice that your horse has never skipped a bite. Other than the swelling and the discharge, the horse is fine. This is very common with tooth root abscesses.

      While every case is an individual case with varied results I can tell you of horses with similar histories that have been let go medically and in about 2 years, the nasal discharge goes away with no ill effects on the horse. This aligns with any research you may do looking for horses with similar tooth issues. You cannot find reports of the demise of a horse with a tooth root abscess that is left untreated.

      If anyone reading this wants to add their thoughts and experiences with letting a draining tooth root abscess, please let us all know. But I have not seen a problem with bone infections. The reason for this is that the definition of an abscess is to wall off from the body and drain the bad stuff to the outside thus preventing any local infection.

      It is very common for antibiotics to work but then to have the discharge recur some time after the antibiotics are stopped. This is because almost every antibiotic cannot penetrate inside the abscess. The leaking bacteria are killed by the antibiotic causing a reduction in discharge but the cause of the abscess has not been affected. Think of an abscess like a sponge with thousands of small cells. As the cells break open the antibiotic kills the bacteria but the bugs still within the unbroken cells are left to live. The antibiotic is stopped and later more cells are opened as the abscess matures causing the resumption of the drainage.

      I also agree with your vet that the complication rate with tooth extractions can be as high as 70%. If he or is willing to go along with your decision to do nothing then start a journal to record dates of observations and come back here and post the results. It may take over a year from now before this is all resolved but I agree with your vet to not extract the remaining tooth unless there is a major change in the health of your horse (she can’t eat for example). If your mare and you and your vet are all on the same page, then all you have left to do is keep cleaning up the discharge (and kudos to you for doing that every day!).

      1. Thank you so much Geoff for your very reassuring reply. I am relieved to hear that there may be a positive end to this, even although it could be a year away! I certainly will post in the future if there are any changes to report and will just keep wiping up the snot in the meantime!

  11. Very interesting. I have a 24 year old Arab gelding that is not wanting oneat his hay. About a year ago he somehow managed to break his jaw on the right side. I was concerned that the teeth that had roots that were in the fractured area may be the cause and brought him in to the clinic, the break was very severe and has taken a full year to heal. The X-rays now show full healing, at 8 months the outer bone was still separated. So my vet took X-rays of the incisors and showed me that some of his incisors exhibit EORTH and wants to pull all of his incisors. The teeth affected are 4 of his upper incisors and canines and 2 of his lower incisors. He wants to pull all of the teehth even the good ones, as the good teeth will move around after removing the others. Can you share your thoughts/experience with this? Also are you familiar with a mushroom supplement, called Equident? They claim it helps EORTH. – is this a condition that can be reversed once it starts. Thank you for reading this and sharing the information you do publicly so we can all learn.

    1. Thanks Stacy for asking about EOTRH – and I’m sorry to hear that your horse broke his jaw. Let’s look at both.

      A broken mandible, in my experience, is something horses heal well from. Isn’t it interesting that horses continue to eat with this. I’ll never forget going to a farm to float a horse but instead discovered that he had a recent fracture of the mandible (jaw). The owner said that there was nothing wrong with the horse until I shower her the fracture. It was swollen and had tissue necrosis with a very bad smell from the area. I think she believed that I had just broken the jaw even though she had been standing there the whole time and the smell could curl your socks! But the horse never stopped chewing.

      EOTRH often makes biting hard things such as a carrot very difficult due to pain. They also limit their consumption of hay from a net or bag because they use the painful incisors. Grass doesn’t seem to be as much of a problem. This disease is of the underlying bone and the dead or necrotic incisors are only secondary to this. According to the leading experts at an AAEP meeting 2 years ago, no one is sure of the cause. It was, however suggested that it is an autoimmune disease. I wrote a blog about this here: https://theequinepractice.com/what-is-the-cause-of-eotrh-in-horses/

      Equident is a mushroom product made to reduce the inflammation from EOTRH. Mushrooms are very effective at binding to lectins which in humans have been discovered to be a leading cause of autoimmune diseases. I now have about 6 hoses who have tried this product and all are seeing a reduction in inflammation: reduced redness, reduced swelling and an overall quietness to the gums. I do not believe that it will resolve the underlying bone damage. I cannot say if removing all grain will help either. But if it is an autoimmune disease and the lectins in the grain seeds (a common problem in humans, for example wheat gluten is a lectin) then removing all grain is logical. Research needs to be done to confirm this but I leave you with this. EOTRH was not in the textbooks in the 1980’s. It is a new disease that appears with the appearance of an abundant grain supply other than straight oats. Oh, and while I mention oats, in 1932 oatmeal was determined to be the primary cause of tooth decay in human children. Hmmmm….

      Finally, if the incisor teeth are causing too much pain for the horse to chew then removal will eliminate the pain. It is not the tooth that is painful but the surrounding soft tissue. Adding Equident may also be effective in reducing the pain. Removing unaffected teeth (all the incisors) will lead to 1 sure consequence. The horse will stand relaxed with the tongue sticking out as the incisors no longer hold it in.

      If the horse can wait, try the Equident first and remove all grain, apples, carrots, treats, and supplements with grain or grain byproducts. I would also be very interested in 2 things: 1) Does he clean his mouth out often with water while eating (such as dunking his hay) and 2) what order do you feed him (hay first then grain or grain first then hay. The primary purpose of mucous in the saliva is to bind to lectins to remove them. The primary purpose of lectins is to penetrate the lining of the gut to cause leaky gut and ultimately like the plant eating animal (it’s a dangerous world!). The gut starts at the lips and includes the gums.

      More on lectins can be found on the nutrition blogs also an the same site as https://theequinepractice.com/what-is-the-cause-of-eotrh-in-horses/

  12. […] “DO SOMETHING!” Is the mantra of veterinarians and physicians and it prays on the fears of the patient or the horse owner.  The process of any dental disease in horses it very unclear with a few exceptions such as food packing in a space between the teeth (diastema).  Treatment for a disease process that is not understood offers a “shoot in the dark” approach that basically comes down to extraction.  I wrote about this in the blog called “Pull The Tooth!” […]

  13. Such a great article. I have a horse who was radiographed last week by our vet due to two “broken” upper molars. This vet is quick to suggest expensive treatments. I was told both needed to be pulled, but am seriously second-guessing this. Looking at radiographs with the vet, there seems to be no pulp exposed, no fracture, and no signs of discomfort in the horse. He is holding weight and otherwise healthy. The molars are nearly flush with the gum and were thought to be missing at first glance. The opposing tooth was long and was floated. Vet’s reason for pulling is to avoid abscess and sinus infection. Should I have a second opinion? I had a tooth pulled on another horse last year because it smelled rotten and had some infection present, but something doesn’t sit right with this scenario as nothing seems out of place.

    1. While I can’t comment on your horse I can say that you have time to observe this horse. There is no rush as pulling teeth has up to a 70% complication rate.

