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Tooth Abscess - Update, pg. 2

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  • Tooth Abscess - Update, pg. 2

    I am dealing with a tooth abscess in my horse for the first time and was wondering if anyone else would like to share their experience. It would be a great help as I try to make some decisions. There has been some discussion with the vet involving 'to pull' or 'not to pull' the affected tooth. She would like us to try and save the tooth, but has warned it may not be possible.

    Here's the situation. I have a 16 yr old gelding who's has been largely free of any physical ailments for the 13 years I've owned him. He is and has been field boarded most of his life. The affected tooth is an upper molar (can't remember which one, but 'in the middle' of his upper set of molars). He had virtually no signs of this abscess prior to the unilateral smelly nasal discharge that started this past weekend. It was distinctive discharge, but not copious amounts. We took his temperature immediately and it was normal. His attitude was normal, eating was normal, normal in all other ways. I'd been riding him several times a week (trail and ring), just took a lesson last Tuesday...all normal...no resistance, no head tossing, nothing unusual.

    So, the vet does a thorough exam and once his mouth is open with the speculum it is relatively obvious which tooth/gum is affected. However, the tooth is not cracked or loose and she poked and prodded and yanked on it and he did not react at all (no drugs used for the oral exam).

    The plan now is antibiotics and a trip to get a standing Xray and decide to pull the tooth or not...again, she said the likelihood that antibiotics alone would solve the problem are slim and the tooth will likely need to be pulled either sooner or later.

    What experience do you have with this? Please share.
    Last edited by cb06; Nov. 11, 2008, 02:15 PM. Reason: Updating
    "A good horse is worth more than riches."
    - Spanish Proverb

  • #2
    I have a 21 year old horse with the same problem. Two upper molars are infected. I have researched this to death, X-rayed, gotten multiple opinions froms vets and dentists who are realistic and have a lot of experience. According to my vet, dentists will say they will pull them out (they usually actually have to go in throught the side of their face and chisel them out), and then either won't try, or break the tooth off at the gum line, or can't get it all out. Then you have a bigger mess. My horse has been living on 25 SMZ's twice a day for quite some time now. I have also had her "trephined", where they drill hole into her sinus and flush it. Then you flush the hole twice a day for about a week. This seems barbaric (and it is pretty mideival-like), but actually the horse let us flush it with no TQ or anything - she really didn't mind. The trephining did calm it down for a while. Sometimes an antihistamine in addition to the SMZ's helps. Bascially, I decided that the surgery for the tooth removal (and yes, it is surgery) is too risky for her in her physical condition and age. I am choosing the management route to give her quality of life vs. quantity.
    There are injectible antibiotics, but problems with each. For example, Chloramphenical is the best for infiltrating the bone, but causes aplastic anemia for humans who get it on their hands - not an option. The SMZ'z have kept it to a dull roar.
    Perhaps your horse is in better condition than mine and tooth extraction is an option. Do yourself a favor and find someone who had done this successfully a number of times. Don't listen to some new vet just out of vet school. Lots of people say ya, ya, ya and then run away when they see the Xrays. My vet has managed a few horses for a few years using my method. Plus there is the chance that there will be enough decay over time to pull it out more easily later. Gross, I know.
    Good luck whatever you decide. I have heard, however, that even if you remove the cause of the infection that sinus infections are very difficult to get rid of.


    • #3
      My mare has an infected tooth - x-ray showed upper, third pre-molar. She had had a few previous episodes with the yellow snots and a ten day course of SMZ's. She was pregnant, so an anaesthetic to pull the tooth was not possible. Did not have a dental specialist who could pull it without cutting the hole in her face. My vet suggested a long course of metronidozol (that is NOT the spelling, I'm, sure), over a month, but the infection has not returned and her foal is three moths old now. Costs of meds add up though. Hope it lasts.

      Meredith Barlow posts here.
      Proud member of People Who Hate to Kill Wildlife clique


      • #4
        I just went through this...

        my mare just had her abscessed tooth pulled 2 months ago. she was at davis for 3 days, and it was done under standing sedation. Hers came out in 1 piece (roots and all), so they did not have to put her under general to search for pieces.

        She's been on a restricted diet since about 3 weeks after it was pulled because a piece of hay had worked its way into the hole. so she's been on hay pellets (will have been for 60 days by the time it's all said and done).

        all in all, it has been pretty easy ever since we determined the problem was a tooth. she was abscessing out the side of her face, and had no nasal discharge or other normal symptoms, so it took longer to diagnose. we did 2 courses of antibiotics, 3 weeks each, before pulling the tooth. it was too far gone to save, unfortunately.

        i'd be happy to answer any other questions if you have them!


