Cardinal Equine Veterinary Dentistry

02/06/2026

When we float horse's teeth, we are not only looking for sharp points. We are also looking for over-erupted or tall teeth. Horse teeth get too tall because they have lost their partner tooth that they usually wear against. Effective tooth loss can be because of malpositioning of either the tooth or it's partner, age-related tooth loss, or pathology-related tooth loss.

When a horse has an over-erupted or tall tooth, it can interfere with their normal lateral chewing motion because the teeth can't slide past each other the way they normally would. When horses can't chew in a way that is comfortable for them, they get less nutrition out of their hay and feed, are more likely to get f***l water syndrome, and are more likely to quid their hay. It is also harder to maintain their weight, especially in cold weather (like this winter!🥶)

It is our job to reduce overly tall teeth to help the horse chew more efficiently. Unfortunately, there is a limit to how much we can reduce a tall tooth in one session because we have to be cautious that we do not expose the blood vessels and nerves of the tooth. These sensitive tissues typically lie between 2-10mm below the chewing surface of the tooth. As we float, there are are changes to the chewing surface of the tooth that we can see as we get close to the sensitive tissues that tell us we have to stop. If we go too far, it is very painful for the horse and typically results in LESS efficient chewing as the horse tries to chew without contacting that tooth. An exposed nerve or blood vessel typically leads to the death of the tooth which is never desirable.

In order to reduce a very tall tooth, we have to float a little bit at a time and wait 2-3 months in between to allow the sensitive tissues to retreat down the tooth, kind of like a dog's toenail. How many times we have to do this depends on how tall the tooth is when we start and how far below the chewing surface the sensitive tissues reside.

The first two photos below show over-erupted teeth. The first is a hook on the first cheek tooth. This is over-erupted because the upper tooth is positioned slightly forward of it's lower partner so the front edge of the tooth doesn't get to wear down on it's own. The blue arrow is pointing to the hook.

The second photo is an aged miniature horse who is missing teeth. The teeth opposing the missing teeth have had lots of time to over-erupt and will need to be reduced over multiple sessions. Blue arrows point to the overgrown teeth. The red line is where the chewing surface should be on the upper teeth, so we have a lot of work to do.

The third picture is of the sensitive tissues that have been pulled out of a 3-year-old's upper cheek tooth. This photo is from a continuing education laboratory that Dr. Lin did back in October, 2025. The blue arrows point to the tips of the nerve that would be just below the chewing surface. The green circle is around the tissues that would be in the common pulp chamber near the roots of the tooth. This is the structure we are trying to protect when we don't overfloat over-erupted teeth. It looks sort of like an odd octopus, doesn't it? 🐙

01/10/2026

Teeth usually get extracted for one of two reasons. Either the structures around the tooth are no longer supporting it and it gets loose (periodontal disease) or the tooth itself is damaged (endodontic disease) and causing pain or interfering with chewing. But every so often, we extract a tooth because of orthodontic reasons, which was the case here.

Horses don't get braces so when their teeth are misaligned, we need to treat them either through corrective floating or tooth extraction. Miniature horses often do not have enough room in their mouths for their teeth, which can cause the teeth to crowd or become mis-aligned. In this case, we had been following the eruption of the adult dentition in this 6yo miniature mare. Her third molars, also known as the last cheek teeth, are supposed to erupt around 3 1/2 years old. Some horses are a little earlier or later, but generally between age 3 to 4. The fourth premolars, also known as the third cheek teeth back, are also supposed to erupt at about the same time.

By the time this mare hit 5 1/2 years old, she still did not have her last molars. We took radiographs and found that her third molars were all present where they should be. They just couldn't get into her mouth because her head was too small (or her teeth were too big.) This would have been ok except that on her upper right arcade, when her fourth premolar (3rd cheek tooth) tried to erupt, it got squashed and started to twist. This meant that instead of having a smooth line of teeth, she had little divots where feed started to collect. Left this way, the feed would sit there and rot and cause periodontal disease and eventually destroy her fourth premolar and probably the tooth in front and behind.

