Horsemen, Surgeons And Equine Dentistry (blog)
Horsemen, surgeons and equine dentistry have a major flaw that was made evident at the AAEP in San Antonio, Texas in 2017. The flaw isn’t easy to explain and has taken me decades to understand.
This year Dr. Jack Easley (treasurer of the AAEP, author of several textbooks on equine dentistry and worldwide lecturer on equine dentistry) invited Dr. Paddy Dixon (director of surgery at the Royal (Dick) College of Veterinary Medicine, prolific researcher and publisher of equine dentistry research, and world lecturer) to be the guest feature speaker from Edinburgh Scotland. His 2 ½ hour lecture was titled “The Evolution of Horses and the Evolution of Equine Dentistry.”
During the first half of the lecture, Dr. Dixon not only did a splendid job describing the development of the horse over the past 55 million years but he also presented relatively new information on the identification of the microbes within the gut of the horse. Called the microbiome, microbiota and holobiome, these words are becoming the catchphrases among health professionals and equine gut health products. I was delighted, as many of you know I would be, because of my previous blogs on grain, protein and lectins and their effects on horses’ health via their gut microbes.
The rest of Dr. Dixon’s lecture were case presentations of mouth disasters. He peppered the talk three times with disrespecting words about non-veterinary equine dentists, one of which brought cheers and applause from the large audience of veterinarians. Later that day Dr. Dixon presented to a very small group of us interested in asking questions which he and Dr. Easley answered for almost 2 hours. It was at this small meeting where I discovered the flaw that is dividing veterinary medicine and all horsemen.
Dr. Easley is an excellent presenter of good information who has decades of experience. His cases are detailed and compelling to listen to and if I were a person with a personality of a surgeon, I would be hooked. But I am not a surgeon or even a scientist at heart. I am a horseman who is more of an artist than a scientist. Back in the Renaissance period Leonardo da Vinci blended art and science and without question is considered one of the greatest thinkers of all time. When questioned about the gut microbiome, Dr. Dixon said, “Hold on. I’m a surgeon. I only just read that stuff and as a surgeon, I don’t really understand it.” That’s when the flaw became glaring to me.
Saggital palatal fracture of #106 before removal.
The Divisions
Veterinary medicine has divisions we all know about: medicine, surgery, anesthesiology, neonatology, theriogenology, immunology, epidemiology, and others. The medicine and surgery departments are compartmentalized and it is a standing joke in veterinary and human medicine that these two parts (medicine and surgery) are not only totally different, but the people in those departments are fundamentally different. Surgeons are usually brilliant in intelligence and have great connections between their brains and the words coming out of their mouths as well as dexterity in their hands. They are very organized and detailed as they need to cut into a body without cutting a vital part. However, surgeons also do things by the book because they are there to “fix” something. In fact, unless your neighbor is a surgeon who invites you to a bar-b-q, you probably will never meet a surgeon unless you need their services. In other words, if you are broken, you will need the services of a surgeon. And surgeons are great technicians like very smart car service technicians. They are troubleshooters and problem solvers.
Horsemen are not troubleshooters or service technicians. They are relationship builders which is an art form (most surgeons are poor relationship builders). Horsemen are only interested in what is in the horse’s best interest. Unfortunately, surgeons have hijacked this expression (“In the best interest of the horse”) and in their minds, they believe that fixing things that are wrong IS in the best interest of the horse. In other words, horsemen are talking about the whole horse and surgeons are talking about a single problem.
The flaw goes deeper than just dentistry. Most lecturers and college instructors are fixers of problems and do very well in teaching or lecturing on how to fix things. For example, most vets draw blood to look for a problem. Diagnosis of a problem is essential for their existence such as Cushing’s disease, gastric ulcers, lameness or colic. However, few of these health care professionals are interested in finding the root cause to prevent these from occurring in the first place. If they did, they would be out of a job.
Researchers are looking for answers but they are dependent on funding and there is no funding for equine dentistry. A few have done retrospective studies or limited studies but none have been conclusive in a way that has determined the root purpose for routine dentistry in horses. This void has left the surgeons in charge of the development of dentistry in horses practiced today. This includes standards of surgery that include immobilization, adequate visualization, and specific instrumentation. Their view of the horse is one with a problem and they are going to fix it using acceptable surgical procedures. Horsemen only want to relieve the pain in the horse’s mouth which exists even when there is no visualized problem.
The movement of the tongue has worn the upper outside incisors of this horse.
Who Is Leading?
