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Tooth extraction. Which procedure would you choose?

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  • Tooth extraction. Which procedure would you choose?

    My 18 year old Clyde cross mare has a bad tooth abscess.

    She started with a watery orange discharge from one nostril. Within two days, the smell was horrible and the discharge thick and yellow. She was started on penicillin that night, vet came the next day and added another broader spectrum antibiotic. The next day, the vet came back to scope and check teeth under sedation (did not take, a twitch worked). Guttural pouches were clear, teeth looked normal. Vet suspected root tooth abscess then, but could only confirm with digital xray which meant we had to wait until another vet from another clinic could come with the equipment.

    A week later, digital xrays clearly showed abscess at the root of the first left upper molar. The discharge and the smell were gone by then since the antibiotics worked quickly. She is still on the broad spectrum antibiotic and will be until we can extract. She has never shown distress, stress, never had a fever, kept eating, drinking and all functions were normal. She refused carrots one day (red flag!).

    My vet presented me with two options. I am pretty confident I know which one I will choose, but would appreciate some advice. This is the first time in 10 years that we have a medical issue with this mare.

    The extraction has to be done off site (mare is a big draft cross, no stocks at the barn, etc.) Two clinics were contacted and both want the mare the day before and maybe one or two days after surgery. The mare usually walks easily on the trailer, but is a very nervous traveler. For this reason, my BO will ship her mare with ours (pasture mates for 7 years!) and will trailer himself. Gotta love them (they have been doing all meds for me).

    Clinic 1 - The closest - 60 km - May "try" to do the extraction as a standing procedure. Suggested drilling the sinus cavity and pulling the tooth through. Will drill to drain the sinus as well. Has an excellent reputation locally (colic surgery, bones, etc. I do not know from their website that they have an equine dentist on site). High quote.

    Clinic 2 - Further - 120 km - Will do extraction standing (like all extractions they do) and orally. Will possibly drill the sinus for a drain. Has two equine dentists on site. Quote was broader but lower. Also a great reputation.

    Basically, my question is? GA or standing? Nervous traveler going further rather than closer?

    Any experience/advice would be appreciated. Sorry for the novel.

  • #2
    I highly recommed standing. I bought and ottb that was 4 yrs old that had a tooth abscess between first and second upper molars, left side.

    I knew nothing about teeth at the time. First surgery at State school vet clinic with external hole punched in sinus and pounded out tooth. Vets left fragements in tooth cavity which ultimately abscessed again a couple years later.

    Second surgery, different vet tried to create bone flap over cavity. Ultimately failed but horse was left with a permanent fistula between tooth cavity and lower sinus.

    I flushed this whenever smelly for many years. Horse didn't get sinusitis until he was 12yrs old, then again at 17yrs old. He's happy and healthy at 18 and never stopped eating.

    With your horse standing, they can withdraw the tooth, then flush and xray the cavity to ensure no fragements are left. At your horse's age, the tooth probably doesn't go into the sinus anymore.

    My horse 'George' was an awesome 3'6" jumper and is now a dressage packer for a friend who brings him fresh carrots from the farmers market.
    www.TackMeUp.com
    'What's in your trunk?'
    Free tools for Trainers and Riders

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    • #3
      Absolutely standing
      And I saw heaven opened, and behold a white horse; and he that sat upon him was called Faithful and True, and in righteousness he doth judge and make war. Revelation 19:11

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      • #4
        OK. My experience was big draft mare, 19.1 hands but thin -only weighed 1920 pounds due to young age and tooth abscess, which she had when I bought her. UGA did the sx standing. Dr Lauder did it- very well known, respected dentist DVM.

        His plan of action. Rock the tooth until it came loose (it took two hours of rocking and then he pulled). He gave a max time of rocking as 3 hours. If it hadn't come loose, he would have gone from the top but his opinion is it is ALWAYS better to rock the tooth and pull rather than drill from the top. If he had to cut a skin flap and drill, he would have probably had to do general. Luckily, he managed to pull the tooth and not drill from the top.

        But the option of being able to do general, in case things go wrong is a nice option. We didn't have to use it but if they hadn't been able to pull the tooth in a timely fashion or if the tooth broke and they wanted to drill, they would have done it right then and there -it would have sucked to have to redo the procedure under general, at a different time and at a different location!

