EDPA Case of the Month

The EDPA Case of the Month is graciously provided by Dr. Richard Miller. All comments, suggestions and approaches are the opinion of Dr. Richard Miller. The EDPA is not liable for the content, animals, procedures or opinions of the following cases provided.

 

Biographical Information: Richard Miller graduated with highest honors from the Washington State School of Veterinary Medicine in 1961.  For the next fifteen years, he practiced in Lexington, Kentucky, in a primarily reproductive and pediatric practice with a good mix of sport horse issues, as he was also involved in polo and fox hunting.  He operated Summerhill Farm in Lexington, as a combination breeding, foaling and training program, before moving to Southern California to join the Equine Medical Center in Cypress, Ca. The next eleven years were occupied by an exclusive racetrack practice at Los Alamitos and Bay Meadow.  In 1987, Dr. Miller decided to retire from the track and dedicate his practice to equine dentistry.

 

For the last 10 years, he has served an area from San Diego to Sacramento, with a 28 ft. mobile clinic that is a full service unit, staffed by him and two technicians.   He is  an EDPA Certified Equine Dental Provider, advanced certified by the International Association of Equine Dentistry. 

~Case of the Month~

Case of the Month:

Supernumeraries

 

By: Richard O. Miller DVM, EDPA/C



June 2017

 

 

SUPERNUMERARIES:
This condition is not rare but is considered uncommon.  Although extra teeth (polydontia) may occur anywhere, this scenario is the most commonly missed.  It has occurred that surgeons and radiologists, as well as practitioners, did not count past 11.  Often this situation can be managed by yearly reduction but the picture shows a retromolar ulcer that is likely caused by the protuberant 212.  In this case, and that shown on the skull of another horse, the angle of eruption has created a major periodontal lesion that prompted the decision to extract the supernumerary.  This case was contributed by certified dental provider, Juston Hutchinson from Oklahoma, in cooperation with his veterinarian.

 

 

Richard O. Miller, DVM, EDPA/C

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month:

Sialolyths

 

By: Richard O. Miller DVM, EDPA/C



May 2017

 

Sialolyths, or salivary duct stones have been mentioned before and have a similar cause as enterolyths –the stones that form in the equine colon.  Usually an irritating object is the inciting cause and mineral deposits build up in an attempt to isolate it.  In the case of sialolyths, the object is likely to be a foxtail or other type of plant awn.  The condition is uncommon if not rare and can occur in all of the salivary ducts.  I have only seen it in the distal parotid duct, lateral to the upper 9’s.  A few cases have been reported in the proximal segment of the duct – much closer to the gland.  Those few cases cannot be reached orally and require a transcutaneous approach.  In the case shown it would be inappropriate to use such an approach, as there is a chance for skin infection as well as some risk to blood vessels and nerves in the area and a possibility of fistula formation.  The transoral approach is easily reached with a # 12 scalpel blade clamped to a long intestinal forceps.  There is typically no after care.  In this particular case, considerable atrophy of the parotid gland was noted.  Whether function will return is unknown.  (photos courtesy of Nicholas Carlson, DVM of Salinas, Ca. and Tiago Silvino, DVM of Porto Alegre, Brazil )

 

Richard O. Miller, DVM, EDPA/C

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month:

Radiographs are a Diagnotic Aid

 

By: Richard O. Miller DVM, EDPA/C



April 2017

 

We have discussed in the past, the value of pre and postsurgical radiographs but what has not been emphasized is the fact that radiographs, with the best of interpretation, are only a diagnostic aid.  From the radiograph shown, it is obvious that the 209 is affected.  On intraoral exam with diligent and thorough spreading and manipulation, no progress was being made.  The occlusal picture shows the attempt to drill and split the tooth in half and still no result, as all the excess tooth at the right was not visible.  Finally, a standing osteotomy was performed and repulsion was successful.

 

Richard O. Miller, DVM, EDPA/C

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month:

Be Prepared

 

By: Richard O. Miller DVM, EDPA/C



March 2017

 

BE PREPARED.  The Girl/Boy Scout Motto also applies to dentistry.  This case was presented by certified EDP’s, Becca Greene and Natalie Hillman with the support of Susan Tavernier, DVM.  The photos themselves offer a very interesting case study but my emphasis is on being prepared.  We have all gone out on an ambulatory visit to do what we thought would be a routine maintenance day, only to be confronted by an unexpected fracture.  In this case, preevaluation radiographs would seem to be unnecessary and how difficult can this 307 saggital fracture be?  But, very wisely, Natalie deferred the extraction in favor of joining her full team in a warm clinical environment with all the necessary personnel, instrumentation and aftercare that might be required.  And, as can be seen, from the 17 fragments that were removed, both from an intraoral as well as an extraoral approach, this was not a routine case. These fractures are seldom emergencies and most often showing no symptoms, so planning the actual procedure is usually the best course.  

