And the award goes to...

MISTY!  

For best dental check-up!

We went back to our local horse doc today for our last, final, concluding, determinate vet  visit since this whole tooth ordeal began four and a half months ago.  

The vet and the tech discussed checking Misty without sedation.  They decided, "Yes, let's try it because she's been such a good girl."  So they inserted the dental speculum and flushed Misty's mouth.  Misty stood patiently while the vet reached in and examined the empty socket...and declared it good!

The socket is granulated up to the gum line. 

There is no putrid odor. 

External facial swelling has decreased to almost normal. 

Misty can go back to work.

I'm not wasting any time.  I'm taking my girl to a clinic on Saturday and then taking her back to her trainer on Sunday.  I'll probably just do ground work at the clinic and will play it by ear on some very light riding.  And Misty's trainer will begin easing her back to work and put some finishing on her.  And maybe, just maybe, I'll get to go on a few trail rides before it starts snowing.

Here are the final pictures of the tooth as it was removed in stages.

Left to right:  The slab fracture removed in March, the pieces that broke apart when my local vet tried to extract the remainder of the tooth in May, and finally the rotten root portion that was removed via Steinmann Pin Repulsion in June.

The dentist who performed the repulsion said this hole was not made by the Steinmann Pin.  It might have been caused by decay and abscess.  Interesting. 

THE END

(I hope, I pray)

Success At Last

Misty's dental procedure went very well and that tooth is outta there!  Finally!

They let me take a couple of pictures during the procedure, but asked that I not post them online.  I'm not sure why.  Maybe because someone might think it looks like abuse rather than a veterinary procedure.  It did look rather Frankenstein-ish, but was fascinating to watch.  I think it is safe to share one of Misty's xrays. After all, I paid for them and they are not as disturbing as seeing a metal pin sticking into her sweet face.

First the dentist inserted a needle into Misty's jaw, above her bad tooth (#207), and took an x-ray to check the alignment.  Next she inserted a Steinmann pin, following the same path as the needle.  Another x-ray was taken and the pin realigned slightly, and another x-ray to confirm the desired positioning. I don't have a copy of the final confirmation x-ray.  After this shot the dentist chose to reposition the pin forward by about 2mm.  Since the tooth was rotten, the dentist was being very careful to aim the pin at the strongest part of the root to lessen the chance of the pin passing through the diseased tooth.

Then the dentist began tapping the pin with a metal surgical mallet, while her tech kept a hand in Misty's mouth, feeling for the vibration on the bad tooth.  It looked like the pin kept sinking deeper and deeper into Misty's jaw, when the tech finally said she was feeling the tooth move slightly.  The dentist switched places and felt the tooth.  The tech continued the tap...tap...tapping...and finally the tooth, root and all, dropped right into the dentist's fingers and everyone rejoiced.  Vets and their techs get really happy when procedures like this go as planned.  My local vet and her tech were there too.  Everyone got a learning experience feeling inside Misty's mouth, including me.  I've never had my hand inside Misty's mouth before.  It was amazing to feel her big teeth and the sharp point of the Steinmann pin still inserted through Misty's jaw and protruding into the huge gap where the rotten tooth had been.

The procedure took about 3 hours.  Misty was discharged a couple of hours later and spent the night at home in her pressure bandage.  I fed her soaked Timothy grass pellets when we got home.  She was very hungry and that bandage didn't slow her down one bit.

The next morning I removed her bandage.   She'll get her little pink stitches out around July 13th.  Until then I will be giving her oral antibiotics through a syringe and flushing her mouth twice a day with diluted Nolvasan.  Surprisingly, she likes the Nolvasan flush.  I don't even have to halter her for it.  She readily opens her mouth and lets me flush it 4 or 5 times with a syringe.  When she realizes I'm done, she tries to grab my container while I'm putting the cap back on.  Silly mare.

Misty is doing well and happy to return to napping with her good buddy SaraJane.  Goodness gracious those two princesses like to nap.  Must be nice.  I think we humans should follow their lead and take more naps.

Here is the official treatment report:

Misty was sedated with Dormosedan and Torbugesic, given anit-inflammatory (Banamine), and a maxillary nerve block was performed. Oral extraction not possible with missing crown. A Steinmann pin repulsion was performed successfully with radiographic guidance. The Steinmann pin tract was flushed with saline/dilute Betadine solution. The socket was packed with Metronidazole and Technovite packing.

Oh...you might be curious what something like this costs.  Me too!  I haven't received the final invoice yet, but the office told me it looked like it would be about $800.00.

Click HERE to see another Steinmann pin repulsion that is documented online by
The Academy of Equine Dentistry.

