The Feet/ Teeth Connection: Q&A with Dr. Tomas Teskey
Dr. Tomas Teskey, DVM, is one of the few, but perhaps slowly growing number of vets who advocates barefoot hoof care. I first interviewed him back in 2013 (see interview here), but he recently agreed to a second interview, this time focusing on a fairly new discovery about horses–the connection between their teeth and hooves. I’m sure you’ll find it very informative.
Can you tell us a little more about when and how you first made the connection between horses’ teeth and feet, as far as how one affects the other?
I’ve been working on horse feet and teeth as a specialty for 17 years, and seven years ago I was doing several horses’ hoof trimming and teeth floating in one sitting—kind of their Spring makeover. I was working strictly with clients dedicated to caring for their horses as naturally as possible.
“Can you look at one more horse?” She is the kind of new client that asks these important questions innocently, and after horse number nine that day, I was sure we were going to head in for some dinner and a drink, and I was also eager to please, so I said, “bring me another horse!”
I was taking a quick look at these horse’s teeth before trimming their feet, watching them walk and trot and turn and getting their “story”: How they were doing? Any problems in the last year? Anything different going on for them? I would then continue the conversation as we worked around all four feet, trimming and balancing and walking before and after each adjustment.
I was taking an hour and a half per horse by the time their teeth were finished up, and I would always take some notes on their feet and what I did before moving in to their mouths to file those sharp points or balance out areas for better chewing. I had all ready learned about looking at the front teeth for length and angle, and I was correcting at least 80% or the horses I looked at. Sometimes it was just a small edge out of balance and other times it was a larger correction of the whole bite angle.
That day after working on horse number eleven this way, I was reading back through my notes, getting all the horse’s colors, size and exact age written down, and adding up the charges. Perhaps being so tired allowed me to take notice of something—every horse that day had some amount of correction made to their front teeth, not only for length, but for straightness from side-to-side, what we refer to as a “laterally skewed incisor angle”.
Since I had the notes about their hoof trimming on the same page, right above the notes I was now making on their teeth, I noticed a connection that literally stole my breath for a few seconds. In every case that day, I could see that the skewed angle of their front teeth corresponded exactly to the balance of their front hooves.
A skewed incisor angle nearly always occurs after a horse chews on one side of their mouth more than the other, and/or holds their lower jaw more to one side than the other, and every horse this day was chewing and/or holding their lower jaw predominantly to the side of their mouth that corresponded to their “better” looking foot.
Most horses have a better front foot, no matter how small the difference, and believe me I can see 1mm differences in horses’ hooves. I was seeing how this hoof soundness was predictive of what their front teeth looked like. Or was it their teeth that were predictive of the way their feet looked? Simply stated, these horses were chewing more to the side where their best foot was, and the reasons why would become clearer later.
I was stunned. This couldn’t be a coincidence. I remember speaking about this immediately with the client, and she nodded continuously while shoving dinner under my nose, probably hoping I would eat something soon so as to not collapse in her dining room after finishing all her horses. I was so excited I don’t remember even getting paid that day. I started looking at every horse in the mouth after looking at their feet, and after several hundred horses, my “amazing discovery” was holding out to be true about 80% of the time. That level of predictability while looking at only two things on the horses was amazing.
What are some of the most common dental problems you see in horses and how should they be addressed?
Our horses inside the confines of domestication do not move, graze, or socialize nearly as much as their ancestors. This is the bottom line for nearly every issue you’d like to look at.
With respect to their teeth, we generally see long front teeth (incisors) compared to the rear chewing teeth (premolars and molars), and abnormally sharp points on the chewing teeth. Simply picking up hay or pellets with their lips, or grazing soft green grass, the front teeth are completely bypassed or worn very little. Without nipping off tough, dry grasses, the incisors do not wear as much as the chewing teeth, and the result is physically longer incisors.