 

Richard O. Miller, DVM, EDPA/C

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month:

Zebra Skulls

 

By: Richard O. Miller DVM, EDPA/C



January 2017

 

Please appreciate this contribution from Graeme Martin of South Africa, sent to him by a client.   The photos of these harvested zebras would have been more clear if the salt had been washed off first but even so, there are many features to note.  A quote from one viewer was that medium lower 06 ramps are quite physiologically normal in an equine with significant curve of spee.   This would include most of the pony breeds as well as those with major arab influence.  Obviously, in this species, those sharp lower ramps would not often be a performance issue, where some rostral profiling is considered necessary by all skilled practitioners.  But even in the latter case,  we might consider less being more when there is no compromise to the upper 06’s or the palate.  Notwithstanding the academic concern of accessing a number 6 pulp chamber, not reducing the lower 06’s to completely level will preserve more occlusion and possibly prevent future diastema formation and periodontal disease between  the 7’s and 8’s. 

What we would consider to be major ETR’s does not seem to be an issue but these specimens are young.  Calculus formation on the canines at a young age is unexplained in my thoughts but this is such a small sample.  Wolf teeth appear to be in contact with the rostral tip of the lower 06 ramps but, again, this might be only a factor in performance situations.

The disparity of width in the upper and lower incisor arcades does not seem to have caused anything more than slight upper caudal prominences on the upper 03’s.   These images demonstrate the true angle of spee.  NOT the ones occasionally published that are actually dominant upper 10’s that have compromised the opposing lower arcades.  Thank you Graeme and Katherine Ros, DVM, for so much food for thought.

 

 

Richard O. Miller, DVM, EDPA/C

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month:

THE IMPORTANCE OF PRESURGICAL RADIOGRAPHS BEFORE ATTEMPTING MAJOR EXTRACTIONS.

 

By: Richard O. Miller DVM, EDPA/C



December 2016

 

We must admit that we have all attempted major extractions without radiographs and been quite successful and lucky.   However this approach cannot be recommended, as demonstrated by this case.   A 3 year old grey thoroughbred was presented to a clinic with the complaint that a sore on the face would not heal.  It was recognized as a fistula and most likely of dental origin.  An oral exam revealed  obvious 108 pathology and appeared to be an uncomplicated extraction .  One and a half hours later, little progress had been made and the procedure was abandoned.  The case was referred to another facility for radiographic imaging and this massive lesion was noted.  The actual procedure required two and a half hours from an intraoral approach and another one and a half hours under general anesthesia to complete the operation.  Presurgical radiographs would have saved a great deal of time and expense and revealed that this was a case for referral to a facility with highly skilled dental practitioners.

 

Richard O. Miller, DVM, EDPA/C

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Melanomas

By: Richard O. Miller DVM, EDPA/C



November 2016

 

 It is well documented that ninety percent of gray horses over the age of 15 are diagnosed with melanomas.   This tumor may be found at any age and can occur anywhere in the body.  Often they are small and unobtrusive but on other occasions are quite invasive and may affect bowel and urinary function.  Another very common site is the lips, where the swelling may interfere with use of a bit.  The images shown here depict a case where the lesions were invasive enough that the 6’s had lacerated the cheeks.   In this situation, the solution was too perform extreme bit seats or rostral profiling to allow for the expansion of the tumor.  If the No.6 pulp were exposed, temporary fillings could have been employed.  If this had been a geriatric patient, extraction of the 6’s might have been considered.  This area of the lip is not usually amenable to surgical excision but a new vaccine is reported to be successful in many cases.  If the Dental Provider advises their clients when the lesions are quite small, appropriate therapy may be instituted to preserve performance as well as comfort.

 

Richard O. Miller, DVM, EDPA/C

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Siamese Teeth

By: Richard O. Miller DVM, EDPA/C



October 2016

Of all the anomalies of equine dentition that you are subject to encounter, Siamese teeth are the most unlikely unless you deal with the small breeds.  Polydontia is observed not uncommonly as an extra incisor and occasionally as an extra molar.  These teeth apparently arise from a separate embryonic primordium and have their own separate periodontal structure and are often normal in appearance.   Connate teeth that apparently arise from the same germ, may or may not share the same root but do share a common periodontium.  These are more likely seen as double canines.  This is not to exclude other morphologic abnormalities that are occasionally seen but Siamese teeth are distinct in the fact that they arise from separate roots but the crowns attach during development.  The cause of this event is speculated to be lateral pressure, as “crowding” is so common in the miniature breeds.  My interest was more in the clinical significance of this situation shown in this yearling photo.  What happens when the adult teeth try to erupt when there is a year’s difference between the 201 and 202?  In those cases that have been followed, only one permanent tooth replaces the “twins”.  The Take Home message is that we should all take heed of the common anomalies that occur in the miniatures, so when they do occur in the larger breeds we can give our clients a predictable outcome.