      A second opinion may help you with this or because there is no outward indications that something needs to be done right away, consider having your vet observe these teeth over the next year or two. Please feel free to come back in the future with an update.

  14. I can understand that your day only has so many hours, and you will no longer be replying. But I am glad to have found this, and will share it with as many as I can. As there is not a lot of information out there for what seems to be a growing trend in equine dentistry. I want to share my story, in case it can help someone make a more informed decision for their equine friend.

    We have owned horses for about 10 years and they have always had regular dental care. In the beginning, by our vet and in the last 7 years by a certified equine dentist. We had noticed in the lest 2-3 years that a lot of people using the same equine dentist were having to have their horses tooth/teeth pulled. Not just wolf teeth, but other teeth. We felt glad it was not us, and thought how extreme those horses situations must have been to have to undergo extraction. We would soon learn that would be us. Our first extraction went well. It was a lower right #6 (1st lower right cheek tooth). Flushed for a week, and that was it. All seemed to go easy and we never had a concern. We were feeling grateful the problem was found, and that is was caught early and our horse was no longer in pain and an abscess would not become a more serious issue. Yes, all of those things are what we were told, and believed to be gospel, as we put all of our faith in our greatly trusted equine dentist. That brings us to our 2nd extraction, and another horse. We had owned this horse for a month, 7 year old mare that was having some stiffness to the left. Her previous owner could not provide her last dental exam, and us being adamant about dental care, we contacted our equine dentist. He did an exam and float, and his vet did xrays. It was found that her upper left (cheek teeth) #8 and #9 were infected and “abscessed”. It was presented to us that we extract the #9 with urgency, just as the last extraction had been presented. It could not be done that day, so we scheduled the procedure at the next earliest date available, a week later. We spent the first couple of days in shock that this was happening again, and also trying to do some research on the extraction of this tooth, because we knew it was going to be a lot more involved than the previous lower tooth extraction. We were told that it was a complicated procedure and there was a possibility it could end in surgery, but if all went well it could be pulled without any issue. Again, we tried to do some research, and could not find a lot of information on it. I did come across a couple of blogs and did consider getting a second opinion from another vet. In the end, we very much trusted the professionals we were working with and decided that they know their profession and we really knew nothing. We were scaring ourselves with what we were seeing online enough that we decided to just stop looking and trust. In hindsight, we realize that we should have been scared and we should have gotten a second opinion. The tooth was pulled. It took an hour of intense wiggling and pulling by 3 people taking turns, to get it out, but it was pulled “successfully”. We asked all of the questions that follow a procedure. What should we watch for? “Nothing to be concerned about, she will heal and be as good as new in no time”. Is there anything we need to do for aftercare, like the flushing we had to do on the other horse? “No need, it’s to far back anyway. She will be fine on her regular diet and you don’t even have to rest her for more than a few days. Go back to normal work after 3-4 days. Run her when you feel she is 100% herself.” Will food be able to get packed in the extraction site though, if we don’t flush it? “It’s possible, but it will work itself out, no need to worry.” That was enough for us, we left and didn’t worry at all about her full recovery. We were naive and obviously uneducated about tooth extraction. But we did fully trust our team of professionals. We went about our regular routine. Fast forward 1 month. Over a 3 day period, a nasal discharge appeared on the right side, and quickly changed from clear, to green, to yellow and smelly. It was a fast transition and stayed yellow and smelly for two more days. We called the local vet (he was not involved with the tooth extraction, as our dentist travels with a vet and we let her handle it) and they stressed to get her in ASAP. We listened. He immediately had no doubts it was related to the tooth extraction, he had 100% certainty. He took xrays. The initial infection around the tooth roots of the #8 (which we decided to do watchful waiting on and not pull right away) looked to be cleared up, but there was some cloudy area of concern in her sinus. He gave us 3 options. Flush and treat with antibiotics. Do a sinus flap and scope to see if there is debris. Do a full on sinus surgery and clean the sinus out. Naturally we chose the least invasive option and went with flush and treat. The flush presented us with a new problem. There was a hole in the extraction site that was open to the sinus, it was a little larger than an index finger. With the flush we discovered that food had definitely made its way into her sinus, but nothing larger came out, just small bits. We were given the option to plug the site and treat with a strong antibiotic, and that’s what we did. We had no idea that a plug was ever an option. It was never mentioned to us before. We left feeling very concerned about what may lie ahead for the horse, knowing that the presence of hay and debris was not a good sign but also trying to be encouraged and faithful that she would heal and be okay. Two weeks later, plug was pulled, sinus flushed again, there was still communication and small bits of hay flushed out. But the hole had closed to about half the size it was two weeks prior. We plugged again, for 30 days this time (still trying to be less invasive)and hoped for complete healing by the next visit. Checked in with vet 2 weeks in about discharge still present but clear and not smelly, he eased our minds and said it could take time for it all to drain and to be patient and try not to worry. I asked if we should be proactive and do another round of antibiotics. He said we could do that, but would rather not yet if we could avoid it. So we didn’t. One month later, plug is pulled, no healing, puss has formed, and infection has returned. Drainage has never stopped during all of this time, but it stayed clear and no smell, at least not strong enough to notice. He immediately said we have to get aggressive, we have to do surgery or this mare would have life long issues with this. Long term infections, a strong chance this hole would never close, she would never be the same. We didn’t waiver long, we went forward with the aggressive approach and did the sinus surgery. It was a good thing we did. There was clumps of hay, grass, and grain, small pieces of wood and shavings, and there was also a bone sequestrom (sp?) in there. It in unclear if the piece of bone was broken off and left behind in her sinus or if it broke off in her gums and worked up into the sinus. That is a question that will probably never be answered. We felt strongly that if the extraction site had been plugged in the first place that we would not be here today. We felt strongly that there was a lot of misinformation given to us and a lot of rush to get this tooth out before we had to much time to think about it. We felt strongly that there was a simple preventive measure that was completely ignored and led us to believe there was certain negligence in this situation. The piece of bone left behind leaves us baffled and unsure if any of this could of been avoided. The one thing we know for sure is that we could have done a lot more research. We could have made more informed decisions in our horses care and we did not have to rush to extract that tooth. We learned that just because a professional is pressuring you to make a fast decision, that it is okay to question them, and you should. In the month leading up to this surgery, we did exhaustive research on the sinus infection and treatment and we knew without doubt that if the vet said it was time to get aggressive, that it was. We still felt uneducated but also knew we had to do something. He was patient with us and explained every option clearly, and also patiently tried all of the less invasive routes first. He did not pressure us ever, but was very clear with us when he felt strongly that less invasive was no longer an option if we wanted to give our equine friend the best possible chance at a full recovery. We are only 3 days in after surgery. She is doing well. We understand that there is still risk, but are feeling very hopeful that she will be back in the arena soon, and this will all be behind her. I hope no one ever has to endure what we have and that no ones horse ever has to through what ours has, but if this story can help someone than it will be time well spent sharing it.

