Dentistry Part 5: Surgical Procedures

The field of equine dentistry is as broad as the field of human dentistry. While your family dentist receives special training in a wide range of topics on general dental care, the endodontist, orthodontist, periodontist, and oromaxillofacial surgeon receive special training to care for more complex problems involving the dentition and the intricate structures of the head.

The range of equine dental procedures and/or treatments extend from simple tooth floating (equilibration) and minor tooth extraction or superficial oral wound repair, to the detailed surgical repair of extensive oral/facial defects that involve numerous structures in the head.


Proper diagnosis of the dental or oral surgical condition is critical for developing a suitable course of treatment. Many conditions are quite obvious, while others might require extensive work-up to develop a diagnosis.

A presurgical work-up should include a complete physical examination, comprehensive oral/dental examination, possible special imaging techniques such as radiology, endoscopy, nuclear scintigraphy, computed tomography (CT), or magnetic resonance imaging (MRI), and ancillary diagnostic techniques such as blood work or tissue/fluid samples for bacteriology, cytology, or histopathology. Based on the results of these tests, an accurate diagnosis can usually be made.

A treatment plan should be developed with several things in mind: 1) correcting the diagnosed surgical problem, 2) healing the surgical site, and 3) causing no damage to associated structures.

Choice of Restraint

The choice of restraint for equine dental surgery is a major consideration. Determination should be made whether to use standing restraint or general anesthesia (the horse is maintained in recumbency with injectable or inhalation anesthesia) at the farm or stable, or in a controlled environment such as a clinic or surgical hospital under rigid sterile control. Your veterinarian will consider the procedure to be performed, temperament and general health of the horse, access to the surgical site, available assistance or adequate facilities for general anesthesia, risk of induction (placing the horse in recumbency), maintenance and recovery of the horse from general anesthesia, and the amount of preoperative and postoperative care required.

Horses do need to be properly restrained for surgery. Inadequate restraint can prolong the surgery time, prevent optimum visualization of the surgery site, cause unnecessary fatigue to the surgeon, or can lead to injury of the surgeon, assistant, or patient. General anesthesia is usually recommended when using noisy or bulky equipment, expensive delicate equipment, or when performing technically difficult or prolonged surgical procedures.

Common minor surgeries or diagnostic dental procedures are often performed with physical restraint such as a twitch and stocks along with mild intravenous sedation and analgesics (pain relievers). Wolf tooth extractions, removal of loose or damaged deciduous teeth (baby teeth), and extractions of diseased loose teeth in older horses are examples.

Less common minor dental surgeries or diagnostic procedures requiring sedation/analgesia and, at times, local anesthesia, include repair of oral lacerations or avulsion (involving tearing away) injuries to incisor teeth, repair of bit injuries to the bars of the mouth, removal or biopsy of small oral growths or tumors, and endoscopic examination of the oral cavity, upper respiratory tract, or paranasal sinuses.

Major surgeries performed in the standing position under sedation, analgesia, and regional nerve block or local anesthesia include dental extraction of diseased (but stable) teeth, root fragment removal, sinus exploration, and lavage. Extensive dental surgeries requiring general anesthesia and significant postoperative care include removal of diseased teeth that cannot be extracted from within the oral cavity, repair of jaw fractures, maxillofacial surgery for repair of congenital or developmental defects (such as cleft palate, parrot mouth, or maxillary deviation, which is known as wry nose), extensive sinus surgery, oral or facial soft tissue repair, and excisional biopsy of tumors. These surgeries usually require extensive work-up preoperatively, a high level of dental surgical expertise, and detailed postoperative attention, often for an extended period of time.

Dental Extractions

Many routine surgical procedures involving the equine mouth can be performed on the farm with the horse sedated. Most equine practitioners are well-trained in surgical principles and are qualified to perform basic surgical procedures. However, surgical interventions to correct or repair the equine masticatory apparatus can be quite varied and complicated, sometimes requiring the services of a more specifically qualified veterinarian.

The most frequently performed major dental surgery involves extraction of a diseased or supernumerary (extra) cheek tooth. Because of the complex and continually changing nature of the pulp chambers and constant eruption and wear of the teeth, root canal therapy has had limited short-term success in the horse. Careful clinical examination and diagnostic imaging should be performed to ensure that "the tooth, the whole tooth, and nothing but the tooth" is removed at the time of surgery.

