Speechless In A Case Of EOTRH In A Horse

(This blog’s header photo is of a horse that is moderately affected with EOTRH)

Every once in a while I become lost for words.  My mind becomes numb and my jaw freezes.  My eyelids slowly sweep moisture across my eyeballs as I try to bring things into focus.  My open mouth dries as I breathe slowly pretending I did not hear and see what I just did.

The text message did not change and the image sent with the text did not alter.  I asked myself how this could happen.  How can someone do this to the innocent horse dependent on our species to advocate for them?  How could the veterinarian, bound to do no harm, support this procedure?  How could a horse owner allow it?

Then I became mad at my helplessness and I wrote this blog.

The Text She Sent To Me:

Good morning… I have a question … we have a horse that came to us with developed EOTRH.. we discovered it a little over a month ago..  after 2 weeks of SMZ antibiotics there was only slight but not significant improvement..it was determined his top 6 incisors needed to be pulled and they were..   horse is doing well , on hay and we hand graze on taller grass.. he will not touch his soaked alfalfa cubes nor his  senior feed( he is 17)..which is fine because I make sure he has hay  24/7 .. my question is… do his bottom teeth also need to be pulled? It just seems criminal to pull them as well.. not clear to me if they are as infected, but I will find out when vet comes to recheck.. but from my understanding for insurance reasons it needs to be done within a month of top teeth being pulled.. Is it normal to pull bottoms if you pull tops if there is not evidence of or little evidence of EOTRH? Can a horse do well with just bottom incisors? I tried googling but got no where. I am going to transition this horse and most others at the farm to the diet (my friend) has her horses on as per (your) recommendation .. but for now it bothers me that this poor horse in 3 weeks will have more teeth removed. Wondering what your thoughts are on this?

These are the extracted incisors that accompanied the text.

I replied to this text with my obligatory line that interfering with someone else’s case without seeing the horse is unethical and not allowed.  I encouraged her to have a conversation with her vet to express her concerns.


EOTRH is a progressive disease affecting the bones in the skull that hold the incisor and canine teeth in position.  As the disease progresses, these teeth react by adding more structural material to keep them in position.  Throughout the process of the horse saving the affected teeth, the gums become inflamed, enlarge to form a ridge and then withdraw from their normal position (recede).  The incisor tooth roots become enlarged creating hard bulges under the gums.  The incisor and canine teeth become dead with abscess formation occasionally causing rupture of some of these teeth.

Pain is not common in mildly and moderately affected horses.  However as food is trapped in the pockets formed by the receding gums, the inflammation becomes painful.  When the teeth become loose there can be pain seen as difficulty biting hay from a net or biting a carrot.  Because the cheek teeth are rarely involved, the horse will continue to chew food normally.

The Cause And Treatment Of EOTRH

I have written about the cause of EOTRH in another blog here (What Is The Cause Of EOTRH In Horses?).  My thought is that EOTRH was not in my veterinary textbooks at Cornell in the 1980s.  It is a new disease that is so obvious to our eyes that we cannot say that it existed before 1980 but we just didn’t notice it.  Lift the lips and look to diagnose.  You can see 186 images of EOTRH at Incisor Decay And EOTRH In Horses to see what I have seen.

My guess is that EOTRH is an autoimmune disease (as per Dr. Paddy Dixon at the AAEP meeting, in December 2017) caused by a reaction to grains and grain byproducts.  This is reasonable because these products were not readily available prior to 1980.

Mushrooms have been shown to neutralize plant lectins in human studies and lectins have been shown to be a major cause of all autoimmune diseases in humans (lupus, Crohn’s, rheumatoid arthritis, Hashimoto’s thyroiditis and others).  Because of this, I have placed several horses with inflamed gums on the shredded mushrooms found in Equident®, a product specifically made for this disease.  The results are consistently seen as reduced inflammation.  More importantly, these owners have also removed grain and byproducts from the diet to prevent further inflammation.  Neither of these actions will reverse the damage already done but they have demonstrated their ability to stop the advancement of EOTRH.

The Reason To Be Angry

I wrote this thought a while back in a blog: “But just because we can do a procedure, is it always in the best interest of the horse?” In this case, was there a need to pull all upper incisors?  I don’t know because I was not there.  Yet in the thousands of horses I visit each year, there are a lot of horses with moderate EOTRH that don’t need their teeth extracted.  They live into their 30s with their front teeth still in their heads and eating well.  In fact, there is only one horse with EOTRH affecting their ability to chew that I did remove all but 1 incisor (see this blog’s header and the images below).  They wiggled with finger pressure and most of them came out with my fingers or forceps with only some IV pain medication.  It took about 5 minutes and the horse went to chewing comfortably in less than a day.

