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A Case for Whole Mouth Dentistry
by Nic Graham EqD 
 
In human Dentistry, all teeth are treated the same. It’saccepted that teeth work as a team in Dentistry, yet inEquine Dentistry the two sets of teeth are often treateddifferently. Like in the human medical fields, there aretrends and beliefs for each topical treatment and thePractitioners are firm believers in their area. However, itis up too each person to decide and choose their owntreatment path. This can be a hard decision to makewhen so many foster their own beliefs as advice. Eachperson and animal is different and each needs anindividual treatment plan to cater to their idiosyncrasies.Having spent many years, spending much money onchiro, physio, dentist and lessons, the frustration I feltwhen I could not get a symmetrical acceptance of therein with my horse. I had come to the conclusion that hewas just a ”Left-sided” horse. Until he smiled at me!Then I saw the uneven front (incisal) teeth. Coming froma career as a human Dental Technician/Prosthesis it gotme really thinking. It dawned on me that my horse wasprobably suffering the same as many patients cominginto the clinic where i work-unbalanced TMJ relatedissues. This list of ailments can be long: from insomnia,migraines, neck and back pain, balance problems just toname a few. As humans we are able to walk in andverbalise where our pain is, our horse cant. So myresearch began.Whole mouth Equine Dentistry is logical Dentistry. All theteeth in the mouth (horse) are ever erupting. This meansthat all the teeth erupt out of the gum at a regulatedpattern: Incisor and molars. My horse (Astroboy)regularly had his molars addressed by the Dentist butnever his front/Incisor teeth. So Astroboy had lovelysmooth molars yet these weren’t able to do their jobcorrectly. Why? Because his incisor teeth hadcontinually grown and locked in together. Astroboy hadthe whole mouth dental experience. We took off 1mm ofthe length of all the incisors, then realigned the rightteeth so they where symmetrically horizontal (removedthe wedge). He also had a high10 molar which sat amillimetre higher than the rest. This was burred back intothe occlusal length of the other molars and the he hadfull occlusal contact. After a couple of days of droppingfood and being grumpy we did the ride test. I’m surethat i was steering a different horse! The ears went backas the pressure came on to take the bad right rein butthe resistance was gone. Couple of minutes into theexercise and barely a change –accepting both sidesequal! It made me think of all the horses I’ve seen in thepast and that such a simple treatment can make such achange.Social changes, enforced by us onto the horse,necessitate that Equine Dentistry advances. Previously,the trend has been to not adjust the Incisor teeth and ina perfect world you wouldn’t. Nowadays it’s a necessity.Our horse’s ancestors spent up to 18 hours a daygrazing on a large variety of grasses, herbs and berries.As the world evolved, they moved inland still dependingon a large variety of high-fibre greases and herbage.Many of these plant species do not exist now. Even inthe 1800’s horses still had up to 18 types of grassesnaturally growing which they grazed upon. So the dietand living conditions have dramatically changed. Withhorses not grazing for long periods and on grasses thatare soft or processed, the nature wearing balance of thetooth tables differs immensely. The Incisors are doingonly a small percentage of the work necessary, whereasthe molars are still working in a higher capacity. Droughtconditions are another added factor with not enoughpasture for grazing.Processed feeds which we all depend on as asupplement do not need the incisors for their entry intothe mouth/gut. Therefore the more processed foods yourhorse consumes will add to incisor changes. The molar
 