Some teeth can be extracted orally (through the mouth), but others require removal via a more extensive surgical approach utilizing a bone flap above the tooth and either sectioning the tooth for removal, or repelling (punching) it into the oral cavity. Sinus surgery or surgery to the bones of the jaw might be necessary to resolve infection of associated structures. The increased chances of contamination from the mouth, the rich blood supply to the head, and the complexity of the regional anatomy means a higher frequency of complications than normally associated with other equine surgeries.

In the case of dental extractions, the tooth socket must be cleaned, and all tooth fragments and diseased bone and tissue removed. The paranasal sinuses, if involved, must be irrigated and thoroughly inspected, and the practitioner should remove any dead tissue or pus. The dental socket must then be plugged to prevent food contamination while healing takes place over the ensuing four to six weeks.


Complications associated with anesthesia, surgery, and hospitalization occur, but they can be minimized with careful recognition, diagnosis and formulation of a surgical treatment plan. Facial deformities, bony sequestra (pieces of dead bone), paranasal sinusitis, salivary-cutaneous fistulas (damage to the salivary gland or ducts can create an abnormal communication from a salivary gland to the skin surface, causing saliva to drain onto the face), fistulas into the nasal passages or sinuses, nasal septal deviations, ocular dysfunction, and/or facial nerve paralysis can necessitate further surgery. Corrective procedures can be more costly, time-consuming, and difficult than the initial dental surgery.

A Team Approach

Surgical techniques have become extremely sophisticated over the past 20 years, and more surgical specialists are being trained. Many invasive techniques require specialty training and expertise. Such trained surgeons should work with your local equine veterinarian to devise a treatment plan and surgical approach to the dental problem. Many of the more complex and invasive surgeries involving dental and oral structures require a team approach for the most optimal outcome.

The equine dental practitioner, at times, might find it necessary to work with a team of surgeons, technical veterinary nursing staff, an anesthesiology support team, and internal medicine assistants in the preoperative and postoperative periods. Additionally, a pathologist might be needed to guide the collection and interpretation of tissues and other samples during surgery in order to develop a plan for the proper diagnosis and treatment of the condition.

Diagnostic imaging, specifically radiology, is critical in some cases--both preoperatively to help plan the surgical procedure, interoperatively (during surgery) to help guide the surgery team, and postoperatively (after surgery) to monitor healing and detect complications.

The treatment team might also solicit the help of molecular biologists or geneticists to help elucidate the cause of a possible tumor, or a congenital, developmental, oral, or dental condition. Such information might help the practitioner devise a better treatment and/or surgical plan or help him counsel the owner regarding future breeding considerations of the affected animal. This information can also help prevent future cases of this condition if it turns out the cause is of a toxic or teratogenic nature (caused by nutritional or environmental factors, in-utero stress, or medications received by the mare during pregnancy). In certain suspect cases of oral or dental tumors (cancer), a veterinary oncologist might be added to the team to advise therapy and prognosis.

It is best to let your local veterinarian evaluate the case. In many cases today, if your attending veterinarian sees the need for dental and/or surgical consultation, this can be done electronically. E-mailing case histories, examination findings, photographs of the horse, and radiographic images to specialists anywhere in the world can be accomplished with the touch of a button. These specialists can offer their knowledge, expertise, and recommendations, and this often leads to the most straightforward approach to the horse's treatment and, thereby, decreases unneeded, unnecessary surgery and complications.

Take-Home Message

A licensed veterinarian is the most qualified professional to provide dental care for your horses, whether it is routine examinations and floating, or detailed, complex surgical procedures. Veterinarians are the only individuals who have the educational training and knowledge of anatomy, physiology, pathology, and pharmacology to properly diagnosis and treat these conditions, as well as the surgical experience to perform procedures. A good veterinarian will have no problem referring dental problems beyond his expertise to a more qualified veterinarian. Good communication between you and your veterinarian will lead to excellent dental care of your valued equine companions.

About the Author

Jack Easley, DVM, MS, Dipl. ABVP

Jack Easley, DVM, MS, Dipl. ABVP (Equine), is a private equine practitioner serving the Central Kentucky area. While his practice provides all equine services, his passion of 35 years has been equine dentistry. He lectures and teaches worldwide, contributes to lay horse magazines and journals, and is the co-author of the three editions of the textbook Equine Dentistry.

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