Prevalence and analysis of equine periodontal disease, diastemata and peripheral caries in a first-opinion horse population in the UK

Evaluating the Role of Inorganic Elements of Camelus Dromedarius Saliva in Protecting Enamel Against Tooth Surface Loss

The aim of this study was to provide insight into the role of camel's saliva in protecting enamel against erosion and to evaluate the levels of salivary sodium, potassium, calcium, and phosphate ions among 2 groups of camels, those with low-grade tooth surface loss and those with high-grade tooth surface loss. Twenty-eight healthy camels, 5 males and 23 females, aged 20 months to 10 years, were divided into 2 groups. Group I comprise camels with "low-grade tooth surface loss" and Group 2 with "high-grade tooth surface loss." Unstimulated saliva was collected by a draining method. The samples were then analyzed for sodium, potassium, calcium, and phosphate concentrations using automated chemistry analysis. Data were then statistically analyzed using the unpaired Student's t-test and Pearson correlation coefficient test. The study found the salivary calcium and phosphate concentrations were significantly lower in the "high-grade" erosion group, in comparison with the other group (P < .0001 and P  =  .0257, respectively). The results also revealed that the more extensive the tooth surface loss, the more carious lesions the subject had (P  =  .023), and that caries are more common in the anterior teeth, particularly the incisors. The authors conclude that alterations in inorganic elements of saliva, particularly the calcium and phosphate ions, play a major role in the development of resistance to tooth surface loss. This work may represent a direction for future research to develop custom-made preventive supplements, which can protect camelid teeth against tooth surface loss.

The prevalence and risk factors of dental disease found in 100 miniature horses

Introduction

Dental disease is a common condition affecting horses. Its prevalence and characteristics among most of the common breeds of horses and donkeys have been investigated and described in the literature, but information about the prevalence and etiology of dental disease of miniature horses is sparse.

Methods

To determine the prevalence and characteristics of dental disease of miniature horses, we performed oral and dental radiographic examinations on 100 miniature horses. The findings of these examinations were analyzed to determine the prevalence of dental disease and its correlation to age, sex, weight, body condition score, height at the withers, head length and head width. Older horses had a higher prevalence of dental disease, diastemata and crown elongations.

Results

The most common dental diseases detected in this population were crown elongation, oral mucosal ulceration, diastemata, class 1 malocclusion and hypodontia. Horses with a high body condition score had an increased likelihood of having a class 1 malocclusion. Horses with wider heads had a higher prevalence of dental disease and class 1 malocclusions.

Conclusion

Frequent oral examinations, starting at an early age, should be prioritized as a part of miniature horse preventive health care to decrease morbidity and slow progression of dental disease.

Bacterial Periodontitis in Horses: An Epidemiological Study in Southern Italy

Equine periodontal disease (EPD) is a painful oral inflammatory syndrome characterized by multifactorial pathogenesis. Although it is well known that bacterial proliferation and consequent gingivitis are caused by the decomposition process of food residues, in hypsodont species, the pathogenetic role and the different bacterial species involved in the progression of EPD must be fully clarified. This study aimed to investigate the association of bacteria, including the complex red bacteria (RCB), with EPD, and to evaluate possible EPD risk factors. Bacterial species, including Treponema denticola, Tannerella forsythia, Porphyromonas gingivalis (belonging to the RCB), Fusobacterium nucleatum, Veilonella parvula, and Prevotella intermedia, were investigated in 125 oral swabs from healthy and EPD-affected horses using real-time multiplex PCR. Subsequently, possible risk factors (i.e., age, gender, and breed of the animals and type of feed used) were evaluated using univariate and multivariate analyses. Tannerella spp. and Treponema spp. were detected in a significantly higher proportion of horses affected by EPD than in healthy animals, although pathogens belonging to RCB were detected in low number of horses. At the same time, none of the investigated pathogens was significantly associated with a particular stage of disease severity. Horses aged older than 20 years were at higher risk of EPD. The high rate of coinfection, statistically associated with EPD, supports the hypothesis that EPD is a complex syndrome characterized by the possible simultaneous involvement of several pathogens and an increased risk depending on the animal's age. Constant oral hygiene is the best prevention to prevent and treat the disease, especially in old animals.