My point of anger though only started with the extractions of the horse in this text.  It deepened as I re-read the text and gleaned more.  He was only 17 years old which isn’t “old.” Why was he on a senior feed?  I have been looking for YEARS to find senior feeds for squirrels, for birds, for people and I have not found them.  My conclusion is that “senior feeds” for horses are only a marketing gimmick to get horse owners to purchase the unwanted byproducts of the human food industry.  Just look at the ingredient label.  And when should a horse be considered a “senior?”

The ingredients of one brand of senior feed listed on the internet are below.  Purina and Nutrena no longer list the ingredients on their websites which adds to their cover-up and confusion.  Red is an inflammatory ingredient and blue is an unnecessary ingredient if the digestive tract is not inflamed.  Green is the only ingredient needed and can be purchased individually.

Soybean Hulls, Dehydrated Alfalfa Meal, Wheat Middlings, Corn Distillers Dried Grains, Wheat Flour, Soybean Meal, Ground Corn, Soybean Oil, Ground Beet Pulp, Cane Molasses, Rice Bran, Calcium Carbonate, Yeast Culture, Salt, Monocalcium Phosphate, Magnesium Oxide, Natural Flavor, DL-Methionine, Calcium Sulfate, L-Lysine, Vitamin E Supplement, Selenium Yeast, Yeast Extract, Zinc Amino Acid Complex, Manganese Amino Acid Complex, Zinc Sulfate, Manganese Sulfate, Copper Amino Acid Complex, Copper Sulfate, Biotin, Vitamin B12 Supplement, L-Ascorbyl-2-Polyphosphate (source of Vitamin C), Cobalt Glucoheptonate, Ferrous Sulfate, Stabilized Flaxseed, Algae Meal, Soy Lecithin, Dried Enterococcus Faecium Fermentation Product, Dried Lactobacillus Acidophilus Fermentation Product, Dried Aspergillus Niger Fermentation Extract, Dried Bacillus Subtilis Fermentation Extract, Dried Bacillus Subtilis Fermentation Product, Dried Bacillus Licheniformis Fermentation Product, Niacin Supplement, Calcium d-Pantothenate, Riboflavin Supplement, Vitamin A Supplement, Sodium Selenite, L-Threonine, Choline Chloride, Pyridoxine Hydrochloride, Thiamine Mononitrate, Calcium Iodate, Vitamin D3 Supplement, Folic Acid, Menadione Sodium Bisulfite Complex (Source of Vitamin K), Cobalt Carbonate, Natural Mixed Tocopherols, Citric Acid, Rosemary Extract.

Blue Seal Feed

My anger then hit a level I had not been to in a while when I read that the insurance company required the rest of the teeth to be pulled within 30 days of the first set of extractions.  What?!? In order to save money, the owner will need to decide quickly to extract the remaining teeth and whether they need to come out or not.  Where is the advocacy for the horse?  Are we so blind to reason that we need to be faced with such a ridiculous decision?


I cannot reach SOME of my veterinary colleagues because they are too far down the path of “Whack-A-Mole” medicine.  In fact, they do “something” because the horse owner wants them to “DO Something!”  One of the most common words I hear from horse owners is, “I just want what’s best for my horses.”  Then they turn over the responsibility to experts without going through and confirming that what is happening is really the best for their horses.

In today’s world of marketing, how do we determine what is best?  How can we agree when we can’t agree on politics, raising children, religion or almost anything else?  I wrote about “Cognitive Laziness” in a recent blog where we just accept what we are told without understanding the information.  You should read this and then ask yourself, is what you are doing for your horses really in their best interest?

Information today is abundant and is unfiltered and not refereed.  It is usually agenda-driven because why put in the effort of creating content if there is no reward?  I become energized by texts like this one and from the decades of watching horses become more ill and lame.  The reward for me is when I get the chance to balance agenda-driven words and actions with novel information based on almost 50 years of experience.  Stopping horse owners in their tracks to look at things from a different perspective, having them try these ideas and then reporting back the positive improvements in their horses is my reward.

Read these and blogs from others.  Avoid agenda-driven information where they are trying to sell you something.  What you will find is that simplicity works in most cases – and pulling teeth is a last resort.