    1. Thanks “G” for this long story. This is a common occurance both with non-vet and vet dentists. They forget to tell you that the complication rate with cheek tooth extractions is about 70% though there is really no “official” rate. There are plugs for the socket to prevent feed entering the sinus but they need to be placed at the time of extraction.

      The use of scare tactics or “urgency” overrides common sense. These horses are usually not showing any outward problems. Decay of the cheek teeth is common and most common in the 9’s. No one has a reason for this other than decay of one or more pulp chambers. The usual outcome is the splitting of the tooth into pieces which can easily be removed.

      In all the literature, is there a case where an infected or abscesses tooth caused the demise of a horse? In fact if left to resolve on their own they heal. But there are no control studies where this is monitored though I have personally seen it in my practice.

      Kudos yo your vet for helping you with this dilemma with compassion. We all pray for a great outcome. Thank you for taking the time to post this. My hope is that some expert somewhere will do the study to help us all understand how decay and abscess Arion of teeth should really be helped using a better approach than “Pull the tooth!”

      1. Thank you for the reply. I have a question. When this tooth was extracted, we were told that this horse will now have to receive dental floats every 6 months, instead of annually like we usually do. The reason given to us was now that there is a void where her tooth was, that the lower tooth will start to grow into that void and could cause her jaw to lock up because of it. At the very least they said the lower tooth will now want to protrude more than the rest and will “catch” on the upper teeth, because it won’t wear the same. Does this make sense to you?

        1. When there is no opposing tooth, the remaining tooth continues to erupt into the unopposed space. This will not cause the “jaw to lock up.”

          Imagine a boat moored against a wooden piling. Over time the wind and waves will cause the boat to rub against the wood until a notch is created in the piling. Does this notch prevent the boat from moving? The tooth that does not wear is by definition not hitting anything and therefore can’t cause the jaw to lock up. In other words the horse who chews 25,000 times a day (ave between 10,000 and 40,000) will wear away what is contacted preventing the “locking up” of the jaw.

          However, if a bit with a nose band is used then the over-erupted tooth may at that point interfere with the movement of the jaw. For this reason I file down the over erupted tooth a few mm. The more important thing to do is smooth the very sharp edges of the socket caused by the STROPPING by the tongue against the new edges of the socket that are now a “focus of attention.” These sharp areas will cause more of a problem that the over erupted tooth.

          Most horses move from prevention to correction somewhere between 6 and 12 months. Floating twice a year keeps the teeth in the prevention mode.

          One more thing. In young horses (less than 10 years) after a cheek tooth has been extracted, the space can close together completely removing the gap of the socket in about 2 years.

      2. Just an update: Tooth was pulled 9/13/18, sinus surgery done 12/6/18. On 1/9/19 she went in for a checkup on the plug and healing of the hole. It has healed, finally! The plug was removed, all signs of drainage are gone. Getting aggressive paid off and it appears she is going to be okay and will go on to continue her career. It was a huge bump, a long road and a close call, but we didn’t lose her and for that we are grateful.

        1. Thanks for this update. There are many successful outcomes with extractions. However, for those where either the cost, the patient or the medical resources prevent having an extraction, they need to know that not extracting may also have the same results. I still have not heard of a horse “lost” to a tooth infection.

          1. Oh yes, had we been more educated, and known what we know now, we would of NEVER pulled the tooth. This has been a big lesson learned, and a huge expense that could of been avoided. Had we not pulled it, we feel that she would of been fine and could of likely cleared up the infection without issue, although we will never know for sure now. When I say we didn’t lose her, I mean due to the large hole left open to her sinus and how hard it is to heal that hole. Our vet told us that more often than not, the hole is very hard to heal, and if it does not, euthanizing is typically the end result, due to chronic infection. Since the hole was not plugged at the time of extraction, and was plugged a month later after a major infection had developed, that made her situation more difficult. At least this is how we have come to understand it.

  15. Hiya! I have an 18yr old mare that has been having white smelly drainage from her right nostril. She was examined by the vet and he found two teeth that were fractured and a channel in one of the roots going to the sinus cavity. They want to pull both teeth and put a ceramic cap to close off the hole to her sinuses. Can something like this be treated without surgery? Thanks!

  16. I have an 8 year old that the equine dentist says has a back upper tooth that is dead with nerve exposed. They are wanting to pull it under surgery. My concern is the hole this will leave.

    1. My belief is if a tooth is not bothering a horse then it should be left alone.

      I have not heard of a cheek tooth dying with a nerve exposed. But more importantly, how is the horse doing? Will extraction actually help the horse? Remember there are high levels of complications with tooth extractions. Please consult your veterinarian and get another opinion.

  17. Hi Dr T,
    I have a 16 yr old QH gelding who has a fracture in #407 it is horizontal. I have had his teeth done every year for the 8 yrs i have owned him by a equine dentist. This fracture was not seen last yr. Unfortunately my dentist for the past 8 yrs is cutting back and she has recommended the vet, dentist that discovered it this yr. Is this tooth common to fracture? I have read all the questions and your answers but have not seen one for tooth 407. The new dentist said to just leave it alone, she said she does not pull teeth if she can help it. So my question, about how long will it take this tooth to break off? He is eating, drinking fine. I will have his teeth checked again next year. Should i get them checked sooner than a year?

    Thank you, Judy

    1. Fractured cheek teeth are very common. I see about 1 in every 100 horses. They can occur in any cheek tooth and in fact I extracted a buccal sagittal 407 this week – with my fingers!

      I agree with your vet in not pulling WHOLE teeth but extracting a fractured piece of a cheek tooth is easy, has few complications and can be done on the farm with mild pain control administered IV.

      You mentioned the most important thing – that the horse is eating and drinking without a problem. I did have a full length fracture of a cheek tooth in one horse I left in for 2 years before it had matured enough to be easily extracted. The horse lived well for another 10 years (at least). So if your horse is OK then you can wait.

      1. Thank you Dr. T for your reply, that is exactly what I am going to do leave it alone. I enjoy your site. It is the unknowing that leaves me anxious.Thank you for putting this information out so that we can learn.

        Sincerely,
        Judy McDonald

  18. Hi Doc T, Came across your site while researching the problems I’m having with my almost 5 year old gelding. His 109 tooth is fractured down the middle (front to back), before I got him the inner half was removed by hand during a float. I’ve had a bit of a run around with the equine dentist escalating to the vet, who has escalated to surgery.

    The remaining half of the tooth is sitting out of alignment and has shredded and ulcerated the cheek. The hole where the tooth half had been removed was filled with rotting food. In order to create some comfort for him for the few days between removal a power float was done to reduce the hook. While this was being done the tooth has signs of looseness but not noticeable by hand.

