Our knowledge of equine dental decay, including peripheral caries, has advanced enormously in recent decades thanks to an expanding body of research. Through my own studies and clinical work in Western Australia, I’ve seen how far the profession has come in recognising, diagnosing and managing these conditions effectively. Even still, conditions like peripheral caries are still very common around the world, even in Western Australia. Seeing it so commonly (in almost 60% of our patients!) and having no idea of the cause or treatment was the driving force behind completing my PhD on the subject, so we could better treat and prevent the condition in our patients.

Over years of field and clinical work, I’ve seen firsthand how a condition like peripheral caries quietly undermines a horse’s dental health. It often progresses for years before external symptoms appear, if they appear at all.

For a real-world example of a severe peripheral caries case, watch our YouTube video here.

Peripheral caries refers to decay of the outermost layers of the tooth’s clinical crown (primarily cementum but can progress to also affect the enamel and dentin), triggered by acidic pH in their mouth which demineralises the tooth’s structure. Unlike many other dental conditions, the reserve crown beneath the gum remains unharmed, which is good news as it means the tooth can recover if the cause is addressed.

In plain terms: a high sugar diet or acidic water supply can set up a chain reaction. This acid production leads to de-mineralisation, increasing fracture risk, soft-tissue damage, long-term discomfort and even tooth death in severe cases.

In Western Australia, a study we conducted found nearly 60% of surveyed horses had peripheral caries. Key risk-factors included breed (thoroughbreds), feeding oaten hay, drinking rain-water or dam water, and limited year-round pasture access.

Long-term research however has shown that complete recovery is possible in many cases with diet and management changes when these risk factors are removed. Because the reserve crown (tooth below the gumline) remains intact, correction of the environmental cause can allow normal tooth eruption and structural recovery.

• Manage the diet: First switch any high water soluble carbohydrate (WSC) hays you’re feeding (in particular cereal hays such as oaten or wheaten hays) to lower-WSC alternatives (lucerne, meadow, rhodes grass, teff or barley straw) where appropriate. It’s also important to ensure your horse has good access to fibre, chew time, and pasture (if appropriate) rather than high-starch feeds. The Dental Vet peripheral caries feed supplement may also help buffer the acids and prevent progression. Finally, it’s a good idea to regularly test your water source’s pH if you suspect acidity issues, as rainwater catchment systems may present a higher risk.
• Routine monitoring and early intervention: Ask your equine veterinary dentist about the severity of the caries (grade) and whether they are currently active or inactive when examining cheek teeth. It’s important that other associated dental pathology is recognised and addressed early; for example, feed packing between teeth, gingival recession, and fractured teeth often occur alongside caries. Lastly, if peripheral caries is present, your vet may recommend a diet change, fluoride varnish application, and floating or restorative treatment as needed (depending on severity).
• Track progress: Improvement may begin within months once risk factors are removed. We look for darker, smoother tooth surfaces, and a new cementum layer at the gumline (see green arrows below) indicating that the newly erupting tooth is unaffected.

If your horse is fed a high-WSC diet, in particular is on cereal hay or drinks from a low-pH water source, you should consider peripheral caries as a likely risk. Combine dietary strategy with regular dental checks (typically every six to twelve months) and watch for subtle signs like slow chewing, decreased feed intake or general ‘grumpiness’, although most horses won’t show outward signs even when severe.

Peripheral caries isn’t just a “sharp point” issue, it’s a management and welfare challenge. It should be addressed proactively, through diet, water, and expert dental care. Done right, this approach sets your horse up for comfort, function and long-term oral health.

Is it time to dig deeper into your horse’s current dental care protocols? Book your appointment with us today.