(Original post – April 13, 2014, updated April 19, 2023)
Please read this first -This post has received a lot of comments. So before you post your question, please read the comments at the end to determine if your question is a repeat of someone else’s. Remember, I cannot give you direct advice about your horse (see disclaimer).
This week a horse owner from over a thousand miles away called me after I had gone to bed. She had an urgent tone as she described her 8-year-old warmblood dressage horse with a firm lump on her jaw for four days. Her vet took X-rays and then pronounced that a tooth needed pulling. This procedure horrified the owner, and she sought out another opinion. I’m glad she chose me because so many vets want to “Pull the tooth” as the treatment when that is like cutting off a finger if you have a splinter in it.
Wait a minute – I must 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 learned at vet school. While the glamor of performing surgery appeals to surgeons, it is not always in the horse’s best interest.
I must remind everyone (again) that we are talking about HORSES, not HUMANS. The teeth are very different. Yet only for emotional reasons, we automatically think we must pull the tooth if there is a tooth problem. It’s like Tom Hanks’ character in “Cast Away.” If you haven’t seen the movie, he becomes stranded on a tropical island with a toothache. His only relief from his agony is knocking out his tooth using a rock and a skate blade. He passes out from the pain for a few days. If this doesn’t make sense, 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 extract the tooth. We all want relief from the intense pain.
Horses rarely exhibit pain from an infection near or in the tooth and always keep eating and chewing normally. According to the caller, her mare showed no signs of distress. So why pull the tooth when a less invasive path is available?
In my four decades as a dentist, there have been only a few instances where pulling the tooth has helped; they were malformed or disintegrating teeth in young horses. Here the misshapen tooth was the cause of the infection. Extracting it then is an obvious choice. But realize that extractions have some severe 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. However, I also have stories where owners have had a tooth removed plus antibiotics, eliminating the problem. So which way would you go – antibiotics alone or pull the tooth and antibiotics?
No doubt 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 unchanged, why extract a tooth? Instead, they remove the tooth because of the owner’s desire to correct something they have associated human feelings with, maybe a painful tooth issue they have had. Or perhaps the owner doesn’t like to clean the dried discharge from the nose or thinks these abscesses should clear up in days when it takes weeks to resolve.
What Is An Abscess?
An abscess is the body’s way of walling off something that should not be in the body (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 a gorgeous event to watch. The body identifies a foreign thing, walls it off, and kicks 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 independently with time, some with antibiotics. Extracted teeth also cleared the swelling or discharge but were done before enough time had passed for natural healing (less than two weeks from the onset of signs). However, the owner wanted immediate results, and they went to a very willing surgeon to do the extraction.
One horse in my practice – a Belgian – resisted every attempt to work on her broken and abscessed tooth with a smelly nasal discharge requiring daily cleaning. The owners couldn’t send the horse in for anesthesia and surgery, plus Belgians are challenging to anesthetize. Several courses of antibiotics and several sinus flushes had no effect. Finally, they turned the mare out in a back pasture. 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. It has not come back in the 10 + years since the onset of signs. Every oral exam since shows that granulation tissue had filled in the infected area and walled off the tooth from the sinus. The tooth fragments remain and will so until she dies, but she has never missed a day of chewing normally.
Answer These Simple Questions
How many horses have you seen with a nasal discharge from a tooth root abscess? Very few, I’d bet. And of those you have seen, how many showed difficulty in chewing? Probably none. If tooth root abscesses with drainage were such a problem, wouldn’t we see horses everywhere suffering from them? But we don’t because they are self-limiting because abscesses are the end stage of healing. The infection has been going on for YEARS!
One more thought is that there are no studies dividing many horses with cheek tooth abscesses into two groups, one receiving no treatment and the other receiving a tooth extraction. What would the results show? And another thought is this – what is the cause of these abscesses, and are they increasing in frequency over the past decades? In 1984, my veterinary textbooks had nothing about cheek tooth fractures and decay.
The owner who called me that night decided to try long-term antibiotics. She was willing to let the horse resolve this abscess independently, and I was pleased with her decision. But then something happened. She became tired of hot-packing the jaw every day. 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. So the owner decided, after only a week of antibiotics, to have the tooth extracted from her horse.
This picture is of the upper cheek tooth extracted from the horse in this story. The tooth looks healthy. If she had waited several months, this mare might have resolved this abscess, but we will never know.
When the owner let me know about her change in treatment, she acknowledged that the horse was showing no discharge from the lump (a sign that the infection was resolving), nor was the filly having problems with the bit or chewing. The only reason she gave was that she was tired of going to the barn and hot-packing the jaw.
I wasn’t surprised. People want convenience and ease when it comes to nursing care. So the tooth was pulled, and the abscess resolved because now there was a giant hole for drainage, and the horse remained on antibiotics for two more weeks.
In over 78,000 floats I have done, I have seen the need for four horses for extraction. Yet, in the past decade, the cry of “Pull The Tooth!” seems to become standard. But is it always in the horse’s best interest just because we can do a procedure?
Cheek tooth fractures are common now. Removal of the fractured piece is the correct procedure done in the stall with light pain medication. Cheek tooth fractures are often confused with “Pulling the tooth,” which this post is about. Many comments below concern cheek tooth fractures, which is a different subject.