EOTRH in Horses: Symptoms, Treatment & Prognosis

What is EOTRH in Horses?

EOTRH stands for Equine Odontoclastic Tooth Resorption and Hypercementosis. This progressive and painful disease primarily affects the incisors and sometimes the canines in older horses. It is increasingly recognized in equine dentistry as a major cause of chronic oral pain in senior horses.

Two processes define the disease:

• Odontoclastic resorption, where the horse’s own body begins breaking down tooth structure.
• Hypercementosis, a compensatory overproduction of dental cementum, leading to bulbous, thickened tooth roots.

This combination destabilizes the teeth and causes inflammation, often resulting in significant discomfort long before external signs appear.

EOTRH, EORTH or EOTHR?

Although the correct acronym is EOTRH, alternative spellings like EORTH or EOTHR are frequently used in online searches. All variants refer to the same condition.

How Common is EOTRH in Equines?

EOTRH in horses is most commonly diagnosed in animals over the age of 15, though it can occasionally affect younger horses. Recent studies in equine dentistry suggest that the condition may be more widespread than previously thought, often going unnoticed until it reaches an advanced stage.

Recognizing Symptoms of EOTRH in Horses

Early signs of EOTRH in equines are often subtle. Many affected horses don’t show obvious pain, which makes early detection difficult. However, there are clear behavioral and physical indicators to watch for.

Common signs of equine EOTRH include:

• Reluctance to eat hard feed, carrots, or hay
• Chewing discomfort or abnormal chewing motions
• Excessive salivation or drooling while eating
• Resistance to bridling or bit contact
• Head tossing or refusal to accept rein contact
• Weight loss despite normal appetite
• Bad breath (halitosis) or visible gum inflammation

As the disease progresses, equine teeth may show:

• Red, swollen gums with visible pockets
• Loose, fractured, or abnormally long incisors
• Gaps between the front teeth
• Yellowish, thickened roots from hypercementosis
• In severe cases: pus discharge, oral fistulas, or tooth loss

These symptoms may affect one or several incisors. Some horses show no outward signs at all – making routine dental exams and equine dentistry radiographs crucial for early detection.

Causes and Risk Factors of EOTRH in Horses

While the exact cause of EOTRH in horses remains unclear, research suggests a combination of age-related, inflammatory, and possibly genetic factors.

Age as the Primary Risk Factor

Most cases of equine EOTRH occur in horses over 15 years of age. As horses age, the periodontal tissues and immune responses in the mouth change, potentially contributing to chronic inflammation and breakdown of tooth structures.

Additional Risk Factors Include:

• Chronic gum inflammation (gingivitis or periodontitis)
• Mechanical stress on the incisors, such as pulling at tight hay nets
• Inadequate dental care, especially lack of regular exams or floating
• Underlying metabolic disorders or immune dysregulation
• Possible breed predispositions (observed more often in Thoroughbreds and Warmbloods)

Because EOTRH equine teeth degradation occurs over time, these factors may gradually increase the likelihood of disease onset. Still, not every older horse develops EOTRH, which suggests additional individual susceptibility.

Diagnosis: How EOTRH is Detected in Horses

Because EOTRH in horses can progress silently, a thorough diagnostic approach is essential. Visual inspection alone is not enough to confirm the disease, especially in its early stages.

Clinical Examination

Initial suspicion often arises during a routine equine dental exam. Common clinical signs include:

• Swollen or inflamed gums around the incisors
• Pain reaction during palpation of the front teeth
• Loose or irregularly worn teeth
• Abnormal spacing between teeth

However, even when no obvious changes are seen, equine dentistry specialists recommend further imaging if the horse is older or showing behavioral changes while eating or being bridled.

Radiographic Imaging

Dental radiographs are the gold standard for diagnosing EOTRH in equines. X-rays reveal:

• Tooth resorption (areas where the tooth structure is being broken down)
• Hypercementosis (abnormal, bulbous root thickening)
• Inflammation or infection around the tooth root
• Potential abscesses or bone loss in the jaw

Early-stage EOTRH may appear normal on the outside, but x-rays can detect changes deep within the tooth and surrounding bone—well before they become visible or painful.

