124
EQUINE VETERINARY EDUCATION / AE / MARCH 2016
no soft tissue lacerations were present. Further inspection revealed that all cheek teeth were wider than usual and that the increased width of the tooth was due to an increase in the peripheral cementum (Fig 1). No significant abnormalities were noticed on the incisors although mild calculus accumulation was present on several teeth. Each cheek tooth was visualised independently using
oroscopy as well as an intraoral mirror and a well defined layered pattern of hypercementosis with focal regions of pitting was visualised on the buccal aspect of the mandibular CT and palatal margin of the maxillary CT (Fig 2). All cheek teeth were also found to be unusually mobile with the maxillary 06s being the most affected and having a range of mobility estimated to be 2 mm using very light pressure with Hewson forceps. No significant periodontal disease or gingivitis was noted. Lateral and oblique extraoral radiographs of all CT
quadrants revealed blunting of the roots, loss or disruption of the lamina dura, bulbous enlargement and an irregular appearance of the roots on all cheek teeth (Fig 3), consistent with previous reports of EOTRH in incisors (Staszyk et al. 2008). Intraoral radiographs of the incisors showed mild resorptive lesions on all incisors with the 03 maxillary incisors being the most affected (Fig 4).
a)
Based on the findings of the oral examination and
radiographs, a diagnosis of EOTRH was made. The incisors were classified as being mildly affected while the CT were moderately affected. Minor odontoplasty was performed and care taken to
ensure that the pressure and forces of mastication were distributed as evenly as possible on all CT. A complete blood count and serum chemistry analysis were performed and all parameters were within normal limits. The horse was placed on a nutraceutical that has shown some promise in potentially ameliorating some of the changes associated with EOTRH (Simhofer and Kowelka 2012). The owner reported an almost immediate improvement in the horse’s head-shyness and appetite. Approximately 10 months post initial presentation, the
owner began noticing a slight head tilt while the horse was eating. A follow-up examination was performed and revealed a fractured 309. Radiographs were taken to assess any progression of the disease. No significant differences were noted on any teeth except for a mild increase in the resorptive lesion on the root of the 303 incisor. The fractured 309 CT was extracted orally under
endoscopic guidance with the horse sedated and standing. No complications were encountered during the extraction
b)
Fig 1: Intraoral photographs, Case 1, (a) Excessive cementum deposits on the palatal margins of maxillary cheek teeth and (b) on the buccal aspects of the mandibular cheek teeth.
a) b)
Fig 2: Intraoral photographs, Case 1, (a) and (b) Well-defined layered hypercementosis with focal regions of pitting on the buccal margins of the mandibular cheek teeth.
© 2015 EVJ Ltd
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88
