Oral Ulcers in Horses

Since I was a little girl my passion, after writing, has been horses. Learning and sharing everything I know with you here. Happy Trails!

Symptoms of Oral Ulcers in Horses

If you are concerned that your horse may have oral ulcers there are clear symptoms he/she indeed has them. Beyond the symptoms listed below you should have a thorough look at the hay your horse is eating. Sometimes you can find the culprit in their hay. If not, here are symptoms to look for:

  • Your horse is interested at feeding time, yet stops eating soon after he starts.
  • They have their mouth slightly open or lower lip hanging down.
  • A very common symptom is drooling!
  • Are you seeing small piles of feed uneaten near the feeding area?
  • Is the mouth and/or lips sensitive to touch?
  • You can see visible ulcers inside the mouth especially along the lower lip canal.

These are the symptoms of undesirable grasses in hay. When the hay being fed to your horse has an overabundance of undesirable grasses, your horse will develop red, open ulcers in his mouth. These open ulcers will have the culprit still embedded in them often.

Ripgut (Bromus diandrus), Foxtail (Hordeum Murinum), and Cheatgrass (Bromus Tektorum) are just a few common and extremely problematic grasses within the US. There are too many variations of undesirable grasses to list them all, but these are the most notorious ones, especially the Ripgut. It has been known to perforate a cows gut when eaten.

The Ripgut grass was the culprit in our situation, so the photos and videos you find in this article are of that grass.

Ripgut, Foxtail, Cheatgrass Distribution

You Need to Intervene (Help)

A horse cannot remove these undesirable grasses from their mouth. These grasses have spines on them pointing in one direction, in. When their feed has a lot of them, they build up in the lower lip, piercing the tender flesh, embedding themselves in their lip. Once one has penetrated the flesh, it's really easy for more to pile into the hole. One after another, as the horse picks up his hay with his lips, the undesirable grasses drop off their spiny arrows, that in turn, they embed themselves into his lips.

The horse will continue to eat until he is in so much discomfort he cannot pick up another mouthful of the hay. At this point, it is too painful to hold his lips together and swallow his saliva. He will then stop eating, stand with his lips apart, drooling profusely. The drool will sometimes extend from his lip all the way to the ground.

Know Your Foxtail Grasses!

Type of GrassSeasonCommonly Found

Foxtail or Wild Barley (Hordeum Murinum)

Springtime: Green and supple. Summer: Dry and brittle.

Roads, paths, "weedy" areas

Ripgut Grass (Bromus Diandrus)

Springtime: Green and somewhat supple. Summer: Dry, dangerous for animals if ingested.

Grassy Hillsides

Cheatgrass (Bromus Tektorum)

Same as Ripgut; Sprintime: Green and somewhat supple. Summer: Dry, but not as dangerous as ripgut grass.

Grassy Hillsides, desert areas

What You Can Do

You can be a diligent horse (or any grass-eating animal) owner and pay attention to what is fed to him. These grasses start growing in the early spring. They are soft and supple at this time, but as the summer months dry out the grasses, they become dangerous. If you know the dangerous grasses, you will be able to avoid or reduce your animal's exposure to them.

Helping Your Horse

When you notice your horse is exhibiting these symptoms, you need to take action to relieve his pain. Some horses don't mind having a person touch his mouth, and others aren't as easy. Patience is the key here. Even the most docile horse in the barn can become resistant when human fingers are probing his tender mouth full of stickers—it hurts!

Have someone help you; it's just easier that way. Put a halter on him so he can't walk away before you're done. Gently put your thumb into the corner of his lower lip and slide it down until you can lift the lip away from the teeth. His natural saliva will help with sliding your finger. Don't put your finger between the teeth at or beyond the occlusion, or you may very well be accidentally bitten.

Now that you have the lip pulled down, look closely at the ulcers. Are there little white or yellow things sticking out of them or lying in them? These are the undesirable grasses like foxtails, ripgut, and cheatgrass embedded into the ulcer. With tweezers or your bare fingers, pull them out. Keep picking them out until you can't see any more.

Check the front of his mouth and the other side. If one side has an ulcer, the other side probably does too. After you have picked it all out, prepare a bottle of warm saltwater and spray it gently into his mouth on the sores. This will help with the healing process.

Alfalfa Cubes

I've used alfalfa cubes successfully. They provide all the nutrients of alfalfa, and some brands even have added nutrients. Alfalfa cubes are especially helpful if you have to feed in a windy area. They won't blow away as alfalfa flakes do. I will wet the cubes before feeding them to the horses and make sure the horses have plenty of water.

Can You Identify the Foxtail in the Left Photo?

Horses are very resilient, especially with oral problems. Don't be surprised if you check the next day and the sores are halfway healed or more! If you find they are not healing by week's end, then there may be a stubborn foxtail embedded or another issue that needs veterinarian attention.

The short video below shows how to open a horse's lips. It also includes still shots of the ulcers at the end of the video.