teeth also are affected when the incisors are in need ofre-alignment. As the incisor angles lengthen andchange, the molars grow in a compensatory pattern: thetooth will hyper erupt to get the molar contact necessaryfor mastication (chewing). Through instinct, the horse willlearn to avoid dental orientated pain, such as quiddingand packing along the molar teeth, lack of bothering tograze, swishing of water and dribbling are commonreactions.As hypsodont teeth are ever erupting, once 1 tooth is outof the pattern, the others will compensatory grow,creating more problems. Incorrect angles of the incisorteeth emphasize the growth of ETR – ExcessiveTransverse Ridging. The definition for ETR is when themolar tables resemble a “washboard” steeped surface.It is extremely common in horses that are stalled andthose fed processed feeds. The gap between the upperand lower molar tables increases as the incisorslengthen, the harder enamel structure of the toothbecomes accentuated from lack of wear whilesimultaneously excessive abrasion of the softercementum occurs thus creating the ridging effect on themolar table surfaces. This also allows for the jaw to“lock” . These conditions cause dramatic change andpain to the TMJ. The tendons and ligaments whichoperate the TMJ are elastic of nature but will adapt andcontinue to operate even whilst in a constant state ofbeing “tight”.The horse will adapt to the constant strain on this jointbut it will have reactions when the pain becomes toointense. Refusal to accept the bridle and general headshyness and the uneven appearance of the temporalmuscle are classic signs of TMJ discomfort. TheTemporal muscle is the “heart-shaped” muscle abovethe eyes. This muscle is easy to recognise and shouldbe symmetrical so it is easy enough for the lay person tovisualize and recognise differences here. Many a ridingor pony club horse has attracted a nasty reputation forpain reaction behaviour and yet a simple adjustment orrealignment could have been all that was needed. Manybehavioural problems can be alleviated if the head is inbalance.An analogy I’ve always been partial to is the car andhorse comparison. I don’t like or feel safe driving a carwith dodgy brakes bad steering and wobbly wheels.That was what my prized horse was when i look back.All his dramas under saddle disappeared once his mouthwas balanced as the connection with the bit=pain wasgone. The head was able to flex both ways evenly andthe bit acceptance was complete and non-resisting.Even the ear scratch was appreciated by him. Youwouldn’t put yourself knowingly into a car with defectsand expect a nice easy ride to get there. The four leggedride deserve the same attention.The cost of processed foods is also problematic to theequestrian. So when you spend good money on thesefeeds, the optimum nutritional benefit is important. TheImbalance of the incisor and molar tables has anadverse effect on the nutritional value you get for yourmoney. With TMJ problems, the reduction in the molartable usage happens. Instead of 100% occlusal powerwhen chewing, a horse with ETR may have only 40%viable occlusal power. This means that 60% of all that isconsumed is passed through not completely digested.This equals a large percentage of feed wastageunnecessarily.Economics then enters the equations. Identify if yourhorse isn’t eating correctly. Watch. Does the food getchewed up along one side, then the other? A patient wedone recently had not had Dental treatment in over 6years. He would rear and behave dangerously if he seenor was approached with a speculum. Bridling him was anightmare and his steering left much to the imagination.After debating with the owner, he was sedated andexamined. He had a severe wedge running down leftwhen we opened his lips. Opening his mouth createdpain which you could read in his eyes. Upon beginningthe intraoral checkups, I grazed all my knuckles as histeeth where extremely sharp. Image the pain in hischeeks each time he chewed. He had a severe ETRhappening, made worse by the fact he was missing 1lower molar (9). The opposing tooth to this gap hadhyper erupted and now contacted the gum each time hetried to close his mouth. This hyper erupted tooth was3mm longer than the other teeth in the molar table. Sothis poor old guy could not physically close his mouthand the more you tried forcing, the intense pain youinflicted upon him.Treatment was a re-adjustment and re-alignment of theincisors, then the hyper erupted hook was cut off and theETR correct making the incisor and molar tables inocclusion. After a week off he went back into work. Thehorse came to the gate instead of the chase & catch thatwas the normal, and then he accepted the bridle withouta drama and though hesitant, was definitely improved inthe brakes department and actual accepted steeringfrom his rider.It was remarkable to then see him later at a PC event, amuch happy team. Long-term health problems can alsobe contributed to long term TMJ problems. The longerthe TMJ is out of alignment the longer the body has to
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