The chewing teeth still wear a good amount, though still less than those ancestors’ teeth. The soft feeds we offer, in addition to an ever-worsening range of motion of the TMJ’s (temporomandibular joints), allow very sharp points to develop, along with deep transverse ridges from chewing side-to-side rather than in a healthier elliptical pattern.
In order for our horses to keep chewing and grinding with longer and longer incisors, they press harder and harder to get their chewing teeth together. Long incisors physically keep chewing teeth from coming together effectively. After a few years, it is especially obvious how the incisor angles deform, pushing forward to get out of the way, while sharp points and ridges get worse and worse, causing ulcers on the cheeks and tongue. At older ages, our horses look “long in the tooth”, with their front teeth pushed so far forward it even deforms their nose and lips.
One-hundred year old dental charts to age horses, and the charts today show these deformities as “normal”. Horses allowed to graze or correctly managed maintain an incisor length and angle similar to what they had at about seven years old. It’s astonishing to realize we are still learning such basic information about our horses after having them by our side the last few thousand years.
When we add in the unhealthy variable of lack of physical activity in a social herd, we also see an epidemic proportion of our horses developing an “overjet”. This is where the upper incisors are further forward than the lower ones. I believe this is due to the disability of the TMJ’s that develop over time due to long incisors, a relatively heavy front end, and environmental stress that causes “tightness” in the jaws, poll and upper neck areas. It is often the worst in horses eating out of elevated feeders.
The result is a dental conformation that leads to reduced circular motion of the jaws, due to loss of the normal forward and rearward motion (anterior-posterior motion). The mandible (lower jaw) becomes fixated in a rearward position. The angle of the incisors becomes more “steep”, overgrowth of the upper front premolars occurs (hooks), and overgrowth of the lower last molars occurs (ramps). The horse’s entire mouth becomes deformed, affecting their ability to move their head normally up and down and side to side.
As compensation and the horse’s best efforts to defend itself, we see the horse’s body following along in this disabling conformation with stiffness of the poll and neck, shoulders jammed upward and forward, high heels on front feet, stubbing of toes with shortened stride, hollowness or upward fixation through the middle of the back (depending on how early or late in the process we find the horse), loss of lateral flexibility and whole-body stiffness, pelvic over-flexion with a tight tail, straightness through stifles and hocks and under run and often inverted conformation of hind hooves.
I also find the majority of horses with the more severe dental balance problems are often the ones with “bad behaviors”, shyness around head, aggressive and/or defensive behavior, mistrusting, spooky, “ungrounded”, or “lazy” if further along in their disability. Neurologic issues of proprioception are also common—this is where we see horses that seem “wobbly” or interfere with themselves as they move in a circle, have difficulty walking backwards, trip excessively or hit their legs stepping over rails.
Other health issues such as respiratory disease and intestinal problems including severe stomach ulcers are much more common than I initially realized in these horses. Incidentally, I notice that adding the presence of a bit in to the mouth of any horse, and especially in horses with these issues, is a recipe for disaster. It is often the “last straw” which leads to a horse losing their grip on life, rearing over backwards, harming themselves and the rider, or worse.
It becomes self-evident that simply dealing with a horse’s poor dental conformation, sharp points, hooks and ramps is just the beginning of addressing a whole-horse condition. Consideration of diet, handling/horsemanship, physical therapy/exercise, bodywork, hoof care, environment and herd conditions are all critical variables.
Many times I am faced with a basic question: How much work should be done to correct what I see in a horse’s hooves and teeth? If their living conditions are unable to change, or if an owner is unwilling to make some basic changes, it may not be helpful to perform what are essentially orthopedic changes in the horse’s body. Abnormal living conditions and poor horse management lead directly to deformities and disease, without exception, and oddly enough these ugly changes are often adaptive. Though I often do my best to help horses feel better in their mismanaged state, I often think about what is truly in their best interest. Many times I am left conflicted, while I continue to learn what practices achieve the best results.
In your opinion, is there both a right and wrong way to go about floating or balancing horses’ teeth?
