What to do with the geriatric dental patient

摘要

Older equine patients inevitably have some degree of dental disease. This may be due to the natural ageing process or due to the compounding of dental disease, which developed earlier in life. The ageing process results in decreased enamel of the teeth as they wear down to the more apical reserve crown and decreased tooth occlusal surface area as the teeth narrow apically. Both of these ageing changes effectively decrease the masticatory ability of the geriatric patient. As 'smooth mouth' starts to develop, the remaining peripheral tooth enamel is often worn in such a way to develop irregular sharp enamel points on the lateral or medial edges of the teeth causing soft tissue lacerations/ulcers of the tongue and cheeks. Older horses often develop a mild wave mouth due to the 'wearing out' of the infundibulae of the upper first molars (109 and 209), which results in the opposing mandibular first molars (309 and 409) becoming overgrown. This wave or step mouth also interferes with the normal masticatory action. The narrowing of the teeth apically also predisposes to the development of senile diastema and interdental periodontal disease, which causes pain and oral discomfort when chewing. The presence of displaced teeth result in diastema, periodontaldisease and potentially overgrowths of the opposing teeth, causing oral pain and reduced mastication. Displaced teeth may be developmental or may develop secondary to periodontal disease and are therefore more commonly seen in older horses. Identification of incisor disease such as equine odontoclastic tooth resorption and hypercementosis (EOTRH) is essential as this condition may be very painful and inhibit the ability to prehend food.