20 June 2012 Equine Dentists – The tooth of the matter
Equine dental care is not a new health care craze, in fact in the UK, records of filing horse teeth date back to the 1600’s. Commonly know as ‘floating’, (or ‘rasping’ if you’re from the other side of the pond), it literally means to ‘make level and smooth’. Over the years, everyone appears to have tried their hand at teeth floating; the farrier, blacksmith, veterinarian and even the horse owner himself, but over the last 20 years, there has been an increasing presence of a new ‘expert’ called the ‘equine dentist’, who may just not be what they proclaim to be.
Why do we float a horse’s teeth?
Similar to humans, horses have baby teeth that are replaced by adult teeth, however, the horse’s teeth have very long roots that continue to erupt, or push out, throughout their life, until they eventually lose them, or the horse dies. This eruption is at a rate of about 2-6 millimeters a year (about 1/16 to ¼ inch for those who prefer the complicated way of measuring things), i.e. not very fast. While youngsters usually require bi-annual oral examinations, and older horses may require more frequent visits to address a specific problem, once a year routine float will usually suffice for most horses.
Horses spend a lot of time chewing, pretty much 60-70% of their day given the choice. However, because their teeth do not lie flat, the upper teeth hang over the cheek side of the lower teeth, this can create uneven wear and extremely sharp points contacting both the sensitive areas of the cheek & tongue, these are the areas that commonly require smoothing out. The actual grinding surface of the tooth is very rough and rumpled and should be left alone to do the job over 55 million years of evolution has been working on, unless there is a specific malocclusion problem such as hooks, ramps, wave mouth or step mouth.
What does it take to be an ‘equine dentist’?
In the human world, the majority of dental students have at least a Bachelor’s degree prior to embarking upon 4 years of dental school, and undergraduate studies are usually in biology, chemistry, anatomy, chemistry & microbiology. Upon graduation, the title of Doctor of Dental Science (DDS) or Dental Medical Doctor (DMD) is bestowed upon the graduate, who is then licensed, regulated, and eligible to be insured to carry out dental procedures on human patients.
In direct contrast, there are no such requirements in the equine dental world: no training, expertise, licensure, insurance, or regulation necessary to bestow upon yourself the title of ‘equine dentist.’ In fact, some ‘equine dentists’ start their professions after only a two-weekend course, some have even less than that, and while a little bit of knowledge can be a very dangerous thing, add in some specialist motorized equipment to the mix and you have a potential for disaster on your hands…or in your horse’s mouth.
In the USA, the laws governing equine dentistry are ‘consistently inconsistent’, and vary from state to state. However, it is universally accepted that Non-Veterinarian Dental Lay Practitioners (NVDLP’s) or lay dentists, are not ‘dentists’, despite the variety of methods they employ to market their self-proclaimed and delusive expertise. They can be brazenly found listed under ‘equine dentists’ or ‘equine dental technicians’, but many do not even have a college degree, and most definitely not in equine dentistry, because no such qualification exists. They may be graduates of an “ABC Institute of Equine Dentistry”, or “XYZ School of Equine Dentistry”, that implies they have some kind of license or formal education, but in fact, the topics taught in such establishments are unregulated, vary widely, and no regulatory agency, worldwide, recognizes qualifications from such schools. Moreover, several of these courses are taught by people who have been convicted of practicing veterinary medicine without a license. Equine dentists may attest to ‘experience in the horse industry’, they may even be a ‘second generation horse dentist’, or you may even be fortunate enough to find one that is ‘world renowned’ or ‘world traveled’, but bottom line is, a lay dentist may have any degree of training, or even none at all. As they are not held accountable to the licensing standards of a profession, you are exposing your horse to unknown risks and potentially life threatening procedures, with little or no recourse.
In some states lay dentists are legal, however, they are only allowed to use hand floats unless otherwise supervised by a veterinarian. However, it is still ILLEGAL for them to administer sedation or anesthesia to your horse: some carry on irrespective of this, others avoid the issue by promoting “gentle” and/or “natural horsemanship” as a beneficial alternative …would you consider a tooth extraction without the benefit of anesthesia, no matter how nicely you dentist whispered in your ear? More often than not, the job that gets done by is either a minimalist ‘sale barn special’, or even worse for the horse, teeth are aggressively ground to smooth ‘chicklet-like’ tablets, significantly decreasing their functional role in digestibility, and potentially causing permanent damage.
Things can, and often do, go wrong with routine dental procedures. Such complications may include soft tissue damage that can lead to infections in the tissue or blood stream, and over zealous grinding of malocclusions, placing bit seats, and shaping canine teeth, can expose the delicate and sensitive pulp cavity leading to tooth decay and eventual loss. Moreover, several horses have died as a result of bone infections resulting from such procedures. As the horse cannot speak for himself: he remains the ultimate victim and silently suffers the negligence and incompetence inflicted at the hands of unregulated laypeople. The well-meaning horse owner is not only duped out of hard earned cash, but is left believing they have provided the best in dental care for their equine partner.