There are a lot of veterinarians and horse owners who feel the same way I do and are serving the horses in a profoundly beneficial way.  However, when I see a case like this and realize the pressure being brought upon the horse owner by the insurance company to possibly make a  very wrong decision, I worry.  I become angry so I write blogs and I remake this website to be a source of information for horse owners so they never say as she did in the text.

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  1. I had never heard of EOTRH until Doc T started blogging about it. I was sickened and saddened for this young horse. I have several friends that still compete their horses at that age. I took Doc’s advise years ago and took all grain out of my horses’ diets. I tried (unsuccessfully) to get some of the supplement manufactures to use anything except grain products in their formulas, so no supplements for the horses. Progressive Nutrition had an outstanding ration balance that supplied the protein the horses needed, and was a suggestion from Doc T. I actually read the list of ingredients before I purchased it – no grain products and soy bean meal was the first ingredient. Then Nutrena bought Progressive and if it hadn’t been for Doc T pointing out the ingredients had been dramatically changed I wouldn’t have known. How many of us read the ingredients list every time we buy something? Whether it for our horses or our families, we trust that things are the same. I stopped feeding the ration balance immediately. It took me years to find someone locally that I could get soybean meal ordered. I’ve asked DocT many questions related to horse injuries because I know he will tell me the truth and offer what’s best for the horse. He has no hidden agenda.

    1. Thanks Debbi for your kind words and always looking out for your horses. It is so true what you say that if you don’t pay attention people / businesses will try to slip one past you. Thank you for your trust. Bet to you and Ray

  2. I feel so sorry for that young horse 🙁
    My horse is 34. My biggest regret is having a young, new equine dentist come out when he was 29 with no issues to ” just have his teeth floated like a good horse parent” and she used an electric tool and must have filed most of his teeth off because as soon as she left, he could never eat hay again!! It just wads up and falls out. I took a perfect healthy horse and had his teeth destroyed. He has since been eating soaked cubes, grass pellets, brewers yeast, and dehulled soybean meal and looks great by mostly following Doc T’s suggestions. Thank you Doc T!! We appreciate all that you do!!

  3. This is a cautionary tale about the dangers of confusing advertising for information. Horses somehow managed to survive for centuries without grain-based diets because of the ability to assimilate forages. The marketers of specialized feeds have brought a number of veterinarians into their “racket” and it has nothing to do with the health of the horse and everything to do with the bottom line $. Your horse needs you and not slick advertising.

  4. So sorry for this horse and owner. My limited knowledge would make it difficult to go against my vet’s recommendation, only to discover in hindsight it was not the right thing to do.
    Just as an aside, Doc T, for purposes of comparison, would you be able to post a picture of what a “normal” mouth would look like?
    Glad to read others’ positive comments about their horses who are on a proper diet. So far so good for my guys.

    P.S. Love your color-coded label. That is soooo helpful!

    -In a later post you wrote: Sorry…never mind! I found a pic on the internet. I now see the difference. Thanks!

    1. The toughest thing we all do is trust and then have that trust challenged or proven unwarranted or even wrong. All of us….

      Glad you liked the colors – it really makes the info pop! Also glad you found some normal looking incisors.

  5. I thank you every day for showing me the path to better feeding of my horses. I am so grateful to have learned this lesson soon enough to make a positive difference for them for the rest of their natural lives.

  6. I had never heard of EOTH until now; but, it certainly reminds me of what used to be called “Trench Mouth”, in humans. That, I am quite familiar with, having developed it in boarding school caused by my big stress in my senior year due to the loss of my best friend in a commercial jet crash and prescribed amphetamines for diet pills. My home dentist stabilized it with massive doses of vitamins B & C; but, over the next 30 years successive dentists and periodontists had me try various things but nothing really worked …. until a periodontist who did DNA testing and targeted the mouth bacteria with antibiotics before cleaning. Things have been great for about 15 years,now. All of which makes me think you are right about the feed. Just guessing.

  7. This is the reason I found Dr Tucker. My horse has advanced EOTRH and a couple of vets told me they need to pull the teeth. I was pretty shocked because I thought they meant all of them. I asked how will he eat. ? Oh it won’t be a problem . I took this horse in because I wanted him away from his traumatized life so I was not going to pull his teeth without a lot of research. So enters Doc T. He did declare my horse years older than I was told but he is a feisty healthy boy missing a couple of teeth that Doc pulled with his hand. So far he is still eating grass ,soft hay and his pellets. If I had been the owner of the horse above that horse would still have his teeth. Very sad on the owner and the vet’s part. We are these horses keepers and need to put effort into knowing as much as we can about their welfare and always put the horse ‘s welfare first !