Diagnostic value of full-mouth radiography in horses

In this observational study, oral examinations and full-mouth dental radiographs were performed on 248 horses presented for routine oral health care. The findings were assessed to determine how often disease was diagnosed by radiographs without having related findings on oral examination. In 50 horses (20%), there were radiographic signs of disease that would not have been predicted based upon the oral examination. 113 horses (46%) had oral examination findings that would have prompted dental radiography, according to the criteria of the study. Of these 113 horses, 24 (21%) had radiographic signs of disease that would have been missed if only targeted radiographs had been taken, rather than a full-mouth survey.

Tooth Elongation of Maxillary Second Premolars and Mandibular Third Molars and Associated Periodontal Disease in Horses: A Retrospective Study

Periodontal disease has been identified in horses and donkeys through the millennia at a prevalence of up to 75% and is a leading cause of tooth loss in horses. We hypothesize that there is a correlation between tooth elongations and periodontal disease. Dental records of all client owned horses examined by a single AVDC/equine board certified practitioner in 2016-2018 were analyzed. Inclusion criteria consisted of the examination finding of tooth elongation of one of the following teeth pairs 106/107, 206/207, 310/311, or 410-411. The included cases were then examined for the finding of periodontal disease in Stages 1-4 (PD 1-4). Bayesian correlation analysis revealed significant positive correlations of elongations and periodontal disease existed between PD1 and proximal tooth pairs 106-107 and 206-207, PD2 and PD4 with all four tooth pairs, and PD3 with 106-107. Clinically, early diagnosis and treatment of newly formed elongations, or prevention of their formation altogether through diligent dental prophylaxis could prove key in preservation of teeth through prevention of the associated development of periodontal disease in the horse.

Pyogenic meningitis and trigeminal neuritis secondary to periodontogenic paranasal sinusitis in a red deer (Cervus elaphus)

An adult female red deer died of a severe seizure and dysbasia. Postmortem computed tomography (CT) and magnetic resonance imaging (MRI) were performed. On CT, deciduous right maxillary second and third premolar teeth were observed, and the right infraorbital canal was disrupted. MRI showed that the right trigeminal nerve was enlarged and the right subarachnoid cavity was occupied by fluid and gas. On gross examination, the right paranasal sinus, swollen muscles of the orbit and tonsils, right trigeminal nerve, and right cerebrum surface contained a yellowish-white, cheese-like pus. Based on these findings, the deer was believed to have developed pyogenic meningitis caused by a neuropathic infection secondary to periodontogenic paranasal sinusitis.

Exodontia associated bacteremia in horses characterized by next generation sequencing

Bacteremia resulting from dental surgery is increasingly recognized as a health risk, especially in older and immunocompromised patients. Dentistry-associated bacteremia can lead to remote infections, as exemplified by valvular endocarditis. Emerging evidence points to a novel role played by oral cavity commensals in the pathogenesis of diabetes, respiratory disease, cardiovascular disease, and adverse pregnancy outcomes. Whether dental extraction, a commonly undertaken procedure in old horses, causes bacteremia has not been reported extensively. In a prospective clinical study using next generation sequencing (based on bacterial 16S rRNA), the circulating blood microbiome was characterized before and at 1 h following extraction of incisor, canine or cheek teeth from 29 adult horses with dental disease. 16S rRNA gene sequencing results from the blood microbiome were compared with those from gingival swab samples obtained prior to extraction at the location of the diseased tooth. Bacteremia associated with translocated gingival commensals was demonstrated in horses undergoing exodontia and was, in some cases, still evident one hour post-operatively.

Retrospective case review investigating the effect of replacing oaten hay with a non-cereal hay on equine peripheral caries in 42 cases

BACKGROUND

Equine peripheral caries can cause significant morbidity and can have considerable welfare implications. Recent research suggests that diets with high water soluble carbohydrate (WSC) content are associated with high risk of peripheral caries. Previous work has indicated that the condition may be treatable if the inciting cause is removed and the damaged tooth allowed to erupt out, being replaced by the unaffected tooth previously under the gingival margin.