 

Richard O. Miller, DVM, EDPA/C

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Importance of Dentistry to the Veterniary Profession

By: Richard O. Miller DVM, EDPA/C



September 2016

IMPORTANCE OF DENTISTRY TO THE VETERINARY PROFESSION:

We all know that dentistry is the foundation of a horse’s health but admittedly this situation is not life threatening.   The trauma to the lower incisors and the resulting deformity, did produce a diagonal and an overbite that were corrected, but the point to be made here is that the condition was not even mentioned on the prepurchase exam.  The client had no idea that this malocclusion existed.  It would not have been necessary for the veterinarian to describe the situation in detail, namely the rotation of the centrals, absence of 302 and mesial drift of the 303 and 304.  But to not mention the condition at all, suggests the reliance of the general practitioner on published data that state that incisor correction is unnecessary.

 

 

Richard O. Miller, DVM, EDPA/C

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Contiuation of Shear Mouth

By: Richard O. Miller DVM, EDPA/C



August 2016

MORE ON SHEAR MOUTH: 

These photos are presented courtesy of Aldo Doveren, a Dutch veterinarian working at the time in my practice.  As in last month’s case, a painful condition on the ipsilateral (same side) causes the horse to restrict mastication to the opposite arcades, which were fairly normal but resulting in the very steep molar angle on the affected site and resulting in a total block.  The original culprit was the deformed, rotated and abscessed 208 which must have precluded any use of the left side.  As the post-surgical photos show, a major reduction of  the molar table angle was accomplished in one procedure – from a molar table angle or 45 to 27 degrees.  When the pack was changed on the fifth day, it was noted that the patient was already chewing on the left side and at the three month recheck, the chewing pattern was equal on both sides.  A similar case was well documented in Equine Veterinary Education and it helps to dispel the rumor that major reductions are not possible and practical without causing pulp exposure.  A major diagonal bite was also present. Who would like to comment on the direction of the bite and why ?

 

 

Richard O. Miller, DVM, EDPA/C

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Shear Mouth

By: Richard O. Miller DVM, EDPA/C



July 2016

This case is offered by Joao Kunz from Brazil, along with the questions “What constitutes a designation of Shear Mouth”  and “ How much can you correct in one procedure?” A very recent and thorough search of the literature describes  the normal molar table angle to be anywhere between 12 and 45 degrees.   Forty five degrees or greater is generally considered by most authors to be classified as “Shear Mouth”.    Many publications consider an angle of 15- 25 degrees as being normal with variations from rostral to caudal.  It is also stated that this should not be changed during equilibration but few practitioners have a measuring device to attempt this verification.  Dr Kunz does have such a device ( refer to Matteo Pellachin IGFP presentation) but its accuracy would certainly be called in question in this case, due to the extreme irregularity of this dentition.  His best attempt read 35 degrees but individual teeth appear to approach 45.  In any case, the dentition is locked with no lateral excursion and in my experience, reduction should be quite liberal until excursion is reestablished.   Hopefully,  photos of the correction will be available soon.

 

Richard O. Miller, DVM, EDPA/C

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Enteroliths in Relation to Dentition

By: Richard O. Miller DVM, EDPA/C



June 2016

We are all aware that poor dentition can cause mastication issues as well as many other intestinal problems.  It is also common knowledge that certain diets and regions cause horses to be more prone to enteroliths or rock-like concretions that form in the intestinal tract.  They typically form around a foreign body (nidus) that is not digestible and is considered the body’s protective mechanism to isolate the object.  So, add to your list of conditions that can be caused by bad teeth, as we have here an example of a very large enterolith that has formed around an expired and swallowed molar.

 

Richard O. Miller, DVM, EDPA/C

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Tongue Paralysis

By: Richard O. Miller DVM, EDPA/C



May 2016

These pictures are offered courtesy of Dr. Joao Ricardo Kunz , of Brazil.   The rostral part of the tongue is paralyzed but the caudal part, the one that can make dental equilibration difficult, is quite normal .  Some quidding has been noted but mastication and deglutition are functional.  It is to be noted that the innervations – motor, sensory and taste are supplied by separate nerves that trace to at least two different cranial nerves/ areas of the brain.   The clinical relevance and differential diagnosis might include Rabies, EPM, Encephalitis and Botulism in their early stages.

 

Richard O. Miller, DVM, EDPA/C

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Another case of what you cannot see without a radiograph

By: Richard O. Miller DVM, EDPA/C



April 2016

 

This case comes to us courtesy of Juston Hutchinson.  It is a 10 yr old referred to a clinic in which Juston provides dental services.  The referral was specifically for the extraction of a shattered 107 which Juston performed under the supervision of the presiding clinic veterinarian.  He requested a post op radiograph to evaluate the presence of any remaining 107 fragments.  It became immediately obvious that major pathology existed in the 108 which was not apparent orally.  All pulps had been probed and there was no facial swelling or nasal discharge.  The extraction was quite difficult due to the bulbous swelling noted in the image.  It is likely a very rare situation when the apices nor the crown is involved but such major pathology is noted in the pulp chambers.   The message here is to obtain post extraction radiographs whenever possible.  