So, even though the tooth was still technically healthy for now, to prevent future problems, we decided to extract the fourth premolar. Doing this will prevent the development of periodontal disease and save the teeth in front and and behind. And, hopefully, as the teeth shift and close the gap that was occupied by the fourth premolar, it should allow the third molar (last cheek tooth) to erupt normally.

In the photos below, the first is an x-ray of the mare before she had her tooth extracted. Her nose is to the left and her ears are toward the right. You can count 6 cheek teeth but you can see that the last one toward her ears looks a little wiggly (dark blue arrow.) That is because it is trying it's darnedest to erupt and can't do it. You can also see that the third cheek tooth back (light blue arrow) looks a little narrower than the other teeth. That is because it's twisted on the long axis and you are looking at it a little sideways. You can also see that the tooth is so long, it's root tip makes a little bump in the skull.

The second photo shows the mare's x-ray right after her fourth premolar was extracted. You can see the gap in the row of teeth.

The third photo will probably get covered by facebook (sorry facebook!) but it shows the fourth premolar right before it was fully extracted. The tooth has been elevated out of the socket and we had to stop for a moment because the tooth was so long it hit the bottom teeth before we could get it clear of the socket. The orange arrows show the chewing surfaces of the top and bottom cheek teeth and the purple border shows where the chewing surface of the extracted tooth was at that moment.

The fourth and fifth photos show the fourth premolar after it was extracted lying next to a 1.5" needle for size comparison. Keep in mind, this tooth came from a mini!

We will keep examining this mare every 6 months to make sure that her teeth continue to be healthy and lined up well enough for her to use them for as many years as she possibly can. She is saucy enough not to thank me at all. 😉

11/14/2025

Why do I sedate horses for dental procedures? This is a very common question, especially since many lay floaters in our area do dentistry without sedation. There are two main reasons I sedate my patients.

First, I can do a better job when my patients are sedated. The sedation allows me to perform a thorough oral exam without stressing out the horse. Once my patients are sedated, I palpate their jaw joints (TMJs), their jaws (mandibles) and sometimes knock on (percuss) their sinuses. I check the excursion of their jaws. This is all easier to do accurately if my patients are relaxed and holding still. Then I rinse out their mouths and open them with a speculum so I can see and feel all the way back to their last cheek tooth, which sits under their eyeballs. I feel all the cheek teeth and check for anything broken, loose, overgrown, or displaced. Then I examine every single tooth with a mirror. I check for gaps between teeth, periodontal pockets, and cavities. I look at their cheeks, tongues, palates, bars, commissures, and under their tongues for wounds or other damage. All this looking around gives me a tremendous amount of information about my patients’ oral health but, just like when the dentist examines a human patient, it is not the most comfortable thing in the world. If my patients are sedated, I can do a better exam more quickly and get the information the owners deserve to know about their horse’s mouth and teeth.

Second, having my patients sedated makes dental procedures safer and quicker for the horse, my assistant, and me. There are exceptions to this including when my patient has cardiac issues, severe arthritis, or on-going neurologic challenges. Barring those, the sedation keeps my patients standing still so they don’t stumble around or step (or rear!) on us. They also don’t get frightened by the dental tools. And the sedation keeps them from chewing in the speculum and making their TMJs sore.

The sedation can cause anxiety for some owners for all sorts of reasons.

Some people get confused between standing sedation and general anesthesia. Standing sedation makes the horse sleepy, but they continue to stand on their feet and are still aware of their surroundings, although less responsive to them. This is what we use for dentistry. General anesthesia is when the horse is completely unconscious and laying down. This is what surgeons use for colic or orthopedic surgery and is not used for routine dentistry.