        Cost: $1200. +/-
        Luistano Stallion standing for 2013: Wolverine UVF
        http://www.youtube.com/watch?v=8IZPHDzgX3s

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        • #5
          I've had a recent consultation with an equine specialty dentist who says he is one of only about five in the US, maybe the world.

          He does not at all believe in punching the tooth out from beneath. He thinks that the most useful procedure is to pull the tooth. I asked about pre-extraction antibiotics, and he said no. Said that the horse should be in a vet hospital post extraction for five days and get the antibiotics then.

          If an infected tooth is pulled and the sinus becomes infected, you are talking about a long, slow and expensive recovery. Upper teeth are far more likely to have that problem.

          He gave me an estimate for the whole procedure of $2500. And with teeth, there is always the possibility that the jaw might crack--also causing much greater expense depending on the severity of the crack and whether metal needs to be installed.
          "I'm a lumberjack, and I'm okay."
          Thread killer Extraordinaire

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          • Original Poster

            #6
            Thanks for the replies. I need to ask more questions ...
            We are leaning towards the standing procedure, but until now I have only talked to my vet. I want to talk with the clinic as well and ask more questions (explain the procedure to me, what if the tooth breaks....). Two hours of rocking??? wow... I am getting more nervous and stressed (the trailering was stressing me more than the surgery... ). Our girl is 16.1 hands and 1400-1500 lbs (pasture fat).
            Quote: Clinic 1 ($2500) Clinic 2 - $1200 - $2200.
            Compared to some friends who have had surgeries at clinic 1 (colic/hernia AND gelding + 5 days care = $2200... it seems very high).
            I am waiting for a call back from my vet.

            Viney - Thanks for the scary thought!! I really do not like the idea of punching the tooth through... She has been on antibiotics to control the infection (and the terrible smell). Not so much to prepare her for the surgery. Hopefully, this is the worst case scenario (but it does freak me out).

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            • #7
              Poor mare.

              Hope whatever you decide goes well.

              I guess I would go with closer if I all else seemed equal. Make sure both quotes are all inclusive (board, taxes, feed, after care medication). Not all clinics quote the same, and one may seem lower because it has left stuff out, or because it is quoting based on being optomistic.
              Freeing worms from cans everywhere!

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              • #8
                Take her to the best facility that has handled the most of these with good outcomes and can give you the best odds of avoiding general anesthesia. A short trailer ride is probably not going to be that much less stressful than a longer one, and you could always give her a little something for the trip to help her relax.
                Click here before you buy.

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                • #9
                  The dental guru that I talked to gave me an interesting bit of history on equine extractions. He said that to his knowledge the first reference to punching the tooth out from the root came in a Victorian vet reference, and it was said to be "the last resort". Then over time, somehow, it became the standard extraction method. That is changing. But, in his opinion, it should always be the last resort. It has too many potential complications, and most pulling is pretty straightforward and causes much less trauma to the the surrounding area and less chance of infection because the procedure is so much simpler-- in most cases.
                  "I'm a lumberjack, and I'm okay."
                  Thread killer Extraordinaire

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                  • #10
                    Originally posted by deltawave View Post
                    Take her to the best facility that has handled the most of these with good outcomes and can give you the best odds of avoiding general anesthesia. A short trailer ride is probably not going to be that much less stressful than a longer one, and you could always give her a little something for the trip to help her relax.
                    YEP!!!

                    I wouldn't go to a any old clinic, but to a University hospital with a dental specialist.

                    The reason to rock and for the DVM to take their time about it is that they don't want to break the tooth -instead they break the bonds that hold the tooth down rather than just yanking.
                    Under standing anesthesia with a monitor, they are not stressed, not feeling any pain!

                    Dr. Lowder (my dentist) has written a number of papers on the subject. Here is one that is a teaching tool:
                    http://docs.google.com/viewer?a=v&q=...s_jL8gc2hmswuQ
                    This is worth reading. Page two and three describe the loosening procedure in detail.

                    Note: most horses the rocking takes 45-60 minutes but with drafts there are more ligaments, bonds, etc holding the tooth in place -just cause they are so much bigger boned and that is why it can take much longer.

