Cardinal Equine Veterinary Dentistry

09/18/2026

I am often asked how often a horse should have their teeth checked. The answer for each individual horse varies based on age, clinical signs, and work level. But at a bare minimum, every single horse should have an oral exam once a year, every year. Even if they seem perfectly comfortable, they are obese, eating voraciously, and do nothing but hang out in a field all day.

This is because horses are prey animals and as such, they hide their pain. On an evolutionary level, horses that did not hide their pain got picked out of the herd by a wolf pack and eaten. Horses that got eaten had fewer offspring and so we get modern horses that mostly hide pain. (There are, as always, exceptions!) By the time some horses show signs of pain that we recognize, they have been hurting for a while.

Sometimes the only sign of pain that horses show us is reduced performance, mild weight loss, or more irritable behavior. These are subtle signs that can be caused by a laundry list of both medical and husbandry causes. But it is important not to forget to take a thorough look in the mouth.

The photos below are from a case that brought this home rather forcefully. This patient is a well-loved, well-cared-for, retired 28 year-old Thoroughbred mare. Her owner sees her daily and she lives at a reputable boarding facility with good care. Cardinal Equine Veterinary Dentistry came out to see her for a regular appointment and her owner had no concerns about they way she had been behaving or eating. After we sedated her and opened her mouth, we found a 2.5 inch wide wound on the back right side of her tongue (third photo, outlined in green.) It was fresh and bleeding and caused by a recently fractured last cheek tooth on the lower right that was digging into her tongue. We removed the fragments that were lacerating the tongue (first and second photos) and expect her to make a full recovery.

The injury to her tongue was obviously recent but had been going on long enough to make a large wound. Had we not been scheduled to take a look at this patient at this precise moment, possible consequences include an infection of the tongue, difficulty swallowing, excessive salivation, slower eating, inefficient eating, irritability and behavior problems, and weight loss. If she had only shown the last few clinical signs, the owner may have never known what was bothering the mare until someone looked in her mouth. We were so glad we were there!

A quick note: Foxtail season is upon us! Please check your fields and make sure there is lots of other grass to eat out there so the horses can avoid the foxtails. And as always, check your hay. Here is a link to Penn State Extension information on foxtails. https://extension.psu.edu/lawn-and-turfgrass-weeds-yellow-foxtail-and-green-foxtail

09/11/2026

Incisors are the teeth you see when you lift up your horse’s lips. They sit in front of the bit and are used for prehension or grasping. Typically, horses prehend grass or other feed material, but they can also use these teeth for biting at flies or each other. Horses can live well without these teeth, as in EOTRH cases where all incisors need to be extracted. However, these teeth can also sustain other types of damage, many of them preventable. It is important for owners to be able to identify the damage early and take steps to protect these teeth so they do not become sources of pain and discomfort (and veterinary bills!) in the future.

The most common way horses damage their incisors is by chewing on inappropriate items. This includes their stalls, buckets, fencing, chains, salt block holders, and literally anything else they can get their mouths on. In the first two images below, you can see a central incisor tooth that has been worn so thoroughly that despite this horse being only 8 years old, he is missing almost 25% of the crown. He did this by running his teeth along a chain across the barn aisle outside his stall. The damage has actually invaded the sensitive part of this tooth (blood vessels and nerve) and required the tooth to plug the hole with dentin. If he keeps this up, he may do more damage than the tooth can repair and he will need the tooth to be extracted. Prevention could include closing in his stall so he can't reach the chain, covering the chain with a hose, moving the chain, changing the chain’s material to rope, or moving the chain further down the aisle where he can’t reach it.

The third photo shows teeth damaged by cribbing. Cribbing is a stall vice where horses plant their upper incisors on a flat, stable surface such as the top of a half door, fence rail, feed bucket or even the withers of another horse. Then they pull back on their teeth and make a gulping sound. The reason some horses do this is not known for certain but many speculate that horses get an endorphin rush from this behavior which encourages them to repeat it. Cribbing destroys the things horses crib on, but it also wears out their upper incisors. This can expose the sensitive tissues of the teeth making them hurt. The wear can also be so severe, as in this photo, that the top and bottom incisors no longer meet making it difficult for the horse to graze or get food into their mouth. Cribbing damage also makes it difficult to determine the age of a horse since the incisors are much more worn than would be appropriate for their age. Once horses learn to crib, it is extremely difficult to stop them. Best prevention methods include cribbing collars, lots of available hay and grass, and keeping them occupied with other activities. Making surfaces unpleasant for them to crib on generally just encourages them to find a different surface.

