Pull The Tooth!

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 resolved with long term antibiotics alone. I also have stories where owners have had a tooth removed plus antibiotics and the problem resolve 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 to, 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 identifying 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 was 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 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 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 the convenience and not the 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 in 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.


  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.

    1. There is usually no reason to avoid using a bit after a cheek tooth extraction but you need to discuss this with your veterinarian.

  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. Really glad I came upon this page. It provides a whole different way of looking at equine dental issues. Thanks Dr. Goeff.

  15. 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.

  16. 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!

  17. 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.

  18. 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.

        Judy McDonald

  19. 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.

  20. 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!

  21. 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,

    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.

  22. 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.

  23. 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.

  24. 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.

  25. 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.

  26. 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.

  27. 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.

      1. I have two photos to upload but unsure how to upload them here of the filly’s face

  28. 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.

  29. 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.

  30. 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,

    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/

  31. 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.

  32. 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!

    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

  33. 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.

  34. Thank you for your reply. I respect my vet, but do sometimes feel as if the treatments we are given may be a bit over the top. In my personal opinion, for what it’s worth as I’m NOT a vet nor anywhere near it, antibiotics should be used in the case of an infection and not as a preventative.
    I feel better going with my gut on this dental issue, given the low instance of possible infection and my desire to avoid complications.
    As far as the ligament injury, the prescription of 3 months stall rest pretty much threw me into a panic. Luckily, we have outside runouts attached to each stall which I keep open for him to get some more movement daily, and I’ve been hand walking. In your experience, what do you typically recommend for a ligament strain?
    As for the grain, I had actually weaned him from grain to a vitamin/mineral supplement as substitute especially with being on stall rest in not looking to add to his calories-then the prescription of antibiotics came along and that’s the only way to get them into him.
    Any additional information is welcome, that you can share…I just feel like I’m doing everything wrong now 🙁 and all I wanted was for him to be better 🙁

    1. Be sure to talk with your vet about your decision about this issue.

      Ligament has 8 letters and therefore takes up to 8 months to heal. They heal faster with stall rest but they heal stronger with purposeful exercise (LSD or Long Slow Distance). This helps to organize the spindle cells and their healing fibers into a stronger patch. 2 schools of thought here so discuss this also with your vet.

      Grain in most horses is inflammatory. See The No Grain Challenge. Most supplements are also either a waste of money or are combined with inflammatory corn or wheat middlings. Try mixing meds and supplements with hay pellets +/- water or Gatorade.

      I am fighting for horse owners like you – wanting to do right but often making things worse. Believe me when I tell you that you are not alone – by a long shot. Become a member of The Horse’s Advocate. It is on “Summer Vacation” right now as I update the site, but be patient and visit often. Doc T

  35. Hi after a routine dental visit today, my dentist has discovered that my 18 yr old Clydesdale had a saggital fracture to 109 molar. She has said that he will need X-rays and the tooth out . I’m really worried about this and need to know that I’m doing the right thing. My horse is insured but due to his age, only for accidents so won’t cover this. He was diagnosed with grass sickness In January and has recovered wonderfully but I’m so worried that this will cause a set back . Obviously I don’t want him to be in pain . What wouldn’t you do in these circumstances? He became very depressed when in the hospital, to the point where the vet even suggested putting him to sleep but he rallied when he saw me and went from strength to strength when I insisted he come home .

    1. Lorraine – I have had 2 109 sagittal fractures THIS WEEK!! They are very common with about 1 a week in my practice (1.5% incidence).

      The first one wasn’t moving much and the owner was “financially drained” with another horse. It was a surprising incidental finding and the horse was having no chewing issues. We elected to come back in 6 months and check it and if necessary, extract it then.

      Today I thought of you as I discovered a 109 palatal sagittal fracture in an 18 year old warmblood. Again there were no chewing signs and it was a surprise to the owner. With the help of a light dose of analgesics I used a dental pick to widen the gap of the loose fragment and forceps to remove it. Very little resistance from the horse who showed gratefulness after the medication wore off (chewing hay, up front of the stall with head hanging out for us to rub, etc.). Here are the images.

      The Equine Practice Inc, 109 Palatal sagittal fracture - fracture side view

      The Equine Practice Inc, 109 Palatal sagittal fracture - end view

      This inspired my Facebook Live today! #EquinePractice

      If your vet would like to consult with me, have him or her contact me using this site’s contact form. Thanks and good luck.

  36. Hi Dr. T! Firstly, I do understand you can’t give me advice for my particular situation because you haven’t seen my horse. Secondly, I have been following this article/page for almost a year now (more on why in a second!)…and I just want to thank you for putting your time aside to help others and offer any experiences you can share.

    Now, onto my reason for posting! My 22 (DOB 3/15/95) year old gelding presented last fall (11-15-16) with some very dramatic motions while eating (he’s dramatic to begin with). He would be eating along just fine, stop, stretch his neck out, gape his mouth open, move his jaw from side to side, and move his tongue around-all with a very uncomfortable and quite frankly unbecoming look on his face. After a chiro visit for possible TMJ and a vet call for a dental checkup, it was discovered he had “fractured outside corner of #107 tooth”. He had quite an unlceration in his cheek. The sharp edges were removed and the rest of his teeth looked fine. He was put on SMZ 17x twice daily, and banamine.

    He is in fantastic condition but with his age and especially now with his fractured tooth, I have him floated under sedation by the vet every 6 months. Upon his last float this early summer 2017, #107 was still solid.

    June 26th 2017 he was diagnosed with a check ligament strain (this horse will be the death of me)…so he is currently on 3 months stall rest for that which was going as well as it possibly could go-until the outstretched neck, gaping mouth routine reared its ugly head…literally. Vet comes back out, dental exam…more of #107 has fractured…she actually was able to pluck it off by the strand it was apparently attached to. X-rays were taken, which will be sent to a specialist but at first glance, this was caught very early and no infection/sinus involvement can be seen. There was a bit of feed stuck. The vet didn’t have much to stay about the sturdiness of the tooth, didn’t say if it was loose or not-because the next words I heard were-the tooth is going to have to come out. I was instantly panicked. I have a 22 year old horse here that does NOT trailer well to put it mildly, doesn’t deal well with stress, can colic at the drop of a hat, AND is on stall rest until almost Oct 2017 with a ligament strain.

    We began talking about the “options” at which time it seems there’s only one…? The tooth has to go. Not today, not tomorrow, but let’s pretty much plan on this procedure having to be done within the next few months. Vet says let’s get him sound, over his ligament injury so he can trailer. Let’s put him on 30 days of SMZ 17pills twice daily to prevent infection. She tells me the antibiotics is really only a bandaid and to put off the inevitable.

    My questions are:
    1. is it possible there will never be an issue with this tooth? I feel like we are jumping the gun here, especially if the roots themselves are healthy. She told me, because some of the tooth is broken near/below gumline, it’s pretty much a guarantee that feed will get packed in there and cause an issue. About 1/3 of the tooths crown is still remaining.
    2. Is it possible we can put this off for an indeterminate amount of time? Seeing as he is 22 after all, wouldn’t it make the most sense to take a wait and see approach? Wouldn’t it be easier as he gets older to extract a tooth of it becomes an issue potentially at home vs the stress and possible ramifications of trailering him to a specialist? I had a mare that lived to 36. She had an extraction where the vet pretty much plucked the tooth out of her mouth at the age of 32/33 with no problem I’m assuming because there’s not much root left at that point.

    As a note, as if this post isn’t long enough!!…my boy is a very good eater, his weight is great (probably a little too great right now with stall rest)…he’s eating, drinking, pooping. Temp is normal and has been, as I live on property and take his temp here and there. I’m his primary care person , and I notice EVERYTHING…if he were to begin having another issue with this tooth, discharge or weird smells, I would know in a heartbeat.
    He is feeling much better after the newly fractured piece has been removed, and is eating his SMZ twice daily. He sometimes gets wise to the meds about 2 weeks in, and then in unable to get any into him (he refuses to take oral meds).

    So if you have any experience you’re able to share, please do. I would do anything for this horse, in his best interest. I love him with all my heart. But I would really like to avoid the stress and possible complications on him and myself that will come along with an extraction if at all possible.
    I know this is long please forgive me! Thank you so much for your time!

    I should have mentioned, he’s eating his SMZ in a mash of senior grain/applesauce. He is impossible to deworm/syringe etc. In my experience he will only have a taste for this mixture for 2 weeks or so, so while he is currently on SMZ as preventative, I would hate to see if he ended up with an infection from keeping the tooth, or complications from extraction and really needed to stay on these meds for 30-60 days. Kinda feeling like I’m darned if I do, darned if I don’t.

    1. While I am not in agreement on the principles being used with your horse (dental, ligament, nutrition), I am NOT his veterinarian and cannot give you direct advice on this case. All I can offer is these generalized statements based on my experience. Your vet may see things differently and is the one whose guidance you should follow.

      Fractured cheek teeth are very common. The decay fissure is usually in one direction (length of tooth or width of tooth) with the fracture going across the tooth but on occasion they can be in two directions (length and width). It is common for them to hang on with a tag of tissue and common for them to break off below the gum level. It is less common for the tooth to fracture in stages but it does occur if the decay has advanced in 2 directions.

      I see cheek tooth fractures every week or so. I remove the fractured piece and file smooth the edges to allow the tongue to clean out the area. I do not place the horse on antibiotics because the fracture is an end stage event of long term decay of one or more pulp chambers of the tooth. I have not had a cheek tooth fracture progress to a point where the area became infected or the remaining tooth needed to be extracted.

      Some people have had a fractured tooth completely extracted and most have not had complications, but some have including formation of an open channel from the mouth to the sinus that required years to close.

      As a side note, TMJ disease does NOT exist in horses according to extensive research by a veterinarian from Saskatchewan vet school. I have seen only one “locked” jaw in 34 years of dentistry (not diseased). Whenever a horse suddenly presents with your horse’s signs, call for a dental appointment before calling a chiropractor. Fractured cheek teeth are exponentially more common than any other issue affecting the horse’s ability to chew normally.

      I recommend all horses not eat grain (see my no grain challenge) especially if they are being stall rested.

      If your vet wants my advice she may email me. Let us all know how it goes. Doc T

  37. They are suggesting pulling the tooth out but I’m not sure what the best option for my horse is.

    1. Natalie – I cannot comment on your horse because I have not seen her. You need to follow your vet’s advice or find another vet to see your mare for another opinion.

      It is interesting that when I receive these types of requests for an opinion about a broken tooth, it is never mentioned whether the horse is having difficulty chewing. This is the most important piece of information.

      Weight loss can be caused by many things but if the horse is chewing and swallowing everything you feed her, then the teeth are not the cause of the horse being underweight. More likely it is lack of protein, overfeeding on grain, parasites, competition for food, lack of food, or any combination of these. A nasal discharge caused by a sinus fistula usually doesn’t cause weight loss.

      If the tooth is fractured, the fractured piece can usually be removed easily with sedation and analgesia medication. If your vet needs some advice on this, have him / her call me and I will help. Doc T

  38. I have a 11 year old Mare. She has had yellow thick discharge coming from her right nostril for 4 months now and probably has longer than that considering I’ve only had her for 4 months. She is quite thin and doesn’t have much of an appetite. When we went to the vet they checked her out using a scope and going up her nostrol and also doing an x-ray. They discovered the farthest tooth back on her right side is split and half of it is broken all the way up the her gums. The tooth is believed to be what is causing the infection since every thing else is normal. From the shape the tooth was in my dentist believes the problems started a few years ago. What do you think?

  39. Hey Doc T, it’s me again! I had to make another post because I was unable to reply to the previous posts i made, sorry for the inconvenience. I just wanted to share my latest update and again, ask you for some advice because I’ve been left with 3 choices by a new vet i got in contact with.
    Since my last reply I’ve had xrays done and it’s been concluded that my boy has a root canal infection which hasn’t yet reached the root. Part of the canal is exposed due to the hole and broken fragment that was previously removed and that’s why the infection keeps reoccurring.

    The vet gave me 3 choices:
    1.) Extract the canine – He said that due to the fact the root itself is currently healthy extraction could prove to be quite difficult as the canine’s have the longest roots which don’t constantly erupt and I would need to get it surgically removed.
    2.) Continue with long term antibiotics
    3.) Leave it alone and see if the tooth becomes easier to extract overtime – I was quite surprised by this option because even though i’d prefer not to pull the tooth I don’t want the infection to take hold and possibly cause bigger problems.

    I know you can’t really comment because you haven’t seen my horse but based on the information I’ve given what would you suggest?

    1. This new vet has all the correct options. You need to discuss it with him or her and agree with the course. If s/he wants to consult that is OK. Have them call me.

      I agree that canine extractions are problematic and difficult.

      Long term antibiotics do work as long as the source of infection is removed (sequestrum).

