Studies and dissertations
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Today I want to tell you about EOTRH. This has been a disease that has become a little more common in horses over the past 20 years. This EOTRH stands for Equine Odontoclastic Tooth Resorption and Hypercementosis. I'll explain what all of this means in a moment.
In the dental practice for horses we repeatedly see older horses with such findings. And now to the term, what is actually all called - the definition - it is a painful disease of the tooth-retaining apparatus of horses, mostly from 15 years, but it is sometimes also diagnosed in younger horses. Mainly incisors and also stallion teeth are affected. There are sometimes cases where molars are also affected. The advantage is that since the horse actually has to grind the hay with its molars, we have no immediate problems with it. Nonetheless, it is a chronic, very painful disease in horses.
What is happening there? It is an interplay between an increased breakdown process of the teeth holding apparatus. The substance of the tooth is what these so-called or odontoclasts make. These are cells that break down the substance physiologically, but here of course pathologically in excess. These are related to an increased formation of tooth cement in horses, as you can see here. On this tooth. This massive hypercementosis is then said to the. Are these two factors that interact a little? So on the one hand tooth substance, excessive degradation and on the other hand excessive this cement to formation in the gums and this is very, very painful for the horses and, as you can see here, favors the development of massive inflammations, which in turn lead to even more pain in the horse .
There are similar diseases, for example in humans. The Multiple Idiopatic Root Absoprtion MIRR. You can see that in this picture. Since the odontoclast activity is also increased and in cats, a very common disease is Feline Odontoclastic Resoptive Lesions FORL or today just called RL.
You see this again and again in the small practice, including cats, where you really have to pull your teeth because these odontoclasts really eat their way into the teeth like holes. The difference between these two diseases and EOTRH in horses is that there is no hypercementosis in cats or humans.
Humans have no cement formation anyway, this is the third tooth substance every horse does not have. This is the only difference. We only have one breakdown process. But here we also have a massive formation process of tooth substance.
Well, the clinical picture There are different manifestations, that makes it partly with the diagnosis partly relatively difficult, where in the past it was rather underdiagnosed, because one simply did not know it and did not know it would today partly if one did so If you have small lesions in your gums, oh, it could be EOTRH.
It is sometimes a little overdiagnosed, but it is not always easy to find out. The early stage, i.e. the clinic, is very important when assessing the incisors and stallion teeth during dental treatment or during a routine examination, depending on the co-operative nature of the horse. In the early stages you can see horses with more frequent gums, inflammation, and slight changes in the shape of points, as you can see here. It often happens up here that there is a fistula formation. I'll get to that in a moment. Such small shaped changes then often cause friction with the gums down here and they often tend to form more tartar, which can be seen very clearly here on the stallion tooth and accordingly, of course, chronic gum inflammation, because that is a great factor for bacteria, which of course can proliferate. Food or leftovers can get stuck. Of course, this also increases the inflammatory response. This can of course progress so far that it looks like this down here. Massive distension in the advanced stage. We sometimes have tooth fistula formations, like here then really a regression of the gums. And you can imagine that. If there is such a massive hypercementosis and such a massive gum inflammation, it is of course very, very sensitive to pain. The horses show that local pressure sensitivity is generally much more sensitive when bridling or when you palpate the gums directly, of course.
As a horse dentist you often see it right because you palpate everything and if a horse reacts very strongly in deep sedation, if you only get to the teeth or press the gums, then you know there must be a painful process . However, there may also be pain when the food is consumed. Especially horses that have to eat out of the hay net or if they have to bite off something hard, i.e. everything they need the incisors for, that can also be that they react violently or with pain or simply do it less. In this context, of course, weakness in performance, apathy up to massive defense against the bridle and unrighteousness. So everything that can actually trigger chronic pain in a horse.
You really have to take into account that it is sometimes extremely painful for the horses, although you don't notice it in the horse, not at all in that sense.
Now to the diagnosis - on the one hand, as shown earlier, on the basis of the clinic, i.e. the typical swelling of the mucous membrane, the typical shaped changes, the painful reactions etc. There are studies where horses have been examined randomly and X-rays have been taken This hypercementosis has also partly been seen in horses, where there were no external clinical signs of EOTRH. So it is not always that easy, but the clinic is very important. At one of the wild pictures earlier, you look and after a second you have the diagnosis, because there is nothing that makes such changes comparable. But in the early stages it is sometimes worthwhile to confirm the suspicion with X-rays. On the left picture we have x-rays of the upper jaw and lower jaw of a healthy horse. And here we have x-rays of my horse with EOTRH with significantly advanced hypercementosis. You can see the difference very clearly, it is massive or very, very dense. X-ray, dense structures. Then we already have an analysis of the tooth supporting apparatus there is it is chronically painful it is. That is self-explanatory with the X-ray image.
