BY PIPER KLEMM Ph.D.
Morgan Krause, DVM MS, a mobile equine veterinarian outside Clemson, South Carolina, posits that the annual oral exam is one of the most underused diagnostic tools in equine medicine — and that the community of people around a horse matters just as much as the clinicians treating it.
Ask Morgan Krause why she performs sedated oral exams on horses, and the answer comes back bigger than teeth. Yes, floating helps enamel wear evenly, extending a tooth’s lifespan. Yes, it catches sharp points and hooks before they cause lesions. But Krause, who runs a fully mobile equine practice serving both the show community and rural recreational owners around Anderson, South Carolina, sees the dental appointment as something not as commonly seen and just as valuable: one of the few moments when a veterinarian gets to slow down and look at the whole horse.
“For some horses,” Krause says, “it may be the only real health check they get all year.”
A proper oral exam should be conducted under sedation with a good light source and a full evaluation of the tongue, cheeks, and palate. It should go well beyond checking for sharp points and include visual, tactile, and olfactory observations. Krause looks for dental disease, foreign bodies, and tumors in the soft tissue of the mouth. She assesses symmetry in how the teeth wear, looks at the condition of the incisors and the state of the temporomandibular joint, or TMJ.
That last item matters more than many riders realize. TMJ sensitivity directly influences how a horse carries its head, which has cascading effects on how an athletic horse moves, responds to bit pressure, and performs under saddle. Pain in the poll and jaw often masquerades as training problems or resistance and stays hidden until an oral exam brings it to light.
In geriatric horses, the mouth can be an early warning system for systemic disease. Unusual decay or disease in and or around the tooth may signal Cushing’s disease, also known as Pituitary Pars Intermedia Dysfunction (PPID). When Krause observes these patterns in an older horse, a Cushing’s screen typically follows. Chronic disease affects the entire body, and the mouth is often where it first shows up in ways that are quantifiable.
One condition Krause notes is becoming more widely recognized: Equine Odontoclastic Tooth Resorption and Hypercementosis, or EOTRH. This progressive disease affects the incisors, causing painful resorption of tooth roots and abnormal cementum production. The problem with EOTRH is that horses rarely show obvious distress until the condition is advanced. Advanced imaging and probing during a thorough oral exam can catch it far earlier, which is why Krause considers annual exams not optional but essential.
Sedation itself is a diagnostic opportunity. A horse that responds atypically, such as being unsteady on its feet or overly sensitive, gives the veterinarian information that a visual exam alone cannot.
The most useful collaboration Krause describes is between veterinary team and farrier, practitioners whose work is deeply interdependent but who often operate in parallel without speaking. Hoof balance affects how a horse loads its joints, which affects how it moves, which affects its back and TMJ. Dental issues can influence how a horse holds tension in its poll, which changes how its neck and topline develop. These systems talk to each other constantly. The humans managing them should too.
Krause’s practical advice for owners: schedule appointments thoughtfully and with coordination. Before booking radiographs, ask the farrier when they’re next out. Before changing a feed program, let the veterinarian know. Small acts of coordination prevent the frustrating situation where two practitioners give conflicting guidance — not because either is wrong, but because neither knew what the other had said.
What rural equestrian communities often lack
The equine community Krause serves spans two distinct worlds that rarely appear in the same magazine feature: the organized show circuit, with its trainers, competitions, and relatively high access to specialized care, and the recreational horse owner, often in a rural setting, making decisions with far fewer resources and far less professional support.
Krause works across both, and the contrast is clarifying. Show horses receive frequent veterinary attention, farrier visits, and trainer oversight; a de facto care team that assembles around them almost automatically. Recreational horses may go months without seeing a veterinarian, with owners independently purchasing vaccines and relying on informal community knowledge for guidance.
For these horses, the annual dental appointment is often the one guaranteed touchpoint with a clinician, which is precisely why Krause treats it as a comprehensive wellness visit rather than a narrow procedure. The sedation window is an opportunity to evaluate body condition, notice changes in musculature, discuss management concerns with the owner, and catch problems that might otherwise go unseen until they become serious.
Krause also highlights a recurring theme in rural communities; access to collaborative, communicative practitioners is not evenly distributed. Some horse owners simply do not have the option of assembling an ideal care team, including the farrier who is available may not be interested in coordinating with the vet, or there may only be one equine veterinarian within a practical distance. Krause does not pretend this is a solved problem. But she does argue that awareness of it is the first step toward improving it.
Krause highlights that whether you own one horse or twenty, whether you practice in a city or deep in a rural county, the knowledge base in equine medicine is not static. What was standard practice a decade ago may have been revised, refined, or reversed. EOTRH, for instance, went from an obscure footnote in dental literature to a recognized, routinely screened condition in a relatively short span of time.
What a sedated oral exam screens for:
- SHARP ENAMEL POINTS AND HOOKS that cause cheek and tongue lesions
- TMJ SENSITIVITY AND ABNORMAL WEAR PATTERNS affecting head carriage and athletic performance
- ABNORMAL DECAY OR DISEASE in and or around the tooth that may indicate systemic disease like Cushing’s (PPID)
- EOTRH early-stage incisor resorption, rarely visible without diagnostics
- SOFT TISSUE ABDORMALITIES including tumors and foreign bodies on tongue, cheek, and palate
- SEDATION RESPONSE unsteadiness or unexpected responses may signal underlying medical concerns
