Oral tumours are a significant cause of oral pathology that are discussed in another presentation in this session.” Recognition and management of oral and dental neoplasia”

Trauma
Aspects of trauma are also discussed in an accompanying presentation “Dealing with oral trauma” by Tim Barnett

External trauma more commonly affects the incisor region and less commonly the mandibular and especially the maxillary regions. Incisor damage often includes damage to the supporting bones and less commonly fractures of the incisors and intra-oral radiographs are optimal for imaging. If there is pulpar exposure of the incisors, even suspect (i.e., indirect) pulpar exposure then endodontic restoration is indicated. Repair of detected incisor area bone fractures are indicated, and many such repairs are very straightforward procedures. Lacerations of the lips are obvious and should be sutured, in 3 layers if full thickness lacerations are present. Mandibular fractures may cause endodontic infection, especially in younger horses that may cause mandibular swelling and discharge, and so be mistaken for a primary apical infection. Radiography is indicated and depending on the type of fracture present, the use of an oral speculum should be performed with care.

Bitting and tack trauma are more common than external trauma and can be caused by use of excessive force on the bit by inexperienced riders, such as using the bit to punish the horse, by using constant bit pressure, or use of the bit to balance the rider. Bitting damage can also be caused by experienced riders who do not care whether they cause oral injury, if they achieve their competition goals. Very narrow bits and damaged bits can cause bitting injuries when using normal forces. Bitting lesions often involve the dorsal aspect of the mandibles, variably causing ulceration to periostitis, sequestration or even osteomyelitis (“polo pony mouth”). Bits can also damage loose buccal soft tissue, the inner commissures of the lips and occasionally the tongue. Bit damage can also cause high wear on the lower Triadan 06s (first cheek tooth) and even cause deep periodontal disease and apical infection of these teeth. Tight nosebands can put focal pressure on the cheeks opposite the buccal aspect of the rostral maxillary cheek teeth, and some equestrian bodies have new guidelines on noseband tightness as well as disciplinary procedures if horses have blood in their mouth following competition. Severe iatrogenic dental trauma can be caused by the unvalidated procedures of “incisor reduction” and “bit seating” that may cause pulpar and thus dental death. Severe tongue damage can occur after falls with a bit in place, also from a riderless horse treading on its reins, neglect of “tongue ties” and from a horse eating too soon after mandibular (with inadvertent lingual) nerve blocks.

Foreign bodies
Typically, these are short pieces of ingested wire that become embedded in the tongue (often at its base), in the oral mucosa at the side of the tongue or in the oropharynx. The clinical signs are usually due to secondary infection/abscessation that often causes soft tissue swelling and marked oral pain. Horses may become distressed, inappetent and may drool saliva. It may be difficult to open the horse’s mouth for examination, even following sedation. Intra-oral palpation may reveal swollen and firmer areas on the tongue or oral mucosa, that are often painful on pressure even in sedated horses. Sometimes, a piece of wire can be felt or seen protruding from the soft tissues. These can be grasped with long forceps and removed. If such painful swellings are detected without any protruding wire, then radiography is indicated to assess the possible presence of metallic foreign bodies. These pieces of wire may have caused abscessation and then become displaced. If metallic foreign bodies are present, identification of their exact site and then their surgical removal, can be difficult, and may involve multiple drainage may also be needed.