Tooth extraction in horses is a common procedure that plays an important role in maintaining equine dental health. Whether due to infection, fractured teeth, or advanced periodontal disease, removing a problematic tooth can significantly improve a horse’s comfort and overall well-being.

Though routine, tooth extractions can have complications and require careful aftercare to ensure the best outcome. Horses often need more frequent dental checkups following removal of a tooth, as extraction can lead to imbalances in the mouth that require ongoing management.

Horses with dental issues also require a modified diet to accommodate changes in their chewing ability. Softer feeds, such as soaked hay cubes, pellets, or mashes, are usually easier for them to consume, helping to prevent weight loss and nutritional deficiencies.

In this guide, we explore the reasons for tooth extraction in horses, the steps involved in the procedure, and what horse owners need to know about post-operative care to ensure a smooth recovery. Understanding the importance of dental health and proactive care can help prevent complications and keep your horse happy and healthy.

Tooth Extraction in Horses

Tooth extraction (also known as exodontia) is a dental procedure involving the removal of one or more teeth from its socket in the jaw bone (mandible). Exodontia is typically performed when a tooth is damaged, diseased, or causing issues that cannot be resolved through other dental treatments.

In horses, tooth extraction is a relatively common procedure, but is still considered major oral surgery. [1] Horses are at a high risk of postoperative complications, which can sometimes be life-limiting and, in severe cases, may lead to euthanasia. [1][2]

Furthermore, horses that have had a dental extraction generally need more frequent dental care as the tooth opposite the extraction site no longer has an opposing surface to help grind it down. [3]

Dental Anatomy

Horse teeth grow continuously throughout their lifetime. Without regular teeth floating and dental exams, horses are at risk of uneven tooth growth and abnormal dental points, which can lead to issues like dysmastication (abnormal chewing) and mouth injuries.

It’s helpful for owners to familiarize themselves with equine dental anatomy so they can make informed decisions about their horse’s oral care.

Horse Teeth IllustrationfIllustration:

Tooth Types

Horses have a variety of tooth types which each serve specific purposes.

Table 1. Summary of equine dental anatomy. [3]

Type Upper Jaw Lower Jaw Total Location Description
Incisors 6 6 12
  • Front of mouth
  • Used for grasping and cutting feed
Canine Teeth (Tushes) 2 2 4
  • Immediately behind incisors
  • Usually only develop in males, very rarely in females
Wolf Teeth Up to 2 Up to 2, rarely 4
  • In front of premolars where the bit is placed
  • Small, vestigial teeth that may or may not develop
  • Sometimes thought to interfere with bit placement and removed
Premolars & Molars (Cheek Teeth) 6 Premolars
6 Molars
6 Premolars
6 Molars
24
  • Premolars: behind incisors
  • Molars: behind premolars
  • Form a continuous grinding surface (“dental arcade”) for chewing and grinding food

Age & Dental Development

Foals are born without teeth and develop them over the course of the first 6 to 9 months of their lives. They eventually develop 24 deciduous (baby) teeth. [4]

Permanent teeth begin to replace baby teeth around 2.5 years of age, and most horses have have a full set of permanent teeth by five years of age. The permanent teeth are much larger, longer, and rooted more deeply than baby teeth. [4]

Tooth Structure

Each equine tooth has three main parts.

  • Crown: The visible part of the tooth above the gumline. This is sometimes divided up into the reserve crown (the part that is below the gumline and gradually erupts over time) and the clinical crown (the part that sits above the gumline.) This part is made of dentin and enamel.
  • Root: The part of the tooth that is anchored into the jawbone. This part is made of dentin and covered by cementum.
  • Pulp cavity: The innermost part of the tooth that contains the nerves, blood vessels, and connection tissue.

Reasons for Tooth Extraction

In horses, tooth extraction is considered a last resort to stop the advancement of disease or to resolve excessive pain. [5][6]

The most common reasons for equine tooth extraction are: [6]

  • Tooth fractures
  • Broken or diseased teeth
  • Equine odontoclastic tooth resorption and hypercementosis (EORTH)
  • Any condition that has already loosened the affected tooth

Tooth Fractures

Fractured teeth in horses can impact any part of the tooth, including both the crown and roots. Fractures can result from mouth injuries, chewing on hard objects, or from underlying dental disease. [7]

Fractured teeth may lead to pain, infection, and difficulty eating (dysmastication), which can impact the horse’s overall health and well being. [7]