Short Video of Ulcers in the Mouth

© 2013 Joanna

How to get rid of stomach ulcers in horses?

Studies indicate that Gastrogard/omeprazole paste is highly effective in treating stomach ulcers in horses.[1] The drug is used in conditions where the inhibition of gastric acid secretion may be beneficial, including gastro-oesophageal reflux disease, dyspepsia, peptic ulcer disease, aspiration syndromes, and Zollinger Ellison syndrome.

Omeprazole dosage for horses is typically 4 mg/kg bwt per os, once daily for up to 30 days.

Studies also indicate that gastric ulcers in untreated horses do not demonstrate a significant rate of spontaneous healing – i.e. they typically do not heal on their own. Treating equine gastric ulcer syndrome with proper products is key to a fast recovery, prevention of recurrence, and prevention of serious health complications due to the stomach ulcer.

Ulcers in horses affect many almost half of all foals and one-third of adults can be affected by this condition. Moderate to severe ulcers commonly develop in horses of all types, and this condition is also known as equine gastric ulcer syndrome. It is also referred to as equine gastric ulcer disease.

Horses are prone to ulcers because the horse’s stomach is very small. The horse’s stomach holds four gallons and has two sections. The esophageal region, or the non-glandular region, has a lining of tissue. The animal’s second section, the glandular portion, of the stomach produces hydrochloric acid, which is used to aid in food digestion. This acid is being produced within the horse’s stomach at all times, and if the horse doesn’t eat, or if the feed does not agree with the horse, then it builds up within the stomach. This acid affects the lining of the stomach and causes painful ulcers to occur.

Horses must eat as they were designed, which is by grazing lightly throughout the day in the pasture. Horses that are workers or are being trained may be stabled and fed on the owner’s terms. Since horses are continuously secreting gastric acid, even when not eating, and a more “restricted” access to food rather than the freedom to graze cause too much acid build-up within the stomach. Horses that are able to eat clean hay and grass are less susceptible to this painful and irritating condition.

Ulcers in horses are periods of inflammation of the lining of the stomach. Ulcers develop from the build-up of hydrochloric acid within the stomach. Ulcers can range from mild to severe and require medical attention in order to be properly treated.

The ABCs of veterinary dentistry: U is for ulcers—what a pain!

Treating these painful lesions in dogs and cats requires figuring out what's causing them.

An ulcer is a tissue defect that has penetrated the border between epithelium and connective tissue. Its base is located deep in the submucosa or even within muscle or bone. An oral ulcer is a break in the mucous membrane with loss of surface tissue and necrosis of epithelial tissue. It is a deeper breach of epithelium than an erosion or excoriation, involving damage to both epithelium and lamina propria (Figure 1).

Figure 1. Superficial and deep ulceration in a dog's mouth. All images courtesy of Dr. Jan Bellows.Oral ulcers in dogs and cats are painful to the patient and often challenging to the veterinarian who has to figure out what to do about them to eliminate suffering.

First things first: Identification

Clients rarely notice their dog's or cat's oral ulcerations. If the lesions were on the tip of their pet's nostrils, they'd be on your office doorstep in a minute. More often it's the veterinarian or technician who finds ulcers either during an exam room check or when the patient is under anesthesia.

The most commonly affected oral tissues include the oral mucosa, the palatal mucosa, the lip margins and the vestibules (areas between the teeth, lips and cheeks) (Figures 2A-2C). Some dogs and cats with oral ulcerations show excessive drooling (Figure 2D), halitosis and a history of pain when eating. Unfortunately, most do not show any clinical signs, suffering silently.

Figure 2A. A rodent ulcer affecting a cat's lip.

Figure 2B. Diffuse ulcerations involving a cat's soft palate and right vestibule.

Figure 2C. Marked oral ulceration involving a dog's left vestibule.

Figure 2D. Ptyalism secondary to oral ulcers.Next: Discover the proximate cause of the ulcer

Oral ulcers arise from either inside or outside causes.

Inside (organic internal medicine) causes. Internal causes of oral ulcers include viruses, bullous mucocutaneous diseases, azotemia and neoplasia (Figure 3).

Figure 3A. Marked ulceration on a cat's tongue secondary to calicivirus and feline leukemia virus.

Figure 3B. Vestibular ulceration secondary to squamous cell carcinoma.Outside (other than organic) causes. Contact ulcers occur secondary to direct mucosal interaction with an irritant, allergen or antigen (Figure 4). Contact mucositis with ulceration is most commonly observed where the labial, buccal or lingual mucosa touches a prominent tooth surface in susceptible dogs or, more rarely, in cats. They have also been referred to as kissing ulcers, kissing lesions and chronic ulcerative paradental stomatitis (CUPS) lesions.

Figure 4A. Contact mucositis with ulceration affecting a dog's maxillary canines and incisors.

Figure 4B. Pseudomembrane formation over ulcer secondary to a hypersensitive reaction to plaque.