        • #5
          One of our boarders had a horse with an absess. On Thanksgiving morning (they always wait for a holiday!!) I went to feed the horses and I noticed his cheeks were puffed out like a chipmonk. So I put my fingers in his mouth and it was all hay and grain packed in there. So I called the vet and we at first were concerned that he was neurological because of not being able to swollow. So we ruled that out and figured out it was his tooth. So we was hauled into the vet clinic and they went through his lower jaw and removed the tooth. Well that was a mess! He has a hole under his jaw that drained for a long time and boy was it smelly! It has been a year now and since he had it removed I have noticed he has a twitch to his head every once and awhile. Maybe they hit a nerve or something. But he is happy and healty other wise! Now he just has to have his teeth floated every 6 months since he has a hole but where the tooth used to be.


          • Original Poster

            This is very helpful. I am lucky in that I live near the Marion DuPont Eq. Center and have an appointment for the Xray and possible tooth extraction next Tuesday. I am a bit worried about the possible complications afterwards with the missing tooth, but I'm not sure there will be much choice. Plus as some of you mentioned, there can be complications from long term antibiotic use also from what I gather.

            Foxtrot - what is the long term prognosis with your mare from just using antibiotics? Do they think the infection is resolved?
            "A good horse is worth more than riches."
            - Spanish Proverb


            • #7
              Actually, the only long term issue I was told to expect was that she'd need tooth floating 2x a year instead of once due to the fact that her bottom tooth would have no opposing tooth. In time, my mare's teeth should move together to fill in the spot where the top molar was removed.

              As for the antibiotic use, mine was on doxy for 3 weeks and ended up with ulcers and a colic.

              Also, I should mention -- the vets at Davis were able to get my mare's tooth out without going through the side of her jaw. They just used a lot of pressure and were able to pull it out without any cutting. The whole thing took about 2 1/2 hours.


              • #8
                I won't tell the whole (awful) story since this particular abcess involved a horse with badly neglected teeth and a host of associated problems - I doubt your mare is that bad! His abcess was in a lower molar, though, and they removed it by drilling a hole up through his lower jaw and pushing the tooth out, rather than pulling it. Follow-up involved flushing the hole (he didn't mind at all) and a long course of antibiotics. Once the tooth was out, he felt much better - even enjoyed being ridden (lightly) with the ugly hole in his face! Can't imagine how he must have felt with the tooth still IN...


                • #9
                  I wouldn't let them convince you extraction is the only way to go-- punch or just pulled. Take the xrays, and if the tooth is solid (no fractures, no heavy rotten spots yet), it would be better to try to save the tooth first. Surrounding roots/teeth can be damaged by extraction, and you could have a domino reaction!

                  SMZs probably will not cure a tooth abcess, as the bacteria most likely involved will not be responsive to the SMZs. Both times my guy has gone through tooth issues (first time he did have two pulled, a year later the next molar back abcessed after floating, but we saved it with antibiotics) he has been on a course of SMZs and metronidazole, to cover aerobic and anerobic bacteria.

                  Having gone through both kinds of treatment, I hands down recommend trying to save the tooth first before resorting to extraction. If the root is badly damaged though, you probably won't have much choice!


                  • Original Poster

                    Thanks ImJumpin.
                    My gut tells me you are correct. I hope we don't have to pull it.
                    "A good horse is worth more than riches."
                    - Spanish Proverb


                    • #11
                      I have had 2 experiences with this, both rescues who came with neglected dental care.

                      The first was an ancient mini. She started out with one infected tooth. I was told by a dentist that it wasn't a big deal. She was still eating fine, just got a wad of hay/feed stuck in there and I popped it out every day. Fastforward a little, she had some major drainage and I got a vet who also does teeth to look at it, she ended up getting 7 teeth pulled and now has only 5 molars left on one side of her mouth.
                      She eats just fine, amazingly, and her overall health improved dramatically by pulling the teeth. Prolonging removal of the teeth cost the pony more teeth in the long run. Aftercare/recovery was minimal and simple. I regret only that I did not pull the teeth sooner.

                      So when rescue #2 had that telltale wad and smell of dental decay, the teeth got pulled as soon as I could schedule it. He is also eating fine (his teeth...2 of them...were pulled just Friday). Vet did the procedure in his stall, and the horse ate dinner (a mash) same evening.

