Sharp enamel points in horses are small, sharp edges or protrusions that form on the edges of the molars and premolars in a horse's mouth. They occur because horses naturally have uneven wear on their teeth, especially if their diet does not contain enough roughage or if they do not chew horizontally very much.

Where do they occur?

• Outside of the upper molars: against the cheek
• Inside of the lower molars: against the tongue

Symptoms of sharp enamel points

• Difficulty eating or messing with food
• Weight loss despite good appetite
• Bit problems or head shaking when riding
• Bad breath
• Saliva loss
• Food clumps in the mouth
• Poor performance or resistance when working

Consequences

• Damage to the inside of the cheeks or tongue
• Ulcers or wounds in the mouth
• Pain when chewing or riding

Treatment

A horse dentist must file these points away with a special tooth file.

Prevention

• Annual dental check-up from approx. 2.5 years of age
• More frequently for older horses (e.g. every 6 months)
• Provide sufficient roughage to stimulate natural wear

Rostral and caudal hooks in horses are dental abnormalities in which hook-shaped growths develop at the front or back of the molar row. These hooks can interfere with chewing, jaw joint movement, and even riding.

What exactly are they?

• Rostral hooks:
  ➤ Form at the front (rostral) of the upper molar row.
  ➤ Often on the first premolar of the upper jaw.
• Caudal hooks:
  ➤ Form at the back (caudal) of the lower molar row.
  ➤ Often on the last molar of the lower jaw.

These hooks develop when the upper and lower jaws do not fit together perfectly (e.g., in the case of an overbite or underbite). As a result, part of a molar is not worn down or hardly worn down at all, leading to overgrowth.

Consequences of hooks

• Limited lateral jaw movement
• Pain when chewing or accepting the bit
• Reduced performance when riding
• Poor grinding of feed → colic or weight loss
• Damage to soft tissues (cheek/tongue)
• Possible problems in the jaw joint (TMJ)

Treatment

• Hooks must be filed away by an equine dental technician.
• It is important not to file away too much at once — this can cause tooth problems or sensitivity.

Prevention

• Regular dental check-ups, at least once a year (more often for young or older horses).
• Correct feeding policy, with sufficient roughage for natural wear.
• In young horses, intervene in good time if there are jaw misalignments.

Remaining milk caps (also known as milk tooth caps) are remnants of milk teeth (usually molars) that do not come loose easily when the permanent teeth come through in young horses. They are also referred to as “caps” in English.

What exactly are milk caps?

• Horses are born with milk teeth.
• Between 2.5 and 4.5 years of age, they change to adult teeth.
• During this change, the milk teeth normally come loose on their own.
• Sometimes pieces of milk teeth remain on the permanent molars ➤ these are the milk caps.

Why is this a problem?
If these caps do not fall out on their own, they can:

• Cause pain while eating or riding
• Disrupt the growth of the permanent molar
• Lead to irregular wear of the teeth
• Be associated with headshaking, bit problems, or weight loss

Symptoms of retained milk caps

• Poor or slow eating
• Teeth grinding
• Salivating or foaming
• Bit problems, throwing the head up
• Bad breath
• Weight loss despite a good appetite

Treatment

• A horse dental technician removes the caps manually.
• This is often done during a routine dental check-up for young horses.

Prevention and control

• Have your horse's teeth checked regularly from the age of 2.5 years (start of the changeover period).
• Annual (or semi-annual) check-ups until the horse is around 5 years old, as this is when all the permanent teeth are usually in place.

A protuberant molar in a horse is a molar that has grown too far and protrudes above the normal wear surface of the other molars. This can lead to problems with chewing, pain, or even damage to the opposite molar or the oral mucosa.

What does “protuberant” mean?
The word protuberant literally means: protruding or bulging.
In horses, a protuberant molar means that the molar is higher than the rest.

How does it develop?
A molar becomes protuberant when:

• The opposing molar is missing (e.g., due to loss or extraction)
• The opposing molar does not wear down properly (e.g., due to incorrect jaw position)
• There is no normal occlusion (tooth-to-tooth contact), so that molar is not worn down as normal

Because horses have lifelong tooth growth and wear, such a molar will continue to grow if there is no normal wear.

