IN-DEPTH: PREVENTATIVE MEDICINE: BEING PROACTIVE IN PRACTICE


rest with their jaws closed tightly together, but if the incisors are purposely held apart or the tongue is held between the incisors, further investigation for EOTRHmay bewarranted.


 Physical exam The clinician’s steps for a routine physical examina-


tion should be followed, with particular attention paid to the horse’s fitness for sedation for a full dental ex- amination. This mainly involves examining the cardi- ovascular system along with the musculoskeletal and nervous systems. The body condition score should be noted, along with any signs of concurrent disease (such as PPID, sinus disease, or other respiratory ailments).


 Sedation Most dental practitioners choose to use a combina-


tion of an alpha-2-agonist and an opioid when per- forming routine dental examination and treatment, most commonly detomidine + butorphanol in practice. A combination of xylazine + butorphanol should be re- served for patients with regular dental records and no previous knowledge of pathology, or patientswith con- cerns surrounding duration of sedation. The amount of sedative administered should be titrated for the patient’s size and temperament, keeping in mind the main goals of sedationwhen performing dentistry:


 Patient compliance  Stationary head  Tongue relaxation  Cessation of chewing


The sedation should be administered intravenously,


and the practitioner should only begin their dental ex- amination when the horse is minimally responsive to external stimulation.


and via palpation. The structures and confirmation of the head should be symmetrical,with note of any focal swellings, condition of the masseter muscles, and any deviation of the nose (wry nose). Even very mild wry nose can be implicated in some cheek teeth malocclu- sions. The submandibular and parotid lymph nodes should be palpated, alongwith the ramii of themandi- ble and temporomandibular joints (TMJs). The TMJs are overimplicated in many occurrences of oral cavity discomfort in the horse, so any suspect pathology should be thoroughly investigated before determining this area to be the cause of any problem, and other more common dental abnormalities should be ruled out. The mandible can also be manipulated at this time to ensure sufficient lateral excursion is present. This will vary by individual, but the mandible should move freely and relatively symmetrically from side to


 External examination of the head This examination should be performed both visually


side, and a slight rostral-caudal movement should also be possible.


 Incisor and canine exam An examination of the incisors should always occur


before placing the full-mouth speculum to ensure they are stable enough to allowfor a safe examination of the caudal oral cavity. The number of incisors should be counted, along with noting any malocclusions and the presence of permanent or deciduous teeth. Findings that may affect the ability to safely place the full- mouth speculum may include missing or fractured inci- sors, signs ofEOTRH, and signs of stereotypic behavior such as cribbing leading to excessive wear. In many of these cases, using dental impression material or soft fabric/cotton to pad the bite plates of the full-mouth speculumwill allow for examination of the cheek teeth. Commonly, calculus deposition may be present on the canines, which can typically be addressed by physical removal of the calculus using forceps to prevent associ- ated gingivitis. In general, reduction of the incisors is performed on a limited basis, specifically when a malocclusion (such as “parrot mouth”)or fractured teeth/uneven wear prevents smooth lateral excursion of the jaw.


 Placement of the full-mouth speculum Care should be taken when both placing and utiliz-


ing a speculum as these are large and heavy pieces of equipment and can cause accidental injury to those restraining the horse. The poll strap should be posi- tioned, and the bite plates slid gently between the inci- sors, and the poll strap should then be tightened. The poll strapmay need to be retightened during the exam and treatment. The speculum should then be opened gradually to the extent the practitioner is able to reach the last cheek teeth (Triadan 11). If the exam is pro- longed, the speculum should be occasionally closed to allow the mouth to relax during the procedure. The mouth should then be lavaged with dilute chlorhexi- dine in warm water to remove any feedmaterial.


 Examination of the cheek teeth The cheek teeth should be examined both manually


and visually (Fig. 2). Manual exam can help to deter- mine where there may be sharp areas on the cheek teeth that can lead to soft tissue trauma, including sharp enamel points and overgrowths. The practitioner may alsobe abletofeel any largediastemata, fractures, or feed impaction. A headlamp and mirror should then be used to visually followthemanual examination, look- ing for any soft tissue trauma, including any bit trauma, and counting the teeth, as supernumerary cheek teeth often are accidentally overlooked when they lay just caudal to the Triadan 11 tooth. The mirror or oroscope should be used to examine the occlusal surface for any pulpar exposure, infudibular caries, or small fractures. The mirror should also be used to examine the entirety


AAEP PROCEEDINGS / Vol. 68 / 2022 417


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