Abstract
Background: Limited objective information is available on the prevalence of non-traumatic equine cheek teeth fractures, the signalment of affected horses, and the clinical features and treatment of these fractures.Objectives: This study aims to document patterns of idiopathic and infundibular caries-related cheek teeth fractures in a referral population and evaluate associations between fracture patterns and horse age, Triadan position of affected teeth, clinical signs, and deemed necessity for treatment.Study Design: A retrospective case review.Methods: The clinical records at Edinburgh University Veterinary School (2010–2018) were examined for the presence of non-traumatic equine cheek teeth fractures. Variations in the frequencies of different fracture patterns were compared between horse ages, Triadan tooth positions, clinical signs, and deemed necessity for treatment.Results: Records of 300 horses with 486 non-traumatic cheek teeth fractures including 77% maxillary and 23% mandibular teeth with a mean of 1.6 (range 1–10) fractured teeth/horse were available. Fracture patterns included maxillary first and second pulp horn (“slab”) cheek teeth fractures (n = 171), caries-related infundibular fractures (n = 88), other maxillary teeth fracture patterns (n = 92), mandibular first and second pulp horn (“slab”) fractures (n = 44), other mandibular fracture patterns (n = 62), and complete clinical crown loss (n = 29; including 23 maxillary and 6 mandibular teeth). The median age of affected horses ranged from 11 years with maxillary “slab” fractures to 15 years with infundibular caries-related fractures. Triadan 08–10s were the most commonly (86%) fractured maxillary teeth. The Triadan 08 and 09 positions were the most commonly (64%) fractured mandibular teeth. No clinical signs were noted in horses with 48% of the fractured teeth; oral pain/quidding was recorded with 26%, clinical apical infection with 23%, and bitting/headshaking problems with 6%. Treatments included extraction of 40% fractured teeth, extraction of small/loose fragments (10%), and odontoplasty. Stable remnants of 60% of fractured teeth were left in horses without clinical signs.Main Limitations: Long-term follow-up information was not available for all cases.Conclusions: There is increasing recognition of equine non-traumatic cheek teeth fractures, with about half not causing clinical signs. Teeth with apical infection, multiple fractures, or advanced caries require extraction. Other fractured teeth with subclinical endodontic disease may not need exodontia unless they later cause clinical signs.
Highlights
Most equine cheek teeth fractures occur in the absence of known evidence of trauma and have been termed idiopathic cheek teeth fractures [1]
In horses with more than one fractured cheek tooth, the more generalized clinical signs such as quidding or headshaking were assigned to every fractured tooth present at that examination if there was no clear evidence to assign the clinical signs to one tooth, such as an acute onset oral pain/quidding caused by a recent maxillary cheek tooth “slab fracture.”
A single fractured tooth was present in 206 horses: two in 59 horses, three in 16 horses, four in 10 horses, five in 5 horses, six in 3 horses, seven in 3 horses, and 10 fractured teeth in 1 horse
Summary
Most equine cheek teeth fractures occur in the absence of known evidence of trauma and have been termed idiopathic cheek teeth fractures [1]. These fractures most commonly affect the maxillary cheek teeth, especially the Triadan 09 position [1,2,3,4], and a pathological study showed 25% of these teeth to have had chronic endodontic disease prior to fracturing [2]. The fracture planes in the remaining non-traumatic (idiopathic) cheek teeth fractures always run through one or more pulp horns causing direct pulpar exposure (i.e., are complicated dental fractures) in a variety of patterns [2]. Limited objective information is available on the prevalence of non-traumatic equine cheek teeth fractures, the signalment of affected horses, and the clinical features and treatment of these fractures
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