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Expert advice on wolf tooth extraction

In the first of a new ‘ask the experts’ series, Kieran asks equine vets with dental expertise about the removal of wolf teeth

by Jennifer Banfield
19 December 2017, at 4:38pm

Although supporting scientific evidence is lacking, horse owners attribute all sorts of behavioural and equitation issues to the presence of ‘wolf teeth’ (Triadan 05) in their horses’ mouths. Removal of these teeth is therefore a commonly-requested procedure in equine practice. Here, we ask Pete Ravenhill and Sam Hole, two veterinary dental experts, about issues that can arise during removal. 

What is your practice’s approach when asked to sedate a horse for wolf tooth removal by an equine dental technician (EDT)? 

Pete Ravenhill We will only sedate for qualified and current BAEDT members, and our vets must provide direct and continuous supervision. The EDT must only perform Category 1 and 2 procedures (blind wolf teeth are Category 3). I encourage all our vets to nerve-block as well as sedate these cases for an EDT. 

Sam Hole The client and the horse must be registered with the practice. The EDT should be known to the practice, ideally have contacted the practice regarding the case in advance of the appointment, and be a current member of the BAEDT. The wolf tooth may be removed if erupted, and in a ‘normal’ position and under the direct and continuous supervision of the vet in attendance.

What is your usual sedation and anaesthetic regime for removal? 

PR I sedate with iv detomidine and butorphanol, and then nerve-block both sides using a human dental syringe and one to two cartridges of lignocaine/adrenaline each side. I block palatal and buccal to each wolf tooth, i.e. two blebs.

SH I use a mixture of an alpha-2 agonist (routinely detomidine) and an opioid (routinely butorphanol) intravenously, pre-operative analgesia using a non-steroidal anti-inflammatory drug (routinely phenylbutazone) and regional anaesthesia. For maxillary wolf teeth, I use an infra-orbital block, a greater palatine block and local infiltration, and for mandibular wolf teeth I use a mental block and local infiltration. 

Do you believe some wolf teeth can only be removed by fracturing them? 

PR Some wolf teeth are extremely fiddly to extract and in some cases, fracture of the tooth is inevitable. 

SH Yes, but only a very small number, which are usually in mature horses or wolf teeth which are worn or diseased. In these cases, the root may be ankylosed or fused to the supporting bone. 

A collection of wolf teeth
A collection of wolf teeth

If the tooth fractures during removal, do you believe it is essential to remove the remaining fragment(s)? 

PR Yes. I always curette out the alveolar socket afterwards with a simple spoon curette and ensure all fragments of tooth root and bone are removed. I check the socket with a mirror to ensure a smooth socket. 

SH The goal should always be to extract the complete tooth; however, sometimes this may not be possible, especially in mature horses or worn wolf teeth. An attempt should always be made to extract the retained root, but if the retained root is healthy and well below the alveolar crest, it may be left in situ as it is unlikely to cause complications. However, the owner should be informed and the complication noted on the horse’s dental chart. 

Have you ever seen any complications following wolf tooth removal? 

PR Tooth and bone fragments retained in a socket or just in the gingiva causing local biting pain, inflammation or bleeding when probed. I have seen one case of palatine artery rupture.

SH Many, including delayed healing, retained roots, foreign body retained within the alveolus, alveolar infection and sequestration, and nasal fistulation.

Have you ever seen large wolf teeth in horses that caused no apparent bitting/ equitation problems?

PR Yes, but usually in disciplines not requiring a large degree of ‘bit contact’ or if very simple snaffle bits are used, e.g. in thoroughbred flat racing compared to dressage/ polo. I examined a TB mare that had won the French 1,000 Guineas and she had enormous upper wolf teeth. But my personal policy is to remove all wolf teeth at first dental check. 

SH Yes, but these are ‘normally’ positioned maxillary wolf teeth rather than displaced, blind or mandibular wolf teeth. 

A maxillary wolf tooth in the usual position
A maxillary wolf tooth in the usual position

Have you ever caused haemorrhage from the palatine artery? What is the best way to deal with this? 

PR I have not caused it myself, but have dealt with a case that was admitted to an equine hospital due to palatine artery rupture at wolf tooth removal. You have to apply pressure until bleeding stops. The artery is very difficult to ligate due to the position of the artery tucked against bone. In this case we sutured a temporary gauze stent across the affected area. 

SH Yes, but only twice in 20 years, which isn’t too bad! Maintain adequate sedation, raise the head and apply digital pressure using medical gauze for five to 10 minutes, then place the horse in a quiet, deeply-bedded stable with the head elevated until the haemorrhage stops and the sedation has worn off.