                    Dr. Lowder was so impressed by the size of my mare's tooth that he kept it so that he can show it off when he teaches about dentistry at UGA and when he lectures at other institutions. In the case of my mare, she had bony growth about the size of a tennis ball on her face from the tooth infection. Her whole head was malformed. This all went away within a year after removal, which was kind of amazing.

                    Do not worry too much about the stress of travel. Be much more concerned about getting the best of the best to do the job!
                    Luistano Stallion standing for 2013: Wolverine UVF
                    http://www.youtube.com/watch?v=8IZPHDzgX3s

                    Comment


                    • #11
                      I think whether you rock the tooth or punch the tooth out will be dependent on how old your horse is.......my horse was 5 when she got a sinus infection........she was scoped and xrayed and found nothing wrong.......so it was concluded her sinus infection was primary......but when the vet looked her upper molars on the xray he was so glad no extraction was needed as the tooth was incredibly long and would in his opinion needed to be punched out from above....and even then it would have been difficult.....rocking the tooth was never an option.

                      Dalemma

                      PS......good luck with your horse and let us know how it goes.

                      Comment

                      • Original Poster

                        #12
                        I talked to my vet and asked her to send the cd to clinic no. 2. Then we will have a better picture of what is required and how they will proceed. So, I may hear from them tomorrow. Keeping my fingers crossed that her own assessment is correct. She said she felt it would be rather straightforward, but of course is not an equine dentist and she is a young vet as well. I do trust her and the support she has at the clinic.

                        Funny coincidence! My daughter and I went to the local tack shop to find a leather halter for shipping (of course it has to be customized, her head is too big for x-large, too small for draft - typical!) and we met the people we bought her from almost 10 years ago... They were pleased to know we still had her, concerned about the upcoming procedure as in 40 years of horses, they have never had a dental problem with any of the horses they have had!!

                        Thanks for the link cielo. I sent it to my vet as well. I will read it thoroughly tonight. So far, I have just looked at the pictures!! Brr...

                        Comment


                        • #13
                          Bonnie had a vagrant (grew in completely crooked) tooth extracted by the "rocking" method at age 3.5. It did take a while (it was an incisor) but nowhere near an hour. She had standing sedation and did well. It was a healthy tooth and very, very firmly anchored. Just too crooked to keep.
                          Click here before you buy.

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                          • #14
                            had this done on a 18 yr.old ottb i own.10th molar abcessed, was told by one dentist that he would need to go to a clinic and have surgery, not an option at 18 yrs.old.i had dr. banner(teaches at university of florida) come out to the farm, looked at the tooth, and said he could pull it. did the rocking action, took about 30-40 minutes. did it standing in the stall at my farm.stayed on bactrim for 10 days after and has been fine with no side effects at all. total cost.250.00
                            www.camaloufarms.com

                            ride it like you stole it! "ralph hill"

                            Comment


                            • #15
                              Originally posted by vineyridge View Post
                              I've had a recent consultation with an equine specialty dentist who says he is one of only about five in the US, maybe the world.

                              He does not at all believe in punching the tooth out from beneath. He thinks that the most useful procedure is to pull the tooth. I asked about pre-extraction antibiotics, and he said no. Said that the horse should be in a vet hospital post extraction for five days and get the antibiotics then.

                              If an infected tooth is pulled and the sinus becomes infected, you are talking about a long, slow and expensive recovery. Upper teeth are far more likely to have that problem.

                              He gave me an estimate for the whole procedure of $2500. And with teeth, there is always the possibility that the jaw might crack--also causing much greater expense depending on the severity of the crack and whether metal needs to be installed.


                              Exactly. I cannot believe that vets/dentist actually punch the tooth out through the top (or bottom depending) instead of elevating (rocking as you guys are saying) and removing with a forcep. I know that horse teeth are much bigger and larger but that just means it takes more time. My boarders horse had a slab fractured upper right molar that needed to be extracted. Mobile dentist has stocks in his custom clinic trailer and it took 4.5 hrs to get it all out, but it was out, and there was no open wound on the face, no damage to the sinus cavity, and healed extremely quickly.