Figure 4C. Contact ulceration caused by a dachshund's left maxillary first molar.

Figure 4D. Contralateral side in the same dog as in Figure 4C where ulceration has eroded through all layers of the mucosa, submucosa and epidermis.

Figure 4E. Ulcers on a dog's tongue after contact with bleach.Treatment

Ulcers are wounds. Their persistence depends on their etiology and the animal's ability to self- repair. Treatment of oral ulcers involves eliminating the cause, allowing re-epithelization to occur. Topical medicaments with zinc ascorbate and zinc gluconate (such as Maxi/Guard Oral Cleansing Gel-Addison Biological Laboratory) help stimulate collagen production, which is part of the healing process. The antimicrobial properties of zinc ascorbate help control infection. Other therapies include tooth extraction to eliminate mechanical irritation, short-term use of systemic anti-inflammatories and antimicrobials, and CO2 laser.

In cases of ulcers caused by plaque-laden tooth contact with the alveolar mucosa (Figure 5A), initial treatment involves dental scaling and polishing followed by scrupulous home care administered twice daily. Daily application of OraVet Plaque Prevention Gel (Boehringer Ingelheim) is advised to create a barrier between the tooth and mucosa. Unfortunately, this does not usually eliminate the ulcers, necessitating extraction of teeth (Figures 5B, 5C).

Figure 5A. Marked ulceration secondary to plaque hypersensitivity in a Maltese dog.

Figure 5B. Full-mouth extractions to remove the plaque-laden teeth from contacting sensitive mucous membranes.

Figure 5C. Resolution of ulceration after full-mouth extraction.The use of a CO2 laser to photovaporize oral ulcers has been met with favorable results. The process decreases pain and the bacterial load, leaving a “Band-Aid” char covering exposed tissue. The laser is set between 3 and 6 watts in continuous mode, and the ulcer is slowly circumscribed by gradually focusing on the lesion until the entire ulcer is “painted” with light energy (Figure 6).

Figure 6A. CO2 laser treatment of a localized ulcer.

Figure 6B. Refractory caudal ulceration in a cat after full-mouth extraction.

Figure 6C. Laser tissue ablation on the affected side in the same patient as in Figure 6B.

Figure 6D. Tongue ulceration secondary to hair foreign bodies.

Figure 6E. The CO2 laser used to help treat the ulcers in the same patient as in Figure 6D after hair foreign body removal.

Figure 6F. Appearance of patient shown in Figure 6D one month later at a follow-up laser treatment.

Figure 6G. Laser treatment for resolving ulceration of a cat's tongue (same patient as in Figure 3A).

Figure 6H. Resolution of the rodent ulcer in the patient shown in Figure 2A after systemic steroid treatment and local CO2 laser tissue ablation.

Straight from the horse’s mouth: Equine dental care

February is National Pet Dental Health month, a time when pet owners are reminded that routine oral care is an important aspect of their animal’s well-being. Just like their small animal counterparts, large animals such as horses also require veterinary attention to keep their mouths in top shape.

Dr. Leslie Easterwood, a clinical assistant professor at the Texas A&M College of Veterinary Medicine & Biomedical Sciences, says that there are not many preventative maintenance procedures owners can do at home with their horse’s teeth, so it is important that owners keep an eye out for signs of discomfort and contact their veterinarian if any concerns arise.

“Dropping grain, holding their head funny while chewing, odors, resistance to the bit, and performance issues are all signs that there could be dental issues,” Easterwood said.

Easterwood says that the most common dental issue seen in horses is due to normal wear. Sharp enamel points along the cheek side of the upper arcades and tongue side of the lower arcades occur because of the side-to-side grind of a horse’s mouth, which is normal.

However, these sharp edges cause ulcers along the horse’s cheeks and tongue, and smoothing the sharp edges allows the ulcerations to heal quickly.

“Dental floating is a procedure to smooth these sharp enamel points,” Easterwood said. “Floating is the common term for routine maintenance of a horse's mouth. The term 'floating' comes from woodworking, in which boards are planed smooth.”

Horses that are going to be ridden should start having their teeth floated prior to introducing the bit. Most horses need their teeth floated annually, but missing teeth, unlevel arcades, or other dental problems may require more frequent maintenance.

Horses may also require dental attention for the removal of their wolf teeth, which are usually removed prior to introducing the bit.

“A horse can have zero to four wolf teeth, but usually have only two, on the upper arcades,” Easterwood said. “These teeth are small and are actually the first cheek teeth.”

Staying up to date on your horse’s oral health can help prevent unnecessary discomfort and larger health issues. Since most equine dental maintenance practices require the care of a veterinarian, it is important that owners establish a relationship with their veterinarian that includes discussion of oral health.

Although equine oral care may look very different from the dental care required for humans and smaller animals, regular maintenance and veterinary care can keep your horse happy, healthy, and champing at the bit.

Watch the video: Equine Gastroscopy 101: Scoping a Horse for Equine Ulcers

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