    I understand you can’t comment on my horse without assessing him, I just need reassurance that I’m not doing the wrong thing by having it removed? Is there a chance that the outer half could be removed to the level of the broken side and grow through with fewer issues than a full tooth removal? Despite the wad of rotting food there isn’t obvious signs of infection. I’ve had this horse for 4 months and am disappointed I wasn’t previously told about the situation, I’ve since been in contact with the equine dentist that saw him 6 months ago and she shared all this information with the rescue coordinator to pass on to the buyer. I’ve had trouble putting weight on him and now that I’m aware of his teeth its no surprise, his jaw is locked preventing him from chewing normally and has only been able to chew with an up-and-down motion.

    I feel like I don’t have any options, I’m worried that the removal will be harder than anticipated and the surgery will end up being a huge procedure.

    Thanks for your time

    1. Thanks for asking about your horse. This issue is very common and should not be a concern for you.

      Start by removing all sources of pain within the mouth. This is done by thoroughly floating off every sharp point. It should also include the edge of the tilted tooth that is digging into the cheek. This will do the following:
      1) “unlock” the jaw by removing the restrictions due to pain.
      2) allow for the tongue to enter the open socket to clean out the food.
      3) allow the tongue to push against the remaining tooth which will strengthen its attachment to the bone.

      If your horse has difficulty chewing after this please allow an adjustment period.

      Losing weight is NOT related to teeth is he swallows everything you feed him. It is usually associated in the food being given. Please go here to read about nutrition in horses: https://theequinepractice.com/travels-with-doc-t/horse-nutrition/ which has 15 or so blogs on the subject. If you want the easy path then read https://theequinepractice.com/feeding-the-horse-as-simple-as-1-2-3/ and https://theequinepractice.com/why-horses-should-not-be-fed-grain/

      Finally, let go of disappointment. It is a disempowering emotion that everyone seems to enjoy following in these days. People will continue to disappoint others because it is engrained in them via what they read and watch. An alternative is to become focused on self improvement and gratefulness as you are attempting here. First be grateful for the opportunity in helping this horse and realize that through your energy you found these blogs. Keep going and don’t let negative thoughts prevent you from becoming the best horse owner you can be. 🤠

      1. Thanks for replying.

        I believe the issue with weight gain has been due to difficulty eating hay and stalky grasses while out foraging. He’s grown nearly 2 inches in height since I bought him and I hadn’t accommodated extra hard-feed to maintain him properly, which I have now. He lives in a herd-style agistment on 200 acres, when I’ve offered him hay he hasn’t shown interest in eating it which I thought was because he was adequately foraging but he was unable to chew in a grinding motion. I’ve changed his diet and will keep researching nutrition, thanks for the links.

        The vet has attempted to remove the tooth, which resulted in the remaining part of the tooth breaking off within 2 minutes of having pressure on it. The initial xray did not clearly show breakage of the root of the tooth, the xray taken after the tooth snapped shows the root is in multiple pieces. The vet also mentioned that the root/tooth hadn’t formed properly. This horse has now been referred to a specialist for extraction via (very expensive) repulsion. I have photos of the tooth and xrays, what remained of the tooth before attempted extraction was completely out of alignment and digging in to the cheek, the remainder of the tooth needed to come off to remove pressure from the cheek. I unfortunately didn’t think to get photos after the tooth had snapped off, but I kept the bit of tooth and felt where the tooth was so I had an understanding of the hole.

        After the tooth snapped off and he recovered from sedation he spent the next 3 hours grinding his teeth because his jaw was no longer locked and it must have felt good for him to stretch his jaw muscles.

        I’d like to chat with you via email and share the photos, happy to pay for your general opinion on the next steps moving forward with this horse and his problem tooth.

        Thanks again 🙂

        1. I’ll bet he is doing well now that the tooth is no longer digging into the cheek. On occasion I have also had these teeth snap off rather than come out. Here is the explanation – it would have snapped off on its own eventually. They do all the time. I removed this week a sagittal fracture of a cheek tooth that was digging into the cheek just like yours. It was already broken off from the parent tooth. This is true in most cases. Your horse’s tooth just had not broken yet.

          If you don’t extract the remaining tooth you may find that the horse lives for years without a problem. If a problem does occur later then extraction may be warranted but in my experience, your vet / dentist who snapped off the fractured piece only did what the horse was going to do later. Please tell him/her this.

          Please keep us updated with his progress. Thanks and no need really to send me x-rays or to call me. This is really something you and your vet can go through together as long as no one panics and “pulls the tooth” when there is no reason yet to do so. Just my opinion.

          1. It is different from what is being told but that’s because I have seen so much. Thanks for finding and reading.

  19. I have an ex show horse that obviously was a cribber. His upper front teeth are excessively worn, when or if it be necessary to remove all or some? I don’t want him to be in pain if at all possible.

    1. Worn down incisors from cribbing have never become painful in my experience. They just disappear. Good to know that the incisors are not needed for harvesting food but good for biting people!

  20. Hi Doc T.

    During my senior gelding’s routine floating the vet found one of his incisors to be mobile, 102 i think. With a bit of force she was able to wriggle it only slightly and said that the best course of action would be to pull the tooth out to prevent pain or infection. This shocked me a bit seeing as he’s been eating absolutely fine. Apart from a receding gum around that particular incisor his mouth is apparently in really good condition for an elderly horse.
    I know you can’t advise on my particular case but i just wanted some incite as to whether pulling the tooth out would be the best course of action, i don’t want to cause my horse any problems with being able to eat but i also don’t want to argue with the vet, i just want what’s best for my horse. I could understand if the tooth was evidently loose and could be extracted by hand with a wobble but it seems quite firmly in place. In your experience would you pull this tooth as it is right now?

    Many thanks in advance,
    Oliver

    1. Thanks and I appreciate your situation. If it isn’t bothering the horse, why pull it? When it becomes a problem then extraction should resolve it but that point is a way into the future. Senior horses often develop EOTRH. Did your vet make that diagnosis? If so, the tooth will wiggle more as time goes on. A local infection will develop that may become painful but often doesn’t stop horses from grazing.

      I just extracted an incisor from a mini. We had waited 2 years until the tooth became loose enough to extract with my fingers. It was painful but the extraction was easy and the horse was eating both before and after extraction.

      Hope this helps. Your vet can call me if it helps but you do have time to make the decision.

  21. Our horse saw the vet today. Sneeze and there was creamy mucus. She was concerned over sinus infection. Checked the teeth and there was a hole large enough to stick the probe into tooth 209. X-rays showed no sinus infection. They are recommending a filling to prevent problems down the road. What’s your opinion on fillings?
    Thank you

    1. The American Association of Equine Practitioners has had speakers who have looked at the effectiveness of filling decayed teeth and have determined that is not a viable option due to a high failure rate.

      If there is no sinus infection then where did the nasal discharge come from? Would filling this cavity stop the nasal discharge? The ’09 teeth are the most common for decay and tooth splitting and no one has the reason for decay selecting these teeth.