Consequences

• Limited jaw movement (when chewing or riding)
• Pain or sensitivity when eating
• Poor grinding of feed
• Damage to the opposite jaw or soft tissues
• Sometimes jaw joint pain or blockages

Treatment

• The protruding molar must be filed down or flattened by an equine dental technician.
• Sometimes this must be repeated regularly if the cause (e.g., missing molar) is permanent.
• In severe cases, extraction or more extensive treatment may be necessary.

Prevention

• Regular dental checkups, especially for older horses or horses that are already missing a molar.
• Proper feeding: sufficient roughage and fiber ensure natural wear and tear.

A wave (also known as wave teeth or wave wear) in horses is an irregular wear pattern on the molars, whereby the chewing surfaces of the molars are wavy (with peaks and troughs) instead of flat and even.

What exactly is a wave (wave teeth)?
In normal teeth, the molars in the upper and lower jaw should close flat against each other. With wave teeth, there is a varying height pattern across the row of molars, as if there is a “wave” running through the teeth.

Row of molars with troughs (worn down too short)
Row of molars with peaks (too long/not worn down enough)

Causes of wave teeth

• Milk caps that remain in place for too long → affect normal wear and tear
• Loss of a molar → opposite molar grows through
• Protruding molars that are not treated
• Crooked jaw or asymmetrical chewing movement
• Poor nutrition (too little roughage) → insufficient natural wear and tear
• Teeth not maintained in a timely manner

Consequences of wave teeth

• Difficulty chewing → food is not ground properly
• Pain in the mouth → reduced appetite or weight loss
• Jaw joint overloaded or blocked
• Limited lateral movement of the jaw
• Poor performance when riding
• Risk of colic due to poorly digested feed

Treatment

• Wave teeth must be corrected by an experienced equine dental technician.
• This is usually done in stages over several treatments to prevent teeth from becoming sensitive or the bite from changing abruptly.

Prevention

• Annual (or semi-annual) dental checkups, especially for young horses (2.5–5 years) and older horses.
• Timely removal of milk caps
• Proper nutrition with sufficient roughage
• Be alert to early signs such as chewing cud or difficulty accepting the bit

Periodontitis in horses is an inflammation of the periodontium—the structures that anchor the teeth in the jaw, such as:

• The gums (gingiva)
• The periodontal ligament
• The jawbone
• The cementum (layer surrounding the tooth root)

What happens in periodontitis?Periodontitis causes the gums to become inflamed and recede. This allows food debris and bacteria to accumulate between the teeth, leading to:

• Deep gaps (diastemata) between teeth
• Pus formation, inflammation, and sometimes loose teeth
• Severe pain and poor eating
• Loss of teeth in advanced stages

Causes

• Food impaction between molars, especially in older horses
• Poor dental alignment or diastemata
• Prolonged presence of sharp points or hooks
• No or irregular dental care
• Poor oral hygiene (e.g., lots of concentrated feed, little roughage)
• Abnormal replacement of milk teeth in young horses

Symptoms

• Chewing with the jaws open
• Bad breath
• Pain or sensitivity when touched or chewing
• Weight loss or reduced appetite
• Poorly ground feed in the manure
• Excessive salivation
• Blood or pus from the mouth
• Bit problems

Diagnosis

• Dental inspection with a speculum (mouth clamp) by an equine dental technician
• Sometimes additional: endoscopy or X-rays to determine the severity (by a veterinarian)

Treatment
Depending on severity:

• Cleaning food debris between the molars
• Rinsing inflamed pockets with antiseptic solutions
• Filing irregularities and opening narrow gaps
• Sometimes filling diastemata with special materials
• Antibiotics for severe infections (veterinarian)
• In advanced cases: extraction of the affected molar (veterinarian)

Prevention

• Regular dental check-ups (at least annually, more often for older horses)
• Good roughage management (stimulates natural wear)
• Prevention and early treatment of diastemata or sharp hooks
• Do not feed too much concentrated feed or sticky feed types

Wolf teeth in (usually male) horses are small, often rudimentary molars that are usually located just before the first real molars (the premolars) in the upper jaw. They are also called “vestigial molars” because, from an evolutionary perspective, they no longer have any real function. Did you know that very dominant mares sometimes have wolf teeth?