Who should provide my horse’s dental care?
There are professionals who are licensed and trained to perform dentistry on your horse and they go by the title of ‘veterinarian’. While veterinary medicine has received justified bad press in the past due to short falls in the dentistry curriculum and the availability of continuing education, there have been rapid improvements made in the past few years. Veterinary equine dentistry now has advanced diagnostic aids, and a better understanding of equine dental anatomy, physiology and pathology.
The American Veterinary Medical Association (AVMA), American Association of Equine Practitioners (AAEP), and State Practice Acts define dentistry as veterinary medicine. So, in addition to a licensed veterinarian, who can legally carry out dental work on your horse in Georgia? Basically, “a veterinary technician working under the direction, supervision and control of a duly licensed veterinarian may provide the following animal patient care under direct supervision: dental procedures including, not limited to the removal of calculus, soft deposits, plaque and stains; the smoothing, filing and polishing of teeth; or the flotation or dressing of equine teeth; dental extraction not requiring sectioning of the tooth or resectioning of bone.” What this means in practice is that if you choose to employ a lay dentist over a licensed veterinarian, and/or supervised veterinary technician, to perform dental procedures on your horse, not only is this practice illegal, but it also means you have absolutely no recourse in the event of a problem. Have you ever considered that if your horse suffers at the hands of an unsupervised lay dentist, your equine insurance company is not obligated to pay for any claims that may arise from such cases of malpractice?
It is not uncommon for horse owners to request that their regular attending veterinarian sedate their horse for the lay dentist to perform dental work. This opens up a complex issue of “who is responsible for what when it comes to working in the equine mouth, and who is responsible should your horse be inappropriately or inaccurately diagnosed, medicated or treated?” Are you, the horse owner, responsible should something go wrong? Would the lay dentist be responsible? Would your regular veterinarian be responsible if your horse develops complications from a procedure performed by a lay dentist? As the choice is yours to make, you are ultimately responsible for the health and well-being of your horse: be aware of the rules and regulations that surround equine dental care in your state, and arm yourself with the knowledge of whom represents a legitimate, trained & regulated equine dental professional.
What should I look for in a good equine veterinary dentist?
If your regular attending veterinarian does not provide comprehensive equine dental care, and many do not, request that they refer you to a colleague that does, we are very fortunate to have several good equine veterinary dentists in our area. Here are a few questions you should consider when looking for good equine dental care.
1) Are they looking at what they are doing?
They should be using a surgical grade light (head or speculum mounted, not a flashlight), a padded stand or dental halter, a full mouth speculum, and a veterinary assistant to steady the head. Dentistry is not something that should be done blindly and by ‘feel’ alone.
2) Is everything clean and sanitary?
ALL dental instruments should be cleaned and washed with surgical scrub between EACH horse…no exceptions!
3) Are they fully equipped to do the job?
If they turn up armed with a single hand float and bolt cutters, this is not a good sign! Good technical instrumentation is vital to do a thorough job, both motorized and non-motorized. In fact recent studies have shown motorized floats produce less reactive horses, which has important implications for human safety and horse welfare.
4) Do they do a thorough examination and keep good records?
Your vet should carry out a complete visual examination, and be more than prepared to show you their findings and explain the work that needs to be performed. Did they ask/do they know the status of your horse’s vaccinations? For dental procedures, is it recommended your horse be current on Tetanus and Rabies for his own health, and the health and safety of you, your veterinarian, and technician.
5) Do they recommend sedation & anesthesia?
The veterinarian will have a selection of drugs available to make your horse more comfortable and relaxed. Not only does this contribute to a less stressful experience for your horse and allows the veterinarian to perform a more thorough job, it also enhances the safety aspect of performing such tasks in such a vulnerable position. i.e. right in front of the horse’s front feet! Not only this, if in the event of an adverse drug reaction (this does not happen often, but it can be a dangerous and life threatening situation) the veterinarian will be trained and prepared to deal with such an event, the event will be recorded in the patient health chart, and that drug can be avoided for future procedures requiring sedation.
6) Do they have diagnostic imaging?
Imaging equipment, such as x-rays, can be vital for uncovering and managing a number of equine dental abnormalities.
7) Do they adhere to sterile technique?
Being in a barn is no excuse for poor surgical technique! When any invasive procedure, such as wolf tooth extraction, is performed, it should be done with sterile instruments using sterile technique.
Don’t just brush it off!
So as a responsible horse owner, when you ask yourself “who should provide my horse’s dental care?” remember that you and your horse are the ultimate consumers, and are therefore the ones at risk. The health and welfare of your horse is YOUR responsibility: ask questions, seek qualified, unbiased professional advice, and always be wary of ‘certified’ non-veterinarian experts…they are at best practicing medicine illegally, and many are no more than traveling con artists.