  22. Hi,

    My 12 year old ottb mare has been dealing with an infected tooth for about two months. Apologies but I don’t know which tooth exactly, just that it is far back and on her lower jaw. The infection first appeared as a sore lump in the middle of her jaw between her lower jaw bones. That lump burst one day and developed into three holes that drained pus. X-rays showed some darker tissue around the tooth root.

    The vet prescribed antibiotics which we did four rounds of, twice a day, for ten days each. The first round was a mess, with two doses missing and the second half of the pills delivered late, so I decided to try a second round. By then two of the three holes had completely healed and only one was still draining slightly. She seemed to be getting better. Finally, when the infection was “85% cleared up”, the vet stopped antibiotics and said to just wait and see if it went away on its own.

    Vet did an exam of the sore on her outer jaw about a week ago and said it was healing well. Today, x-rays were done again just to make sure the infection was gone. Apparently the infection has returned and the tooth has split. It is now draining into her mouth and apparently her breath smells foul. I didn’t notice any stinky breath or resistance to the bit yesterday. I don’t understand how the vet could have missed this from the exam a few days ago, and if nothing was missed, I don’t understand how this is possible in such a short time if it was healing well and almost gone a few days ago. Vet attempted to remove the split tooth today using local anaesthetic but was unsuccessful. Now recommends seeing a surgeon to extract the tooth. Quoted me a ridiculous amount of money ($1000s more than what another vet quoted) for the surgery, which feels a bit like the vet was trying to push me to let her try (and charge me) before I got a surgeon involved.

    During this whole time, my horse has never been off her food (except when we tried to hide pills in it – ended up giving them via syringe). She has tons of energy and works beautifully on the bit. I feel as though I have been strung along financially and emotionally while my horse potentially suffers, if not from pain from the tooth, then from the stress of being force fed antibiotics twice a day.

    Does this treatment seem unreasonable to you? Does the tooth suddenly splitting seem reasonable?

    Thank you.

    1. Fractured cheek teeth are common and on occasion they will cause an abscess to drain outside the mouth. The cause usually is decay working from the occlusal surface towards the root. This decay acts like a wedge driven into a log being split for fire wood. The tooth is spread apart with the potential for the infection to erupt through the lower jaw or sinus. At some point the decay creates enough lateral pressure that the tooth cracks at a right angle to the tooth and usually at or near the gum line. This is a one time event that is sudden and would explain why it was not seen earlier but seen with a subsequent exam. This is a reasonable explanation that should relieve your worries about your vet “missing” it the first time.

      On occasion the crack at tight angles to the tooth doesn’t occur but rather the crack from the pressure of decay moves more vertically down the tooth. This in essence splits the tooth into to pieces running the length of the tooth. These do not come out easily and may be the reason your vet cannot remove it. I had one of these just last week where the tooth root curved and made extraction more difficult.

      Here are some important things to note: 1) The whole tooth does not need to be removed. Just remove the cracked off part. 2) Once removed the drainage to the jaw should stop as it now has a bigger hole to express the infection. 3) Shortly the saliva will clean the area and granulation tissue will fill in the area and the infection will resolve.

      The most important thing to emphasize here is that the horse is not showing any signs of discomfort. Therefore “suffering,” either actual or potential, is not part of this. He is not in pain.

      I had a split upper 4th cheek tooth remain in the horse for almost 2 years before the tooth fragment became “mature” enough to be extracted orally. During this time the horse never showed any chewing or bit problems. After the extraction the horse lived comfortably and without any issues to this tooth for another 10 years dying recently from an unrelated issue. If your horse is OK then you have time to make a decision.

      A comment about your vet. He or she did well and is trying to do the best for the horse and you by referring him to a surgeon for extraction. We all can understand your frustration and feeling of helplessness especially when a high dollar amount is assigned. It is like a roof that leaks or an engine needing a major repair that causes owners to worry. Unlike the roof or engine, there is little written to help them understand what to do with fractured cheek teeth. There was NOTHING in the veterinary text books in the 1980’s when I was in vet school. Today only the whole tooth extractions get the press time while the simple cracked teeth receive no research to competently advise vets on what to do. Please don’t blame your vet for this or the surgeon whose training is only in tooth extractions.

      It is the purpose of this post and ALL the comments here to compile some experiences for all to read and to more fully understand what to do when a cheek tooth fracture or a tooth root abscess occurs. To this end I encourage you to return and reply with meaningful information on what you did or did not do and the outcome of that decision so that we all can learn.

      One final thought. Because there was no veterinary articles or texts 30 years ago describing fractured cheek teeth, what has changed to cause this? If tooth decay is the cause then why was there nothing about tooth decay in horses back then? In 1932 dental decay in children was researched and oatmeal was found to be the cause. Removing oatmeal arrested the further development of tooth decay and actually healing of some teeth. Has your horse been on grain? If so, what have been the ingredients?

      Thanks for your comment and please discuss this with your vet. He or she is really trying to help and sound honest knowing what I know about teeth.

  23. Hi Doc T, I wrote not too long ago about my mare’s tooth. She came off the antibiotics 11 days ago after being on them for about 40 or so, and it is now unfortunately swollen and tender again. Last time it swelled she had a temperature from the infection. My vet said she will send in a referral to our vet college and for me to take her in where they will assess her and do surgery if needed. Is this a logical thing to do at this point? She’s been on long courses of antibiotics twice.i was hoping to not have to take it out but the infection seems to want to keep coming back. She is still eating right now but it just became swollen in the last 24 hours. I read a bit about leaving them if it is swollen and they are still able to eat… but if it causes a temperature and is painful would it then need to come out?
    Thank you.

    1. Thanks Kelly – The first thing to realize is that I cannot advise you. It seems like your vet is advising you correctly by referring the horse to a teaching hospital. There an accurate diagnosis can be made and a treatment applied.

      Because there is a persistent problem (recurring swelling after a length of antibiotics +/- fever) then there may be a reason other than just a tooth abscess. In the case of the Belgian that had a similar issue and was turned out for 2 years before it resolved, it was finially determined with good radiographs that the mare had an extra cheek tooth. I have seen where persistent cases have either an extra tooth, a deformed tooth or something other than a common tooth root abscess. The usual course of action is to remove the tooth because all owners wanted to act on the problem. It is strange but all the horses continued to eat and show no discomfort but all had a discharge from the sinus or the mandible.

      Please counsel with your vet. Work together on this and do what is best for the horse. Let us all know how this resolves.

  24. Hi….i posted a while back regarding my PPID gelding with sinusitis. Its never gone away but now we have breathing issues from upper airways. On ventapulmin and sputolosin (and anti b for forth time)…its been a week and not seen any improvement. Without a CT scan i guess we will never know if its teeth or a growth…i can manage the snot but i feel bad for him if he is struggling to breathe. His immune system is low, i tried the protein route and adding milk thistle to his diet. He is on 2 prascend daily and im wondering now if its time to call it a day.