      Wait and see is a viable option because nothing moves that fast in the mouth. Unless it is something we don’t expect (cancer, EOTRH – both would have been seen on X-ray) then I have not seen a local tooth infection move to the bone. Though it is possible, it is not likely in my experience.

      Looking forward to the future updates. Please include photos. Doc T

  40. Doc T,

    I have just found out my horse has a broken upper molar. The dentist did not tell me a number tooth. He suggested take her to get it punched out barbecue he was scared if he messed with it, it would break off and make things worse. The only symptom my horse has is ear sensitivity one one side. She is not dropping food, fat as a butter ball, and seems happy. When he unpacked the tooth from all of the crud that surrounded it , it smelt very BAD! It is definitely infected. I have called every vet I know to get an opinion. Most say take her to get it punched, but one finally said treat with antibiotics and see what happens. Maybe it will cure the infection and it can be pulled. What would you suggest?

    1. Hi Shannon
      The smell is the digestion and fermentation of the packed food which may cause a local infection (usually painful) but your horse does not have an infection that systemic antibiotics will help.

      If the tooth is fractured into 2 or more pieces, the fractured off pieces need to be removed. This is usually done orally. I don’t advocate for extraction of a whole tooth because abscesses usually resolve on their own or with the help of long term antibiotics.

      Sometimes the fracture will go the length of the tooth. These pieces are difficult to remove. I have had one horse where the fracture went the full length of the tooth and would not budge. We waited two years before the piece matured to become loose enough to extract. During this time the horse gave no indication there was anything wrong with that tooth. 10 years later this warmblood mare is doing fine with absolutely no problems in the mouth.

      If you would like to have your dentist or veterinarian contact me to discuss this case that would be fine. Until then I cannot advise you on what to do with your horse. Doc T

  41. Hello – I’ve just been told I need my 7 year old mare’s teeth checked based on the fact she has “Enlarged Temporalis muscles.” Truth be told i haven’t had her teeth seen to since she was 4 years old because my current vet won’t even inspect inside the mouth without the horse being heavily sedated. My mare had a bout of colic after the first sedation which is why i’ve put off having her teeth looked at for so long.
    As far as i can remember she’s always had raised muscles on the forehead so if it’s a problem caused by the teeth then she’s had it for quite a while and that really concerns me. I’ve noticed myself as well that she has little hooks on her last upper incisors on either side. I’ve read that this is a common occurrence in 7 year olds and the hooks smooth out on their own most of the time without intervention once the horse reaches 8 or 9 – Is this a correct assumption or do you think that the hooks on the incisors and the enlarged temporalis muscles are linked and i need her teeth done asap?

    I’ve tried looking on the internet about the enlarged muscles but i can’t find any information on it. I would be so grateful if you could explain to me what they might mean and if you’ve encountered them in your line of work before.
    I’d like to find a vet or dentist that will do her teeth without sedation before i have her floated again but that seems like a rare treasure nowadays.

    Thanks in advance.

    1. Hi Emma – I have not seen an association either in my practice or in the literature associating the over-development of the temporalis muscles and the need for the teeth to be floated. Let’s look at this in another way.

      The horse chews on average 25,000 times a day (K Houpt, VMD of Cornell University) so this means your horse has chewed and licked into sharpness his teeth 9 million times every year. Add to this that the enamel of the cheek teeth are softer and sharpen more quickly when young and we all can be confident that your horse has very sharp edges. Each horse is an individual but for almost all horses, between 6 and 12 months the teeth become sharp enough to bother them with floating causing relief from oral pain. It is that simple. The most important factor is the horse’s individual threshold of pain.

      The hook on the upper corner incisor is called the 7 year hook which can also appear at 11 years. Or it may never appear at all. Contrary to others, it does not prevent the horse from moving the jaw but is created by the movement of the jaw. A lot of people get this backwards.

      For more information please go to: https://www.horsemanshipdentistry.com/does-my-horse-need-equine-dentistry/

      To find a horsemanship dentist in your state go to: https://www.horsemanshipdentistry.com/find-equine-dentists/

      To send someone from your area to the school go to: https://horsemanshipdentistryschool.com/info

  42. Hi Doc T,

    First of all i’d like to say what an informative page this is and i wish i knew about it sooner!

    So here’s my problem that i could use a bit of advice on. My Gelding had a piece of his fractured canine tooth removed 2 weeks ago. The root is still intact but there’s still a mighty hole. The vet told me to pack it with cotton wool to stop feed material from getting in there and to change it every couple of days. So that’s what i’ve been doing. But today there was white pus coming out of the hole and he was very sensitive in having it cleaned out, it was bleeding a fair bit too. Do you think packing the hole would have caused this? Or maybe the root of the canine was already infected and the whole thing should have come out? Should i continue to pack it or let the pus drain out while running the risk of feed getting stuck in the hole instead?

    Many thanks for reading,


    1. Thanks Luana for finding this page. There are 2 causes for a canine fracture: trauma and EOTRH. This sounds more like the decay found in the necrotic EOTRH. Please discuss this with your vet but the pus is probably coming from the decay.

      In my experience, packing in the mouth is not necessary as the cleaning action of the tongue along with the antibodies in the saliva and granulation tissue formation prevents any infection within the dirty mouth.

      1. Thanks Doc T for the reply, i really appreciate it!

        I’ve since had the vet out again and she’s adamant that it’s a root abscess which erupted once that broken fragment was removed. She’s given me a course of antibiotics for my gelding but said it’s highly unlikely that the hole will close up and that he’s going to keep getting infections unless the whole canine is removed. In your experience is this always necessary? What would be the worst case scenario if i didn’t have the tooth pulled?

        1. Thanks for the update. As always, the attending vet has the only advice you should listen to.
          It has been 9 days since your last comment. Please bring us all up to speed with a report of what the antibiotics and time have done for your horse. Also let us know if you elected to remove the canine or had an X-ray taken to confirm a diagnosis. Thanks from all of the horse owners following this and me.

          1. Hi Doc T! I’m always checking this page now for new posts, it’s helpful to get a second opinion sometimes and to read about problems other people may be having with their horse’s teeth and what worked or didn’t work for them.

            As for an update on my horse, the antibiotics seem to have kicked in and he’s alot less tender around his canine. I’m still cleaning and packing the hole as instructed by my vet but there is little to no pus at all coming from the hole that runs along the side of the remaining piece of canine. I am yet to have xrays done but that will be the next step if the pus returns after he’s finished his course of antibiotics. As for having the rest of the canine removed, i may be called a bad owner by many for not wanting it pulled and although age shouldn’t matter he’ll be 24 years old soon and i’d rather let the tooth ‘rot out’ unless i know the infection will spread and become serious if i don’t have the remaining tooth removed. So long as he’s happy to eat, not dropping too much weight and let’s me mess around with his mouth then I have no problems with cleaning out the hole on a daily basis.

          2. Thanks Luana. Obviously you are NOT a “bad owner” because you are seeking advice for the best interest of your horse. For this I thank you. Stay in touch over time so we can all learn. Doc T

  43. Hello Doc T,

    I sold a horse subject to a two week trial which ends tomorrow April 29th, during this trial the buyer decided she wanted to do a pre-purchase exam. Below are the findings. I wonder if you would actually recommend to extract the tooth or if you would leave it be and just do more frequent floats? I am extremely concerned. The lady is trying to convince me to drop the price significantly. I feel that it might just be best if I go pick him up but it is a 14 hour drive round trip. I wonder if you would advise to PULL THE TOOTH based on the findings.

    Significant dental abnormalities are identified requiring additional intervention. There is a chronically fractured cheek tooth (109), with at
    least 2 fragments remaining and a large portion of the crown missing, the sharp fragment in his cheek has chronically lacerated the
    cheek and produced a large callous. A second fragment is visible adjacent to the palate. The majority of the space previously occupied
    by the tooth is packed deeply with malodorous fermented, bloody feed. There is overeruptuion of the apposing tooth in the lower arcade
    into the void created by this partly missing tooth. The estimated duration of this problem is considered several months, greater than a
    few weeks. Palliative measures were taken to improve oral comfort until definitive measures are taken

    Recommended medical care for this problem, in the very near future, includes,radiography and extraction of remaining fragments.
    Without radiographs it is uncertain how much of the tooth remains deep in the socket. Extraction may be complicated dependent on
    how many fragments remain and how accesible they are. A standing oral extraction would be the preferred route, more complicated
    problems could require general anesthesia and/or sinus surgery. The prognosis for this problem with appropriate medical care is
    guarded to good, however, complications prior to resolution of the problem are not uncommon. An investment in this medical care will
    be necessary.

    There are other occlusal dental abnormalities of the cheek teeth, that have been initially addressed. Additionally, the incisors have a
    slant conformation and early signs suggestive of EOTRH, (enlarged bulging roots, irritated gingiva and few small fistulae). EOTRH is
    typically a slowly progressive, destructive, and proliferative condition effecting the incisor and canine teeth of horses.. No intervention for
    this problem at this time is recommended. IF this problem is progressive, it MAY result in dental pain requiring extractions of the
    effected incisor teeth. Extraction is the only treatment available for this condition, it is not being recommended at this time, but may be
    necessary later in this horse’s life.


    1. Tanya –
      The veterinarian’s report is thorough and accurate. Removal of the fractured piece of cheek tooth is usually not complicated with a good prognosis. I remove fractured pieces weekly. I recommend to follow the advice of extraction of the fractured piece. This is NOT a full tooth extraction.

      EOTRH has been around for ages but is being recognized now due to radiographs of the underlying bone and hence a very long name has been assigned. This is a progressive disease without a known cause. Most live their whole lives without complications (other than being ugly) but a few end up losing their incisors and / or their canines. Please become a member of TheHorsesAdvocate.com and visit the dentistry section with the topic EOTRH to see plenty of pictures. You will also see plenty of fractured pieces of cheek teeth.

      As far as dropping the sale price, in my experience, after removing the displaced fractured piece that is interfering with the tongue or cheek, the horse actually goes better – possibly providing a better riding experience.

      Good luck and let us all know what happens. Doc T

  44. Hi!

    My 23 year old gelding has recently had a problem with grass getting compacted between his upper incisors and lip, he let’s me brush it off if he doesn’t manage to dislodge it himself. I’m suspecting this is EOTRH as he also has very slight gaps between his incisors? I also noticed a couple of weeks ago that he started eating funny. He takes a bite then stretches his neck and head out while chewing. It may just be a coincidence but he only does it when the bucket is on the floor and never with hay or grass. I looked in his mouth and it appears his lower right canine is broken and there’s quite a deep hole down into the gum. I’ve been cleaning it out daily ever since i noticed it and i can stick a cotton swap socked in warm salt water into the hole without him showing any real discomfort but it does smell a bit. I’m worried that it will become infected if it hasn’t already

    Your opinion and any advice on this would be much appreciated and as i know when the vet comes up in a couple of weeks the first thing she will say is “It needs to come out right now!” and a canine extraction is the last thing i want after reading so many horror stories and especially when my boy doesn’t seem bothered by it at all.

    1. Hi Shaz
      As always I am not advising you on your horse because I have not seen him.
      Whenever a horse doesn’t clean a part of his mouth such as the area between the teeth and lip it is usually caused by pain or a physical blockage preventing the horse from getting the tongue in this area. Removing the blockage or removing ALL the pain producing points or conditions (a broken tooth) will allow horses to move the tongue thoroughly within the oral cavity. Also, if the chewing behavior suddenly changes such as head / neck stretching, a cause such as a broken tooth needs to be considered. Broken cheek teeth are very common and are almost always easily addressed in a medicated horse in their stall.

      EOTRH starts with receding gums from the incisors as well as decaying canines. These affected teeth may also cause pain and prevent the tongue from moving. Please become a member of TheHorsesAdvocate.com (free) and then explore the pictures and articles in the dentistry section for more information.

      Doc T

  45. The molar (107) is my horse extracted yesterday. It is winter time, we only have cold water available or a hot water boiler (for tea for example). The dentist said cleaning with flowing water, but the horse is a sensitive one, and does not really accept the water hose, Which I can imagine. We have tried several options, without any luck. Does anyone know a good alternative to keep the hole of the extracted molar clean?

    1. In my experience it is impossible to keep the extraction hole clean. As soon as the horse returns to eating, the hole is filled again. The good news is that granulation tissue will fill the hole in just a few days. The bad news is that in some extractions, the hole never completely fills. Some vets will fill the socket with a plug. While this seems to work, I’m not sure there are any statistics that show the outcome is improved by doing this. The bottom line is that I wouldn’t worry about the hole. I will add though that I try to avoid extraction of any cheek tooth if at all possible. The one we left alone (upper cheek tooth with chronic nasal draining of a foul smelling fluid) self resolved in about 2 years without extraction.