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Wolf Teeth

Wolf teeth are small, vestigial teeth that, when present, develop in the space between the incisors and the molars. [8]

Historically, wolf teeth were extracted in horses because they were assumed to interfere with bit placement. However, this is often not necessary. Extraction of wolf teeth is usually only recommended by veterinarians when they are fractured or if they are otherwise impacting the horse. [8]

Equine Odontoclastic Tooth Resorption & Hypercementosis

Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH) is a progressive, painful dental condition primarily affecting the incisors and, less commonly, the canine teeth of older horses. [9]

EOTRH is characterized by the breakdown of the tooth structure and excessive growth of cementum – the specialized calcified tissue that covers the roots of teeth. [9] Over time, this leads to painful teeth, gingival inflammation, and, eventually, tooth loosening or loss. [6]

When teeth exhibit advanced resorption, root damage, pain, infection, fracturing, or severe hypercementosis, extraction is necessary. [6]

Other Reasons for Tooth Extraction

Tooth extraction in horses may also be required in several other cases, such as: [5][10][11][12]

  • Untreatable dental disease
  • Tooth displacement (diastema) especially with gingivitis
  • Food pocketing
  • Maleruption
  • Impaction
  • Too many teeth
  • Apical or Periapical infection (i.e. tooth root abscess)
  • Dental sinusitis (odontogenic sinusitis) – an infection in the sinus that originates in the upper teeth
  • Neoplasia
  • Periodontal disease
  • Endodontic disease

Procedures

In horses, tooth extractions are performed using two methods: oral extraction and surgical extraction.

Oral Extraction

Oral extraction (also called simple or nonsurgical extraction) is the most straightforward method and is preferred by veterinarians where conditions allow. [9][13]

During oral extraction, the veterinary dentist inserts instruments into the mouth to grip the tooth securely, then carefully pulls it from the socket and removes it from the mouth. This type of extraction is less invasive and has the lowest risk of complication. [1]

Oral extraction is used in cases where the tooth is whole and accessible, and where complicating factors such as disease, abnormal morphology, or impaction do not interfere. [8][14]

Oral extraction is ideal for uncomplicated cases involving the following: [8][9][15]

  • Wolf teeth
  • Incisors that are not overly attached to the jaw bone
  • Incisors where the periodontal ligament can be removed during the procedure.
  • Cheek teeth where the tooth is stable and not fragmented
  • Cheek teeth that are easily accessible

This type of extraction is performed in a standing horse, meaning that the horse is sedated and given a local anesthetic. This is one reason why the risk of complications is lower with oral extraction, as it avoids the additional risks associated with general anesthesia. [1]

Oral extraction techniques are typically used to loosen the tooth even in cases where more complex procedures are needed to complete the extraction. [1]

Surgical Extraction

If oral extraction is not feasible, the veterinarian must perform a surgical extraction. [1][10] Surgical tooth extraction in horses is usually necessary if the tooth is: [14]

  • Fragmented
  • Impacted
  • Difficult to reach
  • Infected
  • Diseased or otherwise impractical to remove orally

Incisors that are diseased, subject to tooth or bone resorption (EOTRH), or are overly attached to the bone or the periodontal ligament may require surgical extraction. In addition, multiple incisors that need to be removed together are better suited to surgical rather than oral extraction. [9][15]

The extraction of canine teeth in horses is often complicated because of their long, curved roots. Surgical techniques typically need to be used for these teeth. [14] Cheek teeth extraction is a more complicated procedure that usually requires the care of specialist. [15]

There are several types of surgical extraction methods used depending on the type of tooth, where it is in the jaw, and the reason for extraction. [14] These procedures require more invasive techniques, including: [10][11][15][16]

  • Removing a bone flap
  • Drilling a hole in the jaw
  • Dissecting the tooth and removing part of it
  • Making an incision through the horse’s cheek
  • Making an incision at the corners of the horse’s mouth

The risk of complications is higher for these types of procedures since healing must also take place in bone, gum, and other tissues. [1][10] In recent years, there have been refinements in some of these procedures to make them less invasive and dental procedure research and development is still ongoing. [11][14]

The risk of iatrogenic complications (injury or other negative effects of the treatment itself) is also higher in these cases because there are more tissues involved, the underlying causes are more severe and/or the placement or morphology of the teeth makes accessing them more difficult. [15]

Surgical extractions in horses are often performed under general anesthesia, which comes with additional risks. [1][10][12] Recently, advances in surgical extraction under standing sedation have been developed to help lessen the impact of anesthesia. [12]

