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Simple Summary  Mouth pain in horses, specifically that caused by bits, is evaluated as a significant welfare issue. The conscious experiences of pain generated within the body generally, its roles, and its assessment using behaviour, as well as the sensory functionality of the horse’s mouth, are outlined as background to a more detailed evaluation of mouth pain. Bit-induced mouth pain elicited by compression, laceration, inflammation, impeded blood flow, and the stretching of tissues is considered. Observable signs of mouth pain are behaviours that are present in bitted horses and absent or much less prevalent when they are bit-free. It is noted that many equestrians do not recognise that these behaviours indicate mouth pain, so that the magnitude of the problem is often underestimated. The negative experiences that are most responsible for welfare compromise include the pain itself, but also, related to this pain, potentially intense breathlessness, anxiety, and fear. Finally, a series of questions is proposed to clarify issues that are relevant to increasing the adoption of bit-free bridles in order to avoid bit-induced mouth pain.Abstract  A proposition addressed here is that, although bitted horses are viewed by many equestrians as being largely free of bit-related mouth pain, it seems likely that most behavioural signs of such pain are simply not recognised. Background information is provided on the following: the major features of pain generation and experience; cerebrocortical involvement in the conscious experience of pain by mammals; the numerous other subjective experiences mammals can have; adjunct physiological responses to pain; some general feature of behavioural responses to pain; and the neural bases of sensations generated within the mouth. Mouth pain in horses is then discussed. The areas considered exclude dental disease, but they include the stimulation of pain receptors by bits in the interdental space, the tongue, the commissures of the mouth, and the buccal mucosa. Compression, laceration, inflammation, impeded tissue blood flow, and tissue stretching are evaluated as noxious stimuli. The high pain sensitivity of the interdental space is described, as are likely increases in pain sensitivity due to repeated bit contact with bruises, cuts, tears, and/or ulcers wherever they are located in the mouth. Behavioural indices of mouth pain are then identified by contrasting the behaviours of horses when wearing bitted bridles, when changed from bitted to bit-free bridles, and when free-roaming unbitted in the wild. Observed indicative behaviours involve mouth movements, head-neck position, and facial expression (“pain face”), as well as characteristic body movements and gait. The welfare impacts of bit-related pain include the noxiousness of the pain itself as well as likely anxiety when anticipating the pain and fear whilst experiencing it, especially if the pain is severe. In addition, particular mouth behaviours impede airflow within the air passages of the upper respiratory system, effects that, in their turn, adversely affect the air passages in the lungs. Here, they increase airflow resistance and decrease alveolar gas exchange, giving rise to suffocating experiences of breathlessness. In addition, breathlessness is a likely consequence of the low jowl angles commonly maintained during dressage. If severe, as with pain, the prospect of breathlessness is likely to give rise to anxiety and the direct experience of breathlessness to fear. The related components of welfare compromise therefore likely involve pain, breathlessness, anxiety, and fear. Finally, a 12-point strategy is proposed to give greater impetus to a wider adoption of bit-free bridles in order to avoid bit-induced mouth pain.

Mouth Pain in Horses: Physiological Foundations, Behavioural Indices, Welfare Implications, and a Suggested Solution