      Hope this helps – Doc T

  46. In the case of a lower jaw tooth abscess with a draining fistula, how long do you go before extraction? 6 months on and off antibiotics and still no better. Not really causing an issue, other than tender when abscess flairs up, it drains for a few days then heals for about a month then flairs up again and so the cycle goes on. How long do you continue like this before deciding to remove the cause and can leaving it cause any long term damage? Many thanks

    1. Thanks Karen for the question. Are you sure it is a tooth? This could also be a sequestrum from traumatic damage to the mandible which I have seen. While 3 different vet clinics diagnosed a tooth root abscess, and the final vet clinic (a vet school) extracted the overlying tooth, the area continued to drain. It wasn’t until an MRI done at a 4th clinic that the bone sequestrum was identified and removed ending the drainage. This is a true story that occurred to my client.

      Like your horse, her horse had no discomfort and it was only a management problem. Remember that drainage occurs when the body wants to eliminate something from the body and is natural and good but can take a long time. We seem to want to rush things, jump in and fix it. In my experience, waiting has no adverse affects to the horse. What you want to do is between you and your vet, but in your question you state: “How long do you continue like this before deciding to remove the cause…” An accurate cause MUST be determined BEFORE you can remove it. In these cases, finding that cause can be difficult, expensive and unavailable for many.

      Please keep us posted. Doc T

  47. I currently have a retired 21yo QH gelding with a (now) diagnosed tooth root abscess. He never showed any sign of discomfort or came off of feed. We just noticed the lump on his face by chance. We are too late in noticing, as the infection has already gone through the bone. I would love to send you the radiograph and get your opinion. Extraction may be a possibility, however the damage has already been done to his bone, so the options there seem slim.

    Thank you!

    1. Sorry but I can’t look at radiographs of a case I have not seen because I am not a board certified radiologist. However, the bone swelling is not “damaged.” The abscess is finding a way out and you are not “too late in noticing” and your options are not “slim.” Abscessation is a process that evolves over time and is natural. Nothing is being damaged and there is no need for a doom and gloom outlook. Consider 30 to 60 days of broad spectrum antibiotics to see if this resolves things. As always, discuss this with your vet. In my opinion cheek tooth extractions are a last attempt to resolve things and should not be considered a first thing to do. As always, as long as the horse is chewing without discomfort, then you have time.

  48. Hi i have a 10 year old horse, who had a veterinary on visit last year. He told me she needed a tooth extraction of one of her upper teeth on the left side. After this everything went fine, but i had a bad feeling about the surgery. Ended with a horse now in january having a inflammation in her left nosetril, my vet says its linked to it, but she had another surgery now where the cleanse her nose with water and a electrical pump.. Then they Will but her on antibiotics again, i have No idea if she Will get any better. If this doesnt work then he told me to put her down was the only option. Due you have any advice?

    1. Yikes!!! As long as she is not showing difficulties in chewing then be patient. I wouldn’t euthanize a horse that is eating and not showing discomfort in chewing but only having a nasal discharge. There must be more to this story that you are not telling us such as cancer in the sinus.

      For all reading this, know that extracting cheek teeth in horses can have unplanned consequences. Please discuss thoroughly with your vet before extractions to understand these complications.

  49. I have a 20 year old mare with a yellow smelly discharge from her left nostril which the vet has diagnosed as sinusitis caused by what what she has identified as a slab fracture in an upper tooth (3 from the back) there is a pustule evident on the inside of that tooth which is visible. The vet has initially put her onto 10days of Noradine antibiotic and some Bute as antinflammatory / pain killer, she has suggested that we have her ex -rayed with a view to the tooth being removed, I am loath to go down this route as I have seen the results of this invasive surgery in the past. The cost in both time and money are also a very big issue for me now that we are both retired, is 10 days enough time for the antibiotic to do its work or would I be wrong to suggest a longer period for antibiotics, I am also aware of the negative affects on the digestive system of long term antibiotics. At the moment, apart from the smelly snotty nose, there are no other symptoms or sign of distress, however this has only been going on for approx 3 weeks.

    1. Gill – fractures of the cheek teeth are common. Until the cause is removed, the discharge will continue. Removing the fractured piece is fairly easy and can be done at the farm with mile analgesia in most horses. Covering with a broad spectrum antibiotic after the extraction is important. Please consult your vet to find someone with experience to extract the fractured part of the cheek tooth. The remaining healthy part can usually be left in but that is up to your vet.

  50. Hi!
    I have a 27 year old Dutch-thoroughbred mare who has had an ongoing jaw abscess in the lower right jaw. It started more than a year ago- vet came and cleaned out the hole. She was on antibiotics for 3 weeks and improved but did not heal. A couple of months later she had another 4 week round of antibiotics and improved again, but again it never healed all the way. She had no meds through the summer or fall, but her jaw is oozing with more intensity. But she is still eating well ( not on any medication) . Should I request that my vet prescribe something for her? Should I be concerned that this long running infection might invade her jaw bone? The teeth in the jaw are solid- it is the hole that was
    left after an extraction 2 years ago that the problem stems from. Anyway, I am willing to wait, as long as I have some positive feedback to do so.

    1. Your vet can radiograph or MRI the abscess to determine the cause of the drainage. Only after getting an accurate diagnosis can a course of action be established. In my experience, drainage will continue until the cause is removed by the draining process. It is relevant that the horse continues to chew without difficulty. Please consult your vet to discuss this case as I have not seen it. Thanks

      1. Thank you for your input. My mare had X-rays last week and it shows there is an abscess around the whole root of 408 (409 was the tooth that was missing and I thought had an abscess in the vacant hole but I was mistaken). The tooth though is not budging. She has been off antibiotics for 3 weeks and the drainage continues although it seems to have lessened. I continue to soak the drain hole and rinse her mouth several times a week (when I go to the barn as she is boarded out). She is on a great mash mixture to try and keep her weight on as she really cannot chew the hay very well and quids it quite a bit. She actually seemed to quid less when she was on the antibiotics but the vet said her teeth are not the greatest and her quidding is not because of the abscess. She has had her teeth consistently maintained so I guess it is just a natural decline of their condition. The vet said that as long as the tooth is there then so the abscess will be there. But I wonder if by removing the tooth we will just create an even bigger area in her jaw where she can’t grind since there will be a two tooth gap. Is there a chance that the tooth will loosen to the point that it could be removed without surgery? The drainage and treating it are not an issue for me. The vet said it could just keep draining until she dies and also said she has never seen it compromise the jaw bone (which has not happened in this case). So, is this what you have referred to about letting the abscess heal itself? Can it possibly heal and the tooth actually not be lost?
        I appreciate any input.

        1. Without being your vet, I can’t advise or predict how this will turn out over time in your horse. This said, I still love an abscess because it means that the horse is removing from the body the problem. In my experience, these eventually stop draining without the horse developing adverse issues. It could be that the missing tooth and the sharp edges that form from the horse focusing his attention on the gap may be the source of quidding, but it could also be the coarseness of the hay. Experiment with different forages such as chopped hay or soaked hay cubes to see if this helps with the quidding.

          I always recommend 30 to 60 days of antibiotics for these cases and you said he quidded less while on them. Ask you vet if he or she is willing to try another 30 to 45 days. In the case of the horse that the owners did not perform the extraction and the draining abscess eventually dried up, they tried two 60 days periods of antibiotics. Each time it resolved but then the draining started again about a week after ending the treatment. Don’t be surprised if this happens to your horse. But if you don’t want to extract the second tooth, I can say that you will have a lot of time to think about this and even change your mind with no problems for your horse.

          Please keep us updated. Doc T

  51. I have a horse with a hole in his canine. He is 21 and over the last year has lost a ton of weight. Blood work is all clean.Doc #1 says after seeing radiographs we will only be chasing the infection and that even though there is risk involved, the tooth should come out and that the issue will most definitely fester into other problems and could lead to having to put him down. Doc #2 says try antibiotics first. Thoughts?

    1. A hole in a canine is usually EOTRH. Radiographs will prove it as it involves not just the tooth but the bone it is in. This usually involves the incisors as well. The decay has already occurred and antibiotics usually are ineffective. Extraction will work but is unnecessary because time will allow the decay to do the same thing. In every case, horses usually feel no pain with canine decay. Please discuss this with your vet because they are the ones who know you and your horse. Please let them know that they can contact me if they want more information.

      1. My boy has a crack in his canine ..vet wants to either cap it or do root treatment..If unable to do this they are thinking of extracting..taking abit of jaw bone too..he has no problems eating and seems not to be distrssed..Are the vets right in what they may do.? After reading your comment above..im now concerned he will go through a procedure which is not needed.

        1. A cracked canine is often seen especially in older horses with EOTRH. See the picture of an advanced case here: https://theequinepractice.com/what-is-the-cause-of-eotrh-in-horses/

          If it isn’t bothering the horse then why remove it? The decay will eventually destroy the canine but it will be pain free. If, however, the cracked canine is from trauma then watch it. Removing canines can be tricky as your vet said because the root can curve far into the mandible. Removal should be a last resort with benefits to the horse.

  52. Hello! I have a 24 year old arabian and he has had the classic bad breath and one runny nose for a week. Had the vet out today and his teeth looked fine, couldn’t find any cracked or loose. No bumps and eats fine. She wants him on antibiotics for a month and then if it doesn’t clear we will take him to a vet to do xrays. My question is will 30 days be long enough to clear it or should I go to 60 days just to be sure? This site is great thank you!

    1. 60 days is often needed to resolve some of these issues. Ask your vet if he or she is willing to do this.

  53. I hope you can help! I have an 18year Gelding Througbreed he has draining yellow from one nostil . He had bad teeth the last time the vet was here she put him on anitbolics and said get his teeth floated but since then we had them floated and he was fine. He doesn’t cough, but he will not open his mouth. I have spent hundreds of dollars on vet bills for him and everytime the vet comes it is always comes down to him having bad teeth. I will not pull any I just want help on getting them healthy, again his teeth have been floated and after the floating I have more problems with him and this yellow discharge from his nose. And after a course of anitbolics it goes away but comes right back………

    1. Thanks Tina – You want your horse to resolve this issue and you are frustrated because after spending money for answers, the issue remains. I find the one comment interesting and perplexing – “…but he will not open his mouth.” Are you saying he does not want to eat, can’t eat, or is his jaw broken and he is physically unable to open the mouth. Either one of these warrants a visit from your vet again.

      However, your vet has already said his teeth need floating but from your story, it appears that your dentist isn’t getting the job done. Your vet needs to inspect your horse right after the teeth are done – or better yet, be there to inspect the mouth while the dentist is there.

      Either your dentist isn’t resolving the problem you vet says is in there or your vet has the wrong diagnosis. It’s time to get the two together and resolve this or find another opinion. I hope this helps you and others to realize that the mouth of the horse is often misunderstood even by the professionals responsible for its care. Talk about frustrating….

  54. Thank you for this page! I recently bought a Norwegian Fyord this summer. When I purchased him the owner said he had his teeth floated last year. Sven is a 12 and absolutely perfect for me to learn on. Last week I had the dentist come out to float his teeth. Well welcome to the horse world he said to me. His teeth looked like they have never been floated. I was shown that is 209 is broken and can lead to problems with sinus infection and should be removed. The dentist has set up an appointment with a vet who specializes in these certain issues. I’m not sure if by having his teeth floated have I poked an angry bear for he is perfectly well right now. I have the appointment on Monday to get X-rays done and talk with the vet. After reading one of the previous post I’m wondering now if they can fill the tooth. This whole pulling the tooth through the sinus cavity scares the crap out of me. I am not a stable so I really don’t have anywhere to keep him in a clean environment. I guess all I can do is go in with a list of questions and concerns. Do you think if he is not showing any signs of sinus infection it is alright to not proceed with the surgery right now? Thank you for your time.

    1. 209 is THE most common tooth to fracture and is very common. With sedation and analgesic drugs, the fractured piece can be extracted and the remaining healthy tooth remains in the mouth. There have been no complications I have seen from these extractions with one exception. If the fracture is sagittal with the fractured piece is on the palatal side, then on occasion it’s removal will tear a hole in the palatine artery. This is very bloody and has happened 3 times.

      Tooth fractures can occur even in horses whose teeth have been regularly cared for. It is unknown why the 9’s fracture more than any other tooth, but any cheek tooth can fracture as decay descends down 1 or more pulp chambers and splits the tooth like a wedge in a log. When it splits far enough, the distal edge snaps off and the piece disconnects from the main part of the tooth. Surprisingly, this is usually an incidental finding but these displaced pieces can also move into the cheek or tongue causing discomfort.

      Finally, it is rare that these fractures lead to a sinus infection. And these fractures are common being seen in one horse in every 40 or so.

