Dental extractions – Beyond wolf teeth (Proceedings)
The principles of extracting teeth are very similar, regardless of the tooth one is attempting to remove. Private practitioners are familiar with the routine extraction of wolf teeth (modified Triadan #05). With an investment in instruments, an understanding of techniques, the use of regional head anesthesia, and systemic sedatives, more extractions can be performed with time and patience. If not doing the extractions yourself, then being able to advise an owner of what might be required and anticipated is good information to provide, and referral to a hospital or mobile equine veterinary dentist capable of doing the procedure is ideal. This paper will focus on the technique of standing oral extractions.
Basic Equipment Needs
Set yourself up for success! Good equipment is a must. The basics are an excellent headlamp and full mouth speculum, especially for the premolars and molars. For the rostral teeth, necessary additional light can be directed from elsewhere besides a headlamp, however it is still useful to wear a headlamp for these extractions. In addition, an interdental space tube gag (relatively stiff rubber pipe works well) is needed for holding the mouth open for incisor and canine extractions. The full time veterinary dentist has a multitude of forceps, spreaders, elevators, and picks to be prepared for most scenarios. At a minimum, one should have a right angled elevator, a molar spreader, and two or three types of molar forceps. A periosteal elevator, mallet, osteotome and bone curette are required for many incisor and canine extractions. Robust wolf tooth extraction forceps can work for securing a hold on canines and incisors. Molar fragment forceps and dental picks are helpful when dental fragments (e.g. a fractured off root) and sequestered alveolar bone need to be loosened and removed. Water and an oral syringe for lavaging the mouth and socket is necessary. Consideration should also be given to what can be used to protect a deep socket from food contamination during healing. Commercially available dental packing or impression materials are frequently used. Polymethylmethacrylate and plaster of Paris are favored by some veterinarians. Others will simply pack the socket with a gauze sponge laced with an antimicrobial of choice (metronidazole or doxycycline are used commonly).Patient Preparation
Restraint of the horse in stocks is ideal but not always possible. Head support, either on a customized stand or with a suspended halter is desirable. Chemical restraint and regional anesthesia has vastly improved our ability to safely and painlessly remove teeth from the standing horse and veterinarians embarking on standing dental extractions should be familiar with sedatives and analgesics and their application. Numerous indepth articles on this topic are available elsewhere, including an accompanying proceeding "Regional anesthesia of the equine head". Antimicrobials are probably not necessary for many extractions, however, when there is osteomyelitis, secondary sinusitis, or significant soft tissue infection accompanying a diseased tooth, systemic antimicrobial therapy is indicated. Nonsteroidal anti-inflammatory drugs are administered for 3-5 days. Horses are usually maintained on their normal diet.
Indications for Extracting Teeth
The reasons for extracting teeth are varied and include fracture, periodontal disease, infundibular disease, supernumerary teeth, displaced/malerupted teeth, retained deciduous teeth, pulpitis and apical abscess, and equine odontoclastic tooth resorption and hypercementosis (EOTRH). Sometimes the decision to remove a tooth is easily made with a physical examination only. In other instances extensive diagnostics and imaging modalities are required to appreciate pathology and determine if a tooth or teeth require extraction. This is stating the obvious, but a tooth should only be extracted when there is convincing evidence it needs to be done, and on occasion giving a tooth the benefit of the doubt may be a good plan in the short term. Consider dental extractions as surgical procedures.