Periodontal disease

Oliver Liyou BVSc (Hons1) MACVSc

Periodontal disease can be divided into gingivitis and periodontitis. Gingivitis is the
reversible inflammation of the gingiva whereas periodontitis is often irreversible and
involves inflammation of all of the supporting structures of the teeth (gingiva,
periodontal ligament and alveolar bone).

In young horses between 2 and 5 years of age, as they are shedding their deciduous
teeth and the permanents are erupting, a physiological periodontitis is occurring -
associated with eruption of the permanent teeth. This will normally resolve once
eruption is completed.

Gingivitis is a precursor of periodontitis.

Sharp enamel points and ETRs are the most common predisposing factors for
gingivitis in the horse. Once sharp points are present, pain results in reduced lateral
excursions. The mastication of larger fibrous food particles will be reduced and
these larger particles will produce trauma to the gingivae. Also the feed material is
not moving through the mouth in the usual manner and pathway, and so feed
particles tend to become trapped in places, and in time fermentation begins.

When an ETR is present opposite the interproximal space on the opposing arcade,
mastication forces those teeth in the opposing arcade apart and forces food particles
in to the space. Continuation of this combined with fermentation of the food results
in periodontal diasease and diastemata formation.

Gastrophilus sp (Bot Fly) larvae are also a cause of mild gingivitis in the horse. The
palatal interproximal gingiva is affected, and the larvae cause pockets up to 5-10 mm
deep.

With gingivitis, the marginal gingiva becomes inflamed and oedematous. This allows
bacteria and food particles into the sulcus around the tooth and eventually into the
periodontal space. Loss of attachment follows and periodontal pockets begin to
form. Chronic inflammation also leads to loss of the alveolar crestal bone, which
adds to the pocket development. These pockets then fill with food and the condition
deteriorates.

Periodontal disease can lead to endodontic disease with periapical abscessation, but
is less common than anorchorectic spread (via blood stream and lymphatics) in the
younger horse due mainly to the long distance along the reserve crown between
the apex and the periodontium.

Eventually the progression is such that the tooth becomes loose and will eventually
be lost. Once the tooth becomes loose it must be extracted.

A large percentage of horses (>60 %) over 15 years of age have periodontal
disease. In older horses, the resolution of pain from extracting the loose tooth is also
met with the dilemma that part of the masticatory apparatus has been lost, and so
extra supplementary feeding needs to be considered.

Periodontal disease is treated in the early stages by correcting the underlying
condition and cleaning out the pockets followed by appropriate antibiotic therapy in
some cases.
A high pressure water jet spray is usually more useful than dental picks or forceps in
removing trapped feed from pockets and in between teeth. Following the removal of
the trapped feed, application of chlorhexidine is recommended, and will result in up
to 48 hours of antibacterial action.

Home care success depends largely on the dedication and skill of the owner and the
temperament and trainability of the horse. Treatment is best done daily or every
second day for 1-2 weeks, and then every 2-3 days. It consists of having the horses
mouth rinsed well with a hose, and allowing the horse to chew on and play with the
hose. This is best done after eating if the horse is hand fed. Following that, the
sweetened chlorhexidine solution can be squirted into the buccal pouches of each
side of the horses mouth.

In very difficult patients, sedation, application of a speculum and direct treatment
every 2 days for 2-3 weeks may be the most effective solution.

In severe cases, antimicrobial oral powders such as TMPS or doxycycline may be
warranted for 1-3 weeks.

A more recent method has been described and used successfully in some cases
where there is feed trapping in between cheek teeth, and the food is fermented and
rotten leading to gingivitis.

This is called diastema widening or burring. Case selection, skill of the operator,
suitable equipment and client communication are very important factors in achieving
success in this technique. Risks include pulp exposure, thermal injury to the tooth,
breaking the diastema burr, and lacerating the adjacent mucosa and gingival.

PREVENTION IS BETTER THAN CURE, AND PREVENTION INVOLVES
REGULAR DENTAL CHECKS AND TREATMENTS THROUGHOUT THE HORSES
LIFE!