  55. This is proving to be one of the most useful pages I’ve ever read. I have a 10 year old Welsh Part Bred mare with an unusual lower jaw root abscess. The vet did X-rays using a probe into the hole. This showed that the teeth, roots and jaw bone were perfect and the pus appears to be draining from between the two teeth. Could this be what some people call a Pus Pocket? She was given two weeks of antibiotics and the vet recommended that a visiting “Specialist” extracts the tooth. Which tooth? Who knows! They are after all perfect. When I asked this she said that there might be a link to one of the adjacent teeth. This sounds too much of s risk to me so I’ve turned the mare back out on the Welsh hills. She is contented, eating and if anything slightly overweight so I’m not really concerned but I do feel terribly guilty after the vet used the emotional black mail of “toothache”. Her jaw is draining constantly and is looking slightly worse today so I think I need to try different antibiotics and for longer. Thanks everyone for your comments on this, it really does help counteract the effects of emotional blackmail.

    1. Beth – I can’t thank you enough for your comment here. We are blatantly steeling the expression “Emotional Blackmail” from you. We have always called it the “Pull the tooth!” syndrome and the “Do Something!” syndrome.

      I have never seen a toothache in a horse and I challenge anyone to find a documented case of it.

      In my opinion, abscesses will continue to drain until the infection comes out – a beautiful process. Antibiotics often clear up the surrounding infection but the process is long taking 4 to 8 weeks.

      Please feel free to update this comment as your mare progresses. And while I’m here, I also want to thank all who have commented and brought to life this page and the awareness that the veterinary profession has done NO controlled studies to look at abscess drainage from the jaw and the optional treatments. All I have is 33 years of experience as a vet and 43 years with horses. I have yet to see a “toothache” or a horse that has suffered a catastrophe from any drainage from a jaw with the exception of a mandibular fracture or invasive cancer. For this reason, an accurate diagnosis is always recommended. But if nothing catastrophic is found, be patient.

      1. Thanks for your reply Geoff. This is a recurring issue which has flared up a few times over the years. This is the first course of antibiotics that she’s had. It never completely goes away, it just dries up leaving a tiny hole which occasionally forms a crust. I have a lot of respect for my vet and have spoken to my her since I first posted on this page and explained that I am going to let it run it’s course. In fairness, she was fine about it but I think she could see that I had made my mind up. I had considered breaking the mare in but am afraid that I may aggravate the situation if I do so. I have seen Welsh Mountain Ponies with the same problem, one of whom had a constant “drain” below his eye along his sinus, where the upper tooth was causing a problem. His tooth was left in situ with no problems other than looking unsightly. I really think that this may be a breeding problem in the smaller Welsh breeds as their heads are becoming smaller. I’m assuming that this at some point will affect the jaw and teeth.

        1. Thanks for the further details. I cannot comment on whether it will affect the jaw or teeth because there is no diagnosis. Please keep us all posted with updates.

  56. Hello,

    I have an 11 y/o QH gelding who has had small cavities in the upper first molars on both sides of his mouth for several years. They’ve stayed around 1/2″ deep for the past 4 years. Today, during his annual float, my vet found that one of the molars had fractured, leaving a very sharp edge on the molar. The fracture does not go below the gum line, but the decayed cavity definitely does, and is now much wider. Her initial suggestion was to have the molar removed, but when I wanted to be more conservative, she agreed to put him on doxycycline for a month, and then recommended X-rays to see how deep the cavity goes. I am extremely reluctant to have the tooth removed, since I know it will require anesthesia and leave a huge hole behind. There isn’t enough tooth left above the gum to grasp and remove that way. The horse shows no symptoms whatsoever. His last float was a year ago, so this fracture may have occurred anytime in the last year. I’m afraid that if the X-rays show significant decay in the root, that I’ll be under a lot of pressure to remove the tooth. What is your experience with cavities, and do you often recommend extraction for severe ones?


    1. Hi Joy – What you have described is a very common thing in horses (1 in 40 seen). The upper 4th cheek teeth are the ones mostly affected followed by the opposing lower cheek teeth, but I have seen every tooth split at some point. The decay acts like a wedge pushing the tooth apart until it snaps off, usually at the gum line, and it either falls out or is removed.

      These cheek tooth fractures are never a problem for the remaining tooth and almost every horse shows no signs of a problem – ever. Those that do show a problem are usually because of the pain associated with the tooth fragment displaced into the cheek or tongue or the remaining socket forms a razor’s edge.

      I usually find no need for antibiotics. The fermenting and decay odor self-resolves after the tongue is allowed into the new space, without interference from sharp edges, and cleans the area.

      In my career, cavities are an incidental finding with no effective course of treatment as in humans. The result of a cavity is either no damage to the tooth or it fractures and the fractured piece is removed without complications. Often the mirror image tooth also fractures at some point. There is one complication that may occur during removal and that is when the palatal side of the upper 4th cheek teeth fracture. There is a possibility that during removal, the palatine artery is damaged causing a bloody mess.

      It is a very rare day that I recommend extraction of any tooth in a horse.

      If your vet has any questions about this, please have him or her contact me through the contact form on this web site. Thanks, Doc T

  57. Hello Dr. T,
    I have a 28 year old mare who upon dental exam/float 2 months ago was found to have a crack in a right lower molar. My vet is not convinced it goes all the way to the root and advises we wait and see if it just grinds down to whole solid tooth. I have changed her diet a bit to make chewing easier (chopped hay, soaked hay cubes etc. in addition to plenty of grass turnout) but notice that periodically while eating pelleted feed or alfalfa pellets she suddenly stops eating, walks away from her food and stays very, very still refusing even her favorite treat. I have checked for quids and rinsed her mouth but found nothing. Eventually, in 5-20 mins she returns to her food. I think she may be experiencing pain from that tooth. What do you think is going on? Should I have the vet come out again? Do cracked molars always need to be removed? Thanks for your thoughts.

    1. Mary – Without actually seeing your horse I would be uncomfortable giving you advice. You should ask your vet to come out and re-evaluate. If the vet needs some help from someone more familiar with cracked cheek teeth then make that happen. I agree that it seems like your horse is showing some pain not just in the reaction but in the fact that you have needed to change what he eats to be comfortable in chewing.

      Most cracked cheek teeth do not extend the length of the tooth. In a 28 year old horse, the tooth will never “grind down” to a solid tooth. It is always in the horse’s best interest to remove a fractured piece to eliminate pain, allow for comfortable chewing, allow for cleaning of the area, prevent trapping of food and prevent local infections.

      I hope this helps. Please come back with an update for all to see. Thanks, Doc T

      1. Hi again,

        Thanks for your response. I spoke to my vet again and he had the dental specialist vet look at her.That vet did not believe that her teeth were the problem. After further work ups and evaluation turns out she has ulcers. Been treated with Gastrogard and Ranitidine and she is dong very well without any more episodes of stillness or disruption in eating.

        1. Thanks Mary. Remember to prevent the ulcers in the first place by increasing hay intake and eliminating grain. Go to TheHorsesAdvocate.com/grain for more information.

  58. Hello, I am interested in your opinion on my 6 yr TB mare. She developed a lump on her lower jaw about 6 months after I purchased her. I had her teeth floated last Sept 2015 and her lower jaw was not straight. i.e it deviated from a straight line, so the back half was straight then it took a jog to the outside and then straight again.
    The lump remained with no drainage and no issues. Now this year April 2016 when her teeth were floated her jaw was pretty much back in alignment again. About 2 months later the jaw swelling started to enlarge and slight drainage. She was prescribed Uniprim for 2 weeks. The drainage stopped after the 3 rd day and all looked well. However about 3 weeks ago the entire jaw swelled again quite large (golf ball size). After a few days it started draining again (whitish). My Vet xrayed and she has a tooth fracture in the molar, it is not loose but split. Recommended it be extracted. The swelling is now really hard, still draining. Mare is back on Uniprim as I await on the Vet’s further direction as to whether they can extract tooth with mare standing or if she needs to have surgery.

    What are your thoughts? Is it possible for this to resolve on its own with time? Should a fractured tooth always be extracted?

    1. Hi Irene – as you probably already know from reading my other replies, I cannot make a comment on your horse directly because I have not seen it. What you decide to do is between you and your vet.

      In my experience I usually look at the horse to determine if she can chew normally. If she can and there is no problem in eating, then there is usually no rush to perform an extraction. If the Uniprim worked immediately then I usually continue for 30 to 60 days. It is common in my experience for the horse to return to swelling and / or discharge when the antibiotic is stopped after 2 weeks. I have had horses with hard swellings on the mandible resolve their problems with this long term treatment without needing to move to extraction.

      X-rays of the jaw are often hard to assess. I have seen x-rays showing definitively a root abscess that 1 week later had move to another tooth. In reality, what looked like an abscess of a root was really an abscess near a root but unfortunately it is almost impossible to get 2 views to make a 3-D position location. I had another horse that went in for a last lower cheek tooth extraction (not my decision) where the surgeon afterwards said to me that the tooth was perfectly normal but the infection was along the side of the tooth. This horse would have probably resolved this infection with long term antibiotics.

      As far as the crooked jaw that became straight after floating – I am suspicious that the jaw itself was not crooked but the teeth within the jaw were not in alignment. I often see horses that after about 2 years (4 floatings) have their teeth realign as if they were wearing orthodontic braces. This is because the horse now chews without restrictions from sharp points causing pain in the cheeks and tongue. This alignment can occur to a whole arcade or an individual tooth.

      In your mare’s case, an infection could have started in the area where this crooked tooth was. In addition, swellings of the mandible from infections commonly occur about 4 to 6 weeks after a change occurs within the mouth including the April 2016 floating. They DO NOT occur immediately which makes people think that the swelling is a separate event. In my experience when these swellings occur, the 30 to 60 days of trimethoprim – sulfa works every time.

      To summarize, talk with your vet about continuing the Uniprim for 30 to 60 days, perform repeated x-rays over this time, and monitor the progress. I would especially appreciate it if, after you and your vet decide together choose to follow this path, that you come back here with a detailed report with x-rays along with permission for me to use this material publicly so others can learn from your experience.

      Doc T

      1. Hi Doc T,
        There is a fracture in the tooth, it is north/south fracture and the tooth is still solid. Mare is given another week of uniprim (will be 3 weeks continuous) and previously had 2 weeks with a 3 week break in between. The swelling is down, still a bit of drainage. Mare is in excellent health, lots of dapples and a bit on the plump side so it has not affected her ability to eat so far. I prefer not to extract unless absolutely necessary, but my Vet suggested removing the portion of the tooth that is fractured even though it is firmly anchored. For now we have not reached a decision, but I am holding out for the best and your information/input has helped me deal with my anxiety. Thank you.

  59. Hello Dr T.
    After reading these questions and answers on this page i thought, i too, should ask!
    I have a 7 year old Quarter horse gelding that has a slab fracture on his 309. He has shown signs of extra saliva during eating his grain, whole oats, and head tilting. His teeth were floated 2 years ago and the signs prompted me to get him checked again. My dentist found the broken tooth. I did take him to get an X-ray. He dosent have any reaction to the tooth not the out side of his mouth. she was able to take the tooth out of enclusion (so it dosent rub anywhere) and he didnt react any. THere isnt any draining, swelling but some bad smells. How serious is this tooth being broken? This has gone on for 2 weeks now since we found the tooth. My i Please have your advice!
    Thank you

    1. Hi Renee and thanks for your question. Cheek tooth fractures are very common in horses and the 4th one back (# 109, 209, 309, and 409) are the common teeth affected. No one has concluded why it is predominately in these teeth.

      A slab fracture usually means sagittal (X axis) but the other 2 directions of the axises (Y, and Z) include transverse and coronal. With sagittal, the fragment can be thin or up to half the tooth. The displaced tooth tilts into the cheek creating an ulcer (rub) on the cheek or into the tongue altering its movement. Either way can cause increased saliva, drooling, head tilting, excessive tongue movement, spilling of feed and difficulty chewing. In some it is only an incidental finding with no unwanted chewing behavior but in others it can be quite dramatic.

      The creation of a cheek tooth fragment is similar to splitting a log using a wedge with a simple exception that the split usually does not go the length of the tooth. A fracture starts with decay of one or more pulp chambers of the tooth. The decay and packing of food over a long period of time wedges into the tooth creating a fissure and the pressure from this splits off a section. At some point after enough force has been applied by the decay, the piece snaps off at right angles to the fissure, usually near the gum line. On occasion the fissure can go completely down the root of the tooth splitting it in half but this is rare. Interestingly, the mirror opposite tooth (#409 in your case) often fractures in the future.

