5 days in San Fransisco at the 2018 American Association of Equine Practitioners meeting and I came away with one clear message about equine dentistry. If I want to increase my profits in this specialized sector of veterinary horse care then I need to step up and purchase specialized equipment to perform my oral exams. This includes a digital X-ray plate that can be inserted into the mouth of the horse to take magnificent radiographs of all the teeth and underlying bone structures. It also included purchasing an endoscope made for looking at all surfaces of the teeth and soft tissue within the oral cavity.
In an ad for specialized equine dentistry radiology had this quote from a veterinarian endorsing the equipment (see image below):
“You cannot practice a veterinary level of equine dentistry without dental radiology. Period. …. It is really quick, it is really easy, it is good for the bottom line, it is good for patient care, and it sets the the general practitioner apart … doing better dentistry on fewer horses while increasing practice revenue. … Dentistry is a huge profit center. The initial purchase of the equipment is minor compared to what you generate long term.”
If This Isn’t Enough…
Listed below are the titles of the talks given this year.
- How to Perform and Document an Oral Examination
- How to Use an Oral Mirror and Endoscope
- How to Radiograph Incisors and Canines
- How to Radiograph Cheek Teeth
- How to Diagnose Periodontal Disease
- How to Use Rotary Burs in Equine Dentistry
- How to Manage the Geriatric Dental Case
Analysis of the talks left me scratching my head. Basically they all said that early detection of disease of the teeth and oral cavity can lead to early treatment. These include “complicated tooth fractures, soft tissue growths, and carries .” At first glance this sounds reasonable especially with the notion that veterinarians have a job of fixing things. However there is trouble with this assumption that these things can be fixed.
“DO SOMETHING!” Is the mantra of veterinarians and physicians and it prays on the fears of the patient or the horse owner. The process of any dental disease in horses is very unclear with a few exceptions such as food packing in a space between the teeth (diastema). Treatment for a disease process that is not understood offers a “shoot in the dark” approach that basically comes down to extraction. I wrote about this in the blog called “Pull The Tooth!”
In each of the talks the summary basically said the same thing. Early detection of disease leads to early treatment. But what are the treatments? More importantly, where is the emphasis on prevention?
Advertisement suggesting equine dentistry a great profit center with intra-oral radiography.
There are no studies that associate the prevalence of disease with consistency of preventive care. In other words these veterinarians are discovering disease in the mouth of the horse and treating it but no study has been done to look at the effects of preventive maintenance.
In my practice I perform maintenance on every horse I see. It is called “floating” which eliminates the sharp edges causing soft tissue pain. It is this pain that reduces tongue movement and alters the movement of the tongue and jaw. From this comes most oral disease because the unrestricted movement keeps the teeth healthy. Evidence from my practice includes the elimination of periodontal disease, strengthening of loose teeth in older horses and movement of the teeth into a better alignment as if they have been wearing orthodontic braces. Horses started at a young age on a preventive program have normal incisor wear without the “smile” or slant caused by abnormal tongue movement. They also have no oral diseases throughout their life and yes, I have been floating long enough to have been with some horses for their whole life.
The purpose of this series of presentations at the 2018 AAEP meeting was to help gain relative evidence to support a treatment proposed by the veterinarian. There still is no evidence showing that routine dental care (floating and removing ALL sources of oral pain) prevents the oral disease they are trying to document. In other words these studies never look at the effect of routine prevention on the development of oral health in the horse.
Melissa connecting with her patient showing why so many love our way of horsemanship dentistry.
There are two costs to gathering evidence of oral disease. The first is the cost to the gut microbiota when every horse is sedated with detomidine. This drug profoundly sedates the horse while giving no pain relief from the painful soft tissue injuries affecting the horse in the first place. It is why many horses fight through this drug. This adds to the disruption of the normal gut microbe flora adding to the digestive dysfunction most stabled horses have (gastric and colon ulcers). The second cost is the expense to the horse owner. Paying for these exams can be significant and therefore prevents many horse owners from using it for diagnosis let alone paying for the subsequent treatment. This adds to the owner’s guilt when all they want is the best for their horse.
I am troubled with where my profession has taken equine dentistry. The advertisement shown above where the veterinarian representing the advertising company says that X-raying teeth is “good for the bottom line” sums up everything. Throughout the presentations were the use of the phrase “standard of care.” This is shocking because I would think the ideal standard of care is prevention through removing the offending sharp points from the teeth and allowing the horse to heal itself. However this is harder to do then dental radiography on a heavily sedated horse with it’s mouth jacked open with a speculum. If priced low enough there would be endless work. If priced low enough there would be many non-veterinarians floating teeth further taking away work from veterinarians. Not to worry because most states have established laws to prevent non-veterinarians from removing any tissue including excess tooth enamel but not including excess hoof (farriers).
I am a Cornell veterinarian with almost 36 years of horse dentistry experience. Horses are 55 million years old. I am just not convinced that horses really need anything more than routine dental care throughout life to maximize health and longevity as well as perform best when a bit is used. Every day that I float teeth I witness horses profoundly relieved when offending sharp points are removed and over time I see the benefits of removing this pain in a healthier mouth. I do not have the time to document this using radiography and endoscopy but I would bet that if someone did explore objectively the benefits of routine maintenance they would have evidence that all horses need, with very few exceptions, is routine maintenance.
Look how many horses you see and look at how little tooth disease there is. They have survived this long without humans interfering. However, as long as we are using them for human purposes, containing them within fences and stalls, feeding them differently, investing money in their purchase and care and expecting longevity and high performance then we need to do dental preventive care. The method I use is working perfectly and I am not about to be swayed by a false standard of care my profession is creating. My methods and standard of care is different and in my opinion is best for the horse.
Melissa with 2 of her 15,000 happy horses after dentistry