 

Richard O. Miller, DVM, EDPA/C

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Relief Cuts/Diastema Widening

By: Richard O. Miller DVM, EDPA/C



March 2016

 

This specimen has had the 100 arcade reduced to show approximate levels at which pulp is exposed.   But my interest is focused on other issues.   In my hands, periodontal disease is best treated by proper equilibration and air abrasion with prophy powder.  The areas that do not respond to this treatment are often corrected with relief cuts/diastema widening.   A minor mitigation at 108-9 may well have been indicated if food was packing but a full medial to lateral procedure was demonstrated at 109-10.   This particular attempt was too invasive of the 110, particularly at the buccal extremity but I find this treatment first published by James Carmault, to have almost a 100% success rate in eliminating food packing and continued periodontitis.   Others will argue that this is too invasive and less is more.  Others will point out that the continuous infolding of enamel in the interproximal space will cause  the teeth to be weakened and result in fracture.  I have seen  the latter in only one case out of several hundred procedures.  3-4 mm of crown can usually be removed on either side of the diastema at the occlusal surface and if  tapered to the gingival level, will not expose pulp.  

 

Richard O. Miller, DVM, EDPA/C

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Under the Tongue

By: Richard O. Miller DVM, EDPA/C



February 2016

Again, if you don’t look, you don’t see.  This was one of two cases presented on the same day who had been eating perfectly soft Teff hay.  Accumulation was only on the right side and had a specific predilection for the salivary duct.  The food material was not firmly imbedded  but was not readily dislodged.   I have seen considerable damage in this area from Foxtails and Barley awns, but this was quite different.   This particular variety of hay is very popular in California and known for its low fructan content.  So it is quite important for the management of geriatric insulin resistant horses and previously not implicated in this phenomenon .

 

 

 

Richard O. Miller, DVM, EDPA/C

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Sharp Canines!

By: Richard O. Miller DVM, EDPA/C



January 2016

SHARP CANINES CAN BE DANGEROUS!

This photo arrived with the caption: “Where are your gloves?”  Although gloves might provide some protection, sharp canines are capable of causing severe lacerations to the hands and arms of the dental provider but have also been noted to cause tongue injury to the horse.   I have also seen situations where it was difficult to bridle a horse due to the length of the canines.   In the interest of safety, it would seem prudent to reduce and shape long sharp canines before even attempting to place a speculum.   

 

Richard O. Miller, DVM, EDPA/C

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: A412

By: Richard O. Miller DVM, EDPA/C



December 2015

A 412.  And for those of you who prefer – a supernumerary 411.  There was no permission to attempt a major procedure, so reduction and a relief cut were the only options.  If an extraction would have been attempted, the most complete set of extraction equipment would likely be wanting as I have not seen a molar spreader designed to operate on a 45 degree angle.  I welcome others to contribute alternate forms of treatment other than simple reduction.

 

Richard O. Miller, DVM, EDPA/C

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Deciduous Trauma of the Incisors

By: Richard O. Miller DVM, EDPA/C



November 2015

 

DECIDUOUS TRAUMA OF THE INCISORS:

When a young horse experiences a traumatic incident, we always like to be optimistic and usually are able to remind the client that there are permanent counterparts to the damaged incisors that will likely erupt unaffected by the previous incident.   HOWEVER, it is wise to remind the owner that the situation does not always develop the way we would like.  This is a case of a 10 yr old that was kicked in the face at age three and seemed to have escaped serious injury.   The photos of the resulting pathology and subsequent extractions proved otherwise. 

.  

 

 

 

 

Richard O. Miller, DVM, EDPA/C

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Slobbers

By: Richard O. Miller DVM, EDPA/C



October 2015

 

“Slobbers” or simply excess salivation:

 

This sometimes spectacular event may be common to those of us in the eastern half of the country, whereas those in the western half may never have seen this condition.  It is caused by a toxin that is produced by a fungus that grows on red clover.  I have never seen this condition in horses grazing on pastures with an abundance of red clover but the first cutting of hay can cause dramatic salivation.  Contrary to the literature, I have fed second and third cutting with no problems for 15 years, as long as the quality of the hay was good.  Also, contrary to other sources of dental information, excessive salivation is almost never caused by dental pathology.  This is not to say that a subject with this symptom may well have dental issues – even major abscesses and fractures, but the pathology does not cause the salivation.  It is not within the scope of this discussion to cover all the causes such as rabies, chemical burns and the occasional over producer that can cause you  to “wear” a face full during an incisor correction!

.  

 

Richard O. Miller, DVM, EDPA/C

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Using a radiograph as a diagnostic aid...