      There are no complications except when it is an upper cheek tooth on the palate side. Removal of this piece can tear the palatine artery which is a very bloody mess. If you think of the fracture as nature’s way of creating a big hole for the decay to escape, then you will have the right idea. The fractured piece should be removed and is easily done with an IV injection of sedatives (xylazine, NOT detomidine !!!!) and potent pain medication (butorphanol) and using fracture forceps. I see fractures in at least 1 or 2 in every 100 horses floated and I remove them on the spot. Not removing the fractured piece only aggravates the horse and allows the decay and the packing of food to continue. There is no reason not to remove the fractured piece. The remaining healthy tooth never becomes a problem with the one exception that there are more fractured pieces that remain. These will become a problem later but can be addressed later. I can remember only a few cheek teeth that have crumbled into multiple pieces that later caused a pathway into a sinus.

      My final note I hope is not taken as a reprimand by you. Horses chew 25,000 times a day (“Motivation for hay: Effects of a pelleted diet on behavior and physiology of horses” Jamie B. Elia a, Hollis N. Erb b, Katherine Albro Houpt b, September 2010). This is 9 million chews a year and 18 million chews in the 2 years you did not have the teeth floated. Unfortunately, most horse owners wait until there is a problem to call a dentist as you stated. While there is obviously a structural problem with some horses teeth that causes the decay and subsequent fractures, I find that horses that are regularly maintained with the removal of the painful sharp points every 6 months (prevention before they become painful enough to alter the movement of the jaw and tongue) allows the horse to maintain the health of the teeth (distribution of saliva, positive pressure from unobstructed occlusion) and prevents decay and gum infections.

      Please have your vet remove the fractured piece and then remove all sharp points through floating every 6 months for the next 2 years. After this, if your budget requires it, reduce the frequency to every 9 to 12 months. Your vet / dentist will see the improvement even though, in the maintenance / prevention mode, you will not. Just because you can’t see a problem doesn’t mean it doesn’t exist.

      Thanks again for your question. I think it will help a lot of others. Doc T

  60. Hi Dr. T.

    Just an update. My vet had me start my horse on another 30 day SMZ course. By day 3, the green discharge turned into just a clear liquid with an occasional white glob mixed with blood (looked very orange). I’m on day 28 now and there is still occasional trickling of clear discharge only when she sneezes. No more thick discharge. We are hoping that her issue is resolving, thought my vet has stressed that chronic sinusitis can be difficult to fully treat. My vet also recommended to try an antihistamine, but I haven’t given it to her at this point since the antibiotics seem to be helping.

    Unfortunately where I live (long island, NY), diagnostics at a clinic would be extremely expensive, so we are trying the conservative route right now since my horse has no other symptoms. Wish us luck!

    Thank you for your continued advice.

  61. Hi, interested on your view for removing teeth fractured in bottom of mandible. 3yo TB got kicked in jaw with adult (not yet errupted) tooth smashed at base still has juvenile tooth as cap so no food getting in to cause infection. He does have a hole draining blood to the outside of jaw. Currently awaiting referal to dental specialist, but found your site, interesting. Have xray but cant post picture.

    1. Jennie – Thanks for finding me. Trauma to the mandible with blood draining from a hole should be X-rayed to look for a hematoma and a fracture of the mandible. A dental expert may advise differently from a veterinary surgeon so listen to both. The horse can still chew with a fractured mandible and since you didn’t mention it, I assume he is chewing. Please work on the trauma to the mandible first before extracting any teeth. Extraction of horse teeth has complications without trauma and more with trauma. In addition, the tooth may be salvaged in the healing process so allow time to discover which way it chooses.

      Feel free to email me any pictures and I will add it to this comment. Also keep us informed with the outcome of this. Thanks, Doc T

  62. Hi Dr. T. I wrote a while back about my horse and her unilateral discharge. After a 30 day course of antibiotics, the discharge didn’t go away. My vet came and xrayed and saw nothing in the sinus. She said she thought tooth root infection. My vet does not believe in pulling the tooth if the horse has no other symptoms due to scary complications , so decided on a wait and see basis. She felt the infection would either resolve, or the root of the tooth would die and the tooth would be loose enough to pull. That was a couple months ago. The discharge has never resolved and in the last week, the discharge has become bilateral. Still no smell or any other symptoms. My question is have you ever seen bilateral discharge with a tooth root abcess?

    1. Jeannine – I thought I had answered this but apparently it never was posted! So sorry.

      No I have never seen a sinus infection become bilateral. I agree with your vet that there are complications when a cheek tooth is extracted and the wait-and-see approach usually is a good approach. However, there is no diagnosis and without one, a plan is difficult to make. You need to talk with your vet and find a way to accurately diagnose the cause and make a sound plan from this even if you need to be referred to a hospital with advanced diagnostics. If this is a tooth root abscess, it should have responded to a broad spectrum antibiotic. Because of this, there may be something else causing the discharge.

      While it is impossible for me to diagnose this from afar, I am grateful for you reaching out to us with this case so we can all learn. Please let us know what you do / did and the results. There will be someone else out there with a similar issue – and I am very curious too. Thanks, Doc T

  63. I agree with this too. I recently purchased an old horse I owned back. I only broke her in last Feb and sold her on to get a phone call 9 months later to say she rears vertical abd she’s to be pts if I don’t buy her back,I would nerve see a 4 yr old pts so got her hime abd firstly 2 Wolf teeth were removed the dentist said she also had a 108 fracture so I contacted my local dental surgeon to be told if it doesn’t bother her leave it. Yet my dentist insists it is removed who is right this fracture happened 4 months ago nobinfection ride everyday eating with novproblem

    1. Hi Anon from across the pond! Fractured cheek teeth are common. We see one in every 50 horses and sometimes 2 fractures in 1 horse. This come from decay into the pulp chamber which splits the tooth like a wedge going into a log to make fire wood. As the tooth wedges wider from the decay and packed feed material, the bottom usually breaks leaving a fractured piece. It is a good idea to remove these because of local infection from the fermenting trapped feed. Removing the piece also allows the tongue to get in and clean the area with the now large hole. Interestingly, most horses will never show their owners any sign of discomfort. But if you carefully smell the inside of the mouth on these horses, you will sniff the tell tale odor of decay. It stinks! Doc T

  64. Hello Doc T!! I just found your site and sooooo thankful that I did 🙂 I have a 31yr old Morgan mare that has a left sided, thick nasal discharge ( creme colored and very smelly). Had rads done to rule out tumor vs tooth. It was determined to be a tooth root abscess. My vet gave me 2 weeks of Baytril and told me if the infection continued she would need to be brought to the clinic and the tooth “tapped” out. I am Vet Tech who is conservative and also always research issues to try and get a good understanding of the problem. We need to be the best advocate for them. I just wanted to say Thank You for taking the time to help us. My gelding stands as a healthy, happy senior today due to people like you who share knowledge. Diagnosed with Atlantal Bursitis that did not resolve with surgical debridement, I was told to euthanize him due to the non resolving infection. They admitted due to lack of experience in this rare case they had nothing left to offer, but would do what ever I wanted to try. It was through researching out here that I came up with a plan for him. He stands above the ground today and not below because people like you share your knowledge and experience. Just wanted to express my gratitude. THANK YOU 🙂

    1. You are very welcome and thank you for taking the time to comment.
      Nuchal bursitis is mor common than people think and can cause unprovoked riding behavior such as unstoppable bolting. An ultrasound guided injection into the bursa of antiinflammatory agents can give you a “new horse” in a day.
      A 31 year old horse with a “tooth root abscess” probably has an end stage tooth that can be extracted relatively easily by pulling on it. No need to do a flap and “tap it out.” Often they come out with my fingers.
      Good luck and thanks again. Remember to send people to the school page: HorsemanshipDentistrySchool.com if they want to learn more.

  65. My 22 yo Arabian gelding (has PPID, on pergolide) fractured his lower incisor (bottom left, outside incisor) about 2-2.5 years ago now. It fractured down the middle, with the front part in tact, back half broke off. X-rays showed some inflamation, but an otherwise in tact tooth/root, besides the half that was gone and a few splinters, which my vet removed. 30 days of SMZs and it tightened back up and had been fine since, until recently. Loosened more than ever and gums are not happy around it. The fractured back part has ruptured through now, and the deepest/lowest point of the fracture has mostly erupted. They want to do more x-rays and extract now. They had warned me originally there can be destabilization of the lower jaw, so were trying to be conservative before. With it being more loose now, I guess they feel it’s too loose and unstable to keep it. He is eating well, though, won’t bite a carrot the way he used to, indicating there’s at least a tad of discomfort. He also doesn’t love having it palpated but not too upset, as he was somewhat right after the fragment removal. But also never stopped eating then either. How risky is pulling a incisor? It is fractured enough I understand the recommendation. Will do an x ray either way. I just want to make best and most informed decision for him. Appreciate any thoughts.

    1. Hi Amanda. Ask your vet if he / she sees any EOTRH of the incisors. To see more of this, go to TheHorsesAdvocate.com and enroll – it costs nothing. Once logged in, go to the dentistry section and look at the posts on incisor decay and fractures and incisor EOTRH. For me, older horses with EOTRH get decay of the incisors with subsequent fractures like you describe. The key evidence you gave was simply that he doesn’t like to bite carrots. This is common with horses affected with EOTRH and indicates that more than one incisor is involved. X-rays of the lower jaw will show the changes to the teeth and the bone. There is no treatment and extracting this incisor won’t help the horse bite a carrot if other teeth are involved. PPID is not a part of this, but being a 22 year old gelding is classic. Please reply back if you go ahead with more X-rays or any other news you would like to share here. Thanks – Doc T

  66. Hi Dr Tucker,
    I am interested in hearing your input on my case. On April 16th, my mare came in from the field with a big, ugly burst abscess hole in her face, a few inches below the eye. Gross and oozing pus, we (barn owner and I) figured the worst must be over since it burst and was draining nicely, so we just cleaned it and drained it as best we could, flushing the cavity with sterile saline solution twice a day. But it got worse – the area got swollen and she started resisting having it messed with. So vet was called, x-rays were taken – they shows what looked like a “once-infected tooth root”, and a tract all the way from the tooth to the sinus and to the abscess exit point. Vet also went in and examined her teeth from inside, he said he couldn’t see any indication of an “active” infection of the tooth/tooth root, that part looked healed over and, by all accounts, fine. But her sinus cavity was full of pus and gunk, so we decided on the hole drilling and catheter installation surgery. It went extremely well, everything flushed out nicely, no complications or issues, and catheter stayed in for 8 days before being removed. Within 36 hours of the procedure, the flush was coming out her nose crystal clear (my barn owner was diligently flushing 2x/day, and the original abscess hole/exit point was getting smaller – though still draining a bit of pus). Catheter came out on the 8th day, we continued to drain the (now extremely small) hole of the original abscess, and up until yesterday my barn owner was only able to get a tiny drop of pus out of the hole, followed by a small bit of blood – the pocket was almost gone and the hole was trying to close/heal.
    As of today, however, my barn owner was not able to drain the hole, it was fully closed up, and she texted me to tell me the mare’s face was swollen – there was a hard, swollen area between the original hole and the hole the vet drilled (now stitched up). She was also very much NOT pleased when my barn owner tried to gently palp the area. Obviously the infection is still present – this whole time my mare has been on Enrofloxacin and Metronidazole. My vet initially recommended she go to the large animal clinic 2 hours away to have the bone-flap surgery and possibly have the tooth removed, but the more we talked about it, the more I became skeptical. Then I found this webpage. I called her back and asked if there was any harm in trying to maintain the rx’s for a while since my mare is eating well, not running a fever and not dropping weight, and she said “absolutely not, there is no urgency at this point in time”, and she is supportive of a wait-and-see-for-a-bit approach. She also suggested the equine dentist (who will be in the area next week) have a look at her in-clinic (so no exorbitant call fee), and I’ve agreed to trailer her there for him to have a thorough look inside her mouth and give me his opinion on whether the tooth really needs to come out or not – they have the x-rays at the clinic so he can have a look at those as well if necessary.
    Also worthy of note – discharge was always unilateral, never smelly.

    What are your thoughts based on all this..? Are there any complications that could arise from NOT aggressively treating this soon, or..? I read somewhere that if the infection spreads to the mucus membranes/lining, that it could begin to affect the bone..?! That sounds bad!

    Thank you!

    1. Thanks Lianne for this thorough description of your case (with the exception of how old she is) – organized and descriptive. Kudos!! Also kudos for you discussing this with your vet and to your vet for allowing you to have an opinion and agreeing to wait.

      Abscesses are not like a pus filled balloon but more like a pus filled sponge with dozens of small cells that at some point coalesce into a a large cell that erupts to the outside. However, all the small cells are still there. In fact as you press and clean the area, you move some of the bacteria into new areas which either expands the original abscess or causes seeding of the surrounding tissue causing small abscesses around the original site or at some other points of the body.

      Because of the spreading, the only thing to do with a draining abscess is to hot pack the area but never apply pressure.

      I have learned a lot about Staph infections. I got an infection that affected only the skin that took about two years to come under control by my immune system. Every time I pressed the abscess, several more would pop up in the surrounding area. My son expressed an abscess at the base of his neck and then dove 90 feet underwater. The pressure drove the bacteria into his spinal canal where it set up a life threatening abscess almost killing him.

