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Every Tooth Tells A Story: Random Equine Dental Pathology Part 1
- Nick Moore DVM
- Jun 3
- 3 min read
One of the most interesting things about equine dentistry is that every tooth has a story behind it. Sometimes that story starts with subtle clinical signs; a little nasal discharge, resistance to the bit, quidding, swelling, or unexplained weight loss. Other times, the pathology has been silently progressing for years before anyone realizes there is a problem. Once a tooth is extracted and placed on the table, you can often work backward and reconstruct exactly what was happening inside the horse’s mouth.
In this case discussion, we pulled random teeth from a collection of extracted equine teeth and analyzed the pathology associated with each one. No planning, no selected teaching specimens — just real-world examples of the kinds of disease processes we encounter regularly in equine dentistry.
The first tooth immediately showed us several clues. Its triangular shape and dual infundibula identified it as a maxillary cheek tooth. While the clinical crown appeared relatively normal, the apical region told a different story. There was extensive hypercementosis around the root region, indicating chronic inflammation and infection. In younger horses, especially, the tooth can become highly reactive, laying down large amounts of cementum in response to infection. This reactive thickening can make extraction significantly more difficult because the apical portion becomes wider than the oral aspect of the tooth.
Next came several incisors affected by EOTRH (Equine Odontoclastic Tooth Resorption and Hypercementosis). Some showed dramatic hypercementosis, while others displayed combined resorptive lesions and abnormal cementum production. In many cases of EOTRH, horses experience chronic pain long before the disease becomes obvious externally. Occasionally, abscess formation develops alongside the resorptive process, further complicating the disease.
One particularly interesting tooth demonstrated a patent infundibulum. Looking at the apical aspect, the infundibulum remained open abnormally deep within the tooth, allowing contamination and infection to track into the apical region. Ultimately, this developmental abnormality resulted in a severe periapical abscess requiring extraction. Cases like these emphasize how developmental defects can create long-term pathways for infection.
Other teeth in the collection demonstrated classic endodontic disease. Several had open pulps associated with fractures through the clinical crown. Once pulp exposure occurs, bacteria gain access to the tooth's internal structures, often resulting in apical infection and abscessation. In horses, these fractures can sometimes appear relatively small externally while causing extensive disease internally.
One tooth showed a severe infundibular fracture extending deeply into the tooth structure — a grade 5 infundibular fracture. These fractures can destabilize the tooth and create direct pathways for bacterial invasion into the deeper structures, leading to chronic apical infection and significant surrounding bone reaction.
As we moved through the collection, the same theme continued appearing over and over again: every tooth had its own unique pathology, its own progression of disease, and its own explanation for the horse’s clinical signs. That is one of the reasons equine dentistry is so rewarding. Dentistry is not simply floating teeth. It is diagnostics, anatomy, pathology, imaging, biomechanics, and problem-solving all combined together. Every case becomes a puzzle where the clinician pieces together clinical signs, oral examination findings, imaging, and pathology to understand what the horse has been experiencing.
Sometimes the most valuable lessons come not from textbooks, but from simply holding an extracted tooth in your hand and asking one question:
“What happened here?”
Because every tooth tells a story.
Want to Learn More?
If you're a veterinary professional interested in expanding your knowledge in equine dentistry, we offer training courses on equilibration, diagnosis, endoscopic assessment, and more. You can always contact us at mooredvmeducation@gmail.com or call the office at 512-508-8141.
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