OBJECTIVES

To see whether the peripheral caries process can be ceased if oaten hay (typically high WSC) is removed from the diet and replaced with a non-cereal hay (typically lower WSC).

STUDY DESIGN

Retrospective blinded longitudinal study.

METHODS

Forty-two cases with peripheral caries that were on oaten hay were asked if they would change the hay type from oaten hay to a non-cereal hay or straw (meadow, Rhodes hay, lucerne hay or barley straw). Photographs were taken at the time and then again at subsequent visits. The photographs were anonymised, randomised and scored by six equine veterinary dentists using the Jackson et al. 'Peripheral Caries Grading System' grading scale.

RESULTS

At follow-up, 69.0% of cases were marked as inactive, compared with 47.6% of cases at baseline (OR: 2.45, 95%CI: 1.12-5.36, P = .02). Significantly lower grades of peripheral caries were observed in the gingival, middle and occlusive third of the molars (triadan 9-11's) at follow-up compared with baseline. However, significant improvements were not observed in the premolars (triadan 6-8's).

MAIN LIMITATIONS

This is a review of clinical records, not a prospective study. As such, other changes in the diet and management were not recorded, and there was no control group.

CONCLUSIONS

Recommending clients change their horse's diet from oaten hay (high WSC) to a typically lower WSC hay was associated with significant improvements in equine peripheral caries located in the molars.

A new equine peripheral caries grading system: Are the caries likely active or inactive?

BACKGROUND

Equine peripheral caries can be a significant welfare issue in affected horses. Recent work has shown that complete reversal of the condition may be possible if the primary risk factor can be identified and corrected. Determining whether caries are active (deteriorating) or inactive (improving) is of vital importance when formulating a management and treatment plan. A new grading system is proposed that looks at whether caries are likely active or inactive to assist clinicians deciding whether intervention is required.

OBJECTIVES

To examine the reliability of an alternative grading method for equine peripheral caries.

STUDY DESIGN

Online survey of veterinary surgeons.

METHODS

Reviewers (n = 22) graded images of peripheral caries using three methods: the traditional grading system, a new research grading system and a new clinical grading system. Percentage agreement and Fleiss' kappa were used to examine the participant's agreement of the severity of caries.

RESULTS

All percentage agreements and Fleiss' kappa values were significantly greater than zero (P < .001). The Fleiss' kappa for the new methods were higher (ranging from 0.48 to 0.58), but not significantly different from the traditional method (0.40). There was a high level of consistency in the assessment of caries as either active or inactive with both grading systems reporting over 80% agreement. Feedback on the grading systems was positive with over 90% of reviewers saying they were likely to use the system.

MAIN LIMITATIONS

The use of photographs provided some difficulties with image quality and judging whether the dentin was affected without an occlusal image.

CONCLUSIONS

The new grading system produced a consistent estimate of caries severity and provided high levels of agreement on whether the caries were likely 'active' or 'inactive'. This is likely to be very useful clinically to assist practitioners to determine whether intervention is required.

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

BACKGROUND

Dental disease is a troublesome health concern in alpacas. Specifically, the occurrence of tooth root abscesses has been described in veterinary literature. Nevertheless, no objective prevalence data are available for dental disorders in alpacas.

HYPOTHESIS/OBJECTIVES

To determine the prevalence of dental disorders in alpaca herds in Belgium and the Netherlands. To study the associations between the different dental disorders encountered in alpacas.

ANIMALS

A total of 228 alpacas (Vicugna pacos) originating from 25 farms.

METHODS

This is a cross-sectional study. Dental disorders were diagnosed by dental examination of sedated animals using a dental mirror or a portable rigid oroscope.

