Senior Horse Dental Problems: Signs, EOTRH, and What To Feed

By Dr Duncan Houston

Older horses do not just need “a quick float” now and then.

As horses age, their teeth wear down, loosen, fracture, shift, develop gaps, trap feed, and sometimes become painful enough to stop them chewing properly. The problem is that many senior horses are stoic. They may not scream about dental pain. They may just eat slowly, drop hay, lose weight, avoid carrots, resist the bit, or quietly stop grazing as well as they used to.

One of the most important senior horse dental diseases to know is EOTRH, which stands for equine odontoclastic tooth resorption and hypercementosis. It is a painful, progressive disease that mainly affects the incisors and canine teeth of older horses.

The goal is not just to keep the mouth looking tidy. The goal is to keep the horse comfortable, chewing, maintaining weight, and able to enjoy normal life.

Quick Answer

Senior horses should have regular veterinary dental exams, at least yearly, and often every 6 months if they have weight loss, missing teeth, quidding, gum disease, EOTRH, or trouble chewing. Dental red flags include dropping feed, slow eating, bad breath, weight loss, refusing hay, nasal discharge, pus around the jaw or cheeks, head shaking, bit resistance, swollen gums, and long stems or large feed particles in the manure. EOTRH is a progressive, painful dental condition of older horses that usually affects the incisors and canine teeth, and diagnosis often requires dental radiographs. Severe EOTRH is commonly treated by extracting affected teeth, and many horses feel much better after recovery. (University of Minnesota Extension)

What Changes Happen in an Older Horse’s Mouth?

Horses have hypsodont teeth, meaning they have long crowns that continue to erupt as the grinding surface wears. That system works well for much of a horse’s life, but it does not last forever. As the reserve tooth reduces with age, older horses become more prone to worn teeth, loose teeth, missing teeth, overgrowths, gaps, periodontal disease, and chewing problems. Utah State University explains that if a horse’s teeth do not wear evenly, hooks, points, and irregular wear can interfere with normal chewing and reduce how well the horse uses its feed. (Utah State University Extension)

Common senior horse dental problems include:

• Sharp enamel points

• Hooks and ramps

• Wave mouth

• Step mouth

• Loose teeth

• Missing teeth

• Fractured teeth

• Periodontal disease

• Feed packing between teeth

• Tooth root infection

• Incisor and canine disease

• EOTRH

• Poor chewing efficiency

The real concern is not just the tooth itself. The real concern is what poor teeth do to the whole horse.

A horse that cannot chew properly may lose weight, drop feed, choke, develop digestive problems, struggle with long-stem hay, or pass poorly chewed fibre in the manure. In practice, dental disease is one of the first things I want ruled out in an older horse that is losing condition.

Signs Your Senior Horse May Have Dental Pain

Dental pain can be subtle. Some horses continue eating enough to hide the problem for months.

Watch for:

• Quidding, where the horse drops partially chewed hay or feed

• Slow eating

• Dropping grain from the mouth

• Refusing hay

• Preferring soft feed

• Packing feed in the cheeks

• Bad breath

• Excessive salivation

• Weight loss

• Poor topline

• Dull coat

• Head tilting while chewing

• Head shaking

• Bit resistance

• Reluctance to accept the bridle

• Nasal discharge

• Facial swelling

• Pus draining from the cheek or below the jaw

• Red, swollen, bleeding, or receding gums

• Long stems or large feed particles in manure

• Water buckets full of hay or grain

That last one is easy to miss. If your horse’s water bucket is packed with feed, they may be using water to soften food because chewing hurts or has become difficult. University of Minnesota Extension lists quidding, foul breath, weight loss, refusing hay, nasal discharge, pus from the cheek or jaw, bit refusal, and head shaking as signs of serious dental problems. (University of Minnesota Extension)

A fat senior horse can still have dental disease. A shiny senior horse can still have dental disease. Body condition matters, but it does not replace a proper mouth exam.

What Is EOTRH in Horses?

EOTRH stands for equine odontoclastic tooth resorption and hypercementosis.

In plain English, it means the tooth is being destroyed and distorted at the same time.