Then to the causes. To this day there is no definite explanation. You still argue. Yes, how does it come about? Is it a disease at all or is it a sign of old age in horses? A certain genetic predisposition is suspected. You can see it on certain lines, a bit more frequent EOTRH diseases due to the fact that the horses are getting older and older, due to the fact that you look at these horses even more intensely compared to the last 20 years, that you go to the horse dentist, that one also judges these incisors. It is also a question. The horses are getting older, so maybe that's why we see it more often. You can't quite answer that. There are studies that say favoring diseases, such as Cushing's disease The PPID. This is a tumor of the pituitary gland that causes more cortisol to be produced. Due to the increased cortisol content in the body, these horses also tend to be more affected by inflammatory diseases. So with them you see the EOTRH much more often. It is also suspected that certain vitamin deficiency minerals such as calcium deficiency, vitamin E deficiency that also has favorable factors or immune-awarded animals. What is certainly very important is that the pressure load as horses get older, the teeth angle more and more and there one has the assumption that there is more pressure on these teeth, the more such a process can develop they favor him. This is also very important in therapy because you look at it that way. What is very important is the tooth correction, i.e. that you really check the incisors of the horses, that you make sure that these incisors are not under too much pressure, most often affected by EOTRH, or the most common teeth that really need to be extracted, the three are the outer incisors. These are the ones who, even in old age, have more pressure due to the development of the incisors. And my personal theory is really, if you reduce the pressure, to see that these incisors are balanced, it is just as important, of course, that the molars are made correctly. Can you significantly reduce these processes a little!
Since naturally removing tartar, cleaning the teeth in horses, which are very often prone to tartar formation, sometimes 6 or 7 year old horses, I recommend the owner again and again. You look at me with such big eyes that you manually, if the horse participates, use a soft toothbrush that really cleans the teeth from time to time in these interdental spaces and also the stallion's teeth and that reduces the build-up of plaque this tartar and that's where all the bacteria then accumulate. And for me that is the one that makes the two 50 percent of this EOTRH. One hand this process the tooth socket, but the other all this gum inflammation and that makes up half the battle, of the pain, tenderness and comfort for the horse. But when a horse looks like this, there really isn't much more you can do than do the horse a huge favor and pull those teeth out. The question is always when, of course, an entire row of teeth is so badly affected. The owners always have a hard time telling what all the front teeth are pulling away. This is a huge invasive procedure when a horse is really severely affected in case of doubt. Then the chronic pain pulls a tooth or two, the pain then continues, then you really do the horse a huge favor and pull all the incisors. The only negative effect for the horse, because most of the owners, who then struggled, say in the end it was the horse. I thought he was older, but now he's fit again. He likes more now. The only disadvantage is that the tongue can protrude because of course the incisors have a certain holding function. That looks a bit funny, doesn't bother the horse at all. It's just a cosmetic side effect.
But now there are these intermediate stages. Of course, you want to preserve these teeth as much as possible. And there is, for example, the use of vital mushrooms in addition to this mechanical correction with this mechanical cleaning. There are also no proven studies that this works. They are immune, modulatory, anti-inflammatory and also have a certain antibacterial effect. Personally, I can say that with certain horses that have been treated with it in this way, I have the feeling, and that also helped the owners. It was a little better. With others, I have the feeling that it didn't do much. Well, nothing at all has been proven, but that is certainly one aspect of it. And what for me to say as an interim solution, Hey, pull teeth or do nothing and correct, which is very, very promising, I find Vetdrop.For me this is definitely something where we really have to stick with it. Do more data collection, more case documentation, absolutely. At the moment I am allowed to accompany two cases in which I am really convinced that this has had a clearly positive effect. I have often talked about the anti-inflammatory and antibacterial effect, about mechanical cleaning, removing tartar and Vetdrop does the whole thing with a deep function through these microscopic oxygen particles that can be combined with herbal products, but in medicine Of course, theoretically also with anti-inflammatory drugs, etc. And since the horses that I was allowed to accompany, I was very surprised. After a few months of treatment, they had much less reddening and there was much less pressure on sensitive gums. The teeth have become stronger in the tooth socket. The funny thing is, the tartar has almost come off by hand over time, so after a few treatments you could really remove the tartar with a finger and the fistula opening and fistula canals have partly receded significantly. So I think there is absolutely an approach. It does not cure EOTRH, but it does significantly reduce the external inflammatory processes. This significantly reduces the pain for the horse and we can stagnate the process with it and prevent that somehow one would have to pull quite a lot of teeth quite early. And of course with the owners, where that is out of the question, who cannot be convinced and it is not so bad for us that you say was that, that is, you absolutely have to do it. With Vetdrop we have the chance to help the horses without actually having to do anything invasive. And we absolutely have to stay tuned. Thank you very much for your attention