Thinking Through Cheek Tooth Extraction Complications (AAEP 2012)

As far as major dental surgeries go in horses, cheek tooth (premolar and molar) extraction is the most common; unfortunately, more than half these procedures pose risk of complication, noted Edward Earley, DVM, FAVD/Eq, of Laurel Highland Veterinary Clinic, in Williamsport, Penn. He addressed some of these potential complications, ways to minimize their occurrence, and methods of treating them at the 2012 American Association of Equine Practitioners convention, held Dec. 1-5 in Anaheim, Calif.

Complications from tooth extraction might arise as a result of the extraction process itself or pre-existing issues. Earley listed a number of examples including:

  • Palatine artery laceration;
  • Iatrogenic (caused by veterinary care) dental and lower jaw fractures;
  • dilacerated (divided) reserve crown (the portion of the tooth within the jawbone that has not yet erupted) and root;
  • Alveolar bone sequestration (death of damaged bone in the tooth socket resulting in a draining tract or a nonhealing alveolus)
  • Paranasal sinus involvement and alveolar plug failure, resulting in a fistula;
  • Iatrogenic upper jaw fracture from a horse chewing on the speculum;
  • Tongue chewing if the veterinarian anesthetizes the lingual nerve during regional or local blocks;
  • Non-healing lower jaw fractures due to a tooth with severe periodontal disease at the fracture site; and
  • Extension of dental pathology to either side of the obvious bad tooth.

Earley explained that pre- and post-procedural radiographs (X rays) can minimize complications because they allow the veterinarian to view potentially complicating pathologies (damage to bone and soft tissue) ahead of time and to verify successful tooth extraction. He said that "the extraction process should never be viewed as a simple one-stop procedure." Rather, the veterinarian should develop a comprehensive plan to minimize the risks of complications and manage these scenarios when they occur. This plan should include:

  • A thorough pre-surgical evaluation, including a complete intraoral examination and radiographs. Earley even recommended referral for a head CT if the diagnosis is still unclear.
  • Treatment planning: pre-procedural treatment (e.g., antibiotics) if indicated, an anesthesia/analgesia plan, and a plan for postoperative treatment and follow-up.
  • Contingency treatment planning (e.g., what will the veterinarian do if a specific complication occurs?)
  • A plan for the extraction itself.
  • Post-procedural evaluation.

Earley summarized, noting that planning for and being aware of potential dental extraction complications is essential to a successful procedure and a satisfactory outcome for horse and owner. "Over half of cheek teeth extractions have potential for complications," said Earley.

Disclaimer: Seek the advice of a qualified veterinarian before proceeding with any diagnosis, treatment, or therapy.