By: Richard O. Miller DVM, EDPA/C



September 2015

 

It is often and correctly stated that radiographs are a ‘diagnostic aid’ and one should not ‘treat a radiograpth’, but in this case it is safe to say that the 209 is severely affected, both apically and within the body of the tooth.  There was no oral evidence, such as open pulps, to confirm the diagnosis in this 5 yr old and the source of infection was considered blood-borne (anachoretic).  Following extraction, it was determined that there was in fact communication from the apex to an infundibular cemental defect, which is considered rare in the literature but has proven more common than previously thought.  

 

Richard O. Miller, DVM, EDPA/C

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: How long do we wait to remove a 308 cap?

By: Richard O. Miller DVM, EDPA/C



August 2015

 

The facial swelling on this 10 yr. old horse might bring to mind an abscess or food packing in the buccal cheek area.  The latter possibility was quickly eliminated, as the swelling was quite hard.  On further examination it was found that the 308 cap, that should have shed uneventfully during his 4th year, was firmly imbedded in the cheek and almost completely encapsulated by scar tissue.   Attempts to remove the cap with standard forceps proved futile but use of the custom instrument shown was finally  successful.  I know some practitioners feel that I remove caps at too early a stage but I think an extra 6 yrs is enough!

 

Richard O. Miller, DVM, EDPA/C

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Dorsal Curvature

By: Richard O. Miller DVM, EDPA/C



July 2015

 

This photo is a contribution of Juston Hutchinson, a certified EDP and member of the EDPA.  It is a good example of a Dorsal Curvature.  The 102 is missing with mesial drift that filled the gap, but it was not likely part of the original trauma nor is it certain what contribution the trauma had to the dorsal curvature.  One can only guess the sequence of events but to me, the most interesting event is the 402.  The entire tooth is in a state of avulsion from occlusal surface to apex, with the pulp cavity completely exposed but still the apex was not involved.  This is an example of the profound regenerative and reparative potential of equine dentition.

 

Richard O. Miller, DVM, EDPA/C

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Retained Incisor Cap

By: Richard O. Miller DVM, EDPA/C



June 2015

 

With EDPA certification fast approaching the emphasis has been more on the everyday issues that make up 90 % of equilibration.   So what is more common than a retained incisor cap?  Not quite as common, is a retained impacted incisor cap.  Now, take a look at what a seemingly ordinary occurrence can cause!  The retained deciduous 202 had forced the permanent 202 and 203 to erupt in a lateral position and unopposed, they super erupted to the point of causing a complete block.  The post extraction and alignment photo shows the immediate solution but only time will tell if mesial drift will close the diastema in a 13 yr old horse.

 

 

Richard O. Miller, DVM, EDPA/C

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Canines 

By: Richard O. Miller DVM, EDPA/AC



May 2015

There has been a request for some simple everyday things - possibly seen daily but not recognized as important when the emphasis is on getting the job done and going on to the next case. These photos of canines are such an example. No gingivitis is noted but there is some gum recession and accumulation of food. We can overlook this or take a moment to scale the calculus and clean up the gingival margins. Then, rather than rush to the next client, we could stop, take a deep breath and ponder a couple things.

 

The lower canines could certainly be reduced and cause less interference with the tongue and placement of a bit, but the uppers are flat with sharp edges on the entire perimeter. This is nearly a universal finding - is this tongue action and also the reason that calculus seldom accumulates on upper canines? And how often does your client ask, "what are those cute little bumps on the side of the tongue -all lined up in a neat row ?" I tell them that they are taste buds but I must admit that I cannot find anatomical verification of this in any text. We welcome your comments.

 

Richard O. Miller, DVM, EDPA/AC

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Canine

Case of the Month: Guess What It Is! 

By: Richard O. Miller DVM, EDPA/AC



April 2015

 

For all of the loyal followers of Case of the Month, here is a contest for you!  If you guess the cause of this condition, you will win a free admission to the EDPA conference in November.  This is a $300.00 value, so put on your thinking caps.  Just to make it a more sporting event, one clue is offered:  This is not a geriatric – the horse is nine years old ! 

 

Email: ExecSec@EDPAonline.org your guess. First one with correct answer wins a free 2015 EDPA Conference!

 

THE CORRECT ANSWER:
This is a very unique case. This is the 3rd time Carl Mitz, C/EDPA  has seen this horse in the last 3 years. This horse has very worn upper molars 6-11 at the age of 9 years. The clue is the tongue. It is thick, dry and abraded. A normal tongue would have a more slick, soft and wet appearance. The answer~ He has been eating rocks! Upon examination, 4 rocks about the size of peas fell into the provider's hand!  Closer inspection found smaller rocks in the bottom of his water bucket as well.  This situation was not man made, it was caused by the horse's own choice and environmental

We did not receive a correct answer, however all who participated will receive $25.00 EDPA Bucks to be used towards membership, CE or the Silent Auction held at the Annual Meeting. Thank you for participating! We had some great guesses!

