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Understanding EOTRH in Horses: Symptoms, Causes and Effective Treatment Options

Maintaining your horse's dental health is a key part of their overall care and National Pet Dental Health Month is the perfect time to talk about it. Not only is it important for their comfort and day-to-day activities—such as grazing and eating feed—but untreated dental problems can also lead to serious infections. Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH) is a condition that can cause horses significant pain and other health issues if left untreated. Learning more about equine dental health and EOTRH specifically can empower you to provide your horse with the best care all year round.

What is EOTRH in Horses?

EOTRH is a progressive dental condition that typically affects a horse’s incisors and canine teeth. Sometimes, it may also affect their premolars. If your horse has EOTRH, their tooth structure can break down and they may experience an abnormal buildup of cementum—a hard, calcified tissue—around the roots of their teeth. This calcified tissue builds up on the roots to try and keep them stable. Throughout the process, your horse may experience serious dental pain and damage, which can really affect their comfort and overall wellbeing. Regular dental examinations by your veterinarian can help you catch and treat EOTRH early.

What Are the Symptoms of EOTRH in Horses?

Identifying EOTRH can be challenging. Many older horses might not show symptoms until the disease worsens in severity. Other times, initial symptoms may be subtle and easy to miss. The symptoms of EOTRH become more evident as the condition progresses.

Keep an eye out for these symptoms:

  • Inflamed or Receding Gums: The extra cementum formation around the roots of your horse’s teeth can cause swelling in these areas, often taking on a bulb-like appearance. This buildup is referred to as hypercementosis.You may also notice red lesions on your horse’s gums that look like pimples. Additionally, their gums may recede from their teeth if they have EOTRH.
  • Behavioral Changes: Your horse may demonstrate more head shaking or become irritable when you ride or bridle. These behaviors often emerge when your horse is experiencing more advanced stages of EOTRH.
  • Difficulty Eating: The oral pain from EOTRH can discourage your horse from eating, leading to weight loss. You may notice your horse stop grazing, dunking their hay in water before eating it, or refusing or having difficulty biting down on apples, carrots and other treats.
  • Bad Breath: A noticeable foul odor can be a sign of infection. This is often due to bacterial growth in the affected areas of the mouth. 
  • Visible Changes in Teeth: Look for teeth looseness and even fractures. Teeth may also experience discoloration. As these changes happen, your horse may experience significant discomfort and difficulty performing basic oral functions.

What Are the Causes of EOTRH in Horses?

The exact causes of EOTRH in horses remain unknown. However, certain factors—or a combination of them—may contribute to its development.

Here are some possible causes of EOTRH in horses:

  • Age: Older horses are more susceptible, suggesting an age-related component. In fact, about half of reported EOTRH cases are in thoroughbreds and warmbloods 15 years or older.
  • Environment: A horse’s type of feed or limited grazing access may lead to dental problems.
  • Bacteria: Some specific kinds of microorganisms or bacteria in a horse’s mouth could make them more susceptible to EOTRH.
  • Genetics: Some horses may be predisposed to dental issues.
  • Medical History: Trauma from past dental procedures or other health conditions—including periodontal disease or pituitary pars intermedia dysfunction (PPID)—could potentially lead to the development of EOTRH.

Understanding potential risk factors can help you and your veterinarian develop better prevention and management strategies, but keep in mind that more research is needed to identify the definitive causes of EOTRH in horses.

An Overview of Effective EOTRH Treatments

Before determining a treatment, your veterinarian will likely conduct a dental examination and ask about your horse’s medical history. They may also complete radiographs of your horse’s incisors and canine teeth to stage the disease from 0 (the least) to 3 (the most severe) stage of EOTRH. 

After a diagnosis, your veterinarian will create a treatment plan that could include surgical extractions, antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs). These treatments can manage infection and symptoms while preventing further progression. As a full-service equine pharmacy, Mixlab provides a variety of branded, generic and compounded medications to help manage EOTRH in horses.

Antibiotics

Sulfadiazine Sodium with Trimethoprim

This antibiotic combination, sulfadiazine sodium 416 mg/mL with trimethoprim 83 mg/mL (30 mL), is available as an oral paste from Mixlab. It can inhibit bacterial growth for a variety of dental infections that could be caused by EOTRH. 

Doxycycline

Available in oral powder (5 g/scoop in 20, 30 or 60 scoops), oral paste (5 g/15 mL in 60 mL), or suspension from Mixlab, doxycycline is a broad-spectrum antibiotic that helps combat bacterial infections that could be caused by EOTRH. Specifically, this tetracycline antibiotic prevents bacteria from surviving and growing by stopping it from making the proteins it needs to survive.

NSAIDs

Phenylbutazone

This NSAID can help manage pain in horses with EOTRH. Phenylbutazone helps alleviate the inflammation associated with the condition or other infections—improving your horse’s comfort. Mixlab offers it in multiple formulations to suit different administration preferences, including oral powders, paste and even the commercially available injectable phenylbutazone.

Available powder formulations include:

  • Phenylbutazone 1 gm/scoop and cimetidine 500 mg/scoop, 120 scoops (5 cc scoop)
  • Phenylbutazone 1 gm/scoop and cimetidine 500 mg/scoop, 60 scoops (5 cc scoop)
  • Smart Bute: phenylbutazone 2 gm/scoop and omeprazole 1 gm/scoop, 30 scoops (20 cc scoop)

Available paste formulation includes:

  • Phenylbutazone 200 mg/mL and cimetidine 100 mg/mL, 60 mL syringe

Firocoxib (Equioxx)

Available as 57 mg tablets, firocoxib is a commercially available NSAID option for managing EOTRH pain. The most rigorously tested NSAID for safety in horses, firocoxib offers proven effectiveness and lower risks compared to traditional NSAIDs. Mixlab offers this medication in 60 and 180 counts.

Flunixin

Flunixin can also provide effective pain relief for horses with EOTRH. Mixlab carries multiple forms of the medication—including oral pastes and powders—and the branded version, called Banamine. 

Available formulations through Mixlab:

  • Flunixin Meglumine 50 mg/mL + Cimetidine 100 mg/mL, oral paste, 30 mL or 60 mL syringe
  • Flunixin Meglumine 500 mg/scoop, oral powder, 120 scoops (5 cc scoop)
  • Banamine in 100 mL or 250 mL vials for injection

Maintain Your Horse’s Dental Health and Beyond with Mixlab

Mixlab understands the importance of comprehensive care for your horse's dental health. Whether you’re seeking EOTRH treatments or medications for other conditions, our full-service equine pharmacy is here to support you with a variety of options. We offer branded, generic, and compounded medications for your horse, along with vitamins and supplements, for the management of their overall health, performance and wellbeing, ready to ship with convenient, two-day delivery. You can easily submit your prescription requests online or get in touch with our team.

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