Part 2: Oral Soft Tissues

Oral Soft Tissue

The second component of our oral examination

Our five component oral check includes our external, oral soft tissue, occlusion, periodontal, and endodontic exams. This post will cover the oral soft tissues, with each of the other components being discussed in its own article. View all articles in our educational series.

The second component of our oral exam involves the oral soft tissues. These include the lips, tongue and oral gingiva and mucosa (gums and cheeks).

Examples of problems in equine oral soft tissues 

Oral soft tissues
As you see in the above image, the upper left shows a horse with a circumscribed round mass (lump) in the lower lip. The horse in the upper right shows a small mass in the gums that has a cauliflower-like appearance. In both cases, a biopsy would be required to figure out exactly what is going on.
The horse on the bottom showed injury to the tongue that could not easily be explained. After ruling out an intra-oral cause, we went searching through the horse’s hay and found that plastic had been baled up with the hay, causing these injuries. 
The tongue is very important for helping move the food bolus through the mouth in the process of chewing. The horse in (A) has a small growth noted on the top of the tongue. We obtained an image with a measuring scale next to the mass so we could monitor for growth.
The horse in (B) presented for a routine float and we were surprised to find that her tongue had been nearly transected at some point! This was likely from trauma from a bitting injury.
The horse in (C) has an ulceration at the base of his tongue from embedded fox tail awns.
The horse in (D) suffered a very large injury to its tongue. This was a self-inflicted injury—the horse had a guttural pouch infection that caused neurologic deficits that resulted in loss of normal tongue function. 
These two images show examples of oral soft tissue ulcerations that we might find when we float your horse’s teeth. They are the result of sharp enamel points that cause abrasions to the local soft tissues.
In the horse on the left, we may inquire about bridling to find out if the horse wears a nose band, as this particularly large abrasion may be related to a noseband that is too snug. The good thing about oral soft tissue abrasions is that they typically heal relatively quickly once the sharp points have been removed through floating. 
This horse was diagnosed with an oral fibrosarcoma. The mass was already quite large in 2008. This horse lived with this tumor for many years, and you’ll see four year later it had grown and pushed out the first several premolar teeth.
Notice the lack of ulceration of the mass in 2011. This horse was able to be maintained on a softened diet for many years despite having a large oral tumor.   
Not all oral tumors are so benign. Both of these horses have oral squamous cell carcinoma. The horse on the left had an incisor extracted, and this oral tumor was found on his post-operative recheck. Due to its location, we were able to perform a curative surgical removal in his case.
The horse on the right was not as lucky. Note the large meaty tumor in his cheek that is pressing the last few molars towards the palate. This was also a squamous cell carcinoma that originated in the horse’s sinus and ended up extending into his mouth. His tumor was not able to be removed. 
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