Cover Story | Dentistry

Don’t Undervalue the Mouth During a Prepurchase Exam

By Marie Rosenthal MS

There is a lot riding on the prepurchase examination, and many veterinarians admit they don’t have time to provide a full oral assessment when examining the horse, but Tracy Tinsley, DVM, Dip DAVDC-Eq, said it could be in the horse’s and new owner’s interest to include a full oral examination.

Dr. Tinsley, of Elite Equine Mobile Dentistry, Holly Springs, N.C., and her colleague, Jack Easley, DVM, MS, DABVP/Eq, DAVCD, surveyed veterinarians to find out how the oral examination was handled during the prepurchase examination “to determine the current common procedures for evaluating oral health during prepurchase exams,” Dr. Tinsley explained at the 69th Annual AAEP Convention in San Diego.

Before she decided to exclusively work in dentistry, Dr. Tinsley worked in a general practice where she did many prepurchase examinations.

“I know they’re complicated and frustrating because there are a lot of things to cover, and there’s a lot of anxiety for owners and buyers. But as I’ve gotten into dental practice, I’ve seen a common pattern. I see new horses or new patients right after purchase, and they have severe and complicated dental disease.The owners would come to me frustrated. They would hand me the prepurchase exam, and the little box by the teeth would be checked as normal or it would say, ‘needs floating,’” Dr. Tinsley explained. “But these horses were having pretty severe issues, and now the owners are facing some pretty severe surgical procedures that could be keeping the horse from doing the desired sport that it was purchased for.”

She found that other equine dentists were having a similar experience. “I found that this is not unique to my practice, and that it’s being seen in specialty practices all over the place. I wanted to just get a little better handle on why that might be.”

She put together a 10-question survey that was distributed to equine practitioners through social media platforms and email, and they received responses from 296 veterinarians.

Although there was international participation, most of the respondents were from the United States (83.4%), and were primarily equine practitioners (79.7%).

The veterinarians did prepurchase exams primarily for sporting or performance horses: Barrel racing/rodeo, cutting/reining, dressage, endurance, eventing, hunter jumper, racing and trail riding, but many horses were pleasure horses or for breeding, she said.

Most veterinarians said they do between 10 and 25 prepurchase examinations a year, but it varied from fewer than 10 to more than 100 a year. The average sale price of the horses varied from less than $10,000 to more than $100,000.

Most people perform either an abbreviated exam (54.4%) or do not perform an exam (<10%). A little more than 30% said they always included an oral exam, but 75% of those that did an exam said they did not sedate the horse or use a full mouth speculum, she said. Most veterinarians (96.6%) visually inspected the mouth, 68.2% said that they felt the mouth, and only 11.6% used a mirror. In addition, only 8.9% of the respondents used a full mouth speculum to do the exam. Respondents could select all options that applied, so the total percentage does not equal 100%.

“As a dental practitioner, I would not consider that a complete oral exam. Not that there’s no value in that, but you’re probably not doing a complete and thorough oral exam in most cases,” she said.

When doing a prepurchase oral exam, respondents looked for age of the horse (95.2%), incisor occlusion (92.5%), external oral exam of the skull (87%), wear abnormalities (78.1%), oral soft tissue health (50.7%), fractured teeth (36%), periodontal disease (25.3%), infundibular caries (13.7%) and endodontic disease (11.6%).

“Most everybody was assessing age, which I think is to be expected,” Dr. Tinsley said. “They were looking at the incisors, the outside of the head and oral soft tissue health. And then periodontal endodontic disease dropped down a little bit and most people were looking for the occlusal wear abnormalities, which would include step mouths, wave mouths, sharp enamel points, and things of that nature. So fractured teeth were only being assessed for in about 36% of exams,”

Many respondents said that their answers were typically dictated by whether sedation was allowed by the seller.

Dr. Tinsley said that oral radiographs may be valuable, but she was surprised that some respondents felt that they fell outside of the scope of a prepurchase examination. She pointed to a 2022 study in Frontiers in which 20% of the 248 horses that had full mouth radiographs had “abnormalities on radiographs that would not be predicted by an oral exam.”

“The ability to sedate the horse was a huge limiting factor [for many veterinarians],” she said. “A lot of these horses are [having] prepurchase exams at shows, and they’re competing either the same day or the next day, or there are multiple buyers looking at the same horse.”

These are reasonable limitations, because the horse can only be sedated once. If the first buyer passes, then the horse can’t be sedated for the next prospect.

However, Dr. Tinsley still believes that a thorough oral examination is important before investing in a horse. To illustrate her point, she spoke about 2 horses that could have benefited from a little extra attention.

The first was a 12-year-old Irish sport horse gelding that was purchased in spring 2022 and did well until the next fall. Photos of the gelding’s mouth showed a supernumerary with evidence that another supernumerary tooth on the other side of the mouth was extracted approximately 10 years earlier. Fortunately, the owner knew this was a problem and was prepared for it. The problem was solved surgically, but the waiting led to a severe sinusitis that had to be managed.

“You can imagine that if the owner had not been aware [of the problem], you might have a very unhappy horse and an unhappy owner down the road,” Dr. Tinsley said.

The second case was an 11-year-old Morgan gelding that had just been purchased and presented for a routine float and oral exam. “We had a look in its mouth [under sedation], and we found that this horse had 2 fractured mandibular teeth and 1 fractured maxillary tooth. And so, the horse was currently doing quite well, but we opted to take him for a CT [computed tomography scan] and radiographs to determine if any of one of these teeth or all 3 of these teeth could be problematic for him,” she said.

They found that one tooth was quite severely diseased, and a mass had developed in the rostral maxillary sinus secondary to the diseased tooth. The horse underwent extraction of the tooth and sinus surgery to remove the cement lymphoma, and is now currently recovering. The surgery prevented the horse from work for some time. “This owner was obviously not aware that this problem was present, and insurance declined their claim based on the fact that it was pre-existing.”

She said many things can happen in the mouth that may affect the horse’s ability to perform or could make the animal painful, so it’s an animal welfare issue.

“We know that a complete oral exam may not be possible in a lot of cases when you’re doing a prepurchase exam. But I think when we look back at the very beginning, there are a lot of pleasure horses, trail riding horses and other horses that aren’t necessarily limited as to whether they can be sedated, and that perhaps it is worthwhile to put a speculum on, sedate the horse and do an exam.

“But at a bare minimum, I think owners or buyers need to be educated that there are things in the mouth that can affect performance, quality of life and be quite expensive to treat. We can’t treat everything with our floats. Oral disease can cause a lot of pain, chronic pain and it is often asymptomatic,” she said.

It is time for veterinarians to talk with clients, educate them, document any issues and start including an oral examination in the prepurchase exam.

“I’m also hoping to prompt some discussion about including a more complete oral exam and or better client education when a complete oral exam is not able to be performed.” MeV