Post-Operative Care

Whether your horse is undergoing an oral or surgical tooth extraction, the post-operative care is the same. Once the tooth is removed, the extraction site is packed with gauze soaked in antiseptic to reduce the risk of infection. This packing must be changed every 24 hours until the horse is cleared by a veterinarian. [7]

During packing changes, the treating veterinarian checks the empty socket to confirm food is not contaminating the wound. Some veterinarians may use gel foam or dental wax to help protect the wound in addition to packing. [7]

In the first few days after extraction, your veterinarian will likely recommend feeding the horse only soft mash, while withholding hay and other forages. [7] In most cases, recovering horses are kept on a grass or soft diet only for a few weeks until the socket has healed completely. [16]

Most horses are prescribed a course of NSAIDs following dental extraction, and antibiotics may be recommended based on the particulars of the case. [7]

Always consult your veterinarian for specific post-operative care instructions for your horse.

Complications and Side Effects

Tooth extraction in horses is generally a routine procedure, with veterinarians taking every precaution to minimize the risk of side effects. However, complications can still occur and vary depending on factors like the type and location of the tooth, the underlying condition, and the extraction method used.

In horses, incisor extraction is less common than the extraction of other teeth and generally involves fewer complications. Possible complications include: [9]

  • Difficult or slow healing
  • Incomplete removal of all dental fragments (especially in cases of EOTRH)

When wolf teeth are extracted, sometimes the tooth breaks off inside the gum. If no infection develops and the gum heals over the fragment without further issues, this is not a cause for concern. [16] However, if a wolf tooth breaks above the gumline, the remaining sharp edge can damage the soft tissues of the mouth and cause inflammation and pain when using a bit. [16]

Additionally, rare errors can occur during surgical extraction of wolf teeth that can lead to the laceration of the greater palatine artery. This can lead to significant blood loss. [17]

There is a higher risk of postoperative complications when a cheek tooth is extracted. [10] This is true for all of the methods that have been developed, although oral extraction has a lower incidence of complication. [10]

Possible complications include: [2][10][14][17][18][19]

  • Tooth fragmentation
  • Incomplete removal of all dental fragments
  • Palatine artery laceration
  • Retained root apex
  • Damage the teeth next to the extracted tooth
  • Damage to the bones of the jaw
  • Dental sinusitis
  • Fracture of the mandible
  • Slow or impaired healing process of the tooth socket (delayed alveolar granulation)
  • Sequestration – the separation of a dead piece of bone from the healthy bone tissue
  • Osteomyelitis – inflammation and infection of the bone and bone marrow
  • Incisional infection
  • Fistulation – the formation of an abnormal passage connecting two structures or cavities
  • Regional nerve damage
  • Damage to the veins or arteries
  • Dry socket (alveolar osteitis) – the failure of a blood clot to form over the socket, leaving exposed bone
  • Hemorrhage
  • Parotid duct injury – damage to the duct responsible for transporting saliva to the mouth
  • Abscesses

Long-Term Complications

Long-term complications after tooth extraction in horses often involve overgrowth of the tooth on the opposite jaw. [20]

Equine teeth constantly grind against each other during chewing to maintain proper shape and size. Since horse teeth grow continuously to compensate for wear, each tooth relies on an opposing counterpart to regulate its growth through natural grinding.

When one tooth is removed, the unopposed tooth lacks this balancing action, causing it to grow unchecked and potentially leading to dental overgrowths. [3]

These overgrowths can form sharp points that may contribute to other issues, including:

  • Oral ulcers or sores on the cheeks or tongue
  • Painful chewing which can lead to reduced feed intake and weight loss
  • Tooth root problems
  • Difficulty eating

Additionally, when an empty space is left in the horse’s mouth, the teeth in that jaw have room to move around. This can lead to dental drift which can also result in difficulty chewing. [20]

Horses that have had teeth extracted require more frequent ongoing dental care to ensure long-term complications do not occur. [20]

Frequently Asked Questions

Here are some frequently asked questions about equine tooth extraction:

How long is the recovery time for tooth extraction in horses?

Recovery time varies depending on the complexity of the case and whether there were any significant complications after the extraction. Cheek teeth extractions are usually the most complex and recovery can take up to 6 weeks in these cases. [16]

How much does tooth extraction in horses cost?