                      The vet did tell me about complications, and how sometimes they have to go in via a punch (excising tooth through the underside of the jaw or by punching a hole in the jawbone etc.) and the aftercare that can arise from that. Upper extractions IME are easy, they drain well on their own courtesy of gravity and heal rapidly. Lingering infections are ugly, and will get you sinus, respiratory and eye problems as result of proximity.

                      I am not sure why dentists (both equine and human) seem so hell-bent on saving bad teeth. I myself had 3 root canals performed on a tooth in an effort to save it. I finally found a dentist who agreed with me that despite the fact that I was on antibiotics and no cracks or issues were showing up on the x-rays, the tooth stunk, and it hurt like he!!. Pulling it was the best thing I ever did. I know how painful that was to me, and I'd much rather have a horse with a gaping hole than chronic pain and discomfort.

                      Finally, my horses are quite a bit older than yours (the mini's in her late 30s, and the newer rescue is in his early 20s), so this may not apply to your 16yo, but the teeth came out suprisingly easily. Good luck.


                      • #12
                        All I can answer you with is my knowledge is like I'm Jumpin's - my vet is a repo specialist and had a mare a couple of years ago and he did the metronidozol/SMZ course (over a month; could look it up) on her and it had not re-occurred. In my case it was because she was pregnant and could not have the procedure. She tolerated the meds very well, no noticeable reaction, and he told me the metro... did not go through the lining to the foal, who arrived safe and well. But it is a gamble - if it does not work, it is a - say $600.00 - experiment, compared to a $??? operation and all the accompanying nursing.

                        Then there is the decision whether it has to be punched out from the outside of the face, or can be done from inside. There are specialists for this work.

                        Meredith Barlow has an interesting website.

                        I often wonder if she ever has toothache? She does not have foul breath and eats like a, well, like a horse. Last exray showed no signs (for now.)

                        Good luck. This board is wonderful for getting people's experiences.
                        Proud member of People Who Hate to Kill Wildlife clique


                        • Original Poster

                          That website IS interesting Foxtrot...


                          Under 'case studies' there is a video of a tooth extraction....Wow..and ouch! (of course the horse looks pretty sedated)..and it looks like they got the whole tooth out. Great stuff!
                          "A good horse is worth more than riches."
                          - Spanish Proverb


                          • #14
                            Yes, I have very sad, long tale about a tooth abscess in my once-in-a-lifetime horse.

                            Very long story short, he was diagnosed at the age of 22 with an abscessed tooth (upper molar). He had the unilateral, "smelly" nasal discharge and radiographs showed an abscess around the roots. They also showed that the tooth could not be pulled--it was "keystoned" in between the other 2 teeth.

                            In my mind, the infection will never resolve unless you get rid of what is causing it. In this case, the tooth itself was decaying and causing the infection. All the antibiotics in the world were not going to solve this problem for any length of time.

                            So, we choose to have surgery done at a local veterinary clinic. They opened a "bone flap" in the skull above where the tooth was and "punched" the tooth out. Sounds barbaric, but it offered the chance of complete resolution of the issue (for a horse that was competing at the Training/Prelim level of eventing). Or so we thought...

                            Come to find out 4 months down the road (when the horse still had a nasal discharge and discomfort) that part of the tooth had been left behind! Our own vet did an exam and could feel the pieces up in the socket. Post op radiographs had been performed at the clinic, but I don't know if they either didn't see these pieces or didn't think they would be a problem (I had even taken him back a few weeks after surgery because I was concerned that he wasn't doing well. They took radiographs and told me he was fine.). Radiographs our own vet did clearly showed the pieces of tooth left behind.

                            Our vet and horse dentist felt that it might be a good idea to try to pull the pieces out versus doing another surgery. However, this caused massive bleeding (we think the palantine artery may moved due to scar tissue and been nicked by the instruments used in the attempt to pull the pieces out) and another surgery was our only option.

                            We chose to go to New Bolton Center at University of Pennsylvania for the second surgery. I really can't say enough good things about our experience there. The surgeon who did the second surgery was concerned afterwards because he felt like there was "something" they were missing when they went in, even though they completely cleaned up the area.

                            Traveler (the horse) did very well and then started to go downhill again. He kept developing massive sinus infections that would respond to antibiotics for a bit and then redevelop. He finally got that look in his eye that he was tired of fighting. We couldn't put him through another surgery and knew the kindest thing we could do is let him go.