Characteristics of wolf teeth

• Usually present in young horses (appear around the age of 6–18 months)
• Located in front of the first premolar (P2), i.e. between the incisors and molars
• Usually in the upper jaw (sometimes also in the lower jaw, but this is rare)
• Small, usually 0.5–2 cm in size
• May be hidden under the gums (blind wolf teeth)

Do wolf teeth have a function?
No, they no longer have a function. They have become superfluous in evolution. In some cases, they cause no problems, but in others they do.

Possible problems caused by wolf teeth

• Bit problems: the bit can press against the wolf teeth → pain, head shaking, resistance
• Sensitivity when taking the bit or bending the head
• Painful or rubbing sensation when moving the cheeks or tongue
• Inflammation or damage to the surrounding mucous membrane

Symptoms that may indicate troublesome wolf teeth

• Tilting or shaking the head while riding
• Difficulty with positioning or suppleness
• Refusing or fighting the bit
• Ignoring rider aids or explosive behavior
• Poor performance without apparent cause

Removal of wolf teeth

• Preventive: wolf teeth are often removed as standard in young horses before breaking in, even if they do not (yet) cause any problems. It is a minor procedure, but requires careful aftercare

Aftercare following extraction

• No use of a bit for approx. 7–10 days
• Monitor for swelling, bleeding, or inflammation

Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH) is a painful, chronic dental condition in older horses, which mainly affects the incisors (and sometimes also the canines). It is a degenerative process in which the teeth are affected, broken down and/or excessively covered with cement tissue.

What exactly does EOTRH mean?

• Odontoclastic Tooth Resorption = breakdown of tooth structures by the body itself.
• Hypercementosis = excessive production of cement (a hard tooth layer) around the tooth root.

EOTRH is a combination of resorption (breakdown) and hypercementosis (overgrowth). Both processes cause pain and inflammation in the tooth root and jawbone.

Which horses are affected?

• Mostly horses older than 15 years of age.
• It can also occur in younger horses, but this is rare.
• It is more common than people think, but is often recognized late.

Symptoms of EOTRH
The symptoms can be subtle. Possible symptoms include:

• Receding or inflamed gums
• Pain when eating, especially when biting off food (e.g., carrots, hay)
• Avoiding hard or long pieces of roughage
• Bulking up food or chewing slowly
• Bad breath
• Blood or pus from the mouth
• Loose incisors
• Weight loss or behavioral changes
• Unexplained resistance to bridling or teeth brushing

In advanced cases, you will see:

• Thickened, bulging roots (visible when the gums are exposed)
• Inflamed gums with fistulas
• Wedge-shaped or discolored teeth
• Sometimes the teeth break off spontaneously

Diagnosis

• EOTRH is not always visible to the naked eye.
• X-rays of the incisors are necessary for a definitive diagnosis. You will then see root resorption, bone changes, and/or cementum formation.
• Without an X-ray, it is difficult to assess how serious it is.

Treatment
There is no cure. Treatment focuses on pain relief. In cases of EORTH, I always refer to a veterinarian:

• In mild cases: dental monitoring, pain relief, soft food
• In severe cases: extraction of the affected incisors

It sounds drastic, but horses can eat perfectly well without incisors. After extraction, appetite and behavior often improve remarkably quickly.

Prevention and monitoring

• No real prevention known, as the cause is still unclear (possibly an immune response).

Important:

• Regular dental checkups, especially for horses older than 15.
• Be alert to subtle changes in eating behavior or oral health.
• Have X-rays taken in good time if you suspect anything.

Unilateral nasal discharge in a horse (nasal discharge from only one nostril) is a classic symptom of sinusitis, or inflammation of the sinuses. Sinusitis can be acute or chronic and is often caused by a dental problem or infection.

What exactly is sinusitis?

• Sinusitis is an inflammation of the horse's sinuses. Horses have several sinuses, including:
• Maxillary sinus
• Frontal sinus
• And several smaller sinuses

These sinuses are connected to the nasal cavity and can become filled with pus or mucus when inflamed.

