June 9, 2011
Equine dentistry involves a lot more than floating teeth.
Jack Easley, DVM, MS, Dipl. ABVP (Equine), says veterinarians with specialized training are the best choice for taking care of the complete horse.
“Why would horse owners have someone with no understanding of medicine, disease or function touch their horse’s teeth?” he asks.
“Dentistry is an area of veterinary medicine that has become very advanced in small-animal care. What we know in human dentistry we’ve applied to dogs and cats, so small-animal dentistry has a big jump on equine dentistry,” Dr. Easley says.
Periodontal disease is common in horses of all ages. Horses 2 to 5 years old may need dental services when deciduous teeth are shed and permanent teeth erupt. Middle-aged horses can experience malocclusion and crowding, especially in miniature horses. Older horses, in their late teens or early 20s, may experience periodontal disease in teeth that normally last about 25 years. Proper feeding and dental care can extend the life of the teeth and the horse.
Lynn A. Caldwell, DVM, chairwoman of the American Association of Equine Practitioners’ Dentistry Committee, of which Easley is a member, says horses kept in stalls and fed only hay and grain show more abnormal wear and occlusa problems than horses who graze in a pasture.
Those allowed to graze and use their incisors for nipping grass and full range of motion of the cheek teeth for chewing will have less periodontal disease.
Equine periodontal disease is common, and overzealous or unnecessary procedures that some lay floaters perform can perpetuate a horse’s dental problems rather than solve them, says Dr. Caldwell, who owns Silverton Equine Veterinary Services in Silverton, Ore.
“Floating every six to 12 months can decrease the life of the teeth if performed improperly,” Caldwell says. For instance, the excess removal of tooth structure will hamper a horse’s eating. Caldwell says she has seen improperly floated teeth that were “carved like soapstone.”
She recommends that veterinarians who want to learn more about dentistry pursue the Equine Fellowship program of the Academy of Veterinary Dentistry, which she is doing. The American Veterinary Dental College recognizes only small-animal diplomates at this time.
Veterinarians can earn 36 continuing education hours by attending the American Association of Equine Practitioners. Series on equine dentistry. The wet lab will run Aug. 10-13 at Texas A&M University in College Station.
Practitioners seeking to gain competency in equine dentistry will get one-on-one instruction and laboratory experience. Attendance is limited to 24 participants.
Lecture and lab sessions will focus on dental anatomy, dental radiology, oral examination, sedation/analgesia, dental equipment and hands-on work using cadaver specimens and live horses.
For more information about the meeting, which is sponsored by Boehringer Ingelheim, visit www.AAEP.org
One development that David Foster, VMD, an adjunct professor at the University of Pennsylvania School of Veterinary Medicine, is eager to share with students is the availability of a natural bone allograft derived from equine donors.
Marketed by Veterinary Transplant Services Inc. of Seattle, Osteoallograft Periomix consists of osteoinductive demineralized bone matrix (DBM) and osteoconductive cancellous bone chips. The product allows equine practitioners to quickly repair fractured mandibles and reconstruct bone that has been lost around teeth because of periodontal disease or tooth extraction.
The company has produced a similar product for dogs and cats since 2008.
Dr. Foster discussed Periomix with VTS founder Helen Newman, Ph.D., CTBS, when he met her at an American Association of Equine Practitioners meeting. He has used it in selected cases at Penn Vet and in his private practice.
This is the sort of newer application in equine dentistry that evolves over time,” he says. “There are not a lot of horses that need it, but the ones who do will benefit.
Allografts are said to offer several benefits over autografts. Visit www.VTSonline.com for more information. —LMT
Veterinarians say horse owners should be told about the importance of hiring veterinarians for dental work rather than lay horse dentists.
Caldwell says lay dentists can, and do, mislead the public about their education and training by the use of the term “dentist,” which implies professional medical training.
“I refer to them as non-veterinary dental care providers, or NVDCPs,” she says.
Veterinarians use scientific methods and peer review to increase their knowledge base, she says. “The process of scientific and evidence-based dentistry, medicine and surgery moves the profession forward. We have an ethical responsibility to do no harm to patients.
“For example, sedatives should only be administered under a licensed veterinarian’s supervision. NVDCPs don’t have the training in pharmacology that veterinarians do. If you’ve ever seen an accidental intra-carotid injection resulting in a seizure, you’ll agree with me.”
Easley, who owns Equine Veterinary Practice LLC in Shelbyville, Ky., suggests that veterinarians take every opportunity to educate horse owners about dentistry by visiting with and presenting information at 4-H clubs, horsemen seminars, pony clubs and other events where owners and riders meet.
Dental maintenance is a core skill for veterinarians.
“Veterinarians know that teeth are but one component of the entire stomatognathic system and that the stomatognathic system is but one system within the whole horse,” Caldwell says says. “The NVDCPs don’t have this training.”
Caldwell encourages NVDCPs to go to veterinary school or become licensed veterinary technicians. “They’ll find out that there is a whole lot they don’t know,” she says. “There’s more to equine dentistry than just floating teeth. It involves the whole horse.”
She also encourages NVDCPs to “find their proper place on the horse’s health care team,” which she says is working under the direct supervision of a licensed veterinarian.
“Equine dentistry can be grueling work,” Caldwell says. “The veterinarian may hire an LVT to work under their direct supervision.”
New technology has made root canals and other endodontic therapy on horses possible. Osteoallografts can provide a type of scaffolding for the bone.
Orthodontia, restorative procedures and implants also are evolving, Caldwell says.
“Implants are used when incisors are lost and are anchored into the bone, similar to human dental procedures,” she says.
New stomatognathic system research has led to the development of more appropriate tools, including more precise power instruments, Easley says. More detailed oral exams are possible with the development and improvement of speculums, headlamps and scopes.
“Even 20 years ago we didn’t use sedation for restraint,” he says. “Today, we know sedation and restraint are both necessary.”
Easley says mineral trioxide aggregate gives more successful results when endodontically repairing diseased teeth.
“The material used to fill the pulp chamber must stand up to mastication,” he says. “Again, we can’t extrapolate techniques and procedures from humans or small animals because the horse is completely different.”
Improvements in imaging technology help veterinarians better understand pathology and develop a course of treatment, Easley says.
“We now know that we need radiographs before extracting teeth,” Caldwell says. “Veterinarians know that extracting a tooth can cause bacterial endocartitis, or shower the body with bacteria.”
Portable digital and computerized radiography give a veterinarian the ability to diagnose and treat the horse in the field. Previously, X-rays were taken back to the clinic for developing and a second trip to help the animal was necessary.
“We can take a look while at the farm and begin treatment immediately,” Easley says. “Without the radiograph, you are only looking at the quarter-inch of exposed tooth crown above the gums, not the entire 4-inch reserve crown and root under the gum. You can’t diagnose a problem without some sort of imaging.”
Some states require that all dentistry work be performed by a licensed veterinarian, while others allow lay dentists to do the work under the supervision of a licensed veterinarian. But many states don’t enforce these laws, Easley says.
“The most important thing we have to do is promote dentistry within our practices,” he says. “We have to pursue more special interests and keep up our education.
“If you don’t want to provide high-quality dental care for your patients, refer your clients to a veterinarian who can provide such services. We don’t want to leave the owners with tooth-floaters as their only option.”
This article first appeared in the August 2010 issue of Veterinary Practice News. Click here to become a subscriber.
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