Recent surgeries

Standing surgical tooth extraction

Since 2005 we’ve been carrying out standing tooth extraction in horses and in 2006 started to perform surgical extraction standing as well. Although we always try and save teeth rather than removing them, we are often presented with teeth in advanced states of decay where saving the tooth is simply impossible. Extraction is the only course of action to remove the pain, source of infection and restore oral function. Over 75% of these diseases teeth can be removed using molar forceps and patience, but the remainder cannot. The most common reasons are that the tooth has died leaving little or nothing showing to grab hold of, or else the tooth is in several fractured fragments.

We have developed considerable expertise removing these teeth and teeth fragments by repulsion in the standing sedated horse or pony with nerve blocks. Repulsion is where a metal punch is used to hammer the tooth out from the root into the mouth. The first stage is getting an x-ray with a metal marker on the skin at the proposed site of repulsion.

Normally carried out under general anaesthesia, our technique prevents the risk and cost of general anaesthesia and massively reduces the rate of serious complications. This is because efforts are always made to loosen the tooth before repulsion, and the standing method makes taking x-rays during the operation much easier. Having decided the position of extraction, a hole is drilled in the skull over the root and a punch used to repel the tooth into the mouth. This pony was unfortunate enough to need two teeth removing.

X-rays after often taken to check the position of the punch before continuing.

After the tooth is removed the socket is checked for any stray tooth fragments and flushed, then packed. The same technique is used to remove teeth from the lower jaw, although hammering upwards is harder work.

Complication rate is low compared to published rates, the only significant one being ongoing sinusitis. Because the roots of the upper cheek teeth sit in the sinus, tooth infection can cause secondary sinusitis. In horses presenting with this type if sinusitis we have occasionally had to do sinus surgery to resolve the problem. Extraction is the last resort, but being able to do it safely and efficiently is very important.