The disease involves two main processes:

1. Tooth resorption, where cells break down tooth structure.

2. Hypercementosis, where excess cementum builds up around the tooth root as the body tries to stabilise the diseased tooth.

EOTRH most commonly affects the incisors, which are the front teeth, and sometimes the canine teeth. It is mainly seen in middle-aged and older horses, but it can occasionally be seen in younger horses. UC Davis describes EOTRH as a progressive dental condition in older equines that predominantly affects the incisors, with the cause still unknown and likely multifactorial. (Center for Equine Health)

This disease matters because it can be very painful.

The frustrating part is that owners may not notice obvious signs until the disease is advanced. The horse may simply stop wanting to bite into carrots, struggle to graze short pasture, become irritable with the bit, or slowly lose condition.

What Does EOTRH Look Like?

EOTRH can look different depending on the stage.

Early signs may include:

• Mild gum redness

• Tooth discoloration

• Reluctance to bite hard treats

• Reduced grazing efficiency

• Subtle bit resistance

• Mild changes in behaviour

Advanced signs may include:

• Swollen gums around the incisors

• Gum recession

• Draining tracts

• Pus or bleeding around the gum line

• Loose incisors

• Fractured incisors

• Bulbous tooth roots

• Bad breath

• Drooling

• Quidding

• Head shaking

• Difficulty grazing

• Weight loss

• Pain when the incisors are touched or manipulated

Merck Veterinary Manual lists severe EOTRH signs including gum recession, incisor gingivitis, draining tracts, tooth crown fractures, and discomfort when the incisors are manipulated. It also notes that diagnosis and staging depend on radiographic evaluation. (Merck Veterinary Manual)

A key owner clue is this: if your older horse suddenly refuses to bite a carrot, apple, or hard treat they used to love, do not laugh it off. That can be a front-tooth pain warning.

How Is EOTRH Diagnosed?

EOTRH is diagnosed using a combination of:

• History

• Behaviour changes

• Oral examination

• Incisor and canine inspection

• Gum assessment

• Tooth mobility assessment

• Dental probing where appropriate

• Dental radiographs

Dental radiographs are especially important because the worst disease can be below the gum line. A horse may have painful tooth root changes that are not fully visible from the outside.

The American College of Veterinary Surgeons states that radiographs of the incisors and canines are essential for evaluating the extent of EOTRH, visualising resorptive lesions, assessing tooth roots, and identifying complications such as infection or bone loss. (American College of Veterinary Surgeons)

This is why “just having a look” is not always enough.

A sedated, thorough dental exam with proper lighting, a speculum, and radiographs when indicated gives far more information than peeking at the front teeth in the paddock while the horse tries to leave the conversation.

How Is EOTRH Treated?

Treatment depends on severity.

Mild cases may involve:

• Monitoring

• Regular dental checks

• Removing trapped feed

• Managing periodontal disease

• Pain control when needed

• Dietary changes

• Radiographic monitoring

However, EOTRH is progressive, and there is currently no proven way to reliably stop disease progression once it is established. UC Davis notes that mild care may include cleaning, topical medications, antibiotics, pain management, and dietary changes, but that there is currently no way to slow disease progression. (Center for Equine Health)

In painful or advanced cases, extraction of affected teeth is often the best treatment.

That can sound extreme, especially if multiple incisors need removal. But horses often adapt surprisingly well. Many are more comfortable, brighter, easier to handle, and better able to eat once painful teeth are gone. ACVS notes that extraction of affected teeth is the treatment for significant EOTRH discomfort, and that removal of all incisors can be well tolerated. (American College of Veterinary Surgeons)

The mistake is thinking, “But he’ll have no front teeth.”

The better question is, “Are those front teeth helping him, or hurting him?”

Painful teeth are not useful teeth.

Can Horses Eat Without Incisors?

Yes, many horses can do very well without some or even all incisors.

Incisors are mainly used for grasping and cutting grass. Chewing is done by the cheek teeth further back in the mouth. After incisor extraction, many horses can still eat hay, senior feed, soaked cubes, soaked pellets, and appropriate forage. Some can graze, especially if pasture is long enough for them to grasp with their lips and tongue.