Some people have had bad experiences with sedation in the past or know someone who has. They may have had a horse fall down, or have a dramatic reaction to the IV injection. This is much more likely to happen when the sedation is administered by someone who may not do an initial physical exam, who may not be as competent in determining the proper dose for a patient, or who may give the injection in the incorrect location. Even competent, experienced veterinarians can sometimes mis-judge dosages or give injections in inappropriate locations because none of us are perfect and every horse is unique. However, when you have an experienced veterinarian administering sedation, this is extremely rare.

Finally, some people just don’t like the way their horse looks under sedation. Their heads hang down, they can lean awkwardly, stand in strange positions, and even snore. Some may get a little sweaty. While it can certainly be odd to see your horse in this position, it is very temporary and has no lasting effects. Most horses are wide awake from the sedation within the hour and looking for their hay.

I have attached some photos of sedated horses to hopefully help folks feel more comfortable with this part of the procedure. The first two photos are of a 10-year-old draft patient and were taken right after he had a tooth extracted (hence the bloody tongue.) He is standing in stocks which act as a support for him to lean on while he is sedated. We like to use stocks for horses that are a little less stable on their feet since it helps them support themselves while under sedation. In this case, we used them because he is enormous and trained to push against pressure rather than give to it. The next two photos are of a 30-year-old chestnut gelding right after his routine dentistry. You can see his back legs are oddly positioned, his p***s is hanging out, and he decided that resting his head in his empty feed bucket was a good plan. He woke up about 30 minutes after these photos were taken, put his p***s away, replaced his legs in a more normal position, and started eating hay. The last attachment is a video of a 15-year-old black Morgan mare also taken shortly after routine dentistry. She is resting her head on her half door and snoring. She stopped about 10 minutes after this video was taken as she started to wake up.

I hope this has helped some people better understand and feel more comfortable with sedation for their horses.

10/11/2025

It is foxtail season in Southeastern Pennsylvania! Foxtails are a type of grass that looks very similar to timothy when it is growing in the field or sitting in your hay. However, the foxtail seedheads have orange fibers extending from them rather than the tan fibers that timothy has. These orange fibers have microscopic barbs on them similar to fishhooks that embed themselves in the oral mucosa including lips, gums, tongue, and palate. Once embedded, the foxtail fibers cause irritation and ulcers. If a horse gets a large foxtail dose, the ulcers can cause them to drool, cause bitting issues if the ulcers are on the bars, or make them reluctant to eat due to discomfort. Many of these ulcers are small but some can be enormous or unfortunately placed.

Once the foxtails are embedded in the mucosa, the only treatment is to physically pull them out. This is most easily done under sedation with hemostats, but tweezers will work if the horse holds still and you are careful. Horses can get the foxtails out on their own, but because of the fishhook-shaped barbs, it takes them a long time to get these fibers out. Many horses are smart enough to sort through their grass and hay and avoid eating the foxtails, but not all are so selective.

Penn State Extension has a good article on identifying and controlling foxtails in your pastures that can be found here: https://extension.psu.edu/how-to-tell-foxtail-from-timothy-and-control-it Visually inspecting hay before accepting delivery is a good policy when trying to avoid feeding foxtails to your herd.

The FIRST photo below is of foxtails growing at the edge of a riding arena.

The SECOND photo shows a foxtail seedhead on the left and a timothy seedhead on the right. You can see the distinctive orange color on the left seedhead and also how similar they look to each other.

The THIRD photo shows foxtail damage around the incisor gingiva. This is a very common place to see foxtail fibers embedded because the horses use their lips and gums to sort through hay or grass and eliminate the foxtails.

The LAST photo shows an ulcer under a horse's tongue caused by the foxtail fibers. In both of these cases, removing the foxtail fibers will allow the horses to heal without any further treatment being necessary.

If you think your horse has been exposed to foxtails, a good oral exam under sedation will let you know if they have ulcers and allow treatment if any ulcers are found.

09/15/2025

Come out and see us this Saturday at Last Chance Ranch in Quakertown! We will be providing the equine dentistry demo at 1pm. Can't wait to see you all there!

