Alveolar bone infection and osteomyelitis of the supporting
bones
The most common indication for equine cheek teeth exodontia is infection
of the tooth apex that is usually caused by mixed anaerobic bacterial
infections (with concurrent infection of some or all pulp horns, the
adjacent periodontal membranes and alveolar bone). Extraction-related
damage to the alveolar bone may allow more extensive bone infection by
these pathogens to develop. Consequently, post-extraction complications
are higher following extractions of apically infected as compared to
fractured teeth without clinical apical infection (Kennedy et al.2020) and especially in horses with pars pituitary intermedia
dysfunction. Concurrent alveolar sequestration is common with alveolar
and supporting bone infections and it may not be possible to determine
which came first (Fig
6 ).
If the supporting mandibular or maxillary bones are swollen and painful
on palpation, the alveolus is obviously infected and will usually
contain malodorous exudate. Systemic and possibly local antibiotic
therapy should be administered to such cases along with removal of
sequestrae and alveolar lavage. Repeat examinations, even weeks later
may show development of new sequestrae that also must be removed.
Because many of the bacteria involved in dental infections are partial
or full anaerobes and possibly 50% cannot be conventionally cultured,
broad-spectrum antimicrobial treatment that is effective for anaerobic
infections should be administered to such cases. Further examinations
including imaging to assess the degree of bone infection and detect new
sequestrae should be performed until the alveolus has complete
granulation tissue cover indicating alveolar healing (Fig 7 ).