Equine dental extractions provide a number of challenges including those related to equine dentition (long teeth that can be hard to access) and to the equine patient. Careful preparation of the patient and equipment help to facilitate more efficient extractions that can help reduce the costs, complications and stresses associated with extraction procedures. Knowledge of the extraction process for multiple types of teeth will aid in equipment preparation for these procedures. In this talk the extraction procedure will be described for incisors, canines, wolf and cheek teeth. Equipment requirements, sedation protocols and some setup routines will be discussed. Tooth extraction principles: Prior to tooth extraction local and/or regional nerve blocks are required to desensitise the area, knowledge of the landmarks for regional nerve blocks (mandibular, mental, maxillary and infra-orbital) will allow appropriate aseptic preparation at these sites. Extraction of a tooth requires sectioning of the periodontal attachments, this can be achieved by direct line access with sharp elevators to cut the periodontal ligament (e.g. incisors, canines, wolf teeth and occlusal aspect of the cheek teeth) and/or by manipulating/moving the tooth within the alveolus using spreaders (that push the tooth backwards and forwards) and grasping forceps (that rotate the tooth). Once the periodontal attachments have been damaged sufficiently the tooth can be elevated from the alveolus (socket) by grasping the clinical crown (bit of tooth visible in the mouth) and pulling (usually over a fulcrum for the cheek teeth) - referred to as ‘oral extraction’. Common Challenges: Horses have long skulls and long teeth, which makes access challenging in many cases. If the clinical crown is damaged (pre-existing fracture, or breaks during manipulation) tooth extraction can be difficult and alternative extraction techniques (e.g. tooth sectioning, Minimally Invasive Transbuccal Extraction [MTE], or repulsion [punching the tooth into the mouth]) are required. Many (most) extractions can be achieved with horses standing under sedation, however achieving a level of sedation that stops the horse chewing but keeps it standing comfortably still can be difficult in some cases. Providing pain relief (appropriate local and regional nerve blocks) and using techniques to maintain a consistent plane of sedation (e.g. continuous rate infusions) can be very helpful.

Setup: Initial workup for cases requiring dental extraction will require careful oral examination (ideally with an oral endoscope) and often radiography. Predicting the need for radiography and preparing the system can save much time during workup and for those where ‘oral extraction’ has not been achieved. Treating horses in stocks is almost always preferable, but particularly for geriatric animals that are more prone to leaning when sedated. Use of a head stand or sling are essential. Equipment needs: These will depend on which tooth/teeth are being extracted but, as described, usually will require a selection of sharp elevators, spreaders and grasping forceps. Most of the advanced extraction techniques require radiography. Tooth sectioning requires a sectioning burr with water cooling - frequent cleaning of sectioning burrs and knowledge of how to change them is advantageous. MTE techniques require additional preparation of the surgical site (on the side of the face), a specialist kit containing multiple components (knowledge of these will allow rapid setup when required) and having the ability to operate the oral endoscope can help some practitioners. Repulsion techniques also require surgical site preparation, specialist kit and radiography. Advanced extraction techniques are sometimes performed after a prolonged sedation, so any assistance that reduces procedure time can be hugely beneficial.

Dental extractions are indicated to treat numerous painful conditions in horses. In many cases extraction can be achieved with short procedures, and with a good team approach even the more challenging extractions can be completed efficiently with good outcomes for patients and their owners.