Differentiating from Other Equine Dental Conditions

Other equine dental diseases, such as periodontal disease or fractured incisors, may mimic some EOTRH signs. Accurate diagnosis requires an experienced equine dental veterinarian and appropriate imaging.

Treatment Options for EOTRH in Horses

There is currently no cure for EOTRH, but the good news is that affected horses can often regain comfort and quality of life through appropriate treatment. The primary goal is to remove the source of chronic pain and infection.

Tooth Extraction: The Most Effective Treatment

In moderate to advanced cases, the only effective solution is surgical extraction of affected incisors. While the idea of pulling front teeth may seem extreme, horses generally adapt remarkably well.

After recovery, most horses:

• Eat more comfortably
• Regain lost weight
• Show improved behavior and willingness under saddle

This treatment is often life-changing—many horses become noticeably more relaxed and active once the painful teeth are gone.

Procedure and Aftercare

EOTRH extractions are usually performed under standing sedation with local anesthesia. Depending on the severity, the vet may remove one, several, or all incisors. Post-operative care includes:

• Pain management
• Soft or soaked feed for 1–2 weeks
• Daily cleaning of the mouth if needed
• Follow-up exams to monitor healing

Cost of EOTRH Treatment

The cost of EOTRH surgery varies based on location, clinic, and number of teeth involved. On average, it ranges from $800 to $1,500 USD. While this can seem high, it's a long-term investment in the horse's health and comfort.

Supportive Therapies

Some owners explore complementary treatments, including:

• Mushroom extracts (e.g., Reishi, Cordyceps) to support immune balance
• Homeopathic remedies for inflammation
• Nutritional adjustments to reduce gum irritation

These may support healing, but they do not replace veterinary care or dental intervention.

Living with EOTRH: Prognosis and Quality of Life

A diagnosis of EOTRH in horses may sound alarming, but with proper treatment and care, many affected horses continue to live comfortably for years.

Can Horses with EOTRH Still Be Ridden?

Yes – horses with EOTRH can often return to work after recovery, especially if the painful teeth have been extracted. Some may need a break from riding during healing, particularly if they were showing signs of bit sensitivity or discomfort in the mouth.

Once pain is managed and healing complete, many horses:

• Accept the bit more willingly
• Regain focus under saddle
• Perform with renewed energy

Life Expectancy and Long-Term Outlook

EOTRH is not life-threatening when treated appropriately. Most horses go on to live full lives post-extraction. However, left untreated, the disease can cause:

• Chronic pain
• Weight loss
• Behavioral changes
• Secondary infections

Early diagnosis and intervention are key to preserving both quality of life and longevity.

When Is Euthanasia Considered?

Euthanasia is only considered in very advanced, untreated cases where:

• All incisors are severely affected
• The horse is in constant pain
• Eating becomes nearly impossible
• Other health issues complicate surgery

These cases are rare, especially with modern diagnostics and access to equine dentistry professionals.

Feeding Horses with EOTRH

Horses affected by EOTRH—especially those who’ve undergone incisor extraction—often need dietary adjustments to help them chew comfortably and maintain body condition.

Soft, Easy-to-Chew Diets

Since equine teeth with EOTRH are often sensitive or missing, the goal is to reduce chewing effort and avoid irritation. Recommended feeding strategies include:

• Soaked hay pellets or hay cubes as a fiber-rich hay alternative
• Mash-style feeds that are easy to swallow
• Short-fiber chaffs or pre-cut forage blends
• Avoid hard treats, raw carrots, and apples, which can be painful to bite

Hay Nets: Helpful or Harmful?