The fourth photo shows a horse that wears a hard plastic muzzle. These muzzles can damage the enamel covering their incisors. Typically this damage is cosmetic and not profound enough to cause pain. However, if the horse is able to wear a different type of muzzle, switching would be recommended. If the horse will not keep another type of muzzle on, the owner should have a talk with their veterinarian about the pros and cons of muzzling. Typically horses are muzzled because they have Cushing’s or insulin resistance and exposure to too much grass puts them at high risk of laminitis and founder. In most cases, the incisor damage caused by the muzzle is much less threatening to the horse’s overall health than the risk of laminitis would be. After all, horses can live very happily without incisors but they cannot live without feet.

The last two photos and the x-ray image come from a horse who was a rescue case. It is unknown how these teeth were damaged though most likely this is a case of chewing on inappropriate material, perhaps in a bid to get at some food. You can see the openings leading to the nerves and blood vessels (pulp horns, purple and orange arrows) in these teeth. Feed material is actually visible in one of them (purple arrow). We ended up not having to extract these teeth because the horse had actually sealed off all of these pulp horns and prevented multiple tooth root abscesses himself.

Incisor damage is rarely life-threatening, but it can be uncomfortable for the horse and result in difficulty grazing and being ridden. Fortunately, if caught early, there are usually management changes that owners can make to prevent or reduce incisor damage and allow their horses to keep their incisors in good shape for many years.

07/17/2026

We get older every day, but getting wiser is a choice. That's why Dr Lin has been going to continuing education recently!

First, she spent a week at the end of June at Cave Creek Equine Sports Medicine and Surgery in Phoenix, AZ. There she observed Dr. Travis Henry, one of the fathers of modern equine dentistry, performing multiple different delicate dental procedures requiring years of practice and expertise. He was supported by Dr. Ashley Alward, a boarded internal medicine specialist. Watching their collaboration was amazing!

This past week, Dr. Henry came to Bucks County Equine and spent two days teaching Dr. Lin and Bridget how to perform some of these procedures. It was thrilling and rewarding to learn from one of the best. We are so excited to bring our new knowledge to our clients and patients in the coming months!

We would not have been able to have this opportunity without help from Bucks County Equine, MidAtlantic Equine Medical Center, and others in our community who have been so supportive of our practice. Thank you!!

02/06/2026

When we float horse's teeth, we are not only looking for sharp points. We are also looking for over-erupted or tall teeth. Horse teeth get too tall because they have lost their partner tooth that they usually wear against. Effective tooth loss can be because of malpositioning of either the tooth or it's partner, age-related tooth loss, or pathology-related tooth loss.

When a horse has an over-erupted or tall tooth, it can interfere with their normal lateral chewing motion because the teeth can't slide past each other the way they normally would. When horses can't chew in a way that is comfortable for them, they get less nutrition out of their hay and feed, are more likely to get f***l water syndrome, and are more likely to quid their hay. It is also harder to maintain their weight, especially in cold weather (like this winter!🥶)

It is our job to reduce overly tall teeth to help the horse chew more efficiently. Unfortunately, there is a limit to how much we can reduce a tall tooth in one session because we have to be cautious that we do not expose the blood vessels and nerves of the tooth. These sensitive tissues typically lie between 2-10mm below the chewing surface of the tooth. As we float, there are are changes to the chewing surface of the tooth that we can see as we get close to the sensitive tissues that tell us we have to stop. If we go too far, it is very painful for the horse and typically results in LESS efficient chewing as the horse tries to chew without contacting that tooth. An exposed nerve or blood vessel typically leads to the death of the tooth which is never desirable.

In order to reduce a very tall tooth, we have to float a little bit at a time and wait 2-3 months in between to allow the sensitive tissues to retreat down the tooth, kind of like a dog's toenail. How many times we have to do this depends on how tall the tooth is when we start and how far below the chewing surface the sensitive tissues reside.

The first two photos below show over-erupted teeth. The first is a hook on the first cheek tooth. This is over-erupted because the upper tooth is positioned slightly forward of it's lower partner so the front edge of the tooth doesn't get to wear down on it's own. The blue arrow is pointing to the hook.

The second photo is an aged miniature horse who is missing teeth. The teeth opposing the missing teeth have had lots of time to over-erupt and will need to be reduced over multiple sessions. Blue arrows point to the overgrown teeth. The red line is where the chewing surface should be on the upper teeth, so we have a lot of work to do.

The third picture is of the sensitive tissues that have been pulled out of a 3-year-old's upper cheek tooth. This photo is from a continuing education laboratory that Dr. Lin did back in October, 2025. The blue arrows point to the tips of the nerve that would be just below the chewing surface. The green circle is around the tissues that would be in the common pulp chamber near the roots of the tooth. This is the structure we are trying to protect when we don't overfloat over-erupted teeth. It looks sort of like an odd octopus, doesn't it? 🐙

01/10/2026

Teeth usually get extracted for one of two reasons. Either the structures around the tooth are no longer supporting it and it gets loose (periodontal disease) or the tooth itself is damaged (endodontic disease) and causing pain or interfering with chewing. But every so often, we extract a tooth because of orthodontic reasons, which was the case here.