Causes of unilateral sinusitis

1. Dental problems (most common)

• Inflammation or infection of a tooth root (especially the molars of the upper jaw)
• Broken tooth or diastemata → bacterial infection that breaks through to the sinus

     2. Bacterial infection without dental problems

• E.g. after a cold or respiratory tract infection

     3. Mycosis (fungal infection) – rare

     4. Cyst or tumor – rare, but can block the sinus

     5. Trauma – e.g. blow to the skull

Symptoms of sinusitis (usually unilateral)

• Pus or foul-smelling discharge from one nostril
• Sometimes bloody or yellow-green discharge
• Swelling or tenderness on one side of the face
• Painful when touching the jaw or forehead
• Eye discharge or watery eye on the same side
• Bad breath
• In more severe cases: fever or lethargy

Diagnosis

• Dental check-up by a dental hygienist
• Clinical examination by a veterinarian
  Endoscopy (looking into the nasal passages)
• X-rays or CT scan of the skull
• Possibly bacterial culture of the discharge
• Dental check-up, sometimes with X-rays to detect tooth root problems

Treatment
Depending on the cause, I will treat the animal myself or refer it to a veterinarian:

• Dental-related: extraction of the affected tooth + rinsing of the sinus
• Infectious: antibiotics + sinus rinses
• Chronic sinusitis: sometimes surgical drainage via a sinus opening
• Tumor/cyst: surgical removal (if possible)

Shear in a horse's teeth (also known as shear mouth) is a serious dental abnormality in which the molars are extremely worn at an angle, with a steep angle between the chewing surfaces of the upper and lower molars. Instead of a flat chewing surface, a kind of smooth “knife effect” is created — hence the name shear, which means “to cut” or “to slice.”

What happens with shear?

• Normally, horses chew with circular, sideways movements.
• With shear mouth, the chewing angle has become so steep that the horse can hardly chew sideways anymore.
• As a result, food is not ground properly and lumps can form.
• The teeth wear down even more unevenly, which exacerbates the problem → vicious circle.

Causes of shear mouth

• Chronic dental problem that has not been corrected in time
• Hereditary predisposition to crooked jaw position or incorrect wear
• Insufficient natural wear due to lack of roughage or chewing movement
• Pain in the mouth causing the horse to avoid chewing movements (e.g., hooks or diastemata)
• Sometimes secondary to other conditions such as EOTRH or sinus problems

Consequences of shear teeth

• Food boluses or messing with feed
• Reduced nutrient absorption → weight loss
• Risk of colic due to poorly ground food
• Pain when chewing
• Limited jaw mobility
• Irritated gums or oral mucosa

Treatment

• Step-by-step correction by a specialized equine dental technician.

        ->Do not file everything at once — risk of tooth sensitivity or                overload.

• Multiple treatments are often necessary.
• Additional: pain relief, feed adjustment (soft and finely chopped roughage).
• In severe cases: lifelong management may be necessary

Prevention

• Annual dental check-up (from young horse to old age)
• Timely treatment of minor misalignments, hooks, and irregularities
• Good roughage intake (stimulates natural wear)

Accentuated Transverse Ridges (ATR) in horses are highly raised, horizontal ridges on the chewing surface of the molars. These “ridges” or ridges are more pronounced and higher than normal and can disrupt the natural, flat chewing surfaces.

What are transverse ridges?

• A horse's molars naturally have ridged chewing surfaces with grooves and ridges (transverse or transverse ridges).
• These help to grind the feed by cutting and grinding.
• In ATR, these ridges are extra high and sharp.

Causes of ATR

Irregular or insufficient wear, for example due to:

• Incorrect bite (malocclusion)
• Limited chewing movements (due to pain or jaw problems)
• Uneven wear (e.g. due to hooks or sharp points elsewhere in the teeth)
• Diet that causes insufficient natural wear (too little roughage)

Consequences of ATR

• Pain or discomfort when chewing
• Prevention of natural sideways chewing movements
• Possible irritation of the tongue or cheek mucosa due to sharp ridges
• May lead to further dental problems such as hooks, hook formation, or deep diastemata
• Poor grinding of food

Treatment

• Excessive ridges are filed down or smoothed by an experienced equine dental technician.
• The aim is to restore a flat and functional chewing surface.
• Regular maintenance prevents recurrence.

Prevention

• Regular dental checkups and maintenance
• Good nutrition with sufficient roughage to stimulate natural wear
• Timely treatment of other dental problems such as hooks and diastemas

Diastases in horse teeth are gaps or open spaces between two teeth or molars where the teeth would normally be close together.