The Next Step - Drill and Punch

My vet was unable to extract the rest of Misty's tooth on Wednesday, even with a variety of interesting dental tools graciously loaned from an equine dentist with whom she has been consulting.  The root is holding strong, but the tooth is riddled with micro-fractures and my vet cannot get a grip without causing the tooth to break into tiny pieces. 

The next step is to take Misty to the equine hospital near Denver and the dentist there will drill into Misty's jaw and punch the tooth out.  I'm just sick about it, but it appears to be the only option now. The tooth has to come out or it will be a chronic problem.

I'm worried and dread the idea of a hole drilled into Misty's jaw.  I don't know what to expect yet with aftercare and healing.  This will be another learning experience.  I just want to get it over with so Misty can heal and get back to normal.   My vet is arranging the appointment so she can be there too.  I hope we can get it done next week.

As Lady Macbeth Might Say

   
Out, damned tooth! out, I say!

Misty spent three days and two nights at the vet clinic last week while they worked on extracting her bad tooth.  

Day 1:  They patiently wiggled the tooth to loosen it.  We're dealing with tooth number 207 on the chart below. (the 2nd upper left premolar)

Day 2:  They spent almost five hours extracting the tooth but could not get all of it out.  It fractured more and they had to remove it in pieces.  Fracturing has been our problem since this ordeal began. The vet has several molar extractors that have worked well for 10 years on all dental cases.  But now they cannot get a good grip on the remaining tooth with their extractors.  They need to acquire some more specialized dental tools; extractors with multiple prongs on the end, I think.

Day 3:  They observed Misty to make sure she was comfortable and eating normally.  The decision was made to send her home for a break.  Misty will return later this week.  About 1/3rd of the tooth remains; hopefully they'll get the rest out without another overnight stay.  Worse case is they'll have to drill into her jaw and punch the tooth out.  I hope it doesn't come to that.

While Misty is home, I am flushing the left side of her mouth twice a day with Chlorhexidine solution mixed in water.  Coincidentally, my own dental hygienist has me using a Chlorhexidine rinse to treat periodontal disease.  So I'm very sincere when I commiserate with Misty on the bad taste.

The good news is we're seeing progress.  Misty is eating well and appears to be in no discomfort.  There is slight inflammation on her cheek from the diseased socket, but she is no longer pocketing a wad of hay the size of my fist in there.

The vet commented on how good-natured and easy Misty has been to work with.  Good behavior deserves a discounted vet bill, don't you think?  A horse owner can hope. 

Modified Triadan from Wikipedia

Misty is an 8 year old Percheron. Her xray is in this post.

Misty's Monday Muse - Troublesome Tooth

Looks like my tooth woes are not over yet, but we have a plan.

I went back to the vet today and the Doc pulled the stash of putrid hay out of my cheek and found some new inflammation.  Something didn't smell right and it wasn't just my stinky rotten hay breath.

The Doc took some pictures of my troublesome tooth and said the root does not look healthy.   I was sneaky because I hadn't shown any signs of infection or abscess all along.

Bad Tooth - 2nd from the right.

At least now the decision is easier to make.  I will go back this week to have the remainder of my naughty tooth pulled.

Everyone is sad that my young tooth could not be saved.  But it is best to be rid of it.

 I should have flossed more often,

Waiting for the Tooth Fairy

I took Misty back to the vet  last Friday for our 7th appointment due to her fractured tooth.  The deep pocket in her gum had to be cleaned and repacked many times because food kept getting packed into the root pocket and slowed the healing process. 

Finally, Misty's gum is healed.  That is good!  But now we have a new problem.

The slab removed was on the outside of tooth 207 (upper left).  Now there is a cup-like gap where the slab used to be.  The location of the fracture - left side and on the outside of her tooth - combined with the mechanics of how Misty chews with a motion from left to right, is causing hay to become wedged into the gap.  She has a huge, uncomfortable lump protruding from her cheek.   And since the gap is on the outside of the tooth, Misty's tongue does not come into contact with the wad of hay and she cannot dislodge it naturally.  The hay is accumulating and putrefying inside her cheek.  The only way to remove the hay is to have the vet sedate her and dig it out.  That certainly is not a good long term solution.

Our first thought is to go ahead and remove the rest of the tooth.  But the remainder of the tooth is large, healthy and solid. Misty is a Percheron; she's got big teeth and she is only 8 years old.  This would not be a simple extraction and might require a costly trip to an equine hospital.  My vet is consulting with some equine dentists to see what our options are and I'm anxiously awaiting a call back. 

I think I'll give them a call now and see if they've come up with a plan.  I'm tired of waiting.