 

Richard O. Miller, DVM, EDPA/AC

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Guess What it is!

Case of the Month: Upper 12s

By: Richard O. Miller DVM, EDPA/AC



March 2015

 

 

“UPPER 12’S”

 

The original complaint in this case was that the horse bleeds from the mouth while being ridden and it did not seem to be due to interaction of the bit with the cheeks.  On speculum examination, it would appear that the puncture of the left side of the tongue would be the likely reason!  I would presume that bleeding also occurred while eating but the evidence was being swallowed.  After the more obvious was noted, further examination revealed a sagittal fracture of 209 and a deep periodontal pocket at the palatal 111-112 .  When asked about nasal drainage – “ Oh yes, that has been an occasional event for the last eight years!” 

 

 

Richard O. Miller, DVM, EDPA/AC

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: What you can't always see

By: Richard O. Miller DVM, EDPA/AC



February 2015

 

The postmortem image provided by Jolana Bushnell, speaks for itself.  No one can ever know if the behavior of this horse was related to the severe malocclusion, but it would be easy to presume so.  Pain management is now a big issue, but the level and severity of pain is still quite difficult to objectively measure.   The other two images provided by Rachel Kimsey, are of a six year old warmblood, competing very successfully on the Gran Prix circuit with no evidence of discomfort.   The stench from the impacted food material was extreme and the dark stained surfaces of the fracture suggested anything but a recent occurrence.  If this was not enough to deter performance, a 405 wolf tooth was also present.  It was worn quite smooth by the bit, with this brave mare creating her own bit seats!      The patient had just arrived in this yard, and the prepurchase exam stated that the dentition was normal, but the highly skilled trainer and rider typically cover all the bases and scheduled a dental exam with a qualified provider.   

 

Richard O. Miller, DVM, EDPA/AC

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Epulis

By: Richard O. Miller DVM, EDPA/AC



January 2015

 

This photo was contributed by Rachel Kimsey, an EDPA member from California, that depicts what I refer to as Epulis.  This is my clinical diagnosis , as I have not biopsied these lesions nor had them identified histologically.  In humans, it may also be called a granuloma or a benign tumor.   These lesions are often related to gingival trauma which is not obvious in this case.  Actually, you are viewing the 107 and 109, as the 108 was extracted several years ago and rostral (mesial) drift has completely closed the gap.  So, trauma could certainly have been the primary insult.   I have seen four other similar cases and had others sent to me for evaluation.  One such case could not be reproduced digitally but involved the entire oral cavity.   The clinical significance for dental practitioners is, to be able to recognize the condition and document same.   I advise the client that this condition should be evaluated for treatment if it becomes significantly enlarged.   Surgical removal is reported to be quite successful, with or without subsequent biopsy.  In this particular case, we note the proximity of the Palatine artery.

 

Richard O. Miller, DVM, EDPA/AC

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Another example of Epulis

Case of the Month: The Ability of Tertiary Dentin to Repair Tarumatic Injury

By: Richard O. Miller DVM, EDPA/AC



December 2014

 

These photos are courtesy of Graeme Martin in South Africa.  In, my opinion, they clearly demonstrate that tertiary dentin can repair traumatized teeth, without an occlusal response.  If this situation had been encountered in the acute stage,  a labial restoration would certainly have been indicated.  Since that did not occur, it is yet another example of the power of dentinal repair.   Exposure of live pulp is certainly an issue and intermediate restorative procedures are available,  but it must be realized that pulp can heal itself in the same manner as skin lesions.   The concept of gradual reduction of malocclusions, is flawed.  It is more important to correct rostro-caudal and lateral-medial interference than it is to fear pulp exposure.  As usual, comments are invited. 

 

Richard O. Miller, DVM, EDPA/AC

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: 101 Palatal Extraction

By: Richard O. Miller DVM, EDPA/AC



November 2014

 

These images were provided by Barbara Botezelli, a veterinarian from Sao Paulo.  With this contribution, she also asked for advice on correction.  After putting this question out to a few well known dental providers,  I received several different suggestions:  Some replied that it was a simple case of deciduous extraction, when ready.  I had missed the actual deciduous 101 on the radiograph, as it had been displaced laterally and rotated vertically, but it is obvious on the photo.

 

It now becomes obvious that this is a case or supernumerary 101 with one normal tooth and one underdeveloped tooth.  If the latter was the labial one, then extraction of same would be straight forward but it was not and was precariously close to the palatine artery.  Even if the palatal 101 could be removed without incident, it is generally accepted that “dental drift’ of incisors occurs mesially and labially (rostrally) but never palatally (caudally).  Another suggestion was to remove the labial normal tooth and wait for labial/rostral drift of the abnormal tooth.  Then, if maturation and drift did not occur, extract the remaining 101 and wait for mesial drift to occur.  This latter is the least expensive root to follow, albeit leaving a large gap for at least a year, inviting the entrance of a fixed object and a subsequent fracture. 