UC Davis states that many horses learn to graze without incisors by using their lips and tongue, and that horses may not require major dietary changes depending on which teeth are extracted. (Center for Equine Health)

The practical point is this: short, heavily grazed pasture can be harder for a horse without incisors. Longer pasture, soft forage, soaked fibre, and complete feeds may be needed depending on the horse.

Feeding a Senior Horse With Dental Disease

The first rule is simple: do not just add more grain.

If an older horse is losing weight because it cannot chew, more hard feed may not fix the problem. It may increase choke risk, starch load, digestive upset, or simply be dropped on the floor.

The aim is to provide enough fibre, calories, protein, vitamins, and minerals in a form the horse can actually chew and swallow.

Useful feeding options include:

• High-quality soft hay if the horse can manage it

• Chopped hay

• Soaked hay cubes

• Soaked hay pellets

• Soaked beet pulp

• Complete senior feed

• Alfalfa cubes or pellets where appropriate

• Higher fat feeds for extra calories when suitable

• Smaller, more frequent meals

• Warm soaked mashes in cold weather

University of Minnesota Extension notes that many older horses have worn or missing teeth that make chewing forage difficult, and that complete feeds can provide 100 percent of a horse’s daily fibre needs for horses that can no longer chew hay effectively. (University of Minnesota Extension)

For senior horses that can chew hay but need more calories, higher-quality forage such as alfalfa or immature grass hay may help. Fat sources such as rice bran, flaxseed, vegetable oil, or higher-fat feeds can also be useful when introduced gradually and balanced properly. (University of Minnesota Extension)

How Much Forage Does a Senior Horse Need?

Forage is still the foundation of the diet unless a veterinarian or nutritionist has a specific reason to modify it.

A common starting target is around 1.5 to 2 percent of body weight per day in forage or forage replacement, adjusted for body condition, metabolism, disease risk, workload, and dental ability.

For a 500 kg horse, that is roughly 7.5 to 10 kg of forage or forage equivalent per day.

The exact amount depends on the horse. An obese senior horse with laminitis risk does not need the same diet as a thin senior horse with missing cheek teeth. An old horse with PPID, insulin dysregulation, or recurrent laminitis needs a more careful plan than simply “feed more.”

What matters most is whether the horse is maintaining body condition, passing normal manure, drinking well, and eating comfortably.

Soaking Feeds: Helpful, But Do It Properly

Soaking can make feed easier to chew and swallow. It can also reduce dust and help hydration.

Soaking is especially useful for:

• Hay cubes

• Hay pellets

• Beet pulp

• Senior pellets

• Complete feeds

• Alfalfa cubes

• Horses with missing teeth

• Horses prone to choke

• Horses with painful chewing

• Horses recovering from dental extractions

Practical tips:

• Soak until the feed is soft all the way through.

• Use clean water.

• Feed soaked feed fresh.

• Do not leave wet feed sitting for hours in warm weather.

• Introduce new feeds gradually.

• Make sure the total diet remains balanced.

Do not feed rock-hard cubes to a horse with poor teeth and hope enthusiasm will solve physics. It will not. It may solve your evening by creating a choking emergency, which is less ideal.

Risk Framework: How Worried Should You Be?

Low Risk

Low-risk signs include mild age-related wear found on routine dental exam, no weight loss, normal chewing, normal appetite, normal manure, and no obvious mouth pain.

Action: Continue routine dental exams, usually yearly, and monitor eating, weight, manure, and behaviour.

Moderate Risk

Moderate concern includes slow eating, mild quidding, dropping some feed, early gum redness, mild bit resistance, or gradual body condition change.

Action: Book a dental exam. This is not usually an emergency if the horse is bright and eating, but it should not be ignored for months.

High Risk

High concern includes weight loss, refusing hay, repeated quidding, foul breath, facial swelling, nasal discharge, loose or broken teeth, pus around the gums or jaw, difficulty grazing, suspected EOTRH, or pain when the incisors are touched.

Action: Arrange veterinary dental assessment promptly. Radiographs may be needed.