🍂🌻 Still in need of plans for this weekend? Looking for a fun idea to do with the kids? Stop by on Saturday for fun, food, and furry friends! 🌻🍂

McCoole's at the Historic Red Lion Inn Mon & Mel’s Sweet Scoops Ice Cream Truck QNB Bank

09/12/2025

Did you know that horses get cavities too? Cavities are found most commonly in the chewing surface of the teeth but they can happen on any part of the crown above the gumline. Cavities can be caused by too many treats or an inappropriate diet, incorrect formation of a tooth, injury, or bad dental genetics. Luckily for horses, they have some defenses against cavities that people do not have.

First, especially in younger horses, their teeth are still erupting and wearing down fairly rapidly. This means that if the cavity isn't growing quickly, the part of the tooth that contains the cavity may wear away before the cavity has a chance to invade the sensitive parts of the tooth. The horse may never even notice the cavity before it's gone.

Second, horse teeth are made up of three materials: enamel, cementum, and dentin. Dentin in horse teeth can respond to damage to the tooth and fill in holes caused by trauma or cavities. Meaning, sometimes a horse can make its own fillings!

Unfortunately, sometimes a horse's own defenses are overwhelmed and a cavity continues to grow. We can help slow the progression of cavities in a few ways. First, we can properly float the teeth to keep feed moving appropriately through the mouth so it doesn't sit and rot the tooth. Second, there are veterinarians who are able to perform fillings in some situations. Third, if a tooth is painful or close to fracturing, we can extract it to keep the horse comfortable.

The first photo below has a blue arrow pointing to a small cavity in the chewing surface of a cheek tooth. This horse is fairly young and this cavity is unlikely to cause this horse any problems. The tooth will probably wear away this portion of the crown before the cavity grows much bigger.

The second photo below shows a larger cavity in the chewing surface of a cheek tooth framed in blue. This cavity is likely going to cause a problem for this tooth. It is likely to continue to pack feed in the cavity which will rot the tooth further and eventually cause the tooth to break. At that point, we would extract the tooth.

08/14/2025

Cardinal Equine Veterinary Dentistry will be out of the office from Monday, August 18 through Friday, August 29. We will be back in the office Tuesday, September 2. While we are out of the office, we will only intermittently be checking voicemails, texts, and emails. If you need prompt attention during this time, please contact Garden State Equine Veterinary Dentistry at 732-946-0767 or [email protected]. You can also contact your regular veterinarian. We apologize for the inconvenience and are very excited to get back to serving you and your horses when we are back at work on September 2!

07/29/2025

Horse's teeth do not actually "grow" throughout their lives. By the time horses are about 5 years old, they have all the tooth they are ever going to have. It is just that most of the teeth are buried in the bone of their upper and lower jaws. As the horse chews and wears down its teeth, the reserve crown from inside the jaws erupts into the mouth so that there is always the same amount of tooth in the mouth.

Eventually, though, the horse will run out of tooth. When this happens, your dental practitioner will start to see age-related wear on the visible tooth crowns inside the mouth. This happens because the horse keeps chewing and wearing its teeth even though there is no more replacement tooth coming in from the jaws. If too many teeth get worn, you will start to notice changes in your horse that we often associate with age- difficulty holding weight, longer fibers in the f***s, f***l water syndrome, quidding (chewing up hay and spitting it out), and dropping grain.

These changes happen because as the teeth wear out, they lose all their enamel. Enamel is the hardest material in the tooth and in a younger tooth, it makes up the ridges on the chewing surface that enable a horse to grind up hay and grass. As these wear away, the chewing surface of the tooth becomes smooth. It's like your horse is trying to grind up hay by rubbing two dinner plates together. It doesn't work very well.

If your dental provider is doing a good oral exam, he or she should be able to warn you that these changes are coming and discuss dietary changes for your horse that will help them maintain weight even though they can't chew as efficiently as they used to. These recommendations should take into account the health status of your horse including current weight and activity level, any relevant diagnoses like Cushings' or insulin resistance, and what is currently going on in your horse's mouth.