    1. I can only imagine your frustration. Whenever there is more than one thing and treatments don’t seem to be working, it becomes easy to give up.

      I have a few questions. Was the “protein route” 0.5 to 1.0 gram of protein per pound of body weight per day from a variety of sources? This is about a pound a day of a combination of 60 to 80% soybeans and 40 to 20% whey protein in addition to pasture and hay equaling about 20 pounds per day (all they can eat in a day). Most people only add a small scoop of protein. In addition, all sugar must be removed for several months to give the mitochondria a rest. This may include limiting access to lush pasture and good hay (or soaking the hay).

      I do not know what milk thistle does to the immune system of a horse whose protein is compromised and the gut possibly inflamed from chronic sugar uptake. If this sentence is confusing then you may want to read these articles: https://TheEquinePractice.com/feed They will tell you some things that most people don’t know about feeding horses. Hang in there and read them all starting from the old and moving to the most recent. You may become overwhelmed but it is better than just calling it a day. At least try something different and give it enough time. Maybe this will also help the nasal discharge. But it will take about 6 months so be patient.

  25. Hi Doc T,

    Was wondering what you thought about this case. My 9 year old warmblood mare’s face swelled up on the upper left side last October. The vet looked in her mouth and couldn’t see anything obviously wrong and decided to put her on uniprim for about 40 days. In that time period she xrayed and saw a flared up root on what seemed to be tooth number 209. After the uniprim my mare seemed to clear up and what was left was a bony lump (that had been there earlier that summer).

    I noticed the lump around July or so- a small bony lump (raised lump about 1/4” high and an inch long)in that same location)- had it checked by the vet but it wasn’t showing any signs at the time of anything else being wrong- except a head tilt when riding going to the right would tip her head to the right and nose to the left. Didn’t really put the two together then (the head tilt and the small lump, especially bc it seemed painless). Vet thought maybe the lump could be some kind of bony cyst and said to just keep an eye on it. Over the winter my mare had chiro and massage done several times but this did not help the head tilt.

    Fast forward 7 months from when the swelling first occurred (to early May this year)and she was swollen again with a temperature. Back on antibiotics, same amount as before but a week into them she swelled back up including the glands. Vet came out and looked inside her mouth. Part of 209 was missing (the outer part). About a 1/3” -1/2” piece off the outside of the tooth. the tooth looked straight on the outside of the tooth on the part that you could see- as in it the part that broke off didn’t look to be angled in further (but could only see so much). Her gum looked good and the vet said it felt tight against the tooth. The vet also pointed out that the tooth was the same length as the others and growing at the same rate. She floated the teeth around it to smooth them out. The vet increased the antibiotics and also added in penicillin. My mare is currently still on antibiotics (about a month in). The vet wanted to do the 30 days.

    The lump on the face where the tooth is has gone down from what I can tell. It looks like it’s smoother. But it is still there. She doesn’t seem to be painful around the area at all. But she will still head tilt (although not as extreme). I’d think she was healing more if she wasn’t still tilting a bit. It was definitely worse before- but that would make sense with having a cracked tooth that may have been pushing into her cheek a bit (it got worse over the winter). Concerned as to why she still would be tilting since it has fallen out.

    Does the bony spot in situations like this usually get reabsorbed? Is a bony spot normal with this type of situation? I was wondering if this is a common chain of events to occur and wanted to see if usually when there is a tooth root abscess with a broken tooth if that means it has to come out? Or is it still smart to wait and see if that remaining tooth might be ok (in general). Do tooth root abscesses mess up the tooth permanently? Or can a tooth still be ok in the end after all this?

    I’m assuming that it is possible the tooth finally broke off in May after being cracked back in July last year…. maybe the swelling in October and root infection was caused by food getting up in the crack. There was never any smell at all though and no nasal discharge. Then when it swelled back up in May maybe food got back up inside where it broke off. In cases like this, is there hope that the remaining tooth can be saved? I’m worried about taking her off the antibiotics and having her swell back up again… and also very concerned about the procedure if it needs to be removed. Any similar outcomes/experiences would be appreciated! Worried about my girl. Apologies for the lengthy message- just wanted to make sure I included the details. I did read through all of these comments but didn’t see any cases exactly like my mares so wanted to comment!

    1. Kelly – Most people do become worried when an unexplained lump appears. I understand but remember I cannot comment about your horse’s case specifically.

      A lump is a lump until proven otherwise. In other words, without diagnostics a diagnosis cannot be made. But in my experience, a sagittal cheek tooth fracture (what you explained here) usually does not cause a bony swelling. It may cause difficulty chewing and a head tilt when eating as the displaced fracture piece moves uncomfortably into the cheek. This usually resolves immediately once the fractured piece is removed.

      Head tilts as well as facial lumps are common with trauma to the face and the tooth may be unrelated. I have seen this.

      What is missing in your lengthy report, as is almost often not reported in these comments, is the most important thing – has the chewing pattern been altered or even prevented the horse from eating? This is SO important because in these cheek tooth cases, while the horse is eating without any problem, the owner starts to ask about tooth extractions. I think owners go there because they really care about their horses and feel they must DO SOMETHING.

      Asking your vet to examine and prescribe antibiotics was a good idea. But please understand that the “crack” you say was really decay of the tooth that has been going on for years. The decay wedges apart the tooth just like a wedge splits a log into firewood. At some point the tooth breaks, usually at the gum line, and the piece comes out often with help from the dentist. Today I removed this exact tooth fracture you describe from a 28 year old horse that the owner never knew was in there. The mare ate without a problem. With a little help from the float blade I was able to remove it with my fingers and without medications. The mare was very grateful.

      If the head tilt still occurs after the antibiotics stop then you need your vet to investigate further. But as far as the tooth fracture goes, these usually heal up on their own. Kudos to your vet for filing smooth the edges as these spots become a focus of attention for the horse’s tongue and the stropping (look up this word) motion sharpens the edges quickly into a razor’s edge.

      Keep us posted, but don’t be pulling a tooth if she is chewing and the swelling is resolving.

      1. Thank so much for your reply, I appreciate it! To answer the question about the eating- the first time it swelled up, yes she was having trouble chewing and it seemed painful… and was tender to the touch around the area that was swollen. The second time after the piece fell out, she was sore to the touch but was still eating. She had a temperature and was not really wanting to eat as much/was off by herself. But it didn’t seem physically hard for her to eat.

        She has a few more days left on the antibiotics. The bony lump on her face has changed more and is now almost flat. Really hoping the swelling stays down this time.

        1. Thanks for the update. It looks like things are heading the right way with the lump decreasing, the tooth fracture removed and less painful. You will know about 1 week after the end of the antibiotics.