The cost of equine tooth extraction varies regionally, and depends on the complexity of the case and whether standing sedation or general anesthesia is required. Prices for surgical extractions range from $500 – $3500 USD. [21]

What to do if my horse is not eating after a tooth extraction?

Always follow your veterinarian’s instructions after your horse has surgery and do not reintroduce fibrous forages until your horse has been cleared. If your horse is not eating after surgery, contact the treating veterinarian promptly.

How are horse teeth extracted?

Horse teeth are extracted either under standing sedation or general anesthesia. In both types of extraction, a veterinarian uses special tools to loosen the tooth and remove it from the socket. The wound is packed with antiseptic gauze to prevent food from contaminating it until it is healed. [7]

 

Summary

Tooth extraction is the removal of one or more teeth from its socket due to damage, disease, or other issues that are unresolvable through less invasive dental care. Horses with extracted teeth require increased dental attention as it can lead to the overgrowth of other teeth that can result in damaged tissues, pain, and an inability to eat.

  • Tooth extraction may be necessary due to fractures, broken or diseased wolf teeth, Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH), or other dental issues.
  • If the tooth is stable and its shape, location, and other factors are favorable, oral extraction is performed.
  • If the tooth is unstable, fragmented, or its shape, location, or other factors prevent oral extraction, surgical extraction is required. This process may involve incisions into the gums, bone, or surrounding tissues.
  • Oral extraction generally has fewer complications than surgical extraction, which carries a higher risk of complications.

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References

  1. Galloway. S. S. and Earley. E. T., Minimizing Equine Tooth Extraction Complications. Veterinary Clinics of North America: Equine Practice. 2020. View Summary
  2. Kennedy. R. et al., A Long‐term Study of Equine Cheek Teeth Post‐extraction Complications: 428 Cheek Teeth (2004‐2018). Equine Veterinary Journal. 2020. View Summary
  3. Dixon. P. M. and Du Toit. N., Dental Anatomy. Equine Dentistry. Elsevier. 2011.
  4. Ramzan, P. et al., Chronology and sequence of emergence of permanent premolar teeth in the horse: Study of deciduous premolar ‘cap’ removal in Thoroughbred racehorses. Equine Vet J. 2010.
  5. Gieche. J. M., Equine Oral Extraction Techniques. Veterinary Clinics of North America: Equine Practice. 2020. View Summary
  6. Baker, G. et al., Teeth: Fracture. VetLexicon.
  7. Baker, G. et al., Teeth: extraction. VetLexicon.
  8. Hole. S. L., Wolf Teeth and Their Extraction. Equine Veterinary Education. 2016.
  9. Rawlinson. J. and Carmalt. J. L., Extraction Techniques for Equine Incisor and Canine Teeth. Equine Veterinary Education. 2014.
  10. Caramello. V. et al., Equine Cheek Tooth Extraction: Comparison of Outcomes for Five Extraction Methods. Equine Veterinary Journal. 2020. View Summary
  11. Tremaine. W. H., Oral Extraction of Equine Cheek Teeth. Equine Veterinary Education. 2004.
  12. Menzies. R. A. and Easley. J., Standing Equine Dental Surgery. Veterinary Clinics of North America: Equine Practice. 2014. View Summary
  13. Henry. T. and Bishop. I., Adjunct Extraction Techniques in Equine Dentistry. Veterinary Clinics of North America: Equine Practice. 2020. View Summary
  14. Dixon. P. M., Complications of Equine Cheek Teeth Extractions. Equine Veterinary Education. 2023.
  15. Earley. E. T. and Galloway. S. S., Equine Standing Surgical Extraction Techniques. Veterinary Clinics of North America: Equine Practice. 2020. View Summary
  16. van den Enden, M., Recovery and aftercare for Advanced Dental procedures. Dental Vet. 2024.
  17. Dixon. P. M. et al., Complications of Equine Oral Surgery. Veterinary Clinics of North America: Equine Practice. 2008. View Summary
  18. Earley. E. T. et al., Complications Associated with Cheek Tooth Extraction in the Horse. Journal of Veterinary Dentistry. 2013. View Summary
  19. Gergeleit. H. and Bienert-Zeit. A., Complications Following Mandibular Cheek Tooth Extraction in 20 Horses. Frontiers in Veterinary Science. 2020. View Summary
  20. Townsend. N. B. et al., Evaluation of the Long-Term Oral Consequences of Equine Exodontia in 50 Horses. The Veterinary Journal. 2008. View Summary
  21. Extractions with North Wind Equine. North Wind Equine. 2023.