"Dental Care and Management of the Geriatric Patient" was the focus of one lunchtime Table Topic on Dec. 5, with topics ranging from diet selection to systemic illness to sedation. With veterinarians filling all seats and standing against the walls, discussion was lively at times, with practitioners asking questions and discussing their relevant experiences.

"Don’t be too quick to assume that if an old horse is in bad shape, it’s because of his teeth,” said one attendee, noting that several systemic conditions can cause weight loss in the older horse. Another reported success with systemic antibiotics in a thin older horse with mouth sores; the horse had low-grade septicemia (bacterial infection in the blood).

Diet ingredients were discussed with the obvious emphasis on feeds that are easy for a horse with poor teeth. “All old horses have bad teeth,” commented one attendee. All pellets aren’t created equal, said another; some are rock-hard and require hard chewing (many old horses cannot effectively chew these hard pellets), while others break down very quickly in saliva. A third recommended using a complete feed for older horses with trouble keeping on weight. Moderator David Foster, VMD, of New Jersey, recommended that a veterinarian be called to examine any old horse which suddenly begins to lose weight. “Otherwise, a serious medical condition might be missed,” he warned. Another suggested that when evaluating older horses, veterinarians should ask to see a sample of the horse’s feed so they can recommend changes, if necessary.

Another pellet problem discussed was that not all pellets are made to be a complete feed--many have significant levels of readily fermentable carbohydrates. If you feed a horse one of these types of pellets as his sole diet, you run the risk of foundering him, said one veterinarian. Fat added to the diet was mentioned as a good alternative for the horse which needs to gain weight.

Foster discussed flushing a horse’s mouth with a weak chlorhexidine (a disinfectant) solution for horses with severe oral hygiene problems, and noted that doing this once a week for the rest of the horse’s life can help keep his mouth in better shape for many years to come.

Tooth Wear

Most dental problems stem from chronic stress on the tooth,” said moderator Jack Easley, DVM, of Shelbyville, Ky. “I think we need to change the way we think about a lot of dental problems. The abnormal wear often is not the problem--the long tooth is often the healthiest tooth with nothing keeping it from erupting correctly. If we straighten out (shorten) this tooth, we completely ignore what the pathology is (in the other teeth).”

He added that young horses’ dental problems generally stem from poor eruption of teeth, while geriatrics’ dental woes often result from the narrower deep ends of the teeth erupting, resulting in gaps between teeth. “Additionally, all horses eventually run out of reserve tooth,” said Foster. “If a horse lives long enough, he will outlive the useful function of his teeth.”

“Good, regular dental care goes a long way for the geriatric horse,” said one attendee. If there is an unstable tooth, he recommended to take it out, but not to be overly aggressive, because you could loosen a stable tooth that is nearby.

Gum pockets (periodontal disease) around the teeth are relatively common in these geriatric horses. Easley noted that packing these pockets (after cleaning) with antibiotic packing such as Doxi-robe to promote healing of the pockets can be successful, but it’s tough to get the medication to stay in place.

Sedation and Restraint for Dentistry

Several practitioners agreed that it’s best to put the older horse in a corner for dental work, to make sure he’s against a wall for leaning, and that these horses are often more comfortable if you work on them with their heads low. Proper sedation can also help make the procedure quicker and easier on horse and human; discussion of this topic took up a considerable portion of the session.

Several attendees maintained that far fewer horses and people got hurt with more sedation than inadequate sedation, while others expressed reservations about sedating older horses with the same amount of medication they’d use for younger adults. Many of these suggested drawing up a normal dose of sedation, using half of it initially, and using more as needed. Several attendees also said that they give phenylbutazone (Bute) to dull pain before working on horses.

The merits and protocols of several different sedatives were discussed at length, as well as possible reactions. Several practitioners also explained their use of yohimbine to reverse sedation once they are finished with a horse. One noted that when the horse is waking up, he will often eat more boldly and the handler should make sure the horse doesn’t ingest something inappropriate.

One attendee mentioned his practice of putting a rope over a horse’s neck and another over his back for restraint when working in stocks. He said that this helps settle a horse down if he tries to rear, explaining that if he can’t go anywhere, then he’ll quit trying.

Dental Radiography

The final topic was radiographs; Easley strongly recommended them for dental work. “You get surprised a lot by open mouth X rays,” he said. “Skull films help a lot, especially before correction. They also can help you explain to the owner what’s going on with that horse.

About the Author

Christy M. West

Christy West has a BS in Equine Science from the University of Kentucky, and an MS in Agricultural Journalism from the University of Wisconsin-Madison.

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