      As I have stated many times before, I love abscesses because it is the body’s ingenious way of kicking out the bacteria. However, when we interfere, perpetuation and serious complications can occur. The lessons I have learned over time is to leave a draining abscess alone except for cleaning the area and hot packing to increase the circulation to bring in more blood for healing.

      This is a lengthy process now and patience will help. Adding the long term antibiotics helps in killing the seeping bacteria but is not very effective in penetrating an abscess.

      Pulling teeth is often done to remove the cause (which I disagree with), but in your case, I think your horse is well beyond that and according to your vet’s exam, has healed the original source. In other words, when the abscess occurred on April 16th, the infection was on its last legs. The rupture of the abscess was the last step.

      I think that with the help of your vet, you just need to be patient and to keep the systemic antibiotics working for maybe 30 or more days (well beyond when it stops draining). Remember to be gentle with it and give some pain medication if necessary for the expanding new abscess. Hot compresses without pressing the abscess helps but adding pressure to express an abscess is not only painful, but actually is counterproductive.

      As always, you must listen to your vet in any decisions you make with your mare. This discussion is only to make you aware of the process of abscess formation and how to effectively resolve them.

      1. Thank you!! Sorry about the age omission – my mare is a May 2006 model. 😉
        I went out this weekend with a kettle of boiling water, mixed in some Epsom salts, and once it was cooled enough for me to be able to touch it without scalding my fingers, I dunked a towel in the water and held it on my mare’s face until it cooled off, dunked again, repeat process, etc. until the water became tepid and was no longer useful. She REALLY seems to enjoy being “hot packed” – she gets dopey-eyed and stands perfectly still, even if half the towel covers her eye, she doesn’t move. She area that has “swelled up” is only about 4 x 4cm across, and very hard.. it almost feels like bone, even though i know that’s impossible. It has not gotten worse since Friday, and so far no discharge, no temp, nothing. She’s now on Uniprim and Metronidazole, she gobbles up all of it in her feed no issues.
        I also lunged her lightly after the hot packing, with the intent to get circulation flowing and help the “cleansing”, if need be. She snorted and blew a lot, was very relaxed.

        My concern now is, how long do I wait before assuming this is “resolved”? This mare is my prized broodmare – I am now terrified of putting her in foal and having this “flare up” again.. 🙁

        1. Thanks for the update. Please be patient because the bone is affected in this swelling and will remodel over the next few months. Your vet will give you more information on this, but I can’t see this interfering with your breeding plans. Please keep us all updated with the progress. And remember, just because it “looks good” doesn’t mean you can stop the antibiotics. I have seen infections return if the antibiotics are stopped too soon. But how long should you go? There is no rule but just be patient and work with your vet on this. The infection is exiting the body and you are helping in the imprecise process.

          1. Hey Geoff,
            Just following up on this with an update for you & your readers.
            So my mare saw the Equine Dentist on May 12th – two weeks ago today. What a revelation that was… I really should’ve had her done by him much sooner (as in, 4 years ago). He first pointed out how one eye socket was higher than the other, and once he was in her mouth he noted that the two sides of her jaw were very different/uneven – she develops crazy waves on the right side of jaw, on the bottom mainly, and it was exerting an enormous amount of pressure on the corresponding upper molar, preventing it from erupting – hence, the pocket/abscess/infection and sinus involvement. My poor sweetie!! He fixed her up, even adjusted her atlas for me, and within 10 minutes of him being done, the hard, swollen bump on her face had receded by about 50%.
            Two weeks have gone by, and as of yesterday she is off antibiotics – she was on them for 5 weeks. Absolutely no change or discharge of any kind, the bump is still there but not as pronounced as it was pre-dentist visit. I even rode her on the weekend and I noticed a definite improvement in her acceptance of contact from what I remember (she was leased out in 2014-2015, i just got her back last fall).
            Plan is to breed her end of June or so. Fingers crossed the infection doesn’t resurface!

            The Dentist also recommended she be done again in 6 months by him – he’ll be back in my area in the fall. I will definitely make that happen. I am very lucky that my regular vet is one of the best in the area in terms of dental work, she shadows this Dentist every time he comes to the area and he is very confident in her ability to maintain his work with my mare in future years. 🙂

          2. Thanks Lianne for the update. If everyone knew the importance of having the oral pain removed from their horses the world would become a better place for them. It is time now for more veterinarians to realize this and to get good answers for great sources. It is why I started the HorsemanshipDentistrySchool.com so that people, especially equine veterinarians, can learn.

            I agree with the every 6 month floating. “If you horse is chewing then the teeth need doing.” Remember, at 25,000 chews per day, he will chew about 4.5 MILLION chews in 6 months. Doc T

  67. Hello! I have a 9 year old gelding who developed a bump on the side of his face over 6 months ago. It never seemed to bother him so we were waiting to see if it would go away on its own. A couple of weeks ago, after riding him, the bump enlarged and he seemed irritated or in pain when we touched the bump. The vet performed a visual examination and said that the tooth will most likely need to be pulled due to a potential root infection but that it is a very complex and long process to pull a tooth on a younger horse. I’m concerned now after reading your article because in my mind, if this is something that can resolve without pulling the tooth, I’m willing to try another approach. I worry about the consequences and long term effects of having a large hole in his mouth if we have his tooth pulled. Right now we have him on antibiotics that we’re top dressing in his grain but I have not heard of hot packing. What exactly does hot packing mean and how is it performed? Do we need to pack antibiotics inside his mouth? Our next step is x-rays to determine the extent and location of the infection.

    1. Angela – Thanks for sending me this case, but for legal reasons, I cannot advise you specifically on your horse because I have not examined him. I will say that “lumps” on the face can be from a number of things and that before extracting any cheek tooth, an accurate diagnosis must be made. Trauma and tumors can also cause enlargements of the flat bones of the head. In the cases I have seen where a tooth infection has caused a lump on the face, there is usually no pain. It would be interesting to observe if the swelling is all bone or if there is also soft tissue edema involved. Also of interest is the response to antibiotics. Be sure that he is actually getting the antibiotics into his body which can be a problem when “top-dressed.” Finally, as far as “hot-packing” or applying a hot compress over the facial swelling, that would be up to your veterinarian to advise. Let us all know the outcome of the radiographs and what treatment you and your vet decided upon so we all can learn. Thanks, Doc T

  68. Hi Doc T,
    Hoping you can help me! I have a 25 year old Appendix QH mare. She seemed to be doing just fine up until we had her teeth floated a week an a half ago. The only abnormal thing we noticed during the dental were a couple of pointy bumps on the tip of her tongue (my vet thought maybe from foxtail in the hay). I wasn’t out over the weekend but early the next week I noticed she was dropping feed and trying to eat hay and grass but just quidding it up and spitting it out. She became dehydrated and ended up having an episode of colic by the end of the week so we hauled her to an emergency clinic that night to get that under control. The vet there examined her mouth and thought she saw a slight pocket in her back right second to last molar. We didn’t take xrays then and decided to start a course of Moxycyline. I do see some swelling in her right jaw but she’s still eating soupy mashes and now she’s advanced to dry senior and dyno sport. The only thing not back to normal is the way she eats hay and grass. I’m tempted to wait it out as I’ve seen you suggest in previous responses but I’m getting some pressure to get xrays taken and possibly scope her throat. She’s 25 years old so I’m not inclined to go the surgical route and there isn’t any kind of nasty discharge coming out of the nostril, just a white/clear liquid at times. I guess my question is would you continue to wait? I’m really worried about her but I also don’t want to start doing a bunch of diagnostics until we give the Moxy a chance to work. It’ll be 10 days on Monday which is when my vet is suggested we do a follow up, is that even enough time to tell?

    1. Hi Katie – what an awful experience for your horse, you and the vet who floated her. But I need to remind you that I cannot offer advice about your horse because I have not seen it.

      However, I might add that I have seen some horses that just become inflamed from the vibration of the floating process. These horses do better with an anti-inflammatory such as Banamine®. Basically, their teeth hurt which will prevent them from eating anything and may lead to colic. I have never seen a “slight pocket” cause a problem like you describe. Also, in my experience, I have seen horses unable to eat hay and quid (ball it up) after floating, but never grass.

      Please reply here with an update so we may all learn from this. If it is pain from the floating process, It is truly rare and is no one’s fault. Also, if it is pain related, then this is the one time I wait till there is a problem before I work on the teeth and I pre-medicate with Banamine about 1 hour before the work, I sedate with pain relievers for the work, and I follow up with Banamine as needed. I have 1 horse in my practice that this is the standard procedure for her.

      Thanks for telling us about her and sorry for the delay in my reply. Doc T

  69. Thanks. Covergirl is on a week of uniprim and seems happy and normal. She is on good pasture comes in once a day for a scoop of feed with her meds. There is no external swelling at the site and pressing the area firmly with fingers gets no reaction. I have no plans to inspect inside visually unless I see a problem. Thanks !

  70. Thanks for the reply! We did pull the entire tooth though…can I post a pick here?
    (My apologies but the image must have been lost when I moved servers.)

    1. Thanks for the picture Bob. It looks like the tooth was split right down the middle. Nice job by your vet and I agree with using antibiotics anytime there is a lot of fresh red tissue on the extracted tooth.

      1. Hi Dr. T!

        I’m so happy I have stumbled across this page. I’m aware that you do not know my horse, but maybe you could provide me some insight into my options here. I have a 15y.o competitive Warmblood gelding who had gotten a runny nose (white’ish discharge) with a funny smell about two weeks ago. All in all, he has been acting totally himself, happy to go for rides, and has never missed a meal.

        For background : 2 years ago, I noticed him eating a slower with pauses in-between bites. Thus we found out that he had two cracked molars at the very back of the upper left side.I believe they are cracked in the sagital plane.
        Once this “smelly nose” appeared two weeks ago I had a feeling it was tooth related- and sure enough when the vet came out three days later we discovered the second last molar seemed to have a tooth root abscess thus causing the sinus infection. He has been on TMS for a little over a week now, and after day three of TMS his nose seemed to clear up right away ( no discharge and no smell). However, the vet does want the tooth out and is recommending surgery. She has attempted to pull the tooth and fragments have been falling out but nothing substantial.

        I am uneasy about having my 15. yo horse undergo surgery which would be very invasive from what I understand ( drilling through the skull and knocking the tooth out through the sinus). I feel as if his immune system will eventually push the pieces of his remaining tooth out, and it doesn’t seem to affect him too severely! My vet had said that with the tooth still in his mouth, he is prone to developing more sinus infections which would result in more antibiotics in the long term. I am aware that long-term use of antibiotics is not the answer either…. Anyways, If you wouldn’t mind clarifying maybe some of my options that would be great!

        Thanks so much,
        Emma (nervous horse mom)

        1. We all need to recognize that this horse is eating well and shows no problems with this tooth so there is no rush to do something. You need to talk with your vet and agree to a plan that keeps your horse’s best interest in mind. This sometimes is difficult but when done then your “nervous horse mom” can relax.

          In my experience, when multiple tooth fragments come out through the mouth then the tooth will have more to come out over time. These are usually not painful. However, if a tract of bacteria and food has made its way into the sinus, then you will have 2 options. 1) extract the remaining pieces via the sinus flap as your vet suggested. This will usually be successful though there are always the possibility of complications to these surgeries. 2) Give broad spectrum antibiotics (SMZ’s work well) for 30 to 60 days continuing even if the smell and drainage stops. There are few side effects and if this doesn’t work you can always perform the extraction afterwards. You have time.

          But first have a conversation with your vet and if he or she has a question, have them call me. Also, please give us an update. This is important so that others can learn from what you are going through. Be sure to find this comment and reply to it to keep things nested. Doc T

  71. We did a routine float on one of my polo mares yesterday, 15+- year old TB. lower right jaw 2cd molar from the back cocked at a crazy angle toward the cheek, nice ulcer on cheek, slab fracture visible. Probing showed nasty black stinky mass of feed down deep. Vet recommended extracting,it moved easily laterally with finger pressure. Took about 10 minutes to extract. decayed feed all the way down between branches at root. Was searching web for after care ( week of uniprim) and saw this thread and curious about your comments. Thanks!

    1. Hi Bob – This type of sagittal cheek tooth fracture is a very common occurrence in horses and in my experience is seen in about 1 horse in every 40 to 50 I see. The most common tooth is #209 which is the 1st upper left molar but I have seen every cheek tooth fracture. The most common direction of the fracture is front to back (sagittal) with the fractured piece leaning either into or away from the cheek, but the fracture can also go from left to right (transverse) or flat across (coronal).

