01/07/2025
OUCH…
Retained Deciduous Premolars in Young Horses: A Hidden Source of Pain and Postural Disruption
By Lucinda Stockley MRes Equine Performance (BSc (Hons) Equine Dental Science, Equine Smart Bowen Practitioner.
The image below shows a retained 508 deciduous cap (fourth premolar) in a horse over 4 years of age. This tooth should have been exfoliated by around 3.5 years old to allow the underlying permanent premolar 108 to erupt in a correct and symmetrical position. When exfoliation is delayed or incomplete, the result can be chronic discomfort, mechanical interference with tooth eruption, and the development of secondary pathology.
In this case, the horse exhibited significant heat and swelling in the maxillary region, and eruption cysts were both visible and palpable. These findings are more than just “teething” issues — they can have far-reaching consequences for dental development, oral health, and whole-horse biomechanics.
Dental Transition in the Young Horse: What Should Happen
Equine deciduous premolars (specifically 06s, 07s, and 08s) are normally shed between 2.5 and 4 years of age, replaced by the permanent premolars (Easley et al., 2011). The process of exfoliation relies on resorption of the deciduous root and timely eruption of the permanent successor.
However, retained caps can remain in place due to incomplete resorption, abnormal positioning of the permanent tooth, or disruption in occlusal pressures (Weller, 2013). When retained, these caps create abnormal contact points and interfere with the path of eruption of the permanent tooth.
Consequences of Retained Deciduous Teeth
1. Malocclusion and Eruption Disturbances
Retained caps can deflect the erupting permanent tooth, leading to angulation errors or crowding. This may cause premature dental wear patterns and contribute to conditions like shear mouth or wave mouth later in life (Dixon & Dacre, 2005).
2. Eruption Cysts
The presence of erupting teeth, particularly when delayed or deviated, often results in eruption cysts — submucosal swellings overlying erupting premolars or molars. These cysts are part of a normal developmental process, but when aggravated by retained caps, they can become painful, inflamed, and even infected (Sisson & Grossman, 1975).
3. Periodontal Disease
Retained caps often result in feed packing between the deciduous and permanent teeth. This creates an anaerobic environment ideal for the proliferation of periodontal pathogens such as Fusobacterium necrophorum and Porphyromonas gingivalis (Staszyk et al., 2015).
This bacterial load can trigger:
• Gingivitis and gingival recession
• Periodontal pocketing
• Destruction of the periodontal ligament
• Alveolar bone loss
Early onset periodontal disease in young horses is an underdiagnosed but increasingly recognised contributor to poor oral health and discomfort (Dixon & du Toit, 2011).
4. Behavioural and Training Implications
Many horses begin ridden work between the ages of 3 and 5 — during the very time their dental arcades are undergoing significant transitions. Nosebands and bits often apply pressure directly over the maxillary 06–08 region, where eruption cysts or retained caps are commonly found. Horses may exhibit:
• Resentment of bridling or contact
• Headshaking, head tilting, or abnormal chewing
• Unexplained tension or asymmetry in the poll, TMJ, or cervical region
Mandibular Symmetry and the Biomechanical Chain
The mandible is not only a tool for mastication — it is a biomechanical structure that interacts with the temporomandibular joint (TMJ), the hyoid apparatus, and the axial and appendicular skeleton. Disruptions in occlusion or chewing symmetry can cause uneven loading through the jaw, leading to:
• Asymmetric development of the TMJ
• Altered hyoid tension patterns
• Compensatory head and neck postures
• Long-term effects on limb loading, stride symmetry, and spinal alignment
Mechanoreceptors in the periodontal ligament and TMJ provide constant proprioceptive feedback to the central nervous system. Disruption or chronic nociceptive input from periodontal inflammation alters this feedback loop, potentially affecting muscle coordination and postural tone (Haversath et al., 2013; Nickel et al., 2003).
Recommendations for Young Horse Dental Care
To reduce the risk of retained caps and associated pathology:
• Conduct oral exams every 4–6 months between ages 2–5
• Monitor for signs of oral discomfort (e.g., quidding, feed packing, bitting issues)
• Ensure caps are exfoliating in a timely and symmetrical manner
• Address malocclusion early to support balanced chewing and mandibular development
• Educate owners and trainers on the importance of functional dentition before introducing tack and training loads
Conclusion
Retained deciduous teeth in young horses are not a trivial finding. They can create a cascade of effects — from oral pain and periodontal disease to asymmetrical development of the jaw and compensatory biomechanical dysfunction. As equine professionals, we must look beyond the mouth and recognise the influence of dentition on whole-horse health and movement.
Functional teeth support a functional mandible.
A functional mandible supports a balanced body.