Tuesday, July 13, 2010

Drastic Measures?

No, necessary measures.

Two years ago, when we first heard of Fitz, then 25 years old, he was living in Maryland and looking for a place to go. He hadn't had any dental attention for some time and his pictures showed he was a little thin.  TREES arranged for an equine dental technician, accompanied by a veterinarian, to examine Fitz' teeth, thinking that if he had his dental issues addressed he would gain weight more easily and be easier to place in a new home.

Addressing Fitz' dental issues, however, was more easily said than done.    At first glance, it was easy to see one incisor jutting sideways from between his lips.  A few other teeth were loose, periodontal disease was out of control and Fitz whole mouth seemed unstable.  Meredith Barlow, the attending dental technician, called TREES from Fitz' side and asked "just how much dental work does TREES want to cover?"

Uh-oh.  Fitz' immediate needs were to have three teeth extracted: two incisors and one canine.  It was agreed to remove the "sideways" incisor and canine and return for the second incisor and a re-evaluation at a later date.

In the meantime, it was becoming obvious that this would be a very "special needs" horse and not one easily placed in a new home. 

Over the next few weeks, space at the Sanctuary became available and the process to bring Fitz here as a resident began.  Fitz arrived in August 2008.

By November, we were looking at this odd sight:

Fitz' gum was deteriorating, exposing the root of this incisor.  The root itself was covered by what was indentified as a "cementoblast."  Cementum is normal material covering the roots of teeth, but this was cementum gone wild.

At about the same time, we noticed that Fitz was very lethargic, and experienced some respiratory distress with very little physical exertion. 

Off to the vet clinic, where ultrasound found a significant bacterial infection in Fitz' heart.  At the same time, the incisor pictured above was removed, revealing infection in the tooth itself and in the jawbone behind it.   Not uncommon in dogs, cats, and humans, it appeared that the massive infection in Fitz' mouth led to bacteria entering the blood stream and lodging in his heart.

This tooth and one other were extracted, treatment for infection was started, and several other teeth were identifed as abnormal, requiring close monitoring.

Meredith, meanwhile, was finding bits and pieces of information about other horses with dental problems similar to Fitz'.  Then, at an AAEP convention..........PAYDIRT!  We finally had a diagnosis.  Fitz suffered Equine Odontoclastic Tooth Resorption and Hypercementosis.

As study of the syndrome advanced, most researchers agreed the only way to get ahead of the infections and other complications was to remove all of the horse's incisors.  According to all reports, the patients were immediately more comfortable after having affected teeth removed.

But, that seemed drastic!  As time went on, though, it became obvious that might be our only choice to preserve quality of life. 

Fast forward to July 7, 2010:

We could see that the angle of Fitz' incisors were changing drastically.  During our annual Summer Dentathon, xrays showed that none of the incisors were "viable."   None.

Below, the odd angles and exposed roots are easily noticeable.

Even more obvious at this angle.  Notice the small area of root becoming exposed in the area above the little wad of grass, up toward the lip attachment.

In this photo, again notice the tooth exposed the full length of the root.  Areas of decay of the teeth themselves are also easily seen.

Sedation and a little local anesthesia were administered and nine incisors were removed in less than 25 minutes.  That alone is evidence of how unstable and "unattached" these teeth were..

On this tooth, note the cavities at both ends.  Everything in between was decayed.

This tooth was also decayed from one end to the other and broked apart under very little pressure.

This one was completely hollow!

Here - on the left - is an incisor (not from a TREES horse) with a more normal, tapered, appearance.  Note that Fitz' incisor - on the right - is not tapered at all, due to extra cementum layers.  All nine of the incisors removed had the same "fat" appearance.  It is, in part, this extra cementum that pushes the teeth out of their proper positions in the gum and bone.

Fitz is on Day 6 of a 10-day course of antibiotics.  He is already more comfortable.  Naturally, we'll need to make hay available year 'round since he can no longer graze.  Is that in itself a big relief to him?   He is no longer trying to pull grass with extremely unstable teeth. so it may be.

We don't know what to expect next, but we do believe Fitz, now 27, is past the worst of his problems now. 

Big Big Big thanks to Meredith Barlow for researching this very odd issue and to both Meredith and Dr. Tracy Brown for setting our big bay Thoroughbred on the path to better health!

1 comment:

Harriet said...

It just goes to show how important good equine dentistry is, especially at younger and older ages (just like us humans!) I try and care and maintain my horses teeth - even with the occasionaly bit of floating, eventhough I still have annual check-ups each Spring. Poor Fitz though, the pictures seemed quite uncomfortable. I doubt there was much need for some Carbide Cutters considering how hollow and rotten the teeth removed were!