Hi Dr Tutt,

P. and I just wanted to send you a note to say a very sincere thank you (from the bottom of our hearts) for the amazing job you did with our baby, A. (16 year old Yorkie).

She means the world to us and it was absolutely dreadful watching her suffering and gradually getting weaker and weaker. By the time we saw you, she had been extremely sick for over 4 weeks, her regular vet said that at the age of 16 she was too old to undergo anaesthetic and declined to operate on her. She basically didn’t eat for a month other than what we forced her to eat through a syringe, her weight dropped by a kg in a month from 5kgs to 4kgs, we were so worried about her and then one night while at the emergency clinic at Panorama Veterinary hospital the Vet on duty said A. definitely had a problem with her mouth and suggested we make an appointment to see you, which we did.

On the 7th of August we came for our appointment, and I can honestly say – best decision we made. As scared as we were to put our 16 year old baby under anaesthetic, you gave us so much confidence and reassurance. A. was operated on late afternoon and we were able to collect her at 18:00.

Dr Tutt, we want to commend you on an amazing job, A. has had many operations in her life and she has never handled anaesthetic very well, sometimes even taking days before the effects wear off. Your operation was the best anaesthetic recovery A. has ever had, she has never come through anaesthetic that well, on the evening of the operation she was not disorientated or distressed in any way and by the morning it was as if she hadn’t had an operation. All this time I thought A. had a low tolerance for anaesthetic but now I believe it is obviously to do with the way it is administered, thank you very much.

It is now a week after the operation and we have our little A. back, she is eating, she is sleeping, she has energy to go for walks and she has her character back. I cannot get over the incredible recovery following your surgery, the work you did on her is amazing, in just one week she is 95% back to full strength.

We also wanted to thank you for coming out to talk to us while you were operating on A., you didn’t have to do that but we so appreciated the feedback and the reassurance that everything was going well in the operation.

All in all, an incredible experience dealing with you, you are an exceptional doctor and surgeon, we appreciate everything you did for our little A..

Thank you

Kind regards

S. & P.

Cedric is leaving South Africa today to visit his patients in Hong Kong during a week. During that stay, he will spend a full day at the Ocean Park. He will then fly to Kuala Lumpur for 4 days, and to Singapore, where he will spend 2 days treating the residents at the Singapore Zoo. He promised to take a few pictures to be posted here.

After all the teeth in that area have been cleaned and fixed, Cedric will travel all the way to China to share his knowledge. He will be teaching in Beijing and Shanghai during 10 days. He will then fly back to Kuala Lumpur to attend a 3 days feline dentistry course, then to Hong Kong for 4 more days, including 2 days of teaching dog dentistry.

After all this, South Africans will finally get their favorite veterinary dentist back.

To take an appointment with Cedric Tutt in Hong Kong, Kuala Lumpur or Cape Town, please don’t hesitate to contact us.

Teeth that make contact with other teeth become worn by the constant contact and this is defined as attrition. The pulp chamber may become exposed, in which case root canal therapy will be required. Teeth with “near exposure” will require placement of a restoration and odontoplasty of the tooth causing attrition and that tooth or teeth may also require placement of a restoration.
Abrasion of the teeth occurs when the teeth wear due to play with balls, sticks, stones and other abrasive items. If the teeth wear slowly, the body reacts to the stimulus by laying down additional secondary or reparative dentine (also called tertiary dentine) in the pulp chamber to protect the pulp. Where the teeth are worn faster than tertiary dentine can be laid down, the pulp chamber will become exposed, exposing the pulp and leading to inflammation. In rare situations, the pulp will form a granuloma to protect itself but these teeth often have bone loss around the root tip, when radiographed. Root canal therapy is the treatment of choice when the pulp has become exposed. The only other option is extraction of the tooth.
Tooth fractures
Uncomplicated crown fractures are defined as fractures of the crown that affect the enamel and dentine only.
Complicated crown fractures are defined as fractures that affect the enamel and dentine and expose the pulp chamber.
Uncomplicated crown-root fractures are define as fractures that involve the enamel and dentine and extend below the gum margin.
Complicated crown root fractures are defined as those fractures that involve the enamel and dentine, expose the pulp canal and extend below the gingival margin.

Daily brushing is best care but feeding appropriate diets and providing appropriate chews and treats will also help keep the teeth and gums healthy.

Puppies have 30 teeth, while adult dogs have 42. Usually the puppy dentition is replaced over about 4 months – the deciduous teeth being replaced by secondary teeth. Some of the dog’s secondary teeth develop from a tooth bud that does not have a primary precursor. These include the molars and premolar 1 in each quadrant. The first secondary premolar tooth to erupt is premolar 1 in each quadrant and the last teeth to erupt in the mandibles are the last molars (molar 3). In some breeds, the deciduous canine teeth do not undergo the normal resorptive process normally see during teething, and they persist in the mouth. This can cause severe problems that may include eruption of the secondary canine in an abnormal position. Persistent teeth that are close to the secondary tooth can trap food leading to periodontal disease.
The most commonly seen oral disease in dogs is periodontal disease and the prevalence increases with increasing age. Periodontal disease in its mildest form is known a gingivitis. This is inflammation of the gums, that can be resolved by daily tooth brushing. If not noticed early and treated the gingivitis can progress to periodontitis where the other three component of the periodontium become affected. These include: cementum on the tooth surface; periodontal ligaments which anchor the teeth to the bone; and the alveolus (also known as the tooth socket). When these structures are damaged the teeth will become loosened and eventually lost.
The most common dental disease in dogs is probably fractures of the crowns. When the crown is fractured and enamel is lost, dentine, the porous central part of the tooth that houses processes that are attached to the nerves, becomes exposed leading to pain and inflammation. Teeth that are broken should either be treated by root canal therapy or be extracted. To leave a fractured tooth in the mouth is not only painful, but will result in the formation of an “abscess” around the root of the tooth. This leads to more discomfort and may result in a swelling that may erupt through the skin of the face.
Dogs may also be affected by tooth resorption.