The first picture below is an x-ray of a 11yo Morgan mare's jaw. We took this x-ray to investigate the lump on her jaw, but the important thing in this case is to see how much tooth is still tucked inside her jaw bone waiting to erupt into her mouth as it is needed. The purple line is her gumline. The green line surrounds the teeth that are visible in her mouth. All the tooth material below the purple line is waiting to erupt into the mouth as it is needed.

The second picture shows a worn out first bottom left cheek tooth. The orange arrow points to the part of the tooth that is now smooth. This will be almost useless for grinding up hay and other forages. The red arrow points to a thin white line toward the back of the tooth. This is the last enamel ridge this tooth has. Once it is worn away, it will not be replaced. You can see in the picture that the teeth behind it are in better shape but this owner should be warned that her horse is going to start becoming a harder keeper in the near future.

The last photo shows the upper cheek teeth of a 3yo Belgian cross mare. (Can you spot the wolf tooth? 😉) The red arrows point to multiple bright white lines on the chewing surface. These are ridges of enamel that will enable this young mare to efficiently grind up hay and other forage.

06/16/2025

When dealing with Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH) I am often more concerned with the resorptive part of the condition because that is the disease process that makes the cavities that the bacteria shelter in which become abscesses. Those abscesses are typically the painful part of the disease.

But the hypercementosis process causes its own set of problems and discomfort. When the tooth roots bulge, they break down the ligamentous attachment between the teeth and the socket making the teeth loose. The bulging also changes the orientation of the front teeth meaning those weaker attachments get stressed in a way they are not designed for. And finally, the bulging roots cause the gums to recede, further weakening the tooth's attachment to its socket.

The pictures below are before and after extraction for a very hypercementotic upper left corner incisor from a 22yo Morgan gelding. There is a purple line in one pre-extraction photo showing approximately where the gum line should be. You can see the gum has receded far north of this mark. In a post-extraction photo, there is a green line on the root showing the shape the root should be if it were not diseased. You can see this tooth looks more like a renaissance faire turkey leg than a normal incisor. 🍗 This horse actually had three almost equally hypercementotic incisors and was very glad to have them out.

06/06/2025

As per request, here are some normal and EOTRH incisor x-rays. The first two pictures below are from a 26yo Thoroughbred mare who does not have EOTRH. You can see that her corner maxillary incisor roots are not perfect, but she's been using them for about 22 years now so some wear and tear is expected. She also has a habit of lunging at the bars in her stall if she thinks someone is after her breakfast, so that probably doesn't help the condition of these roots either. You can see in these pictures that the upper teeth have a mostly nice smooth curve and taper and the bottom teeth have nice smooth edges that end in a nice tapered tip. The edges of the teeth are clear and parallel to each other and you can easily find the dark root canal running down the middle of each tooth.

The next two images are from the same 27yo Arabian mare whose photos I posted last week. The purple arrows point to cavities in her teeth and the blue arrows point to abscesses surrounding the teeth. The cavities in the teeth are typically colonized by bacteria and abscessed. You can see that these teeth are a very different shape from normal. They have a fuzzy, moth-eaten look from all the cavities and the roots bulge in ways that are typical of EOTRH. It can also be difficult to find the central root canal in these teeth because it is being destroyed. These teeth are likely quite painful for her.

The last two x-rays are from a 26yo Hanoverian gelding. On the image of his bottom teeth, I have drawn a red arrow to a fractured tooth. The root tip is actually no longer attached to the tooth. This would not be visible without an x-ray. For his top teeth, I drew light green lines around approximately the shape his teeth SHOULD have and then darker green lines around the shape his teeth actually DO have because of EOTRH. (Please excuse my crappy drawing!) His teeth are also likely rather painful for him.

