Page 136 - Manual of Equine Field Surgery

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CHAPTER 22

Tooth Repulsion

David A. Wilson

tion, including the use of a full-mouth speculum
INDICATIONS
with appropriate illumination, and a radiographic

examination are recommended if dental disorders

Repulsion is indicated for cheek teeth that cannot are suspected. Additionally, ultrasound, nuclear

be removed orally, teeth with broken crowns, or scintigraphy, and computed tomography may be

fragmented teeth.!" Although the techniques

useful to evaluate certain dental disorders.9
described in this chapter are applicable to the first

five cheek teeth, repulsion in field or suboptimal

conditions is most practical for the rostral cheek EQUIPMENT

teeth. Improved extraction techniques and anes-

thetic protocols have expanded the capability of A dental punch and mallet are used for tooth

oral extraction of affected teeth. Oral extraction is repulsion. A trephine or large bone rongeurs, or a

the preferred method of removal when possible high-speed burr can be used to remove overlying

and practical. 3,5-7 bone to access the tooth roots. Ideally, pre-

Specific indications for tooth removal include operative, intraoperative, and postoperative radi-

retained deciduous teeth, interventional ortho- ographs should be taken to ensure identification

dontics, severe periodontal disease, loose teeth, of the correct tooth, to assess the approach, to

supernumerary teeth, dental impactions, end- evaluate the positioning of the dental punch, and

odontic disease with secondary osteornyelitis, to check the tooth root socket for remaining frag-

severe disease or injury to the dental crown or ments after repulsion.

root, malocclusions, occlusal trauma, neoplasia,

biting discomfort, and sinus disease secondary to

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dental disease. POSITIONING AND PREPARATION

The clinical signs associated with dental disease

are broad and typically include quidding, the The horse should be placed under general anes-

presence of a head tilt while eating, nasal dis- thesia in lateral recumbency with the affected

charge, sinusitis, the presence of a chronic drain- tooth up. If a mandibular tooth is affected, the

ing tract, headshaking, facial pain, excessive horse may be placed in lateral recumbency with

salivation (ptyalism), anorexia or pica, and the the affected tooth up or in dorsal recumbency.

presence of long forage stems or whole grain in

the feces. Additional but less common clinical

signs include facial swelling or distortion, weight ANATOMY

loss, diarrhea, colic, reluctance to start eating, slow

or intermittent eating, difficulty in prehension, Pertinent structures to be aware of when consid-

choke, and epistaxis.8 A thorough oral examina- ering tooth repulsion include the facial muscles,

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