When Liz Jackson and Tracey Smallwood’s horses came into their lives, each brought with them the gift of joy. 

At 2 years old, Alchemy was gifted to Smallwood by friends back in 2007, and the little Arabian became a bright spot at a very difficult time in her life. 

“Alchemy was just what I needed to start me on a path of emotional healing,” Smallwood says. “It’s crazy to think that we have been together for 18 years, and it is amazing how our bond just keeps getting stronger. When I’m with Alchemy, all the stresses of the world just fade away.”

Jackson first met now 27-year-old Teeba at a boarding barn where he stayed in a stall next to her horse, Dyna. Two years later, Dyna passed, and a heartbroken Jackson avoided the barn for another year before she learned Teeba’s owner was searching for a new home for the Arabian. It wasn’t long before Jackson and Teeba became teammates. 

“A day did not go by without a visit to the barn to spend some quality time with Teeba,” Jackson says. “He and I developed a strong and trusting bond throughout those months. I was totally in love. What a dream come true!”

While both Alchemy and Teeba have inspired happiness in their companions' lives, they also have faced a major health challenge that often develops in middle-aged and older equines: equine odontoclastic tooth resorption and hypercementosis (EOTRH). 

EOTRH is a progressive dental condition that primarily impacts the incisors and canines. Affected teeth are destroyed or resorbed by specialized cells called odontoclasts. To compensate for the damaged teeth, the body produces excess cementum, a hard substance that anchors teeth to the jaw. If left untreated, the condition can cause pain and discomfort, difficulty eating, broken teeth, and weight loss. 

There isn’t one definitive cause of EOTRH, but factors that likely contribute to it include certain mouth bacteria, feed type, periodontal disease, trauma from dental procedures, and genetics.

Devastating diagnoses

In all the riding Alchemy and Smallwood had done together, she had never had trouble with him accepting the bit. Then, at about 18 years old, he started to gradually resist it. 

“It just got worse and worse; eventually, he would just lift his head high in the air and downright refuse to take the bit,” Smallwood recalls. “I was naive and thought he just developed bad behavior.”

At a routine spring check-up, she mentioned to veterinarian Haley Markow with West Metro Equine Practice that he had been refusing the bit. Markow suspected EOTRH and mentioned X-rays would be needed to confirm. Alchemy was eating well and his weight was good, so Smallwood opted to have the X-rays done at his fall check-up. 

“In hindsight, it was a mistake to wait,” she recalls. “Over the next few months, he started declining. He lost quite a bit of weight, and one of the lower incisors actually broke.”

The X-rays revealed Alchemy’s disease was advanced, and he would need surgery to remove all of his affected teeth. 

Extracting the affected teeth is the only treatment for EOTRH.

“Removing the teeth relieves the dental pain,” says Elizabeth Coppelman, DVM, an assistant professor of large animal surgery at the UMN Department of Veterinary Population Medicine. “While extracting so many teeth may seem scary, it does improve quality of life for our horse companions.”

As for Teeba, his road to a diagnosis began when Jackson noticed his grain consumption began to decline. At first, she thought he was tired of the brand, so she tried a different one. It worked for a while, but eventually, he would barely touch his grain. At a spring check-up, Jackson mentioned the issue to his veterinarian.  

The same devastating diagnosis of EOTRH was confirmed, and the same treatment was recommended. Jackson admits she went into denial and tried another grain but was unsuccessful and struggled with the next steps. 

“My biggest concern was trying to figure out what was best for Teeba,” she says. “He was clearly losing weight and, more importantly, he was losing his wonderful spark. His life force was fading in front of my very eyes.”

As part of that effort, Jackson sought a second opinion from Sara Wefel, another veterinarian with West Metro Equine Practice, who examined Teeba and confirmed EOTRH. 

Two happy endings

Both Alchemy and Teeba were referred to Piper Equine Hospital at the University of Minnesota College of Veterinary Medicine’s Leatherdale Equine Center for treatment. 

There, the cases were overseen by veterinarian Elizabeth Coppelman and then-veterinary resident Maria Granello. Both horses would need teeth extracted to treat the disease. The impact on their quality of life was of great worry to Smallwood and Jackson, but Coppelman and Granello presented the medical evidence at hand and offered guidance. The path forward for Alchemy and Teeba was up to their respective companions.

“It can be daunting as an owner to decide to have all your horse's front teeth pulled,” Dr. Coppelman says. “Horses are also very good at hiding pain so oftentimes owners do not see the full benefit of the extractions until after surgery––then they notice their horse eating better, gaining weight, and appearing generally happier.”

Jackson says she felt everyone working at the Leatherdale Equine Center understood what a difficult decision this was for her.

“They recognized the agony that I went through trying to make a decision that would be best for Teeba at his age,” she says. “They were calm, professional, and compassionate as they guided me to make the choice that would give Teeba additional pain-free years, and I truly could not be more grateful.”

Teeba underwent surgery in October 2024, and surgeons extracted all of his incisors. He made a speedy recovery, eating with enthusiasm in the days after his procedure. It’s a habit he’s kept up since. 

“He nickers with delight when his grain bucket is filled,” Jackson says. “He is able to mow down grass with a vengeance using just his lips and gums, and he now spends most of his time in a large pasture with three other geldings munching grass all day. He can chew hay, grain, and grass with his remaining molars, and he is doing just fine.” 

Over the course of two surgeries, one in September 2024 and another in April 2025, Alchemy’s affected teeth were removed, which included all his upper incisors and all his lower incisors and canines. 

Without their teeth, both horses sport a unique look with tongues that often hang out of their mouths. Smallwood and Alchemy have embraced it, though, and even turned it into an opportunity to educate others about EOTRH. 

“He has gone with me on several trail riding excursions since the extractions,” she says. “His new look has made him quite the conversation starter. He is helping me meet lots of new people who are curious about why his tongue hangs out. Alchemy is thriving, he is out of pain and living the best horse life possible.”