      Your horse had the most common fracture in a very common tooth with a common outcome. It is caused by decay working its way down the core and like a wedge in a log, eventually split the tooth. When enough pressure occurred sideways in the split, the tooth fractured off at right angles to the split and your horse was left with a fractured piece of cheek tooth loosely attached with gum tissue. Feed acted like a wedge driving the fractured tooth into the cheek causing the ulcer. It also created a bad mix of odors from decay and fermentation.

      The treatment is removal of the fractured piece and filing smooth the edges (as well as the rest of the mouth) allowing the tongue to freely clean the area and distribute saliva with antibodies. I rarely follow up with antibiotics because this process has been going on for a very long time (years) and is usually an incidental finding during routine floating. There is no other follow up care. I have never had one become worse or need any other further care, and I have extracted hundreds of these fractured pieces.

      And just to be clear, extracting a fractured piece is NOT extracting a whole tooth. The remaining tooth piece is healthy and in my experience will never need extraction.

      Finally, I have a student in my dentistry school from Hawaii. This explanation is part of her training. Through the school, my goal is to bring my experience to every part of the world so you will never need to worry about your horse’s teeth. Thank you so much for this comment. Doc T

  72. Hi Doc T

    I have a 12 year old horse that presented a month ago with unilateral yellow/green thick discharge, mixed with a thin orange discharge from her left nostril. No smell and no other symptoms. Vet came out and scoped her and did an oral exam. Everything seemed fine, so was decided to treat her for a primary sinus infection. She was given a penicillin shot which lasted for 10 days. No change. Now she is on Sulfa Trim. It’s been a week and no change. My vet said the horse will have to be on antibiotics for 30 days. If not better, than they will do x rays to check for tooth root abscess and do a possible sinus flush. My question is how long does the horse have to be on antibiotics before I see a change in discharge? The full 30 days, or would I have seen a difference by now if the antibiotics were going to work? Thank you.

    1. Hi Jeannine – Usually an appropriate antibiotic will become effective quickly. However, antibiotics don’t penetrate abscesses. They only work on the bacteria that leaks out providing pain relief from the swelling. So if the abscess continues to drain, that doesn’t mean that the antibiotic isn’t working.

      There is time for you to make decisions. Your vet’s plan of waiting 30 days before taking X-rays is valid, and if he / she expands this to 60 days, in my experience, that’s OK too because long term antibiotics will help many of these horses overcome tooth root abscesses.

      As you may know, I cannot advise you specifically on the treatment of your horse. I can say that in my experience, long term antibiotics have helped horses overcome abscesses but they never “cure” an abscess. An abscess is a beautiful process that has a visually disgusting face. Don’t be discouraged as this abscess evolves. As long as your horse is doing well and is not affected by the disease, then you have time.

      Thanks for contacting me about your horse. Doc T

      1. Thanks for responding.

        My horse has no discomfort and is behaving normally. I think my plan at this point is to go the 30 days, then do the x rays and see if it even shows anything obvious. I have read so so many horror stories about tooth extractions, that unless she has a damaged tooth, extraction will be a last resort. As long as my vet is on board, I’ll probably continue the antibiotics another month and if still no change, try the sinus lavage first. I just hate putting my horse through all this if this is something that may just resolve itself eventually, and from what I’ve read here and other places, they often do.

  73. Hi! I have a warm blood yearling who has had a snotty nose for 6 months. Sulprim cleared it up for a couple of weeks but then it came back. I have had further consultations as the nasal discharge (on one side only) suddenly became smelly. Examination of the teeth from the mouth showed nothing obvious neither did scopes of xrays. I was under CT that they saw the root of the number 9 molar was damaged and casing the infection and nasal discharge.
    The Equine hospital is now considering options of whether to do the bone flap surgery to flush the sinus and “patch” or “fill” or “cap” the root. They say that dong this might keep the tooth there but it may need to be extracted down the track. My question is should you just extract the tooth so that the horse only has one surgery rather than “patching” and then maybe having to extract the tooth in a few years?

    1. Thanks Anne – I am glad to hear that keeping the tooth is becoming an option at some surgeries. I am also impressed with the ability of CT to see these small causes. Too bad it isn’t available to the majority of horse owners because it is such a valuable diagnostic tool.

      What makes this case interesting is that it is in a yearling. The formation of the cheek teeth has not finalized yet and presents thoughts and decisions that might not be the same as for an adult (older than 5 years in teeth discussions).

      I am glad to hear that Sulprim cleared this up. In my experience the length of therapy is important to it’s permanent success and usually is 30 to 60 days with tooth root infections. You should discuss this with your vet first, but I have had no adverse effects on this long term administration of trimethoprim and sulfa in adult horses. However, I have not done long term therapy in growing horses.

      A sinus flush can be performed in a sedated horse with the puncture of the sinus using a 14 gauge needle. This can be repeated often and should be done in conjunction with systemic antibiotics.

      Finally, I have seen one adult horse resolve a tooth caused nasal discharge over two years time after the therapies above did not work.

      To answer the question you asked required the above perspectives. It did not mention “filling, patching or capping” because I think this is a new and novel approach to a problem we don’t really understand thoroughly. If it is a deformed tooth, will this procedure actually help? You should ask your surgeon if this is experimental or find out the data for similar procedures performed in other young horses with not fully developed cheek teeth. Remember, the tooth is still developing AND the tooth is NOT a human, cat, dog, etc so extrapolation from procedures done on other species may not be accurate. The other consideration to removal of the tooth is potential damage to the adjacent developing teeth.

      I prefer conservative approaches to everything and you have time to decide on the course taken. Talk this one out with your vets involved. I cannot give you direct advice, but I can give guidelines that help you discuss things. Consider long term antibiotics and if necessary, repeated until this horse becomes older. If it is a deformed tooth, then the tooth should be removed, but waiting until the cap is naturally expelled first might be beneficial for the horse. Lots of issues in young horses. The most important consideration is always the horse: is he affected by this tooth? chewing well? maintaining weight and growth? What about taking serial CT scans over a period of time to create a better picture of what is happening over time rather than basing a decision on a snap shot of a moment?

      PLEASE keep us all informed here with follow up posts so we can ALL learn through your documentation. I suggest you develop a time line book for this that starts at the first sign of the problem. When all is resolved, send that to me for posting. I would be glad to post it here and in The Horse’s Advocate web site. Thanks, Doc T

      1. Hi Doc T
        It’s not good news. After lots of consultations across Australia and the USA, the vets have decided that there is no option but to extract the tooth. They feel that the evidence from the CT scan shows that the damage is too great and the sinus is very impacted and is already causing deformity (The yearling has a bump on the left side of his forehead between the eyes).
        When I queried a bout a more conservative approach – wait and see – they are advising against this because of the severity of the sinus infection and the already apparent distortion of the sinus cavities. They feel the extract of the tooth is in the long term best interest of the horse.

        It sounds like an awful operation – they are proposing to do a bone flap to get to the tooth and to drain the sinus – and long post op care. I feel so sorry for the horse as he is so well mannered with a lovely nature and is taking all the prodding and poking in his stride. Regards Anne

        1. Thanks Anne for the update. Please keep all of us informed.

          You need to trust the vets because they have more information to base their decision on. Sinus flap surgeries have been around for a long time and their success rate is high.

          The most interesting thing about your horse is the age. Because he is a yearling, it is a good assumption that there is a developmental problem with the tooth and that this will continue and destroy the sinus. Removing the cause will logically work. If he was a 10 to 20 year old, then a more conservative approach might be considered.

          I know you feel sorry, but if parts don’t develop correctly (teeth, limbs, heart) then there are consequences in the health and longevity of the animal or human. You should be happy and grateful that we have options today that have not been available to our parents and grandparents for conditions like this. I know I am. The problem today is knowing when to step in with these new options. I thing your vets are correct in their decision because of the advanced condition in such a young horse.

          Again, please keep us posted and send some pictures along too to my email address. Doc T

  74. Thank you so much, the general consensus amongst my regular dentist , a board cert. Equine surgeon my vet consulted with and now yourself, is to put tooth extractions on hold until and only if they become necessary. The risks are too great complications of infection etc.and the trauma involved in extracting some 20+ teeth over 2 surgeries would in all likelihood compromise this horses quality of life. Right now he is happy and by all appearances pain free (as my dad always says “don’t go borrowing trouble!”)We will be increasing his dental exams to every 3-4 months. I will repost any compelling changes, again thank you so much!

  75. Hello, I have a 23 year old Appendix Quarter, between my sister and I we have had in our family 18 years no previous dental problems have kept up with dental checks(floating) with our regular vet, same vet for 15 years. Recently through a neighboring farm a veterinarian equine dentist was coming to do dental checks on their horses as my 2 were due I took mine over. The veterinarian dentist took one look at my 23 year old gelding and said uh oh looks like EOTRH. As said before up to this point no real problems , ate fine, weight is great but was showing some receding gums. The dentist proceeded with full set of X-rays and full blood panel. Blood was good but X-rays did show moderate amounts of EOTRH and cementin. Horse has not exhibited any signs of pain no problems quidding or eating. This dentist advised removal of all incisors, canines and possible 4-8 molars. Said getting rid of teeth would get rid of the (pain causing) disease.he immediately wanted to schedule the first of the two procedures it would take For all the extractions . Now I would do anything for my animals to keep them pain free as possible including pulling all their teeth but he isn’t showing any pain. I consulted my regular vet who came out and looked at him, who while agrees with probable diagnosis says putting my horse through such traumatic procedures is uncalled for and the risks involved too great, I definitely tend to agree with my regular vet, I hope this older guy is not just being stoic and is really in a lot pain. Any thoughts or advice on follow up.
    Thank you

    1. Hi Laurie – EOTRH has been around for a while. I used to call it “ugly teeth of old horses” and the worse thing that happened was the horse could no longer bite a carrot before the incisors fell out. It wasn’t until a few years ago that vets started to radiograph these teeth that they gave it the name condensed as EOTRH (Equine Odontoclastic Tooth Resorption and Hypercementosis for anyone interested). I have documented several of these cases and have found the following:

      1) Some horses become very painful and extraction of the diseased teeth eliminates the pain. These horses are very uncomfortable and have difficulty biting grass and hay. The incisors at this point are easily removed with IV analgesia (not local nerve blocks) and extraction using my fingers (they are that loose) or forceps.

      2) The teeth affected are the incisors and canines. I have not seen a case yet involving the cheek teeth. There is research suggesting that EOTRH is only seen in geldings though a veterinarian in AZ has documented it in a mare (I wonder if this mare has canines as a small percent do).

      3) Removing all the incisors has no effect on the horse’s ability to harvest grass or hay into the mouth.

      4) As a conservative vet, unless there is compelling reasons to do otherwise, I always wait to pull any teeth in a horse. Too many complications can occur from extraction of teeth that are not bothering a horse.

      Frankly, your horse has about another 7 years of life. This is a slowly progressive disease. But the bottom line is always this – talk with both vets involved with the case and then listen to your gut feelings – and always do what is in the best interest of the horse.

      This link may not be good in a little bit, especially if I forget to redirect it after migrating to a new domain. If it doesn’t work, go to HorsemanshipDentistrySchool.com and look there. But for now, you may find this post interesting. It is in the Public Library of my dentistry school. I will also have it soon on my other website TheHorsesAdvocate.com which will become free very soon.

      Thanks for commenting and good luck – Doc T

  76. Im so sorry for the confusion, and of course I realise you cannot give answers specific to my case 🙂
    The way I understood it ( and perhaps I am completely incorrect here) is that most of the tooth is within the gum- there is little in the mouth to actually grab hold of so the vet wanted to give it time to “grow out”?
    I’m not sure what you meant about the complications but we had a sinus flap surgery done, pus removed and it got extremely infected. The vet assured us it wouldn’t happen but it did. We didn’t entirely understand why it was done, partly to remove pus and partly exploratory to see if there was anything else that it could have been? But after it was done and nothing was found there the vet and dentist decided it was the tooth based on the original X-rays. As for the infection on the other side, post sinus flap surgery he developed discharge and an abscess near the wound edge on the originally unaffected side of his face and we xrayed his skull- he had developed a new horizontal skull fracture allowing the infection to move along to the other side. Apparently the vet hadn’t seen that happen before so I suppose we are very unlucky. Antibiotics and flushed cleared that up quickly. That is the way I understood it so apologies if that is incorrect.
    The horse is 13 so could very well have bilateral fractures but I don’t believe the X-rays showed anything. I’m terrified of more surgery after the mess we had following what was promised to be a simple procedure.

    1. Thanks for the clarification. It sounds like you are frustrated with the care he has received. While difficult, the only way to resolve this is to talk with the vets involved.

      I will tell you this – there is NO surgery that can’t have complications even when everything is done correctly. This is a fact that EVERY surgeon goes in knowing. I used to joke with the owner before anesthetizing a horse with this comment. “Did you leave your horse the instruction manual on anesthesia and the surgery last night for him to read?” There is nothing worse than a successful surgery and the horse dies in recovery. I had to face this myself when I was anesthetized. There are no guarantees and I tried to forget this point as my lights went out.