Critical Risk

Critical concern includes choke, not eating, severe facial swelling, severe pain, fever with dental signs, heavy bleeding from the mouth, suspected tooth root abscess with systemic illness, severe weight loss, or any horse that is dull, dehydrated, colicky, or unable to chew.

Action: Treat this as urgent and contact your veterinarian.

What Else Could Look Like Dental Disease?

Not every senior horse that loses weight has bad teeth, and not every horse that resists the bit has EOTRH.

Important rule-outs include:

• PPID, also called equine Cushing’s disease

• Equine metabolic syndrome

• Poor-quality forage

• Inadequate calorie intake

• Parasite burden

• Chronic pain

• Arthritis

• Gastric ulcers

• Liver disease

• Kidney disease

• Cancer

• Chronic infection

• Poor herd access to feed

• Bullying by other horses

• Poor saddle or bit fit

• Respiratory disease limiting appetite

• Choke or oesophageal disease

• Sand accumulation or chronic gut disease

In practice, I do not like blaming age alone.

“He’s just old” is not a diagnosis. Senior horses can lose weight because of dental disease, but they can also lose weight because of endocrine disease, pain, poor diet, chronic inflammation, or multiple problems happening at once.

The mouth is a major place to start, not the only place to look.

When Is This an Emergency?

Call a veterinarian urgently if your senior horse has:

• Choke signs

• Not eating

• Severe quidding with inability to swallow normal feed

• Colic signs

• Severe facial swelling

• Swelling under the jaw with pain or discharge

• Pus draining from the cheek, jaw, or gum line

• Bad smell with fever or dullness

• Heavy bleeding from the mouth

• A fractured tooth with obvious pain

• Severe weight loss

• Dehydration

• Repeated coughing while eating

• Food and saliva coming from the nostrils

• Sudden refusal to eat after dental work or extraction

• Any dental problem combined with depression, fever, or rapid decline

University of Minnesota Extension advises calling a veterinarian for abnormal signs such as not eating normally, reduced or abnormal manure, diarrhoea, and abnormal vital signs. It also lists dental-related clues such as hay or grain packed in the water bucket, which may mean the horse is struggling to eat and using water to soften feed. (University of Minnesota Extension)

A horse that cannot eat comfortably is not just having a dental issue. It is at risk of weight loss, choke, colic, dehydration, and worsening systemic health.

What Should You Do Next?

If your senior horse seems normal

Book routine dental care.

For most mature horses, a yearly veterinary dental exam is a sensible minimum. University of Florida’s equine dental care guidance notes that after 5 years of age, mature horses should be examined yearly, and that sedation, a speculum, good lighting, and a thorough oral exam allow more accurate dentistry. (Ask IFAS - Powered by EDIS)

For older horses, especially those with missing teeth, EOTRH, weight loss, feed dropping, or previous dental disease, every 6 months may be more appropriate.

If your horse is losing weight

Do not just add grain.

Start with:

1. Body condition scoring

2. Weight tape or scale tracking

3. Full dental exam

4. Diet review

5. Faecal egg count

6. PPID and metabolic testing if indicated

7. Pain and lameness assessment

8. Bloodwork if weight loss is unexplained

Then adjust the diet based on what the horse can actually chew.

If you suspect EOTRH

Ask your vet about incisor and canine radiographs.

EOTRH is often underestimated if you only look at the visible crown. Radiographs help determine how much tooth root disease, bone loss, infection, or resorption is present.

If your horse cannot chew hay properly

Discuss forage replacement.

Options may include soaked hay cubes, hay pellets, chopped forage, beet pulp, and complete senior feeds. A true complete feed is different from ordinary grain because it is designed to replace some or all forage when fed at the correct amount.

If your horse has had extractions

Follow aftercare closely.

This may include soft feed, oral rinsing, pain relief, antibiotics when prescribed, restricted bit use during healing, and follow-up checks. ACVS notes that aftercare may involve antibiotics, anti-inflammatory medication, oral flushing, and a soft diet, with bit use restricted while extraction sites heal. (American College of Veterinary Surgeons)

Common Mistakes Senior Horse Owners Make

Waiting until the horse loses weight

Dental disease is easier to manage before weight loss becomes severe. A senior horse should not need to become thin before the mouth is examined.

