appear to be neurological symptoms. In horses, continuous grazing leads to dental attrition. Also, due to the continuous development of a horse’s hypsodont teeth, there will be dental crown wear which can create jagged and sharp edges and attribute to uneven wear. Dental care for horses is designed to prevent "quidding,” or dropping food out of the mouth while eating, ulcerations on the cheek or tongue, resistance or unusual sensitivity to the bit, root abscessation, development of mandibular fistulas from infections in the lower cheek teeth, and difficulty flexing at the poll. Oral disease Periodontal disease The most common and significant oral disease is the inflammation of the deeper supporting structures of the tooth and surrounding tissues of the periodontium; it is also called periodontal disease or periodontitis. It begins with the formation of plaque, specifically subgingival plaque within the gingival sulcus or periodontal pocket. This allows a proliferation of bacteria; the subsequent inflammation and the animal's own immune response starts the progression of periodontal disease. The hallmark feature of periodontitis is attachment loss of the tooth from the alveolar bone. Periodontitis is an irreversible process unless the animal is treated with advanced periodontal surgery techniques. Consequences of periodontal disease Periodontal disease eventually culminates in tooth loss; however, significant health problems can precede this. Local consequences include the development of an oronasal fistula or periodontal-endodontic lesion, infections or abscesses in the eye, a fractured jaw, osteomyelitis, and oral cancer. Systemic consequences affect multiple organs. For example, bacteremia from periodontal disease can cause inflammation of the hepatic tissue, portal vein fibrosis, and cholestasis. Chronic stimulation of the immune system can lead to immune complexes in the kidney, causing glomerulonephritis, chronic kidney inflammation and secondary scarring, decreased kidney function and ability to filtrate, and chronic kidney disease. Bacteremia also affects the heart, because circulating bacteria attach to the heart valves, putting the heart at increased risk of endocarditis, hypertension, and roughening of the epithelium of the heart tissue. There may be metabolic changes such as insulin resistance due to the increased inflammatory proteins. Gingivitis Gingivitis is the earliest stage of periodontal disease. It is the inflammation of the gingiva and is caused by bacterial plaque, but it is reversible and preventable. Gingivitis appears as a thin red line along the margin of the gums and may be accompanied by swollen gum margins, bad breath, plaque and tartar. The earliest clinical sign of