RESULTS

At the animal level, 82% (n = 187) had dental disorders of which 74.6, 41.7, and 3.9% were cheek teeth, incisor disorders, and canine disorders, respectively. At the level of the cheek teeth, diastemata (43.1%) were most common, followed by wear abnormalities (WA; 39.6%) and periodontal disease (PD; 33.3%). A significant association was detected between the presence of diastemata and PD (odds ratio [OR], 13.1; 95% confidence interval [CI], 6.6-27.7; P < .001). Pulp exposure was significantly associated with the presence of diastemata (OR, 11.8; 95% CI, 3.8-51.5; P < .001), PD (OR, 8.2; 95% CI, 3.1-25.3; P < .001) and WA (OR, 2.9; 95% CI, 1.2-7.4; P = .002).

CONCLUSION AND CLINICAL IMPORTANCE

Dental disorders are highly prevalent in alpacas in Belgium and the Netherlands. Several dental disorders in alpacas had significant associations. To prevent the development of advanced stages of dental disease, routine dental examinations are advised to allow early detection and prompt treatment.

Dental disease in alpacas. Part 2: Risk factors associated with diastemata, periodontitis, occlusal pulp exposure, wear abnormalities, and malpositioned teeth

Background

Dental disorders, of which tooth root abscesses are best documented, are highly prevalent in alpacas. Identification of risk factors can be valuable for prevention of dental disorders in this species.

Hypothesis/Objectives

To identify risk factors associated with wear abnormalities, malpositioning, diastemata, periodontal disease (PD), and occlusal pulp exposure at the level of the cheek teeth.

Animals

Two hundred twenty‐eight alpacas (Vicugna pacos) from 25 farms.

Methods

Cross‐sectional study. Dental examinations were performed on sedated animals. Risk factors were determined by clinical examination and interview. Multivariable logistic regression was used to identify risk factors for wear abnormalities, malpositioned teeth, diastemata, PD, and occlusal pulp exposure.

Results

Mandibular swelling was significantly associated with PD (odds ratio [OR], 11.37; 95% confidence interval [CI], 3.27‐48.81; P < .001). Nearly 73% of included animals with mandibular swelling concurrently had PD. For every increase in herd size of 1 animal, the risk for PD increased by 2% (95% CI, 1‐4%; P = .01). The association between severe stages of PD and body condition score (BCS) indicates a painful situation, impairing animal welfare (P < .001). For each 1‐day increase in interval between pasture cleanings, the odds of finding pulp exposure for a single animal was estimated to increase by 1% (95% CI, 0‐2%; P = .05).

Conclusion and Clinical Importance

Simple management tools such as measuring BCS, palpating the mandible for bony swellings, removing feces from pasture on a regular basis and decreasing herd size might help identify animals at risk for dental disorders or prevent their development.

Recent developments in equine dentistry

Equine dentistry is a rapidly developing clinical specialty. It has benefitted from key advances in anatomical and physiological research, development of equipment and instrumentation, utilisation of standing sedation and anaesthesia protocols, a change towards minimally invasive surgical techniques, and the introduction of restorative and endodontic techniques translated from techniques used in human and canine dentistry. Anatomical research has provided further insight into the endodontic system of incisors and cheek teeth and how it changes throughout development with age. Studies of the periodontium have demonstrated a rich vascular supply and repair capacity. Routine dental visits are increasingly being performed utilising sedation and clinical instruments for routine examinations. Equipment has become more efficient, battery-operated and miniaturised giving benefits to both equine dental maintenance work and advanced techniques, assisting the transition to minimally invasive techniques, and the development of endodontic and restorative dentistry. Diagnosis has also benefitted from advances in equipment such as patient-side digital radiography systems, high definition oroscopy, and small diameter flexible fibrescopes that are capable of visualising inside a pulp canal. Dental units combining endodontic high- and low-speed drills, suction and air or water flush are becoming increasingly used and adapted for equine use. Sedative combinations and standing anaesthesia protocols have meant that revisions of traditional techniques, as well as novel techniques, can be performed with almost no requirement for general anaesthesia. Equine dentistry can only continue to advance in this way if there is early identification of dental disease through clinical oral examinations, leading to a system based on prophylaxis, as in human dentistry. This necessitates a change in attitude of the public and industry in general to a proactive approach, with early intervention based on examination and diagnostic findings of practitioners and not necessarily based on the clinical signs displayed by the patient.