The way I approach the horse’s mouth has come from years of learning new stuff all the time, so it is “right” for me. I look at the whole horse: The stance, the attitude, the body condition, the position of the head and neck. Watching the owner and horse move in straight lines and wide circles and backing up gives me lots of information. I look for evidence of discomfort and/or asymmetry. Observing a horse eat and/or graze is really interesting. Then I take a careful survey of head symmetry, lips, muscles, eyes, ears, head and/or body tilting, and drainage of eyes, nose and ears.
The first thing you see when parting a horse’s lips is their front teeth, and this is where many processes start for the horse. The feet and teeth are foundational balancing structures, and the incisors are like looking at the rudders of the ship. I check them for length and balance before taking a peek at the chewing teeth for any major problems, and then go back to assess movement and range of motion of the TMJ’s. Only then do I bring out the human-powered files to adjust the length, straightness and angles of the incisors.
Our domestic horses develop these problems with their front teeth FIRST, so I address them first. I find that as the TMJ’s relax and/or “unwind” from the stress of long incisors, the chewing teeth need less work overall. If I correct incisor problems, the other teeth tend to self-maintain themselves much better. Using a full mouth speculum to carefully check the chewing teeth comes next, and I open and close it twice before leaving it open to put my hand inside. Having this speculum placed on balanced front teeth is also a great benefit of doing the incisor work first, as no unnecessary torque and tension is applied to the TMJ’s. Placing a speculum on a horse with long, imbalanced, and/or skewed incisors, however, can be painful and damaging to the TMJ’s.
If the chewing teeth are “floated” first without addressing the incisors at all, the deformities of the entire mouth worsen at an accelerated rate, because even more tooth mass has been removed exactly where a horse may need it for chewing and longevity of those teeth through their life. I think the majority of horses having their teeth “floated” are treated this way. The mentality behind much of this is simple tradition, similar to the notion that horses “need to be shod”, because that’s “just the way we do things”.
I remove the sharpest portions (points) of chewing teeth that are traumatizing the horse’s cheeks and/or tongue. The edges of the teeth underneath the points should NOT be completely smoothed out. I often find broken, infected, loose or missing teeth, and these cases require more attention to achieve as good a balance as possible. I feel each individual tooth, and I always recheck the incisors after working on the chewing teeth and make any final adjustments for this session. Often times it is necessary to balance incisors and other teeth incrementally, revisiting a horse every few months instead of waiting until the next yearly check. Afterwards, I take a good amount of time checking range of motion, occlusion, freedom of movement, poll and neck position, using a combination of active and passive manipulation, acupressure, stretching and massage.
Observing a horse after dental work is also important. A lot of information can be gathered while taking just a minute or two to watch. The teeth and head are connected in an intimate way to the horse’s body balance. I have seen horses that have visited the chiropractor every two weeks for years for the same problem finally become correct after simple incisor balancing. Thoughtful dental and hoof changes can rock a horse’s world in very positive ways. The connections with their entire body, breathing, digestion, freedom of movement and feeling of well-being is undeniable, and working on both the teeth and the feet in concert beautifully addresses the horse’s foundation, allowing for better results using every other treatment modality.
I am not in favor of using motorized dental equipment, using heavy sedating drugs like detomidine, or placing horses in dental halters with their heads hanging up high in a speculum for long periods of time. This may be comfortable for the dentist, but the horse’s TMJ’s and neck end up hyperextended or even sprained. We have mounting evidence that motorized equipment damages the teeth. It also has the tendency to remove way too much tooth mass too easily.
Perhaps in the right hands, under very low speed and cool temperatures, these tools may be appropriate, but this is rarely the case. I have followed behind hundreds of horses that have been treated with power tools, and their teeth are a wreck. Many of these horses are very painful for weeks after their dental visit. Some of this kind of work is reminiscent of seeing horses’ hooves over trimmed, another situation that is unnecessary and damaging.
