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What is involved in tooth extraction?

25 year old QH mare with one-sided stinky thick yellow nasal discharge diagnosed through radiographs with probable tooth root infection in 209. Multiple rounds of antibiotics (smz and doxy) with no result. Mare has moderately advanced dsld, Cushings and high level of anxiety. She is eating well and seems comfortable (well, except for the globs of mucous from her nose and pain managed by bute for her dsld). We were referred to surgery clinic for tooth extraction. What is involved in this? Standing or general anesthesia? I can’t imagine hauling this mare much less putting her under anesthesia. What is the rehab? Any input appreciated!

I’ve not dealt with one that was already infected like yours, but they are sedated standing, in the stocks, just like normal dental work. It’s tough to get a horse tooth out, I can tell you that, so if you are squeamish I would not watch.
I would guess that once the tract is open, antibiotics would be much more effective. Generally they advise squirting out the open area 2-3x/day with saline altho in some cases mixed with a little chlorhexidine. Not sure how far back #209 is but you might need to use a hose to reach, gently.
Aside from having an infection, getting a tooth pulled is truly not that big of a worry.

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It’s relatively straight-forward - like OF said they sedate standing and then extract. It is grisly to watch but is over quickly (usually), and the tooth may come out quite easily if it’s infected. After extraction, a daily rinse with chlorhexidine or saline (a large livestock drench gun is perfect for this) to flush out the site.

Has the vet done a culture? If you don’t see improvement post-extraction you may want to consider a sinus infection. I had experience with one that presented the same way - infected tooth but wasn’t the root of the problem.

Can you find a dentist to do it on site? If you explain the mare is DSLD maybe they would understand your reservations for hauling her. Advising/referring to a clinic for this is the safest suggestion but you could also reasonably do this in the field.

Jingles for your mare!

Sometimes, if the tooth is REALLY rotten (and it sounds like yours is)… They come out really easily. Not much holding them in place. Good luck!!!

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She had two cultures, both of which were negative, which is rather confusing. The vet says secondary sinusitis. How did you get the sinus infection cleared up? We have tried 3 weeks of SMZs and 2 weeks of doxy. Vet does not recommend Excede since it is the same class as smz but it would be worth a try if there is any chance of it working?
I have a dentist coming next week - she had said she wanted to do it in the clinic but I will definitely ask if it could be done on the farm.

I had a horse who experienced this. We treated with SMZs and metronidazole. We also did nasal flushes - drilled a hole in his head and flushed with saline. Basically like a neti-pot. The metro made a big difference, so I would talk to your vet about that.

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If the horse is 25 there might not be much root left to the tooth and the extraction will be easy. But some horses still have root left at this age, I suppose you could x-ray to see. I had an old pony, age unknown but probably 30’ish, that had several abscessed teeth that needed to come out. There wasn’t much left to them and the dentist removed them easily. He just grabbed them and yanked. Pony was happy to have them gone.

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A good video is worth a thousand words. You can skip to about the middle. The beginning is about preparation and sedation.

https://www.youtube.com/watch?v=oiO3Q02JrZ8

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If there is secondary sinusitis the vet may have to install a lavage system to flush the infected sinus for a few days like one1horse said. It involves a catheter placed through a tiny hole in the forehead, into the sinus and through that the flushing is done. I have been through this 3 times with one of my minis. Twice while he was an inpatient at the hospital and once when he was home. It sounds worse than it is, though it is kinda gross. I used to be a nurse so I wasn’t to icked out over it. His teeth were done in the clinic because of the secondary infection.
My old gelding just had 5 teeth removed at home and he sailed through the procedure. Took two hours for 5 teeth and he was hoovering up mashes a few hours later. We chose to do him at home as there was no infection.