Horses don't get braces so when their teeth are misaligned, we need to treat them either through corrective floating or tooth extraction. Miniature horses often do not have enough room in their mouths for their teeth, which can cause the teeth to crowd or become mis-aligned. In this case, we had been following the eruption of the adult dentition in this 6yo miniature mare. Her third molars, also known as the last cheek teeth, are supposed to erupt around 3 1/2 years old. Some horses are a little earlier or later, but generally between age 3 to 4. The fourth premolars, also known as the third cheek teeth back, are also supposed to erupt at about the same time.

By the time this mare hit 5 1/2 years old, she still did not have her last molars. We took radiographs and found that her third molars were all present where they should be. They just couldn't get into her mouth because her head was too small (or her teeth were too big.) This would have been ok except that on her upper right arcade, when her fourth premolar (3rd cheek tooth) tried to erupt, it got squashed and started to twist. This meant that instead of having a smooth line of teeth, she had little divots where feed started to collect. Left this way, the feed would sit there and rot and cause periodontal disease and eventually destroy her fourth premolar and probably the tooth in front and behind.

So, even though the tooth was still technically healthy for now, to prevent future problems, we decided to extract the fourth premolar. Doing this will prevent the development of periodontal disease and save the teeth in front and and behind. And, hopefully, as the teeth shift and close the gap that was occupied by the fourth premolar, it should allow the third molar (last cheek tooth) to erupt normally.

In the photos below, the first is an x-ray of the mare before she had her tooth extracted. Her nose is to the left and her ears are toward the right. You can count 6 cheek teeth but you can see that the last one toward her ears looks a little wiggly (dark blue arrow.) That is because it is trying it's darnedest to erupt and can't do it. You can also see that the third cheek tooth back (light blue arrow) looks a little narrower than the other teeth. That is because it's twisted on the long axis and you are looking at it a little sideways. You can also see that the tooth is so long, it's root tip makes a little bump in the skull.

The second photo shows the mare's x-ray right after her fourth premolar was extracted. You can see the gap in the row of teeth.

The third photo will probably get covered by facebook (sorry facebook!) but it shows the fourth premolar right before it was fully extracted. The tooth has been elevated out of the socket and we had to stop for a moment because the tooth was so long it hit the bottom teeth before we could get it clear of the socket. The orange arrows show the chewing surfaces of the top and bottom cheek teeth and the purple border shows where the chewing surface of the extracted tooth was at that moment.

The fourth and fifth photos show the fourth premolar after it was extracted lying next to a 1.5" needle for size comparison. Keep in mind, this tooth came from a mini!

We will keep examining this mare every 6 months to make sure that her teeth continue to be healthy and lined up well enough for her to use them for as many years as she possibly can. She is saucy enough not to thank me at all. 😉

11/14/2025

Why do I sedate horses for dental procedures? This is a very common question, especially since many lay floaters in our area do dentistry without sedation. There are two main reasons I sedate my patients.

First, I can do a better job when my patients are sedated. The sedation allows me to perform a thorough oral exam without stressing out the horse. Once my patients are sedated, I palpate their jaw joints (TMJs), their jaws (mandibles) and sometimes knock on (percuss) their sinuses. I check the excursion of their jaws. This is all easier to do accurately if my patients are relaxed and holding still. Then I rinse out their mouths and open them with a speculum so I can see and feel all the way back to their last cheek tooth, which sits under their eyeballs. I feel all the cheek teeth and check for anything broken, loose, overgrown, or displaced. Then I examine every single tooth with a mirror. I check for gaps between teeth, periodontal pockets, and cavities. I look at their cheeks, tongues, palates, bars, commissures, and under their tongues for wounds or other damage. All this looking around gives me a tremendous amount of information about my patients’ oral health but, just like when the dentist examines a human patient, it is not the most comfortable thing in the world. If my patients are sedated, I can do a better exam more quickly and get the information the owners deserve to know about their horse’s mouth and teeth.

Second, having my patients sedated makes dental procedures safer and quicker for the horse, my assistant, and me. There are exceptions to this including when my patient has cardiac issues, severe arthritis, or on-going neurologic challenges. Barring those, the sedation keeps my patients standing still so they don’t stumble around or step (or rear!) on us. They also don’t get frightened by the dental tools. And the sedation keeps them from chewing in the speculum and making their TMJs sore.

The sedation can cause anxiety for some owners for all sorts of reasons.