          Swelling of the face, painful to the touch, head tilt, difficulty chewing – this could all come from trauma. Most horses with a cheek tooth fracture either show no problems or they chew with obvious difficulty. But as time moves on, she seems to be improving so pulling the tooth seems lees likely as an option.

          Let us all know how it goes.

    1. I never use Dorm Gel for 2 reasons. 1) it can be absorbed through my skin and I don’t think I would like that. 2) it is only a sedative with no pain killing properties within the mouth. The reason to medicate a horse for any dental procedure is to remove pain. Dorm is great for the face (eyelids or ears) but does not affect the oral mucosa. therefore I don’t use Dorm as an injectable for dentistry either.

      Thanks for this question.

  26. If a horse has an abscess that will not clear on the side of the face lower jaw. Had x-rays and it is a tooth route causing all the trouble is it best to have the associated tooth and route removed or is there anything else that could be done. Or what would happen if nothing was done and just carried on cleaning the open wound/abscess on the side of her face. Filly eats and drinks fine and has not loss any weight

    1. There are 2 choices – 1) pull the tooth which will usually resolve the drainage but also can have some associated complications. 2) Wait and keep cleaning. If you do option 2, please take very clear pictures and write your observations with the date, her response to this (eating, pain, etc) and the progress and send this to me with permission to post.

      It is my opinion that if the horse is not adversely affected by this tooth root abscess then you have time to watch and observe. In my experience, owners who elect the wait and see approach report that the problem resolves but does so slowly (periods of draining then no draining) and over a year or more to full resolution. This usually is discouraging for most owners who eventually go for extraction.

      In my time with horses I have not seen a report where a tooth root abscess causes the demise of a horse. Furthermore, in all the texts I have ever read, there is no discussion of long lasting tooth root abscess problems in the horse. Before surgery all of these resolved on their own. Also, there are no vet studies performed where these draining abscesses were observed by scientists in a controlled study. Hence we need some accurate reporting from people like you willing to wait and see. This is so important because you are not the only one to ask me about this. I am looking for data to offer people in the future that will help them decide, like you, to wait and see or to pull the tooth.

  27. I have a 27-yr.-old TB that was given to me four years ago. He has recently starting dropping some chewed hay. My barn manager will not allow anyone except a licensed veterinarian to float teeth on the premises. My vet has told me to contact the area Equine Dentist. My farrier says don’t go there, his treatment will be much too drastic. Add in all kinds of conflicting advice coming at me about hand floating vs. power floating. I only want to do what is best for my horse. His front teeth are an uneven, worn down mess as he used to crib for many years. His weight is maintained and he is bright and healthy looking. Any suggestions. I could send you the photos of his incisors.

    1. I feel your pain about abundant conflicting advice. At 27 years he will probably do OK with a routine float by someone who is conservative in their approach. Discuss this with your vet and ask for a non aggressive approach to a routine floating. Be aware though that even a easy floating may worsen his ability to chew.

      1. Dr. Goeff, I did find a vet who does hand floating who took a conservative approach. She said she would have to come back to take a little more off in about four months. After the float his chewing did improve and he seemed comfortable. So, about a month later (three days ago) he couldn’t swallow but it was not a choke. I had to call my regular vet and he came out, sedated, put in a speculum and felt around with his hand in the horse’s mouth and came out with a molar, then another one. They were each second from the last on the bottom. Also, the fleshy part between the two lower mandibles (about halfway up from chin to cheeks) was swollen and he did not want it touched. He did have a slight temperature. The horse started to feel better later that same day. Had a shot of something and then went on SMZ and Banamine. There was no diagnosis as to the cause of him not being able to swallow. Do you think the float could have loosened the teeth? She did not mention any loose teeth. Was it correct to take them out if they were loose? I really don’t know what to think. Today he was chewing fine but sometimes making kind of a grinding sound which he was not doing right after the floating.

        1. If the teeth can be removed by hand then they were ready to come out – so the answer is yes it was correct to remove them. I also have seen horses after floating have teeth either loosen or fracture. This is due to the relief of pain from the sharp points allowing the tongue and jaw to move freely and without restriction from pain.

          This is a GREAT EXAMPLE of the expression that floating teeth is a PROCESS and not an EVENT. Changing the oil in your car is an even that is performed the same in every place on earth because it is a machine. Floating teeth is a process that once done, allows other things to happen (new sharp points, loosening of end stage teeth, fracturing of cheek teeth, biting of the tongue). The floating allowed the horse to work the end stage teeth into a loose condition. This affected the horse causing a choke – like event. The attending vet to that discovered the teeth and extracted them by hand.

          It is common for a horse to have a more purposeful “chew” creating a different sound. If the vet who extracted the teeth did not float him then you might ask the hand floater to come back and re-asses and file any sharp edges (common about the new sockets). Even if no edges are found, the exam will help put your mind to ease that this new sound is actually normal and has been absent for a while from the restricted jaw movement.

          Thanks for the update. Doc T

          1. Thanks so much. That really helped explain things and put my mind at ease. It makes sense what you said about it being a process, not an event. My regular vet also said, the hand floater had taken off sharp points but had not “evened” the teeth out. Am I correct to think that was for the best? I’ve been told that in an older horse if the teeth are evened out, chewing power may be lost that can’t be regained. Right now the horse has been off the SMZs for three days and seems to be fine. He is not quidding that I’ve seen either. No recurrence of the inability to swallow. The attending vet said he did not think the loose teeth had caused the episode.

          2. I am not sure what “chewing power” is because no one has ever measured the power applied by chewing. If the horse is chewing, the teeth wear according to the power and movement applied. The primary cause of decreased jaw and tongue movement is the pain caused from sharp points. Removing the cause of pain allows for the most movement of these and probably would increase the “chewing power.” From this, the teeth will wear according to the new movement. It is NEVER the other way around and therefore there is never a need to “balance” or “level” the mouth. That is just a trick played on the eyes.

            If a boat moored to a wood piling rocks for a while from the wind and waves, it will create a notch in the wood. Does that notch prevent the boat from moving? No. It is the movement that caused the notch. Any tall tooth is there only because it is not being worn down. If jaw and tongue movement is improved, the tall teeth will wear themselves down according to the new movement. They will never block the movement.

            One last thing. Loose teeth often become firm again after improved movement of the tongue because the tongue is now allowed to move against the teeth. This cleaning motion, unrestricted because the pain has been removed, is resisted by the teeth and improves the ligament attachments to the tooth. This tightening process still amazes me.

  28. Hello!

    I have a 6-year-old Percheron x Thoroughbred mare that I purchased in April of 2017. When I purchased her, she had an abscess on her cheek that still has not gone away. She exhibits no pain when it is touched, has a totally normal appetite, chews normally and has never had any kind of nasal discharge.

