Monday, 10 August 2015

Does Basil have a Tooth Abscess?

If you follow me on Instagram you will know that what I thought was a fly bite on Basil's face has not gone.  When Basil gets fly bites he often gets a swollen patch for a few days, but this wasn't going away.  I decided last week that I needed to call the vet. 

I spoke to my Equine Dental Technician first to describe the problem.  He agreed that it sounded like a tooth root abscess and that as Basil would need anti-biotics to kill the infection I should call the vet.  After using the Speculum (which holds the horse's mouth open) she said that yes it could be an upper tooth root abscess.  As he does not have any discharge from his nose it is not a root that is close to the sinus.   He has a few days of anti-biotics and pain killers which hopefully will work, if not he will need to go for an x-ray :(

So, I thought that I would find out a bit more about tooth abscesses.

What is an abscess?
It is basically a collection of pus which is enclosed in a capsule under the skin.  

A tooth abscess?
Also known as tooth root infection the 'proper' name is apical infection!  Apical refers to the tooth root area and the surrounding tissue.  It is relatively common and occurs mostly in cheek teeth (molars).  As the cheek teeth in horses are so long the infection usually includes the tooth and peridontal ligament and the surrounding bone and sinuses.  It can affect horses of any age!

What causes a tooth abscess?
There are many different causes of these including, developmental disorders, blood borne pathogens and fractures.  In young horses, overcrowding may mean that teeth do not erupt correctly and if there are teeth missing there will be an increase in the chance of peridontal disease.  This  usually begins at gum level surrounding the tooth.  Fractures can be small fissures (deep narrow cracks) which are not seen until the tooth is extracted.  Larger fractures will likely be a result of a traumatic incident.    

What are the signs?
There may be a discharge from the nose (if the sinuses are affected).  The horse may have a head tilt or a decreased appetite but again this is not always present.  Certainly Basil has none of these symptoms!   

 There may be a swollen jaw on one side or the other.  The horse may be eating slowly or 'quidding'.  Signs can vary depending on which tooth is affected and to some extent the age of the horse.  In older horses that have shorter reserve crowns the infection can drain through the peridontal membrane or through the pulp cavities and into the mouth.   This will mean that infection of the supporting bones of the face and sinuses does not occur.  

However,  apical infections often occur in young or middle aged horses that have long reserve crowns.  The infection in these cases does not drain into the mouth it spreads into the bone surrounding the tooth.  Therefore these cases often have hard, bony swellings on the mandible and the abscess may develop external cutaneous draining tracts.  Infections of the first 2 upper cheek teeth  cause bony swellings of the maxilla.  This can burst into the nasal cavity causing nasal discharge.  Infections of the 3rd and 4th cheek teeth will cause infection in the sinuses, causing a secondary infection! 

What should you do?
The mouth should be thoroughly examined by either a vet or dental technician using a speculum.  However, this will not always show up any problems and so a radiograph is often the best way to determine if an infection is present.

What is the treatment?
Anti-biotics may stop the infection in its tracks.  However, extraction is often necessary.  Usually the infected cheek tooth can be extracted with few complications as long as the exposed crown is large enough to be grasped and the tooth is not fractured below the gum level!  The empty tooth socket is then filled with antibiotic and a plug is made with dental impression material to fill the hole which the tooth filled.  After 2 weeks the plug is removed and the horse re-evalulated.

Future care.
If the tooth is removed then Dental Technician visits will need to be bi-annual to ensure that the opposing tooth does not become sharp.  (see my Dentistry blog).  In young horses the adjacent cheek teeth will slowly move to fill the void.  

Obviously I am a concerned that Basil will have to have his tooth removed - I will keep you up to date! 

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Until next time!

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