The question of who should practice equine dental care remains a hot button issue. Many veterinarians are expressing alarm over the lack of oversight among non-veterinary equine dentists and the apathy within their own profession about whether dental care remains a medical procedure.
The American Veterinary Medical Association and the American Association of Equine Practitioners agree that both large- and small-animal dentistry are medical procedures, and that veterinary dental assistants or technicians can be utilized by veterinarians in their offices and under their direct professional supervision.
But Gregory Beroza, DVM, Dipl. ACVS, Dipl. ABVP, of The Long Island Equine Medical Center in Huntington Station, N.Y., a practice that focuses on equine dental care, says although veterinarians are required to have both state and nationally recognized training and professional credentials, not all equine dentists who practice have even proper state licenses.
“And now there’s a battle in who really owns the turf of dentistry between non-trained self-proclaimed lay-dentists and well-trained veterinarians doing dentistry,” he says.
“I personally believe that equine dentistry belongs to veterinarians, just as the human dental work belongs to human dentists. There are some within my profession who don’t agree, and another significant proportion who aren’t standing up and being vocal about this issue, but who also agree with me.
“In some states horse owners are gaining momentum to let non-veterinarians do equine dental work,” Dr. Beroza says. “Even if you consider dentistry a skill that technicians alone can do, which I don’t, no human dental technician is allowed to work on a person’s teeth without a license or without a trained dentist being immediately present in the same office. We’re not taking care of the back door and not protecting our own professional market.”
Losing the Fight?
The power to regulate professional care is in the hands of each state in its Veterinary Practice Act, but many veterinarians fear they are losing the battle to keep dentistry in their control.
In 2008, the New York Racing and Wagering Board went up against lay dentist Chris Brown in court to prevent him from practicing; he won. Three equine veterinarians testified for Brown and the judge supported the fact that Brown would be restricted in his ability to earn a living if he lost.
“We’ve allowed lay dentists to infiltrate dental care and now they can argue that they have the legal precedent and we can’t stop them,” says Dr. Beroza. “How are lay dentists regulated and/or even insured against malpractice?”
Lynn Caldwell, DVM, outgoing chair of the AAEP Dental Committee and a solo private practitioner in Silverton, Ore., who focuses on equine dentistry, says she recognizes that many of her colleagues have problems with lay dentists and are asking the AAEP for help.
“AAEP’s position is clear, and we have not washed our hands of this problem, but the AAEP has no legislative or judicial or criminal authority,” she says. “We’re a practitioners organization set up for the benefit of the horse and each other.”
Dr. Caldwell says that one of the problems is that many state veterinary boards are peopled with small animal veterinarians who don’t really understand what is going on in the equine world.
“And we have equine practitioners who don’t have an interest in dental care,” she says. “That’s fine; we all have our interest and expertise. But our colleagues should refer their clients to veterinarians, much like I would refer a colic surgery patient to a surgeon.”
Geoff Tucker, DVM, whose Palm City, Fla., practice focuses on dental care, is also concerned about equine dentists “twisting facts” to make them fit theories.
“That’s what many equine dentists are doing,” Dr. Tucker says. “They are coming up with a theory about equine dentistry and then they come up with facts, not supported by science, to prove their theories.
“The worst example is incisor reduction, which was touted by veterinary and non-veterinary equine dentists to be very important about 15 years ago. A non-veterinarian decided that filing the front teeth was the thing to do. There is no scientific basis for it, and more than one horse has died from this because of subsequent bone infection.
“In truth,” he says, “what’s happening in the front teeth is secondary to what’s happening in back of the mouth. Yet there’s a whole school of thought being taught in the U.S. that says start with the incisors first before you even work on the back teeth. None of this has been proven. There are no studies that say what they are [saying] is true.”
Beroza, an advocate of power floating, says that some lay dentists are further hurting the veterinary dental profession by convincing their clients that a veterinarian should not put power equipment into their horses’ mouths.
“Properly done, power floating does a better job,” he says. “Having said that, untrained people or someone just learning should not be doing power floating.”
Beroza is a board-certified surgeon and used his surgical expertise and his own barn of 40 horses to perfect his skills before offering power dentistry to other clients.
“With power floating, the standing horse is lightly sedated—something a lay person cannot independently do—and the horse’s mouth is propped open with a speculum,” says Beroza.
“This enables the veterinarian to look and reach far back into the caudal recesses of a horse’s mouth, where they may have sharp hooks, especially common to older horses. Diamond and/or carbide bits are used, which only grind the hard teeth and do not injure the inner soft tissues of the horse’s mouth. With power equipment, I consistently get equally balanced results in all four quadrants of each and every horse’s mouth.”
Regulation and Oversight
Caldwell was involved with the non-veterinary dental organization the International Association of Equine Dentists (IAED), and she says although many of the members are well intentioned, many have been misled into thinking they are dentists.
“They are not dentists,” Caldwell says. “But dental care is an extremely lucrative thing for them to do. The investment is a two or three-week class and buying the equipment.”
The IAED did not respond to requests for an interview for this story.
Caldwell says her breaking point with the IAED came when she realized the association wants autonomy with no licensing or regulation.
“Their association with veterinarians was purely political,” she says. “They had no intention of actually telling the truth about who they were. And now they are complaining about restraint of trade and how the veterinarians want all the money, which is ridiculous. There are a lot of things vets can do to earn money. Now lay dentists are organizing and going after deregulation on a state-by-state level.”
Caldwell says that she would welcome the human dental hygienist paradigm—floating points or correcting malocclusions under the supervision of a veterinarian.
Tucker agrees. In fact, he employs a lay dentist in his practice whom he has trained. “I’m the living example of a veterinarian and a non-veterinarian working together,” says Tucker. “But I think veterinarians have that critical role of being the advocate for the horse. That’s important.”
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