 

Dr. Botezelli has chosen the “difficult route of extracting the abnormal  palatal 101 (photo included), will wait for healing and subsequent application of and orthodontic appliance to move the normal 101 caudally.   We wish her good luck in this project and look forward to the continuing case study.

 

Richard O. Miller, DVM, EDPA/AC

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Bit Trauma

By: Richard O. Miller DVM, EDPA/AC



October 2014

 

“Other examples of bone spurs that were likely caused from bit trauma”.  

 

Richard O. Miller, DVM, EDPA/AC

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Incisor Malocclussion

By: Richard O. Miller DVM, EDPA/AC

 



September 2014

 

In spite of publications that state that incisors need no reduction or alignment corrections, it is obvious in many cases that lateral excursion is inhibited by such conditions. It is well recognized that in captivity, food is provided in a form that can be prehended without use of the incisors, since the lips are quite prehensile. But, once the food has reached the molars, the mastication cycle will be compromised if the incisors are laterally restricted. In this photo, it is apparent that there is an obstruction. Notwithstanding the obvious crowding and subsequent rotation, even if the upper centrals can move laterally, a "camming" effect will occur from the prominent lower corners, which will physically separate the molars prematurely. In this case with the presence of excess palatable feed and no clinical signs of disease or parasitism, the patient is quite thin. You make your own decision as to the cause.

 

 

Richard O. Miller, DVM, EDPA/AC

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Hooks

By: Richard O. Miller DVM, EDPA/AC

 



August 2014

 

This image was contributed by Lance Rubin. The caudal hook would have penetrated the palatine bone and/or the artery if it were not for the curvature. Why it did not lacerate the tongue is a mystery! The rostral hook was only reduced by half, not to prevent pulp exposure but due to less than perfect patient tolerance. Upper incisors were worn to the gum line due to cribbing, so excursion was immediate with no relief from a vertical dimension of occlusion (gap). The lower sixes were worn to the gumline. So reduction was adequate. The patient was under weight but no other clinical signs were evident.

 

 

Richard O. Miller, DVM, EDPA/AC

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: PARROT MOUTH- THE EXTREME FORM OF OVERBITE

By: Richard O. Miller DVM, EDPA/AC

 



July 2014

 

There is considerable confusion amongst my clients regarding this terminology.  Often, when I am called to treat a “Parrot Mouth”, it is happily no more than an overjet with some remaining contact between maxillary and mandibular incisors.  These cases are usually easy to correct/mitigate and may or may not, be associated with rostro-caudal disparity of the molars.  The images presented are obviously an example of the title of this discussion.  I feel that reduction of the maxillary incisors is important since it may interfere with labial prehension.  I have removed as much as 15mm without reaching live pulp.  This observation, of course, flies in the face of the literature stating that deposition of secondary dentin is in response to occlusal contact.   The main clinical issue, however, is usually the lower incisors traumatizing the palate.  But, if these teeth are well-rounded and smooth, palatal trauma is either eliminated or reduced.  As for those that feel “ three point contact” is essential, it appears to me that these horse have no mastication problems nor excess TMJ discomfort.  Again, discussion is invited.

 

 

Richard O. Miller, DVM, EDPA/AC

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Canines

By: Richard O. Miller DVM, EDPA/AC

 



June 2014


This collection of images emphasizes the necessity of a thorough exam in the area of the mouth which may be easily overlooked.  Do you see the issues? 

 

 

Richard O. Miller, DVM, EDPA/AC

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Severe Malocclusions

By: Richard O. Miller DVM, EDPA/AC

 



May 2014


SEVERE MALOCCLUSIONS ARE OFTEN SYMPTOMLESS

 

This Hackney mare presented as somewhat underweight but with no other symptoms.  This severe malocclusion was found on routine exam.    Publications that emphasize so-called signs of dental disorders such as    dismastication, excess salivation, weight loss, head tossing , etc . must be disregarded.    Not shown in this picture, was the severe periodontal disease in the 400 arcade that most certainly would have soon caused an abscessation of the 408 and/or the 409.  This equilibration was performed in one procedure with no pulp exposure.  Contrary to published data that this should be corrected in multiple stages, the fact remains that as long as any of the protuberant 108 remains in contact with opposing dentition,  rostro-caudal interference will remain a factor and periodontal issues cannot be resolved.

 

 

Richard O. Miller, DVM, EDPA/AC

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Extraction of Retained Incisor Deciduous Dentition

By: Richard O. Miller DVM, IAED/AC

 



April 2014

 

The first photo describes a sitation that can have an arguable solution. Some would say that the lingually displaced lower 2's that have just barely erupted, will displace the more labially placed deciduous counterparts. In my opinion, this will not occur unless the entire deciduous 2's (including fragments) are extracted. Some practioners may be reticent to remove these teeth at this time, as, due to lack of apical resorbtion, will usually be nearly four centimeters in length. The following photo shows the resultant diciduous teeth. The results will be posted at the time of the next intervention.