Misty on the Mend

Misty's bump was diagnosed on Monday.  She had a slab fracture of tooth #207 on her upper left jaw. Fortunately there was no abscess. The bump was inflammation caused by a HUGE ulcer where the broken slab of tooth was digging into the side of her mouth.  Poor girl must have been in a lot of discomfort, but she never showed how much.

Misty had two vets working on her and it took them about one and a half hours to remove the slab. They took turns wiggling the slab loose until they could fit their big tooth-puller around it. Then it was quick business to pull it out.  She has about two thirds of the tooth left. Misty was a good patient, albeit stoned out of her mind.  They had to give her a couple extra shots of sedative to get that big mouth of hers to be still.  Even with her head drooping almost to the floor and her legs splayed to keep her balance, her mouth remained very busy. She managed to wriggle out of the speculum twice while they were examining her.  Good thing vets can pull their hands out of a horse's mouth with lightening speed.  But the third shot was a charm and her busy lips finally succumbed to the sedative.

Wow, it was a stinky job with a very strong odor of putrid hay and dental decay.

Misty is home while she heals and receives antibiotics.  The inflammation is going down slowly.  Hopefully she'll be ready to resume her training sometime next week when the swelling is completely gone.

Misty's Monday Muse

Spring! Tis the season for veterinary care. Marley and I have been busy with our check-ups and we have pictures to share.

Usually, our equine general veterinarian (like a human's primary care physician) takes care of our teeth, but this time My Lady called a specialist; an equine dentist/chiropractor. My Lady is very glad she made that call because it turns out we needed a little more than the routine floating performed by our general veterinarian. (Floating is the process of leveling and smoothing a horse's teeth when they wear unevenly).

I went first. They doped me up with some drugs and put a big dental speculum in my mouth to prop my jaws open. I was backed into a corner so I wouldn't fall down while under sedation.

My legs are wobbly.

Feelin' Groovy.

I had some very sharp points on my teeth that were causing ulcerations on the inside of my cheek. Ouch!

The dentist used her power tool to grind down those sharp points and make my teeth level and smooth. Her assistant helped hold my head up. Nobody has ever accused me of being petite; I have a huge noggin!

Bye bye sharp points.

A close up of the power tool in action.
The assistant holds my tongue out of the way.

Equine dentists use a combination of power tools and other instruments much like a human dentist.

In addition to those sharp points, the dentist found the root of a cap (baby tooth) wedged between my molars. I'm 6 years old and this thing should have fallen out by the time I was 4. She said it probably felt like I had a piece of popcorn stuck between my teeth. Imagine if you had popcorn stuck between your teeth for 2 years! The nice dentist extracted the root. Ah, relief at last.

The annoying baby root that shouldn't have been there.

The dentist also found that my TMJ (temporomandibular joint) was a little stuck. This might account for the strange noise My Lady has heard when I chew my food. Since the dentist is also a trained equine chiropractor, she put her hands under my jaw and with a quick move and a popping sound, she adjusted it.

The dentist points to my TMJ.

All done, but still dopey.

Since I had a few issues and seem to wear down my teeth a lot, I'll be visiting with the dentist again in six months.

Next it was Marley's turn. His bite was better than mine and his teeth looked pretty good considering he hadn't been floated in more than a year. However, he did have a cavity. Too many Pony Pops Marley!

Marley gets a minor float.

Leveling Marley's incisors.

Rinse and spit.

Horses don't get cavities very often because their teeth are much harder than human teeth. But it can happen. The dentist filled Marley's cavity because it was large. Equine dentists use the same filling material as used on people and they cure the filling with the same kind of blue light. They don't like to numb the tooth though, because a horse won't understand not to rub their face raw if they can't feel it. The sedation has some general pain killer within and Marley was a trooper. He didn't react to the filling at all. In fact, the dentist said it was the easiest filling she's done in a long time. Good boy Marley.

Here is Marley's pretty new filling. Yes, this is Marley's mouth, not that of a hippopotamus. Look for the part of the tooth at the left that is all white, where the dentist is shining the light. Click to enlarge.

Those dark spots in the center of the other teeth are typical. Horses don't have teeth covered in enamel like people. Our teeth are made up of enamel and dentin, so those ugly dark spots are not decay, but are normal.

Marley is done, but still in la-la land.

While sedated, the dentist was kind enough to take care of Marley's personal hygiene needs unique to the boys. To maintain Marley's dignity and keep this blog G-rated, we did not take pictures of that!

If you would like to know more, here is an interesting article from U.C. Davis School of Veterinary Medicine about Equine Dentistry.

You humans with the opposable thumbs...remember to brush and floss tonight!