                              No way I would ever let someone punch a tooth out on my horse. Of course I also work in the human dental field so maybe Im just too picky?
                              ~~~~~~~~~

                              Member of the ILMD[FN]HP Clique, The Florida Clique, OMGiH I loff my mares, and the Bareback Riders clique!

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                              • #16
                                Originally posted by FalseImpression View Post
                                Thanks for the replies. I need to ask more questions ...
                                We are leaning towards the standing procedure, but until now I have only talked to my vet. I want to talk with the clinic as well and ask more questions (explain the procedure to me, what if the tooth breaks....). Two hours of rocking??? wow... I am getting more nervous and stressed (the trailering was stressing me more than the surgery.
                                In general terms, there are ligaments that hold the tooth into the socket which connects it to the bone. This allows the teeth to flex/move slightly while eating so they do not break under the force of biting/chewing. In order to get the tooth out, you have to elevate, which basically uses a tool that kind of looks like a flat head screw driver. You place it interproximal, IE in between, the tooth you are taking out and a tooth beside it for leverage. You then rotate the elevator and it starts to move the tooth within the socket, loosening up the ligament. Kind of think about a post in the ground and to get it out you make a circle and keep wiggling it until the hold is bigger around it and the ground is loose around it and you can pull it out. Pulling teeth isnt actually PULLING. Its all about the proper amount of torque placed in the right place and basically lifting the tooth out. I have had some human teeth that take over 1.5 hrs to get out, and that is just a single molar. But it depends on how decayed the tooth is, if the roots are curved, or if the tooth is ankylosis which is where the tooth is basically fused to the bone and the ligament is resorbed.

                                The elevation process is not as "traumatic" as you would think. Its not about jerking and forcing the tooth to move. You do that, and you are snapping root tips off and then you have to go digging.

                                Now I am not sure exactly what equine dentist do if the roots do break off, but more than likely it is similar to humans where you try to loosen the root tip in the socket like you were with the tooth. Sometimes a bur, IE drill, is used to remove some of the bone around it, make the root tips easier to access and remove.
                                ~~~~~~~~~

                                Member of the ILMD[FN]HP Clique, The Florida Clique, OMGiH I loff my mares, and the Bareback Riders clique!

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                                • #17
                                  Extractions vary a lot from horse to horse. My friend had 2 teeth on her 18 year old draft extracted last month. They did it standing at the clinic. It took a total of 4 days working off and on. The total time spent on those two teeth doing the extraction was 14 hours. The total bill was over $5000.00 Hope yours goes better then that one!

                                  Comment


                                  • #18
                                    Oh, also I would much rather have a tooth punched out then extracted orally if it is going to take that long. Usually punching a tooth takes much less time. To me, keeping a horse under standing sedation for hours on end is pretty rough on them. I would never let them do that to my horse. I would much rather have them put mine under GA so he isn't getting such a sore TMJ and mouth. Let alone the pain from the actual extraction if the horse doesn't nerve very well.

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                                    • Original Poster

                                      #19
                                      ok, now I am definitely freaked out!! 4 days??? I know, I know, I should not stress out until the surgeon has seen the xrays, etc. but ... wow. My daughter gets angry at me for reading these horror stories, but I want to know what to expect... 4 days!!! I agree, if it takes that long, drill the darn hole. My poor mare.... I will certainly ask questions to the surgeon.
                                      When do the vets feel it is ok to extract at a barn? A front tooth? a small pony?

                                      Maxxtrot: Why was he not a candidate at 18? cost? other issues?

                                      KrazyTBmare: Thanks for the explanation. It makes sense and I hope everything is that simple for us!

                                      Comment


                                      • #20
                                        Of course there are always horror stories but you hear more about the bad stories than the good ones. Think about how many plane crashes you hear about. But they dont tell you how many thousands of planes landed safely that day. So dont stress out!

                                        When my 3 y/o had his partially erupted wolf teeth & a retain cap taken out, they did it standing while floating him at my house. Way easier on primary teeth though as the roots are just so much shorter.
                                        ~~~~~~~~~

                                        Member of the ILMD[FN]HP Clique, The Florida Clique, OMGiH I loff my mares, and the Bareback Riders clique!

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