A long‐term study on the clinical effects of mechanical widening of cheek teeth diastemata for treatment of periodontitis in 202 horses (2008–2011)

Abstract

SummaryReason for performing study: Cheek teeth diastemata are a common cause of painful periodontal disease in horses, but there is limited objective information on their treatment. Objective: To assess the long-term response to diastema widening in clinically affected horses. Study design: Retrospective study. Method: Medical records from cases of cheek teeth diastemata treated by diastema widening referred to the University of Edinburgh Equine Hospital from 2008 to 2011 were analysed. Results: During this period, 302 horses were diagnosed with clinically significant cheek teeth diastemata, of which 202, median age 11 years, with severe associated periodontitis were treated by widening of 674 problematic diastemata; 89.8% between mandibular cheek teeth and 10.2% between maxillary cheek teeth, with a mean of 1.5 treatments performed per case. These 202 cases showed quidding in 76.2%; weight loss in 33.2%; bitting problems in 20.1% and halitosis in 10.9%, with 5.4% being asymptomatic. Follow-up of 92% of treated cases, a mean of 20.8 months after their initial treatment, showed that 72.6% had complete remission of clinical signs that was permanent (for the duration of this study) in 50.5% and temporary in 22%. A partial response was obtained in 17.2%, no response was obtained in 4.3%, and owners were unsure of response in 5.9%. Clinical improvement was sometimes delayed, with 19% taking >4 weeks following treatment for improvement. Inappropriate sites were burred in individual teeth of 6 horses, causing iatrogenic pulpar exposure in 2 cases, but following treatment none developed clinical signs of apical infection. Conclusions: Diastema widening is an effective but potentially invasive treatment for horses with cheek teeth diastemata with severe periodontitis. Potential relevance: Diastema widening by trained personnel is suitable for advanced cases of cheek teeth diastema, but many cases require repeated treatments.

Dental disease in alpacas. Part 1: Prevalence of dental disorders and their mutual relationships

“…The significantly higher prevalence of diastemata in the older age groups is attributed more to the development of senile diastemata, as described in horses. They develop after continued eruption of teeth and a decreasing crown diameter toward the apices, resulting in decreased surface area at the level of the occlusal surface 33 . The strong association between the prevalence of diastemata and PD also has been noted in other species 19,20,30 .…”

Is your practice diagnosing cheek teeth diastemata?

“…In a university referral practice, mandibular 09–10 diastemata comprised 24.8% of all cases treated by diastema widening (Dixon et al . ). In studies where an oral endoscope was used to examine the oral cavity, clinicians found diastemata at all interproximal sites with the lower and upper 06–07s and 10–11s most commonly affected (Simhofer et al .…”

“…As the distal pulp horns of cheek teeth lie very close to the caudal aspect of the teeth, an attempt must be made to remove most of the dental tissue from the rostral aspect of the tooth lying caudal to the diastema (Bettiol and Dixon ; Dixon et al . ). Following this procedure, many horses experiencing severe oral pain and quidding become asymptomatic within a week or so of treatment and some younger horses are permanently cured (Dixon ; Rucker ; Dixon et al .…”

Is flushing and packing adequate for diastema treatment?

“…The 6 cheek teeth (CT) of the horse should act as a single grinding unit with tight interproximal contact due to the opposing angulation of the 06 s, 10 s and 11 s. Diastemata (inappropriate gaps between the CT) and associated periodontal disease is recognised as the main cause of oral pain and quidding in referral cases (Collins and Dixon ; Dixon et al . , ). Diastemata can be divided into ‘valve‐type’ or ‘open‐type’ and most frequently involve the caudal 2 mandibular interdental spaces – making diagnosis and treatment a challenge (Collins and Dixon ).…”

“…For valve type diastemata – widening with a mechanised burr has been shown to be an effective treatment for carefully selected cases (Dixon et al . , ).…”