What exactly is a diastasis?

• A narrow to wide opening between two teeth or molars.
• It is particularly common between the premolars (front molars) of the upper or lower jaw.
• These gaps can trap food, and food debris and dirt can sometimes remain there.

Why are diastases problematic?

• Food that gets stuck can ferment and become inflamed.
• This often causes painful inflammation of the gums and surrounding bone (periodontitis).
• Horses may therefore chew with difficulty, have trouble chewing, and sometimes even bleed from the mouth.
• Prolonged irritation can lead to worsening of the diastasis and loss of teeth.

Causes of diastasis

• Naturally occurring in older horses due to tooth displacement or wear
• Dental abnormalities such as crooked teeth or molars
• Loss of a tooth or molar, causing the opposite molar to grow
• Irregular wear or dental problems (such as hooks and sharp points)
• Incorrect bite or jaw position

Symptoms of diastasis

• Forming lumps while eating
• Reduced appetite or pain when chewing
• Bad breath
• Painful or inflamed gums between teeth/molars
• Sometimes visible gaps with food debris

Treatment

• Cleaning the diastemas by a horse dental care professional
• Opening or widening the gaps to prevent food accumulation
• Sometimes filling or treating with special materials
• Regular check-ups and maintenance to prevent worsening
• In severe cases, extraction of affected molars

Tooth fractures in horses are breaks or cracks in a tooth or molar, which can range from small cracks to large pieces of tooth breaking off.

What exactly is a tooth fracture?

• A break in the tooth tissue: enamel, dentin, and/or dental pulp (the soft inner part containing nerves and blood vessels).
• Can occur on the chewing surface, the crown (visible part) or deep into the root.

Causes of tooth fractures

• Trauma: e.g. impact with hard objects, boxing against fencing
• Biting down on hard objects such as stones or iron parts
• Overloading due to incorrect chewing or dental problems (such as hooks)
• Weak tooth tissue due to age, caries, or infection
• Sometimes spontaneous in weakened teeth

Consequences of tooth fractures

• Pain and sensitivity, especially if the pulp is exposed
• Risk of infection from bacteria entering through the fracture
• Inflammation, abscesses, or sinusitis (in upper jaw fractures)
• Difficulty eating or chewing
• Loss of the tooth in severe fractures

Symptoms

• Pain when eating or touching the mouth
• Reduced appetite or food boluses
• Bad breath or pus from the mouth
• Swelling of the jaw or face
• Head shaking or refusal to bite while riding

Diagnosis

• Visual inspection with a mouth speculum by an equine dentist or veterinarian
• Possibly X-rays to determine the depth of the fracture

Treatment
In the event of a tooth fracture, I always refer the patient to a veterinarian

• Small cracks: monitoring and pain relief
• Deep fractures with exposed pulp: often root canal treatment or extraction
• Large, damaged teeth: usually extraction to prevent further problems
• Antibiotics for infections
• Aftercare with appropriate food and pain relief

Tartar in horses is a stubborn, chalky deposit that can form on the surface of teeth, usually around the neck of the tooth (the transition between the tooth and the gums).

What is tartar?

• It is caused by the accumulation of plaque (a sticky layer of bacteria and food debris).
• Plaque mineralises and becomes hard and rough, which we call tartar (or calculus).
• It is less common in horses than in humans, but it can still occur, especially in older horses or horses with reduced saliva production.

Causes of tartar in horses

• Poor oral hygiene (no natural cleaning through chewing or insufficient roughage)
• Excessive accumulation of food debris and bacteria
• Dental problems that prevent teeth from staying clean
• Age: older horses are more susceptible
• Some foods can promote plaque formation

Consequences of tartar

• Irritation and inflammation of the gums (gingivitis)
• Increased risk of periodontitis (inflammation of the supporting tissue of the teeth)
• Bad breath
• Pain or discomfort in the mouth
• Possible deterioration of the teeth due to underlying infections

Symptoms

• Brownish or yellow hard deposits on teeth/molars
• Red, swollen, or bloody gums
• Bad breath
• Difficulty eating or chewing
• Reduced appetite

Treatment

• Professional teeth cleaning by an equine dental technician
• Removal of tartar with special instruments
• Treatment of any inflammation
• Regular dental check-ups to prevent recurrence

Prevention

• Sufficient roughage to ensure natural wear and cleaning
• Regular dental check-ups and maintenance
• Good nutrition and oral hygiene

A tooth root abscess in a horse is a painful infection around the root of a tooth or molar in which pus accumulates in the surrounding bone tissue.