• Horses’ teeth erupt at about 3mm per year
• Routine dental care requires trimming of sharp enamel edges once or twice a year depending on individual horse requirements Main points Horse teeth have a limited life span – do not let anyone shorten the tooth’s life span!
• Zebras don’t need routine dentistry so why would my horse?
  • Zebras eat a varied diet, most of which requires thorough grinding before it is swallowed and very little of their diet needs to be chomped.
  • Domesticated horses on the other hand, are fed commercial rations and hay, some of which is fed above the ground (for example in hay nets) leading to abnormal chewing behaviour. Horses are grazers and when their heads are down eating grass, the jaws are in their most natural positions.

Equine dentistry

Horses’ cheek teeth grow at about 3mm per year. That means that a thoroughbred or Warmblood starting out with about 100mm of tooth height will have about 33years of active tooth substance. It is therefore important to maintain as much of the tooth as possible and not over trim the teeth.

Each horse has between 36 and 40 teeth depending upon whether they have premolar 1 and canine teeth in each quadrant. Premolar 1 is often referred to as the “wolf tooth” and may engage the bit when contact is made, causing some discomfort to the animal. Is these cases the teeth are extracted. It is often not necessary to extract Premolar 1, the decision whether to extract or not is dependent on the animal’s response to the bit and contact.

The horse’s lower jaws (mandibles) are fused at the front enabling better grinding of food. They are about the same length as the upper jaws (maxilla) but they are narrower that the maxilla. The mandibular cheek teeth chewing surfaces are rectangular when viewed from front to back, while the maxillary check teeth chewing surfaces are square.

The cheek teeth have enamel, cementum and dentine on the chewing surface, and since the cementum and dentine are not as hard as enamel, they wear sooner resulting in peaks of enamel and valleys of dentine on the chewing surface. This helps the horse grind its food more efficiently.

To increase the robustness of the chewing surface of the upper cheek teeth, each of Premolars 2 to Molar 3 have what is known as an infundibulum which is an enamel lined conical structure running throughout the height of the tooth. Normally the cheek teeth infundibula are filled with cementum, but in some horses the cementum may not have been formed to fill the enamel cone or it may be defective and undergo decay. All incisors, when they are young have infundibula but they are not completely filled with cementum – these unfilled infundibula and known as cups. As the incisors wear they become shallower until there is no longer a cup and its remnant is then known as a “mark”.

During the grinding process, the upper and lower cheek teeth on one side come together to grind food between them while the upper and lower cheek teeth on the other side are apart from each other. As a result of this grinding process, the edges of the maxillary cheek teeth that face the cheeks and those of the mandibular cheek teeth that face the tongue become sharpened. These sharp edges can ulcerated the cheek mucosa and cause a lot of pain and this is exacerbated by bridle cheek straps that pull the cheek against the teeth when contact is made. In mild cases the cheek mucosa adjacent to sharp teeth becomes rough and stained by plant pigments. The sharp lower cheek teeth can cause ulceration of the tongue.

During routine trimming of equid teeth, only the sharp enamel edges must be removed. Taking away more than the sharp enamel, effectively reduces the active grinding width of the tooth.

The maxillary cheek teeth have vertical in-foldings facing the cheek, the edges of which prevent forage from traveling up between the teeth and the cheek surface. Unfortunately some teeth are over trimmed, removing these folds, which in severe cases, can lead to pouching of forage which decays causing pain and halitosis in affected horses.

Sedation of the horse by a veterinarian facilitates the examination and treatment process and also prevents the horse from having an adverse experience.

Never allow your horse to be sedated by an equine dental technician – it is illegal for technicians to inject animals or administer oral sedatives / tranquilizers.

Routine dental examination and treatment requires the placement of a dental speculum (commonly known as a “gag”) to enable thorough examination and treatment of the teeth and mouth.

A light will also be required to illuminate the mouth. A dental mirror is often used to inspect parts of the mouth and teeth that are otherwise difficult to examine.

After sedation there is likely to be unswallowed food in the mouth that must be flushed out to enable visualization of all of the teeth and prevent clogging of the trimming device.

The horse’s maxillary teeth are not in a straight line, but rather in a gentle curve from front to back, which means that the last two molars are tucked behind the rest of the teeth. A straight shanked rasp will not reach these teeth so one with an incline will be required. The chewing surfaces of the successive mandibular teeth follow a gentle arc from front to back, known as the curve of Spee, which is more pronounced in horses with a shorter face (Arabian and Welsh Pony.

The tooth examination and trimming interval is dependent on the individual horse. Some horses require treatment every 6-8 months while other need treating every 15-18 months. The required interval is determined at the second treatment.

The canine teeth are not involved in the chewing process and often accumulate plaque which becomes mineralized to calculus. The gingiva around these teeth is often inflamed and may be enlarged. The calculus must be chipped or scraped off periodically. When the calculus is removed, plaque build-up can be prevented by regular brushing of the teeth. Older horses may suffer from tooth resorption and excessive deposition of cementum on the canines and incisors (EOTRH) and in severe cases the affected teeth will need to be extracted.