Many malocclusions, such as hooks, crooked or displaced teeth, stepped teeth, diseased or fractured teeth, periodontal disease, and other dental abnormalities can cause severe pain. It is not uncommon for horses to be in chronic pain for years without the owner being aware of the situation. Sharp enamel edges on the teeth can lacerate the sensitive soft tissues of the mouth.

It is important to begin comprehensive dental care early as to prolong the useful life of the teeth to last the horse through his lifetime. When horses only lived to be 20 or so, perhaps it didn't matter so much if their teeth lost effectiveness in their late teens. But now, thanks to advances in equine veterinary care and nutrition, our equine companions are living well into their 30's. Therefore, their teeth need to last longer, too. Dental malocclusions in the horse are progressive in nature and usually start in the young animal. Left unaddressed, a small abnormality will progress to a large one over the years until the teeth become worn out and diseased.

Horses are susceptible to tooth root disease, just like people. Tooth root abcesses can result in severe sinus infection. A horse with poor dentition is more susceptible to choke and impaction colic. Also, feed is better utilized and absorbed if it is chewed properly.