Assuming quidding is just old age

Quidding is a sign that chewing is not working properly. It deserves investigation.

Feeding more grain instead of fixing the chewing problem

If the horse cannot chew, more grain may not solve the issue and can increase digestive risk.

Ignoring the front teeth

Cheek teeth are important, but senior incisors and canines can be very painful, especially with EOTRH.

Avoiding extraction because it sounds dramatic

Removing painful teeth can dramatically improve quality of life. Keeping diseased teeth because they look useful from the outside can prolong pain.

Not using radiographs

EOTRH and tooth root disease can hide below the gum line. Radiographs are often the difference between guessing and staging the disease properly.

Thinking a horse with no incisors cannot live well

Many horses do very well after incisor extraction once they recover and their diet is adjusted.

How to Prevent Senior Dental Problems From Becoming Major Problems

You cannot prevent every age-related dental disease, and there is currently no definitive way to prevent EOTRH. But you can catch problems earlier and reduce suffering.

A good senior dental plan includes:

• Veterinary dental exam at least yearly

• Six-monthly exams for high-risk horses

• Incisor and canine checks, not just cheek teeth

• Dental radiographs when EOTRH or root disease is suspected

• Body condition scoring every month

• Weight tape or scale tracking

• Watching for quidding or feed dropping

• Checking water buckets for hay or grain

• Monitoring manure for long stems or poorly chewed feed

• Adjusting feed before weight loss becomes severe

• Using soaked or soft feeds when needed

• Managing PPID, insulin dysregulation, arthritis, parasites, and chronic pain

• Keeping dental records over time

UC Davis notes that annual oral exams and radiographs every 1 to 2 years may be beneficial for monitoring older horses with EOTRH risk or disease progression. (Center for Equine Health)

The best senior horse care is not reactive. It is pattern recognition.

A little more dropped hay this month. A little more weight loss this winter. A little more gum recession at the incisors. A little less enthusiasm for carrots.

Those little things are how older horses ask for help.

FAQs

How often should a senior horse have dental work?

Most senior horses should have a veterinary dental exam at least once a year. Horses with missing teeth, quidding, weight loss, EOTRH, periodontal disease, or chewing problems may need exams every 6 months.

What are the first signs of EOTRH?

Early signs may include gum redness, tooth discoloration, reluctance to bite carrots or apples, reduced grazing efficiency, bit discomfort, or subtle behaviour changes. Advanced signs include swollen gums, draining tracts, loose incisors, broken teeth, bad breath, quidding, and weight loss.

Do all horses with EOTRH need their incisors removed?

Not always immediately. Mild cases may be monitored and managed, but EOTRH is progressive and painful cases often need extraction of affected teeth. Your vet will usually use dental radiographs to decide how advanced the disease is and which teeth are involved.

Can a senior horse live without front teeth?

Yes. Many horses adapt well after incisor extraction. They may need longer pasture, soft forage, soaked feeds, or complete feeds depending on how well they graze and chew.

What should I feed an old horse with bad teeth?

Feed depends on the horse’s condition and chewing ability, but common options include soaked hay cubes, soaked hay pellets, chopped hay, soaked beet pulp, complete senior feed, and soft high-quality forage. Make changes gradually and check that the horse is getting enough fibre, calories, protein, vitamins, and minerals.

Final Thoughts

Senior horse dental care is not cosmetic. It is comfort, nutrition, behaviour, and quality of life.

An older horse that drops hay, loses weight, refuses carrots, resists the bit, packs feed, smells bad from the mouth, or has swollen gums is not “just getting old.” They are giving you clues.

EOTRH is one of the big conditions owners need to know because it can be painful, progressive, and easy to miss until it is advanced. The good news is that with proper dental exams, radiographs when needed, extraction of painful teeth when appropriate, and smart feeding adjustments, many senior horses improve dramatically.

Old horses deserve more than survival. They deserve to eat comfortably.

If you are unsure whether your senior horse’s weight loss, quidding, mouth pain, gum changes, or feeding difficulty is urgent, ASK A VET™ can help you decide what can be monitored, what needs a routine dental appointment, and what should be seen by your equine veterinarian promptly.