External Examination

The head should be evaluated for symmetry. Look for bumps or protuberances which may give clues to dental problems. Look at and apply pressure to the temporalis (forehead) and masseter (cheek) muscles if these are asymmetrical, prominent or show sensitivity this can indicate dental problems. Look at and apply pressure to the temporomandibular joints (TMJ lies between the eye and base of the ear and is where the jaw connects to the skull). If these are uneven or the horse shows sensitivity this can indicate dental problems.  Young horses between the ages of 2.5 and 4 years of age will have symmetrical, non-painful bony enlargements on the lower and / or upper jaw. These enlargements are the result of normal tooth crown and root development of erupting permanent teeth and the shedding of deciduous (milk teeth) caps. If these enlargements are hot, swollen, asymmetrical or associated with an abcess, tooth problems should be suspected.

Examine the bars of the mouth, feeling for protuberances above or below the gum line and wolf teeth just in front of the second premolars. Observe the horse's response to pressure. The unerupted wolf teeth, referred to as 'blind wolf teeth', can cause discomfort and training problems in bitted horses. Wolf teeth come in a vast array of shapes and sizes with the visible crown shape having no relation to the size or shape of the root.

Look at the canines. Most stallions / geldings have between one and four canines and about twenty five percent of mares have canines but these are usually much smaller. Calculus (tartar) builds up on these teeth and needs to be removed to prevent gingivitis (gum disease).  Lampas, or thickening of the palate, in some cases to below the level of the upper incisors, is common in young horses that are erupting permanent teeth. This is quite normal and requires no treatment.  Feel along the outside lower edge of the upper cheek teeth for sharp enamel points as this gives a good indication of the rest of the cheek teeth arcade.

Note a full mouth speculum is used as metal coil gags that are slid between the cheek teeth to keep the mouth open can cause slab fractures to the cheek teeth and should be avoided. Wedge type gags have a greater surface area in contact with the cheek teeth and are unlikely to cause slab fractures but when kept in place for many minutes have been known to cause temporomandibular joint sensitivity, as the pressure on the TMJ is uneven.

A torch is used to look at the oral cavity, The tongue and soft tissue should be checked for abrasions, ulcers, lumps and bumps which could be tumours.  The cheek teeth should be checked for position and number. At a young age less than 4 years common molar findings would be erupting teeth and premolar findings loose caps (remains of milk teeth) or cap slivers.

At an older age from the late teens onward on the front and back of the cheek teeth table hooks (an end tooth has worn to a downward hook shape) and ramps (an end tooth has worn to an upward ramp shape) are common. In the center of the molar table you may find stepped teeth (one tooth in the table is longer than the rest and the tooth opposite it is shorter than the rest), ‘wave mouth’(uneven wear along the whole table gives a wave like appearance), cupped out (worn out) teeth, decayed infundibula, missing teeth or split or misplaced crowns.

At any age the front and back of the dental arcades should be inspected for hooks, ramps, supernumerary (extra) or missing teeth. The dental margins between each tooth should be inspected for diastema (gaps) as food is forced into the space where it decays causing chronic gum disease and for abnormal tooth contact or feed packed into gingival pockets (between tooth and gum). The crown height should be the same on the front and back of each tooth. The crown height should be longer on the outside of the uppers and the inside of the lowers. This reflects the normal 10 to 15 degree slope of the molar arcade.