                            We took him back to NBC to be euthanized and donated him to the school so they could use him in a study evaluating MRI protocols for dental cases. What they discovered upon MRI was the missing piece of the puzzle--a piece of left behind tooth that had "woven" itself into the skull. There would never have been a way to retrieve it.

                            Losing Traveler broke my heart. To lose him because of, what I consider, a stupid surgical mistake just makes me angry. What I've taken away from the situation is the following points:

                            --Get rid of the source of infection, ie the tooth, if that is what your vet recommends.
                            --Get the surgery done by the best clinic/university available to you.
                            --Be diligent in follow-up and trust your gut--I never thought I'd lose a horse to a bad tooth.

                            Best wishes.


                            • Original Poster

                              Oh KellyS, I am so sorry for your loss.
                              I think it is safe to say that your story is my greatest fear...that something seemingly 'minor' like this could snowball into something major or life threatening.
                              "A good horse is worth more than riches."
                              - Spanish Proverb


                              • #16
                                Thank you so much cb. I wanted to share my story in the hope that it may make some of your decisions easier. I never realized that a tooth problem could turn out so badly (and be so expensive to treat). I think if the first surgery had removed all the tooth or that we caught that it didn't sooner that the outcome would have been much different. My thoughts are with you.

                                I wrote an article for USEA's magazine, Eventing USA, about Traveler's story (we had been the recipients of a USEA scholarship). I can email it to you if you'd like. I don't have posting priviledges on here.


                                • #17
                                  Kelly, thanks for sharing your experience. It sounds like you and the vets involved did everything they could for Traveler but plain bad luck just wouldn't let it succeed.

                                  I remember a news article last year about a boy who died from an abcessed tooth. I didn't even know that was possible, but apparently earlier in this century it was a common cause of death.

                                  (cb06, I didn't post that to scare you, I promise! Hope all works out well for your horse).


                                  • Original Poster

                                    No worries MO.
                                    It is so helpful to know all the possiblities (good and bad) of what to look for with this seemingly straight forward issue....I don't feel like I am 'flying blind' anymore. As tragic as it is, just knowing Traveler's story means he has not died in vain because I am sure it will help someone else in a similar situation.
                                    "A good horse is worth more than riches."
                                    - Spanish Proverb


                                    • #19
                                      So sorry about Treveller, very sad ending to his story.

                                      cb - keep us posted.
                                      Proud member of People Who Hate to Kill Wildlife clique


                                      • #20
                                        I have been hesitant to post, because my situation was very similar to KellyS.

                                        For several years, my mare had an on and off bi-lateral discharge. Usually, it would occur in the Spring, last about a week and return again in the Fall. A round of antibiotics would resolve it. When Belle was 15 years old, it did not clear up and the discharge became extremely odiferous. My Vet could not resolve it, so I took her to down to The Ohio State University's Vet school. They did an x-ray of her skull, which showed the problem with her tooth. They recommended the flap/punch surgery.

                                        After the surgery, I brought Belle home. Because of the severe swelling where they had made the flap and continued discharge, I had to soak the area with hot packs twice a day. After a week, it did not resolve, so my Vet put Belle on Ambi-pen shots. She showed immediate improvement, so I thought that we were out of the woods. As soon as I stopped the shots, the swelling and discharge returned, worse than ever.

                                        I called Ohio State and made a return trip back down to the Vet School. Instead of being seen by Dr. Robertson, who had done her surgery, Belle was seen by an Intern. He deemed it necessary to put her back on antibiotics. He gave her the first shot. When he finished, I asked him why he did not aspirate? He told me that he was supposed to, but "had forgotten to do it". Belle was loaded into the horse trailer and she started to shiver. What I didn't know, at the time, was that she was having a reaction to the shot.

                                        When I gave Belle her next shot, she went into shock. I managed to get her out of the barn, before she dropped. Within five minutes of her dropping, she died. It was horrible to watch. I felt responsible. Even though I had aspirated and had no blood return, she died.

                                        For over twenty years, I had given horses shots and had never thought a thing about it. I had been taught by a Vet and was always very careful.
                                        I will not ever give another horse a shot. No Vet, even the one who taught me how to give shots, had ever told me to have an epi shot on hand, just in case a horse had a reaction. How many of you, who give your own shots, keep epi on hand?

                                        It took me many years to believe that I was not responsible for Belle's death. The first reaction to a shot happened at Ohio State. I do wish that I had recognized it for what it was. Now, at least, most Vets will prescribe oral antibiotics.

                                        Whatever you choose to do, I will be jingling and praying for a good outcome for your horse.
                                        When in Doubt, let your horse do the Thinking!