Some owners use hay nets to slow down eating—but for horses with EOTRH, tight nets can cause strain on the incisors. Instead, consider:

• Ground-level hay feeding
• Wide-mesh nets to reduce resistance
• Raised tubs lined with rubber to soften contact

Nutrition Tips

Feeding horses with dental issues like EOTRH means:

• Ensuring adequate calorie intake without relying on rough chewing
• Monitoring body condition regularly
• Considering senior feeds or supplements for immune support

Consulting an equine nutritionist or veterinarian is especially helpful for tailoring the diet to each horse’s needs.

Preventing EOTRH in Horses – Is It Possible?

Unfortunately, there is no guaranteed way to prevent EOTRH in equines, as the exact cause of the disease is still unknown. However, certain proactive steps can reduce risk and help catch the disease early.

Best Practices for Prevention

While you may not be able to stop equine EOTRH entirely, you can minimize its impact by:

• Scheduling regular dental checkups, especially for horses over 12 years old
• Requesting routine radiographs of the incisors as part of senior dental care
• Monitoring for subtle behavioral signs (e.g., bit resistance, slow chewing)
• Keeping the mouth clean and addressing gingivitis early
• Avoiding chronic stress on the incisors (e.g., very tight hay nets)

Immune Support and Diet

Though not scientifically proven to prevent EOTRH, some owners use:

• Mushroom supplements (like Reishi or Coriolus) to support immune regulation
• Anti-inflammatory feeds or herbs to support gum health
• Balanced mineral and vitamin intake to maintain oral and systemic health

The earlier EOTRH is identified, the more manageable it becomes—and the better the outcome for your horse.

EOTRH in Horses – Now What?

EOTRH equine dentistry is a field that continues to evolve, and thankfully, awareness of this painful dental disease is growing. While there is no cure, early detection and proper treatment can significantly improve your horse’s well-being.

What you can do:

• Don’t ignore subtle signs—changes in chewing, bit resistance, or behavior matter.
• Work with a veterinarian trained in equine dentistry and request dental x-rays for older horses.
• Don’t fear tooth extraction—most horses thrive after the removal of painful incisors.
• Adapt feeding routines to reduce discomfort and maintain nutrition.
• Explore supportive therapies like mushroom supplements if desired—but always under veterinary supervision.

With attentive care, even horses with advanced EOTRH can return to a happy, pain-free life—eating, working, and interacting just like before.

FAQ – EOTRH in Horses

What is EOTRH in horses?

EOTRH (Equine Odontoclastic Tooth Resorption and Hypercementosis) is a painful dental disease affecting the front teeth of older horses. It causes tooth breakdown and abnormal root thickening, leading to pain, infection, and tooth loss.

What are the symptoms of EOTRH?

Typical signs include difficulty eating, excessive drooling, bit sensitivity, inflamed gums, bad breath, loose or deformed incisors, and behavioral changes during grooming or riding.

How is EOTRH diagnosed?

Diagnosis requires a clinical exam and dental radiographs to detect root resorption and hypercementosis. Visual inspection alone may miss early-stage disease.

Can EOTRH be cured?

No, EOTRH cannot be cured, but it can be effectively managed—usually through tooth extraction—to eliminate pain and improve quality of life.

How much does EOTRH treatment cost?

EOTRH equine dentistry procedures like incisor extraction typically cost between $800 and $1,500 USD, depending on the number of teeth involved and post-op care.

Can horses with EOTRH still eat normally?

Yes. After recovery, most horses adjust well to eating without front teeth. Feeding soaked hay pellets, soft mashes, and avoiding hard feeds is often sufficient.

Can horses with EOTRH still be ridden?

Yes—many horses return to work after treatment. Once the painful teeth are removed, behavior and performance often improve significantly.

Is euthanasia ever necessary?

In severe, untreated cases where a horse is in chronic pain and cannot eat, euthanasia may be considered. With timely diagnosis and care, however, this is rarely necessary.

Are there ways to prevent EOTRH?

While prevention is not guaranteed, regular dental exams, x-rays, and reducing incisor strain (e.g., avoiding tight hay nets) can help detect and manage the condition early.