    She had her teeth floated in August and the vet prescribed 2 weeks of Sulfa, which diminished the abscess but did not fully eliminate it. I had the vet out again to float her teeth last week, and had radiographs taken, which were sent to a dental specialist at the OVC. She and the vet agree that it’s the tooth root of the first molar on the bottom left arcade that is infected. My mare is now on 2 weeks of metronidazole, and the vet suggested that if this doesn’t clear things up, that the tooth be surgically extracted.

    The tooth seems to cause her no pain, does not impact her work and has had no impact at all on her appetite – do you think that extraction is necessary?

    Thank you so much!

    1. I apologize but I cannot comment on a case that I have not examined. That is the law. You must either trust your veterinarians or trust your gut feelings.

      What I can say is simple that there is no rush and multiple exams can often give more information to base your decision on. This include multiple X-rays to determine any advancement or improvement. Hope this helps.

  29. Dear Doc T, I am grateful to have found this page and thank you in advance for any insight you can share. Yesterday my vet discovered that my 29/30? year old draft horse had either a fractured or infected lower, right canine tooth. Some of the enamel was missing and the tooth appeared to be raw or bleeding. He has no lumps, no discharge, a good appetite, and the tooth is not loose. An x-ray showed that the bone underneath (maybe the size of half a golf ball) was fairly dark. (Please excuse my total lack of medical knowledge.). The vet did not want to pull the tooth yesterday due to concerns of fracturing his jaw bone. We decided to let it abscess and let the tooth loosen on its own so that it will be easier to pull. She estimated this might take 3-4 weeks. I want to do the kindest thing possible. Given his advanced age, is it even smart to put him through this? Or is pulling a canine not as bad as I imagine it to be?
    Any thoughts you might have would be appreciated.
    Thank you,
    Julie

    1. This sounds like EOTRH of the canine. Equine Odotoclastic Tooth Resorption and Hypercementosis. I have many pictures here: https://www.thehorsesadvocate.com/canine-decay-and-eotrh/ and here: https://www.thehorsesadvocate.com/incisor-eotrh/ (you need to become a FREE member first here: https://www.thehorsesadvocate.com/become-a-member-of-the-horses-advocate/

      Extraction is pointless unless it is very painful or fragmented. Then a partial extraction is simple. Removing the whole tooth is unnecessary and would be difficult because the disease is of the bone and not the tooth. The tooth is an unfortunate victim of the bone disease.

      More info here: https://theequinepractice.com/what-is-the-cause-of-eotrh-in-horses/

  30. Thank you, I don’t think PPID is necessarily an age thing as it’s possibly hereditary. The protein deficiency is interesting. The problem is he won’t eat anything other than hay as he thinks it’s all spiked with poison! Anyway 4 weeks after the flush the infection is back though not as bad as before so back on antibiotics. I am still not keen on tooth pulling but I do feel pressurised by vets. In fact, he is a grumpy old nag but the vet feels this is tooth pain related. If that’s the case why is he eating every morsel of hay?

    1. I have not heard that PPID is heritable. The age is only because of the chronicity of protein deficiency making its mark on depleting either dopamine or some other interrupted function of the hypothalamus-pituitary connection.

      There are multiple good sources of protein such as straight soybeans, coolstance, straight whey, and legumes. I’ll bet you can find something!

      Thank you for trying the long term antibiotic route. I’m glad that it seems less. Tooth extraction may improve the grumpiness as it can be an annoying pain that doesn’t interfere with chewing. Extraction abruptly ends the healing process and while it “fixes” things, I don’t believe that grumpiness is an important issue. If he couldn’t chew then it would be another thing but I agree with you. Have patience as long as there are no adverse reactions to the antibiotics.

  31. Hi I have a 22 year old cob that has had PPID for the past 5-6 years. He initially started on half a tablet and is now on 1.5. 3 weeks ago he had an episode of colic and dropped 3 times, he now has unilateral smelly discharge. I assumed he may have broken a tooth during a fall and its infected. The vet has been out and floated his teeth but all are intact. rays were not conclusive either. I was offered 2 options, to either take him to the clinic for better exam and to pull 2 potential infected teeth or to drain the sinus and give more antibiotics. I opted for the second. My worry is that his PPID has advanced (he is showing other symptoms) and is now immunocompressed. The cost of option 1 was beyond my means, esp as already have 2 vet bills. I feel that if he does not recover from option 2 I need to think about letting him go. I just worry that even if I found the money to pay for option 1, the infection would be back due to the PPID. I just need to add that every time I up the Prascend he goes off food and becomes depressed. His quality of life is not great!
    D

    1. Dina – I can’t legally give you advice about your horse. But let me ask you a question – What is the cause of the PPID? Most will say it is just an old age thing. I believe it is a result of a chronic protein deficiency brought on by feeding lectins causing leaky gut syndrome plus excessive carbohydrates which causes muscle loss.

      Please read my articles on chronic protein deficiency as well as lectins. They can be found here: https://theequinepractice.com/travels-with-doc-t/

      Adding a good protein source in good amounts will boos the immune system. Let us all know how it goes. Doc T

  32. I have a 8 year old Finnish Warmblood mare. She have had occasionally smelly extract from her right nostril couple of years. Some times she has been given penicillin (5-6 days) some times Trimetroprim Sulfa (10 days). Problem has earlier solved and been gone for couple of months.
    Last spring she fractured her upper molar (right side). My vet could remove the piece easily by her fingers. By then she had again Penicillin for 5 days.
    During the summer she has a smelly yellowish stuff running out from her right nostril . Her head was x-rayed and there was liquid in her
    sinus, but there was no clear evidense that the teethroots were the problem, The specialist could not say for sure that the roots were ok, but either he could not say that there were a problem.
    This autumn the bacteria was cultured and it was Streptococcus zooepidemicus. We put her again on trimetroprim sulfa for 10 days (huge dose per day) and that helped couple of days and the smelly stuff was back. Next thing to try was Metrodinazole for 10 days and it did not help either.
    Last week she went to clinic and got a hole to her sinus (that was really bad smell coming out from that hole). we have been flushing since that twice a day. She still smells bad and the smelly stuff keeps coming out….
    Vet suggested that if this flushing does not help in next six days they should remove two upper molars (they cannot say wich one is the possible problem)
    I am not very sure about this operation

    1. I cannot comment or advise on an individual horse.

      Finding the cause for a sinus infection is often frustrating. However there is now access to the sinus for flushing and I have seen horses on 30 to 60 days of antibiotics. I have also seen a horse with a bad smelling nasal discharge unresponsive to sinus flushes and long term antibiotics stop all treatments and self heal in 2 years.

      If a tooth is extracted and it is not the cause of the discharge then it will continue. In addition there can be complications from extractions. You need a thorough discussion with your vet.

ALERT! – DURING SEPTEMBER, I WILL BE WORKING ON THIS WEBSITE. THINGS WILL BREAK OR CHANGE AS YOU VISIT. SO PLEASE BE PATIENT AS I MAKE THE MODIFICATIONS. THANKS, DOC T!
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