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Antibiotics don't fix dead teeth in horses.
- Nick Moore DVM
- 7 days ago
- 3 min read
When it comes to treating dental disease, there's an important misconception that needs to be addressed: antibiotics are not the cure. While they can be useful in certain situations — like controlling secondary infections — they don't fix the root of the problem.
Let’s dive into why that’s the case, and take a look at a real-world example.
When Antibiotics Are Useful (But Not Enough)
In dentistry, antibiotics can sometimes play a supporting role. For instance:
If a horse has sinusitis related to an infected tooth.
When an infected tooth is being extracted, and we want to control potential secondary infections.
Around the time of oral surgeries, depending on the severity and history of infection.
However, it’s critical to understand that antibiotics only help manage bacteria temporarily. They do not:
Repair fractured teeth.
Heal pulp infections.
Cure dental disease.
They are never a long-term solution. They simply help quiet down bacterial activity until definitive treatment (like extraction or endodontic therapy) can be performed.
A Real-World Case Study
We recently worked on a case that highlights this perfectly.
The horse we treated had a small chip fracture on the occlusal (chewing) surface of a tooth. At first glance, it appeared minor — the pulp looked sealed. However, the horse had a history of sinusitis, which had previously responded to antibiotics. This made us suspicious that the problem might be deeper.On standard X-rays, the tooth appeared fairly normal, although there were very subtle signs that could have been overlooked. Because of the horse's clinical signs and history, we proceeded with a CT scan — and that’s when the real issue was revealed.
After extracting the tooth, the full extent of the damage was obvious. The pulp was completely necrotic — black, gangrenous, and severely infected. The smell alone was enough to confirm the infection's severity.
This degree of necrosis is important: antibiotics cannot penetrate dead tissue. There’s no blood supply to carry the medication into the infected area, meaning the infection continues to fester beneath the surface.
In this case, extraction was the route of treatment we decided on. While we did administer antibiotics around the time of surgery — primarily due to the horse’s history of sinusitis — it was clear that antibiotics alone would never have resolved the underlying problem.
It is important to note that in this case, the horse had been placed on antibitotics for the sinusitis before the surgery by the referring vet. This was very helpful as the sinusitis was mostly contained by the time we did the surgery to remove the tooth. This is an example of a good use for antibiotics.
The "Iceberg" Effect
Dental disease often works like an iceberg: what we can see in the mouth is just the tip. The real damage can be hidden deep within the tooth or below the gum line. Advanced imaging like CT scanning becomes invaluable for revealing the true extent of dental issues, allowing us to treat the real problem with 100% certainty — not just the symptoms.
Final Thoughts
In dentistry, antibiotics are a tool, not a treatment. They help control infections temporarily but don’t fix fractures, pulp infections, or dead tissue. Long-term resolution requires definitive action like endodontic therapy or extraction.
This case is a powerful reminder of how subtle dental lesions can hide serious problems — and why thorough exams and appropriate imaging are critical for successful treatment.
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