 

 

Richard O. Miller, DVM,
IAED/AC

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Bit Chewing

By: Richard O. Miller DVM, IAED/AC

 



March 2014

 

BIT CHEWING.  We are all aware of this condition but there is considerable difference of opinion as to dealing with it.  If the attrition of the lower 6’s is minor and there are no performance issues, it is probably not of clinical significance.  But in this case of a five year old that has already destroyed over 50% of the visible crown, we can start to think pulp chamber exposure.   It is my opinion, in these severe cases that substituting a solid mouth piece for a snaffle, would diminish the attrition rate but others comment that “they will find a way” when the habit is of long-standing duration.  We invite your comments.

 

 

Richard O. Miller, DVM,
IAED/AC

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: SUBLINGUAL LACERATIONS

By: Richard O. Miller DVM, IAED/AC

 



February 2014

 

SUBLINGUAL LACERATIONS. 

These photos were submitted by Fleur van de Wiel, an EDPA member from Holland.  Lacerations of this sort are often overlooked since the symptoms , if any, are minor.  Excess salivation was not even seen and the lesion was noted only because a thorough oral exam was performed.  As noted by the pointer, the lesion extended to the bony mandibular symphysis .  The cause was undetermined but a major consideration is that some bite plates could  cover this area and complications could occur and it would be considered to be  caused by the dental provider.  This lesion reportedly healed uneventfully.

 

 

Richard O. Miller, DVM,
IAED/AC

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Worms in the Mouth!

By: Richard O. Miller DVM, IAED/AC

Photos Courtesy of: Graeme Martin from South Africa



January 2014

 

WORMS IN THE MOUTH!

It has been well documented that the life cycle of  the Bot Fly (Gasterophilus species) includes a larval stage that encysts in the mucous membranes of the mouth.  Illustrations have been presented that actually show the larva crawling between teeth as they exit the oral cavity on their way to the stomach, where they encyst again and spend several months developing into second and third stage larva.  They will spend several months in this location before passing in the manure, pupating and developing into adults.  Whatever environmental trigger that causes the progression of this cycle must have been activated early to cause these larva to encyst on the soft palate.   A  respiratory noise may well have been the primary symptom but an endoscopic examination through the nose could have missed this situation entirely.  Treatment would  be the administration of an appropriate anthelmintic.     

 

This photo is compliments of Graeme Martin from South Africa.  It was not the only case on the premises and this condition  has also been reported from Europe.

 

Richard O. Miller, DVM,
IAED/AC

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Slab Fractures

By: Richard O. Miller DVM, IAED/AC

Photos Courtesy of: Graeme Martin from South Africa



December 2013

  


SLAB FRACTURES:  We have all seen similar cases as this but my message here is different.  In this particular situation, the mobile sagittal palatal fragment was removed and appears to have involved open pulps.  The dark staining is from food accumulation but also suggests a chronic duration.  Whether a dental bridge could form fast enough to prevent apical infection is unknown at this time but radiographs are reported as negative and no sinus drainage has been noted.   A conservative “wait and see” plan is in place  but if clinical symptoms develop, it would be wise to save the fragment in an antiseptic fluid storage container.  If intra oral extraction was attempted in the future, the fragment could be cemented to the existing crown to allow a more stable surface to grasp with forceps.  It is not the intention to search the literature for verification of this technique nor to describe the actual process , but only to bring to the readers attention the possibility.  If you extract such a fragment, KEEP IT.

 

 

 

Richard O. Miller, DVM,
IAED/AC

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

Case of the Month: Cribbing

By: Richard O. Miller DVM, IAED/AC

Photos Courtesy of: Dr Remko Sweere of Holland



November 2013

  

CRIBBING   These pictures are indeed extreme but not a rarity.   The designation of “cribber” may not cause a major health problem but is certainly expensive for any facility that has wood fences!   There is so much difference of opinion as to cause and control.   Cribbing straps are notoriously ineffective but may reduce the severity.  Is this a learned habit or is there a genetic predisposition?   Only the records of major bloodstock sales would show a familial connection.  Some feel that this is a learned condition.  One of my horses tried to learn and failed!  Horses restricted to stalls and limited space are likely to develop vices of some kind but cribbers released to a pasture environment, continue the habit.  Others feel that it is gastric ulcer related but studies with Gastrogard are wanting.   The production of endorphins is another theory but again unproven.  Your comments are welcomeJ

 

 

Richard O. Miller, DVM,
IAED/AC

23411 Via Alondra

Coto de Caza, CA 92679

949-233-0707

richdent1@gmail.com

www.richdent.com

 

January 2013- October 2013 Case of the Month
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