Unfortunately for the horses in the last 4 x-rays, the only treatment for them is removal of all of their incisors. Although this treatment is dramatic (and bloody), the results are incredibly gratifying. Many patients are grazing enthusiastically while still bleeding from the procedure because they are so relieved these teeth are no longer attached to them. Horses tend to become more friendly, brighter, more active, and easier keepers after these painful teeth are removed. It is always a big decision for owners because this disease tends to affect the elderly. We are lucky to live in an area where there are multiple practitioners offering multiple ways of going about this surgery that all end up with a happier horse.

05/30/2025

If someone has not yet learned about EOTRH (Equine Odontoclastic Tooth Resorption and Hypercementosis) they will often ask me if what I am showing them might just be old horse teeth. It's not, but the differences can be subtle. It is important to be able to tell the difference, though, because understanding what is going on (or not!) with your horse's front teeth can be the difference between ending their lives in pain and having some pretty awesome senior years.

The first two photos below are normal old hose teeth. These are from a 31yo Arabian mare. You can see she has a thin line of tartar around her gumline (yellow) and some gingival recession meaning her gums should ideally come closer to the chewing surfaces of her teeth. But her teeth are a normal shape, none of them are particularly loose, and they meet at an angle that is appropriate for her age. These are pretty decent incisors (front teeth) for an older horse.

The rest of these photos are of two different horses with EOTRH. The third and fourth photos show a 27yo Arabian mare. The blue circles and arrows indicate irritation of the gum tissue. The arrows are pointing to petechiae, which are burst blood vessels indicating irritation, typically cavities, under the gums. One of the blue circles surrounds a pustule, which is like a zit. This zit is an exit point for the pus in the cavities underneath the gum. When you see these petechiae and pustules, you know there is some sort of infection underneath the gingiva. The orange is outlining tartar. While tartar is often found on canine teeth, finding it on other teeth usually indicates that the body is trying to stabilize a wiggly tooth. The last thing to notice in these photos is the angle at which this mare's teeth come together. It is very up-and-down, rather than pointed out toward her lips. This is an indication that her incisor roots are bulging, or hypercementotic, which changes the angle that the front teeth come together. We took x-rays of this mare and they clearly show that she has EOTRH.

Another indication of advanced EOTRH is visible cavities or broken teeth. The fifth photo below shows a 26yo Hanoverian gelding. You can see that his bottom corner incisor is broken off at the gumline (green line shows where it should have been.) His upper corner incisor has gingival recession. The gum should be down where the pink line is. If you look carefully at the gumline above the pink line, you will see a little point of gingiva pointing down toward the chewing surface of the tooth. This little point of gingiva is doing it's best to fill in a cavity in the tooth. When I poked at it with my probe, the probe fell right into the tooth. We took x-rays of this guy and he also has EOTRH.

EOTRH is a progressive, extremely painful disease and we do not yet understand the cause. What we do know is that we can completely relieve these horses' pain by removing their incisors (front teeth.) The surgery is a big deal, but they are typically ecstatic afterwards. Some horses can be done on the farm. Others need to go to the clinic, but almost none of them need to go under general anesthesia. The procedure can be done standing and they are usually happily eating as soon as the sedation wear off. Nuts, right?

05/19/2025

Horses have incredibly dynamic teeth. The pictures below show the bottom left cheek teeth in a 25-year-old gelding who had 2 upper cheek teeth extracted 2.5 months before the photos were taken. Despite the short time since extraction, the bottom teeth are already changing in response to the new conditions in the mouth. Because this horse is more senior, these bottom teeth are not overgrowing much (yet!) and may never overgrow. But they have changed color. The brown areas of the chewing surface (bracketed in purple) are the areas that are no longer in contact with an opposing tooth. The areas that are more creamy yellow (bracketed in blue) are the areas that still have an opposing tooth to wear against.

The brown does not indicate decay- just disuse. Sometimes increased color on an oral exam can help lead a careful practitioner to an area of the mouth that the horse is avoiding using because there is pain or other pathology there. This is something we always watch for on oral exam and can sometimes clue us in to a problem before teeth are fractured or loose or more obviously damaged. In this case, it just reminds us that he is missing teeth. Which we already knew. Because... we took them out. 😉