What do you believe most people are ‘missing’ (not understanding) about the horses’ mouth and teeth?
If there’s something to really take home and study further, it’s how this part of the horse’s body affects their whole well being. It’s not just about whether they can eat OK. I would encourage you to take in to consideration how we can better respect the horse’s body, by realizing that their mouth and teeth and feet are working together to keep things in balance.
Anything you can do to encourage movement while getting the front teeth working makes a huge difference in health. For example, spreading out hay in slow-feeding hay nets for several horses in a group brings so many physical and psychological issues in to balance for horses—I highly recommend this practice.
Horses that use all their teeth have stronger muscles and circulation and nerve function in their head and neck and back, and throughout the rest of the body. They also have better saliva production and chewing movements, improving their metabolism starting with better digestion. Where the head goes the body must follow, and freedom of movement with the jaw translates to freedom of movement for the body: side to side, up and down, forward and backward.
Can you tell us about some specific changes you’ve seen in horses once both the feet and mouth have been addressed?
Sometimes it’s like finding a new horse that was locked inside. One mare I worked on was so wobbly she nearly fell down when asked to back up, and now she runs around and is strong on the trail, and much more confident and easy to be around. There have been many horses labeled as idiots, or even dangerous and crazy that became downright cuddly after fixing their teeth and feet. I would never label a horse as unfriendly or lazy or spooky simply because the owner or trainer says so.
Some of the worst stomach ulcers I’ve seen have healed after getting the horse’s teeth correct. And there’s always the weight gain, muscling, willingness to move forward, better lead changes and improved attitude that are so common. Some horses that were cribbers have stopped this habit! Many horses have just seemed to “wake up” and now like to run more and be more sociable. It doesn’t surprise me at all, given the pain they were in and also dealing with being off balance in their whole body. I’ve also noticed a lot of happy owners, too.
In your opinion, who is best qualified to work on horses’ teeth—vets, equine dentists, barefoot trimmers who’ve undergone dental training?
Most veterinary schools are not teaching students how to do good dentistry or hoof care. I learned by taking extra classes and teaching myself, taking a special interest in these important parts and pieces. There are specific schools teaching equine dentistry, and they are quite varied in how progressive or traditional they are and the depth of their curriculum.
My first choice for the most qualified people to work on horse’s teeth would be veterinarians that have taken a special interest in the subject and can provide good references and speak very well about the relationship that the incisors have with the rest of the mouth and body. This is information we have been looking at for several years now, so if an equine veterinarian is not up to speed on these things, I would recommend looking for one with a special interest in dentistry or one that is open minded about looking at the big picture. Often times there are loose teeth, abscesses, broken teeth, orthopedic problems, or trauma that a veterinarian will be able to handle on the spot, since some of these issues may require drugs for pain, surgical repair or tooth removal.
Many horses I work on have special issues and I will use some sedation and/or local anesthetic to fix them up, so it helps to have the training to handle these drugs safely and effectively. It’s quite an abnormal sensation for a horse to have their front teeth filed, whereas their chewing teeth seem to be quite simple to file. Forcing them to “deal with” the incisor work without drugs has generally resulted in head shyness and resentment, and is dangerous for everyone, so now I am pretty careful to create the best situation possible. This generally means that a small amount of short acting sedative (xylazine) is used when there is significant incisor correction to be done, or precise work deep inside the mouth. Often times after this initial work with a horse, little or no drugs are needed to maintain their teeth in future visits.
Many non-veterinarian equine dentists are doing good work with the horses and are knowledgeable about the incisors and body balance issues. I would ask them about their schooling and experience and check on a couple of their references, and find out who they use for veterinary back-up. The use of drugs by non-veterinarians can be problematic, not only from a legal standpoint, but from experience and also having reversal and other emergency drugs and expertise on hand in case of a problem or abnormal reaction. If an equine dentist finds an infected or broken tooth, they can then recommend the veterinary dentist get involved, or take over the case.