Antibiotics and Dental Problems in Horses: What Does the Science Say?

In horses with (secondary) sinusitis or dental problems, it is often assumed that antibiotics are necessary for treatment. However, "recent" research shows that this is often not the case. In this article, we want to inform both horse owners and referring veterinarians about the effectiveness of antibiotics in dental extractions and secondary sinusitis, and the importance of proper inflammation and pain management through NSAIDs.

In 2025, it is no longer responsible to use antibiotics as a first-line reflex. Antibiotic resistance in humans, animals, and the environment is a real and widespread problem that we can no longer ignore. Conscious and restrained use of antibiotics is therefore essential. The use of antibiotics is only justified in specific cases and is strictly regulated by the authorities.

Antibiotics: Frequently Used, but Limited Effectiveness in Equine Dental Extractions

Dental extractions in standing horses are (too) often combined with peri-/post-operative antibiotic administration by many veterinarians. However, a large retrospective study (Christiansen et al., 2022) and a literature review (Brinhol Souza et al., 2022) showed that in standard oral extractions, antibiotics had no significant effect on the risk of postoperative complications. Of the 264 horses that underwent an oral extraction, complications occurred in 18.4% of those with antibiotics versus 16.3% without – a statistically insignificant difference. Furthermore, administering antibiotics in horses carries a risk of severe complications, such as life-threatening diarrhea (colitis).

In the less common technique of minimally invasive transbuccal extraction (MTE), a higher complication rate was observed in horses that did not receive antibiotics. While clinically relevant, this finding was not statistically confirmed, indicating that further research is needed.

Another study on horses with sinusitis secondary to dental problems came to a similar conclusion: the chance of successful recovery after extraction of the affected tooth was not higher in animals treated with antibiotics compared to those without (62.5% vs. 60% successful treatment without the need for additional therapy).

NSAIDs: Essential in Preoperative Preparation for Equine Dental Extractions

While antibiotics appear to be of limited use, non-steroidal anti-inflammatory drugs (NSAIDs) show their value on several fronts:

• They reduce local inflammation around the affected tooth or in the sinus.

• They improve the response to local anesthesia, which is essential in standing extractions.

• They contribute to better postoperative pain control.

Therefore, we advise referring veterinarians to start NSAID therapy in time before the dental extraction. This can improve the horse’s comfort and facilitate the procedure.

Conclusion on Antibiotics and NSAIDs in Equine Dental Extractions

Although antibiotics have long been a standard part of treatment for dental problems and sinusitis, recent studies show that their benefit in standard extractions is limited. In contrast, NSAIDs play a crucial role in both pain management and optimizing local anesthesia.

Moreover, from a societal standpoint in 2025, it is no longer acceptable to use antibiotics routinely. The global threat of antibiotic resistance demands conscious and well-founded use of these drugs. Of course, a minority of complex patients or high-risk cases may still require additional medication.

Equide treats every patient individually with a customized treatment plan. The focus is on addressing the primary problem, using non- or minimally invasive techniques to support this, and ensuring proper follow-up.

We are, of course, available for consultations or support with referrals for dental extractions.

Questions or want to discuss a case?

Feel free to contact us for consultation or to discuss/schedule a referral.

FAQ

1. What is the difference between pre- and post-operative medication in equine dentistry?
Before the procedure, the horse receives medication to reduce pain and inflammation, usually an NSAID such as Metacam (meloxicam). Post-operatively, the same medication is continued to ensure recovery. Antibiotics are rarely used.

2. Which drugs are most commonly used?
The most common drug is Metacam (meloxicam), highly effective against pain and inflammation. Antibiotics are almost never prescribed, except in very specific cases with a high risk of infection.

3. Why is proper post-operative medication important?
Adequate pain relief and anti-inflammatory support with Metacam allow the horse to recover more comfortably, resume eating quickly, and reduce complications.