Some people get confused between standing sedation and general anesthesia. Standing sedation makes the horse sleepy, but they continue to stand on their feet and are still aware of their surroundings, although less responsive to them. This is what we use for dentistry. General anesthesia is when the horse is completely unconscious and laying down. This is what surgeons use for colic or orthopedic surgery and is not used for routine dentistry.

Some people have had bad experiences with sedation in the past or know someone who has. They may have had a horse fall down, or have a dramatic reaction to the IV injection. This is much more likely to happen when the sedation is administered by someone who may not do an initial physical exam, who may not be as competent in determining the proper dose for a patient, or who may give the injection in the incorrect location. Even competent, experienced veterinarians can sometimes mis-judge dosages or give injections in inappropriate locations because none of us are perfect and every horse is unique. However, when you have an experienced veterinarian administering sedation, this is extremely rare.

Finally, some people just don’t like the way their horse looks under sedation. Their heads hang down, they can lean awkwardly, stand in strange positions, and even snore. Some may get a little sweaty. While it can certainly be odd to see your horse in this position, it is very temporary and has no lasting effects. Most horses are wide awake from the sedation within the hour and looking for their hay.

I have attached some photos of sedated horses to hopefully help folks feel more comfortable with this part of the procedure. The first two photos are of a 10-year-old draft patient and were taken right after he had a tooth extracted (hence the bloody tongue.) He is standing in stocks which act as a support for him to lean on while he is sedated. We like to use stocks for horses that are a little less stable on their feet since it helps them support themselves while under sedation. In this case, we used them because he is enormous and trained to push against pressure rather than give to it. The next two photos are of a 30-year-old chestnut gelding right after his routine dentistry. You can see his back legs are oddly positioned, his p***s is hanging out, and he decided that resting his head in his empty feed bucket was a good plan. He woke up about 30 minutes after these photos were taken, put his p***s away, replaced his legs in a more normal position, and started eating hay. The last attachment is a video of a 15-year-old black Morgan mare also taken shortly after routine dentistry. She is resting her head on her half door and snoring. She stopped about 10 minutes after this video was taken as she started to wake up.

I hope this has helped some people better understand and feel more comfortable with sedation for their horses.

10/11/2025

It is foxtail season in Southeastern Pennsylvania! Foxtails are a type of grass that looks very similar to timothy when it is growing in the field or sitting in your hay. However, the foxtail seedheads have orange fibers extending from them rather than the tan fibers that timothy has. These orange fibers have microscopic barbs on them similar to fishhooks that embed themselves in the oral mucosa including lips, gums, tongue, and palate. Once embedded, the foxtail fibers cause irritation and ulcers. If a horse gets a large foxtail dose, the ulcers can cause them to drool, cause bitting issues if the ulcers are on the bars, or make them reluctant to eat due to discomfort. Many of these ulcers are small but some can be enormous or unfortunately placed.

Once the foxtails are embedded in the mucosa, the only treatment is to physically pull them out. This is most easily done under sedation with hemostats, but tweezers will work if the horse holds still and you are careful. Horses can get the foxtails out on their own, but because of the fishhook-shaped barbs, it takes them a long time to get these fibers out. Many horses are smart enough to sort through their grass and hay and avoid eating the foxtails, but not all are so selective.

Penn State Extension has a good article on identifying and controlling foxtails in your pastures that can be found here: https://extension.psu.edu/how-to-tell-foxtail-from-timothy-and-control-it Visually inspecting hay before accepting delivery is a good policy when trying to avoid feeding foxtails to your herd.

The FIRST photo below is of foxtails growing at the edge of a riding arena.

The SECOND photo shows a foxtail seedhead on the left and a timothy seedhead on the right. You can see the distinctive orange color on the left seedhead and also how similar they look to each other.

The THIRD photo shows foxtail damage around the incisor gingiva. This is a very common place to see foxtail fibers embedded because the horses use their lips and gums to sort through hay or grass and eliminate the foxtails.

The LAST photo shows an ulcer under a horse's tongue caused by the foxtail fibers. In both of these cases, removing the foxtail fibers will allow the horses to heal without any further treatment being necessary.

If you think your horse has been exposed to foxtails, a good oral exam under sedation will let you know if they have ulcers and allow treatment if any ulcers are found.

09/15/2025

Come out and see us this Saturday at Last Chance Ranch in Quakertown! We will be providing the equine dentistry demo at 1pm. Can't wait to see you all there!

🍂🌻 Still in need of plans for this weekend? Looking for a fun idea to do with the kids? Stop by on Saturday for fun, food, and furry friends! 🌻🍂

McCoole's at the Historic Red Lion Inn Mon & Mel’s Sweet Scoops Ice Cream Truck QNB Bank