      This said, please remember that abscesses are a beautiful way our bodies remove a problem and expel it to the outside. If you are seeing pus, then the abscess is working. If given time, the abscess will resolve the issue, though it may take years if reinfection occurs from a bone fragment. If the abscess is enclosed (hoof abscess) then it can become very painful. If it is deep inside, such as my son’s abscess within his spinal cord last year, then it can be life threatening.

      The ethical and legal answer is that you need to talk with the vets who have seen your horse and have a vested interest in the outcome. All I can offer you is that as long as the horse is showing no discomfort and is chewing and swallowing, then you have some time to think about this. All dental issues are slow to form and slow to heal. As long as pus is draining, your horse’s body is working at resolving the issue. Surgery may speed up the process.

  77. Thank you so much for that, I really appreciate the advice. We’ve scoped and done X-rays- it seems that the last upper molar is fractured. Being a young horse there is little tooth to grab onto to remove it and our dentist has said the surgery would have a high rate of complications. We had a sinus flap surgery done last year as vet seemed to originally think it was a tumor- but it helped remove the pus in the sinus and after the flush and a month of antibiotics the discharge went away for a few months and I resumed riding. We had a lot of trouble after the sinus flap surgery-somehow the infection went to the other sinus and ended up with catheters in both sides of his head… The wound also got infected and there was also infection due to sequestration of bone fragments post surgery. He had IM penicillin and then a procaine reaction, resulting in multiple injuries. It turned out to be a huge ordeal with months in the stable. I would really like to avoid any more surgery if possible. It’s great to know there won’t be long term damage from leaving it alone- would it be best to spell him in a big paddock for a year to see how he goes? I’ve been riding lightly with metronidazole for flare ups but not sure if this is a good idea. Sulprim doesn’t seem to work but perhaps I didn’t give it enough time. He is acting normal, eating well and has good energy. I really appreciate your help with this.

    1. Anna – Please accept my apology, but your comments are the reason veterinarians (or doctors or plumbers or auto mechanics) can’t help without first seeing the problem, getting a detailed and chronological history (time line), and consulting with the other professionals who have seen the horse.

      After reading your comment I become confused. For instance: 1) What to you mean too little tooth in a young horse? Young horses have the most tooth of any aged horse. 2) Fracture of the last upper cheek tooth is uncommon but does occur. It is the hardest to remove orally especially because of its length in the smallest space in the mouth. 3) A sinus flap would be a good approach to the removal of a split upper last molar but they do have a high rate of complications. However, the least of the complications are wound infections and bone fragment sequestrations. 4) Tumors in the head are rare especially in a young horse but not unheard of. If a tumor was not visualized at surgery, then was the cause actually determined then? When was the diagnosis of fracture made? 5) Sinus infections, in my mind, don’t travel to the other side of the head. A bilateral smelly nasal discharge from the sinuses indicates 2 problems, one on each side of the head, and the causes need to be determined.

      Based on your story, I suggest you have a long and detailed discussion with your vet(s) and bring your time line along so that you can get a better understanding as to why these things are occurring with your horse. If after that you are still without answers, seek out another opinion from a vet who can visit your horse (or that you can take your horse to).

      It is always interesting to me how the horse continues to eat as this process develops. Some of the questions that need answering are these: 1) Why does metronidazole work but sulprim (is this trimethoprim 160mg and sulfamethoxazole 800mg?) not work when it is usually effective on dental disease? 2) Are these bilateral fractures? While common in the upper 9’s they are usually in horses around 10 years old and up. 3) Is there a plan (conservative or aggressive) that can be developed that is in the best interest of the horse based on the evidence? 4) What other diagnostic information is necessary to get the missing pieces?

      I started this with an apology and I end it with one too. I cannot help you because I am not there, but I can help you in suggesting the creation of a detailed time line and then approaching the professionals available to you. In my experience, most medical things are simple. When they are not, then a team approach to solving the mystery is necessary. Gather your evidence and assemble your team. Please let all of us know via this post how your horse and you make out in this interesting case.

  78. Hi 🙂 My horse has a tooth infection and has had white smelly discharge on and off for a year. Our vet/dentist is hesitant to extract it due to high complication rate ( it’s the last upper molar), our regular vet thinks we should just do nothing and eventually it will resolve on its own. It seems to go away with metronidazole but apparently this can’t be used for long periods? IM penicillin post sinus flap surgery to remove pus also cleared it up for awhile but it seems to come back.Sulprim doesn’t seem to have an effect but perhaps we didn’t use it for long enough. Is there a particular antibiotic you would recommend that can be used for a long course? Thanks so much.

    1. Hi Anna – Thanks for reaching out around the globe to ask me about this. It is important that you know that I cannot give advice specific to your horse. What I can tell you is some of the experiences I have had.

      It is always important to have an accurate diagnosis before a treatment is applied. However, in cases similar to yours, the cause is often not found. If the “white smelly” discharge is coming from the nostril, it could be coming from several sources. In my experience, trimethoprim-sulfa antibiotics usually reduces or eliminates this within a few days if it is tooth related. I often treat these for 30 to 60 days with no side effects. In most cases the issue resolves as the horse heals the problem and the abscess does its job. But if the tooth is split from the crown to the root apex, then tooth removal may be your only option. If the smelly nasal discharge is coming from a local cancer, then pulling a tooth won’t do a thing. So a good diagnosis needs to be made.

      The good news is that there is no rush in these matters if it is tooth related. I have had 1 draft horse that was impossible to work inside the mouth and the only solution was to anesthetize her. There were risks to this so the owners elected to do nothing other than long term antibiotics and sinus flushes. After a year of treatments with little effect on the nasal discharge, the owners stopped all treatments. A year or maybe a little more, I asked about the mare. They reported that the nasal discharge had completely stopped. And the mare never went off of her feed or lost weight.

      The bottom line is that I have never seen a horse suffer in any way or even die from an infected tooth. If they never self-resolved, then we would see dozens if not hundreds of cases every year of horses with this condition. But we don’t and because of this, other than the mess you have to clean up every day, I usually don’t worry too much about them. Unfortunately, few horse owners are willing to do nothing with a wait and see approach.

      Talk with your vet about this. Schedule several check-ups for the future over the next year and follow this case together. What works for a lot of people is to write a time line starting on the day you first noticed this. Be sure to include all treatments (time, dose, frequency) and their results. This helps with long and protracted cases. It can also be sent to me a year from now as a form of documenting what works and doesn’t work for others to learn from. Interested?

      Thanks again, Doc T

  79. My 18 y/o gelding just recently was diagnosed with a sinus infection. After x-rays the vet didn’t see any thing wrong with his teeth and there was no mass. But behind the teeth that are connected to the sinus, the roots were very blurred, as if they weren’t there. Would it be a good idea to pull them? She sent the x-rays to a specialist and they recommend that I do but his performance is still the same as normal and he doesn’t seem to be in any pain and loves food as much as ever! The only problem is that the thick green discharge irritates him. He is on antibiotics but she said they rarely work and if they do the infection would most likely come back. What do you recommend?

    1. Thanks Nikki for this comment. This is an example of a horse owner placed in a position of making a choice without enough information and it can be frustrating. The horse is otherwise healthy and acting normally, yet there is a nasal discharge that one vet says isn’t from a tooth and another says it is. The recommendation is to pull the tooth, yet you are not sure.

      A thick green discharge is interesting. Is there food in it? If so, then that is coming from the mouth through a direct path. Pulling the tooth may make that hole larger and the discharge worse. If there is no food, then why is it green? Usually a tooth root abscess is cream colored.

      There is never a rush on these things. You have 3 options: 1) 30 to 60 days of antibiotics (your vet will work with you on this). This usually eliminates the discharge. If it returns then you can either try the antibiotic route again or extract the tooth. Maybe by then a more definitive diagnosis can be made (identifying the exact tooth and cause). In addition, you can have a sinus flush performed on your sedated horse to help flush the pus out of the sinus. 2) Do nothing and follow its development with future exams and x-rays. 3) Go to a university for another opinion.

      Remember that a tooth extraction has its complications especially if there is a tract for food to enter the sinus. I remember a surgeon that told me once that he extracted a tooth only to find that the tooth was OK and the infection had gone up the side of the tooth. And I know of another where the tooth was extracted and for the next 2 years there was food passing from the mouth into the nose. The bottom line is that you need more information before extracting. This comes over time and trying things. Until you have an accurate diagnosis, avoid surgery. Abscesses are inherently a good thing and is a natural process. Yes it can smell but the horse is expressing the bad thing to the outside. Abscesses almost always resolve even though they can be messy and smelly. Oh, and one last thing. Float the teeth so that the tongue can clean the area on the inside of the mouth.

  80. Hi there!
    I’ve been worried for almost a week now. My 12 year old mare broke a back molar in many pieces last week and could barely eat. She chewed with wide eyes, spit out her hay and salivated profusely. The vet came two days after I noticed this strange behavior and began looking at her teeth and next thing I knew, The tooth was out. Her gums were raw from the sharp teeth rubbing so I presume he felt this was the only option… She is now on an antibiotic for 2 weeks and I am rinsing out her mouth with salt water every day. Even then , he told me there is risk of a root infection which would then lead to my mare needing surgery….. What do you think the odds are that she needs this !?
    A stressed out owner!

    1. Thanks for this great example Alexandra of a common event in horse teeth. It is common for a cheek tooth to develop decay that over time progresses down the tooth and eventually splits it causing a section to break off. This section can often lean into the cheek or tongue which causes the discomfort you saw in your horse. Removing this fractured piece is the only solution and it is what I have done for many years. Your vet probably did not remove the whole tooth but only this fractured piece which can be fairly large. While a tooth root abscess is always possible, I have found in my practice it is uncommon. What your vet has asked you to do (antibiotics and mouth flush) is reasonable. Have him / her keep an eye on things but there is no need to stress out! Tooth fractures are very common. Add a reply here in 2 weeks as a follow up. Thanks again.

  81. Hi – I took my 19yr old mate to an equine dentist last week after her having bad smelling white discharge from right nostril- &yes there is an infection. A golf ball size and it is starting to grow bone around it. She has been on antibiotics for 3weeks now. She is booked in to get tooth removed at end of jan. she is on noradine granules. Should I continue to try them for longer? She appears to be in good form, but over the pass fees days is slower at eating and doesn’t seem excited for her food. Still eats meal.

    1. Thanks for your comment and I can understand your concern. Your veterinarian may need to take several X-rays to monitor how effective the antibiotic is working. Based on this will determine if you should continue on them. I am unfamiliar with Noradine but it may be the reason why your horse is backing off of her feed. You should ask your vet about this. Remember that there is a difference between a horse having difficulty chewing (tooth related and hungry) versus a horse not wanting to eat (not hungry). Let us all know what happens.

  82. I have a 19 yr old Dutch Warm blood/ Irish TB. He has exhibited a thick yellowish discharge from the nose mostly one side on and off since Aug. Antibiotics were prescribed and discharge lessened. No other symptoms by the way. X rays of sinuses and scoping of guttural pouches were negative of any abnormalities. A small darkened area did seem apparent over one tooth. The vet has recommended extraction of the tooth but I would like to research other possible treatments. Can an antibiotic be injected directly into the infection site?

    1. Thanks Brenda – I cannot offer advice over the internet about your horse because I have not seen your horse. I can say that tooth extraction is permanent and I feel that all other options should be tried before extraction. Seek out another opinion if you are not comfortable with what has been advised. This could include sending the radiographs to a radiologist at a university. In answering your question, there are other options out there. But the most important thing is to get an accurate diagnosis. Sometimes another radiograph taken of the same tooth will no longer have a dark spot.

  83. Hi there. I also have a 7 yo KWPN mare with a hard lower jaw swelling which came up overnight last week. I suspect an abscess and have hot packed twice a day for the last 4 days to see if I can initiate drainage. Nothing is draining at present so have requested a vet visit. She is eating comfortably, has an alert demeanor and doesn’t object to the mass being manipulated. However, she and a chum took to chewing a fence last month, so a splinter needs to be ruled out.

    If it is indeed a tooth root abscess, I would follow the antibiotic avenue for as long as possible to avoid extraction. I have also heard of a process of endodontic therapy where the tooth was preserved successfully which sounds promising.

    1. I apologize Penny for not responding to you. Apparently I missed the notification! Please let us know what was discovered over the last 4 months. Usually a tooth root swelling develops over several days and not overnight so I agree that it might be a splinter or trauma. The advantage we have with swellings is that we have time. They are not life threatening and usually don’t affect the horse’s ability to chew.

      I agree that if it is a tooth root abscess to try long term antibiotics. If you end up trying any other therapy I certainly would be interested in the outcome. Thanks, Doc T

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