What exactly is a tooth root abscess?

• It is an infection of the jawbone around the root of a tooth or molar.
• It often occurs when bacteria enter through a fracture, caries, or gum inflammation.
• The body responds with inflammation and pus formation, leading to an abscess.

Causes

• Tooth fractures where bacteria reach the pulp (nerve)
• Diastemas where food and bacteria accumulate
• Deep caries (tooth decay)
• Infection due to dental problems or sinusitis
• Traumatic injury

Symptoms

• Swelling of the jaw or under the eye (depending on which tooth is affected)
• Pain, often noticeable when eating
• Fever or general malaise (in severe infections)
• Unilateral nasal discharge (in cases of upper molar abscesses)
• Reduced appetite or problems with chewing
• Sometimes pus discharge through the gums or nose

Diagnosis

• Clinical examination by an equine dental technician, followed by referral to a veterinarian.
• X-rays of the jaw to examine the abscess and tooth root (veterinarian)

Treatment

• Antibiotics to fight the infection
• Sometimes pain relief
• Rinsing of the abscess if possible
• Extraction of the affected tooth, especially in the case of persistent abscesses
• Aftercare with appropriate nutrition and monitoring

Caries is tooth decay in which bacterial damage to the tooth tissue (enamel and dentine) causes holes or cavities to form in the tooth. This is less common in horses than in humans, but it can occur and cause problems.

1. Infundibulum caries

• The infundibulum is a funnel-shaped groove filled with cement and tooth material in the molars of the horse's upper and lower teeth.
• Infundibulum caries is tooth decay that forms in this groove (infundibulum).
• Because this area is a natural cavity, food and bacteria can accumulate there and lead to caries.
• This can cause the tooth material around the infundibulum to weaken and break down.

2. Pulp caries

• The pulp is the soft inner part of the tooth/molar where the nerves and blood vessels are located.
• Pulp caries means that the tooth decay has penetrated so deeply that the pulp becomes damaged or inflamed.
• This often causes pain, possible inflammation, and can lead to abscesses or tooth root problems.
• This is a more serious stage of caries and often requires more intensive treatment.

Causes of caries in horses

• Food debris accumulating in grooves or crevices
• Insufficient natural wear (too little roughage)
• Food high in sugars or starch can accelerate the process
• Irregularities in the teeth that make cleaning difficult

Consequences of caries

• Pain and discomfort when chewing
• Sensitivity or inflammation of the dental pulp
• Risk of tooth fractures or abscesses
• Poor chewing function

Treatment

• Early detection through dental check-ups; if detected, referral to a veterinarian at all times
• Removal or cleaning of caries lesions by an equine dentist
• In severe cases, extraction of the affected molar
• Good dental care and nutrition for prevention

Pulpitis in horses is an inflammation of the dental pulp, the soft, living tissue in the center of a tooth that contains nerves, blood vessels, and connective tissue.

What exactly is pulpitis?

• The pulp is located deep inside the tooth, protected by enamel and dentin.
• In pulpitis, this tissue becomes inflamed due to irritation, infection, or trauma.
• This can be the result of, for example:

         -Tooth fractures

         -Deep caries (tooth decay)

         -Excessive wear that exposes the dentine

         -Infections that penetrate into the pulp

Symptoms of pulpitis

• Pain or sensitivity in the mouth
• Difficulty chewing or avoiding food on one side
• Reduced appetite or weight loss
• Sometimes swelling or abscess formation around the affected tooth
• Behavioral changes such as refusal to the bit

Consequences if pulpitis remains untreated

• Inflammation spreads, possibly to the root and jawbone
• Abscess formation around the tooth root
• Tooth loss or extensive damage to the teeth
• Chronic pain and health problems

Treatment
Depending on the severity, a referral to a veterinarian is always necessary:

• Pain relief and anti-inflammatory medication
• Antibiotics for infections
• Root canal treatment (in some cases)
• Extraction of the affected tooth/molar in case of irreparable damage

Aftercare and regular dental check-ups.