Where does this leave horsemen with horses not having a problem but with a specific need for routine maintenance? In all of the discussions in all of the lectures and in all of the articles I have read on dentistry in horses, no one is mentioning the threshold of pain, the importance of the tongue or the skills of approaching a horse without drugs. Are immobilization and visualization really important in routine dentistry? Furthermore, are the issues found in the mouth such as exposed pulp, apical root abscesses, peripheral carries, diastema (space between 2 teeth), enamel fissures and other findings really affecting the horse (pain, tooth loss, general health demise)? While surgical and medical intervention seems to be effective, where are the studies that also look at the progression of these problems in the overall health of the horse? There are none but we are led to believe that if we don’t “fix the problem” seen in a visualization of the teeth that the horse will lead a life of misery or worse.
Equine health care in general and specifically in dental care has been limited by the views of the people teaching it. They believe that through them, care for horses is coming out of the dark ages. Maybe so, but they are only using a spotlight and the need to flood the stage with light is desperate. But like most people, surgeons believe that they are right and everyone else is either wrong or stupid. The arrogance of bullying non-vets from a stage without their input is not the type of people I want to associate with (unless they are willing to apologize). We can learn from everyone and it is the reason I attend these meetings and listen to everything about dentistry. It is also why I blog and teach directly to horsemen. While I may never be recognized by my profession as a valuable source of experience in equine dentistry, I do know who I am and my mission in life. I was left out of the box when they built it so I always think outside of the box (See my autobiography “Since The Days Of The Romans – my journeys of discovering a life with horses”).
This is a great read thanks Doc T – because I too value horsemanship above my veterinary degree as I am very priveleged to be married to a master farrier/horse trainer and our family lives and breaths the horse industry whereas most vets dont even own a horse let alone ride one……the turf war between equine vets and lay dentists has become very ugly here where I live in Western AUstralia. Lights have been shone by the vet dentists into horses mouths and dental caries have been found so now its mandated that this prolific occurrence of dental caries is due to high sugar hays …SUddenly now we have an explosion of demand for Low sugar hays which are difficult to grow here and unpalatable to horses….. what are your thoughts?
Hi Jenni from “down under.” In 1932 children in the US were having a high incidence of dental carries. Researchers stopped feeding these children oatmeal which every child ate in that period. They also supplemented with vitamin D and E. The carries not only stopped advancing but many actually reversed the decay! The author of the book, “The Plant Paradox” Steven Gundry, MD, suggests that it is the lectins in the oats causing the decay.
There is no one offering a reason for so many cheek tooth fractures secondary to decay of the pulp chambers. Could it possibly be the oat lectins? At Texas A&M vet school the work on the microbiome of the gut is exciting. There are 700 individual species of bacteria within the mouth! One dose of NSAID, antibiotic, and anthelmintic are now being shown to remove whole sections of these bacteria (think – the Jones and Smith families are OK but all of the Adams families are now gone). Fascinating – see this year’s AAEP proceedings.
I am now saying “It’s NOT the sugars people! It’s the damage from the lectins!”
While I have you thinking, read my thoughts as to the cause of EOTRH here – https://theequinepractice.com/the-equine-practice-rounds-vol-2-issue-2/
Would lectins be adsorbed differently 7-10 days after administering de-wormer products ?
Nobody has studied that. Deworming medication has been shown to alter the normal distribution of gut flora. So have lectins.
Lectins aren’t actually “absorbed.” They actually actively force themselves into the tight junctions between the enterocytes (cells of the gut lining). As far as I know the only thing that prevents this is the layer of mucus lining the gut.
Sorry I can’t answer your question but there is no data.
WOW!Sometimes it seems as though these experts are living in bubble.Perhaps a day will come when a common sense approach to dentistry will be a topic at one of these
conventions.Being left out of the box,probably a good thing,after all we should not be limited to what comes from textbooks,but rather learning to think for ourselves.I´ve learned more since
meeting you and graduating from the horsemanship school of dentistry than I could possibly learn from books by these intellects.Here´s a little tidbit.Perfectly health horses are shipped to slaughter houses in Canada for meat production,with great care given to their end.However the gov´t frowns on any non veterinarian doing any routine floating of a horse,because they do not think trained non vets can do the work without harming the horse.I fail to see the rational.
What a great point John. The more I live in this world the more clearly I see the agendas driving the actions of people.
I promise you that I will continue to voice my opinion on what I know is in the best interest of the horse. Thanks too for your kind words. Doc T
I’ve met too many “professionals” with letters after their names who don’t listen to anyone without those letters. I’m glad you were left out of the box!
Hi Barbara – Those of us with degrees should have a thirst for knowledge and be questioning everything. “But why Mommy” was something I wrote ( https://theequinepractice.com/the-equine-practice-rounds-vol-2-issue-1/ ) to discuss just this concept, but for so many overwhelmed with data and underwhelmed with experience, these experts hold on to what they know because to explore other options is a form of insecurity they are unwilling to experience.
Thanks!
Wow. Incredible article and insight. As a horse owner I strive to find the best professional, one who will talk with me, educate me, and most of all, listen to me about my concerns regarding my horses. I know them better than anyone and it is important that I am considered part of the process. In the end I am wholly responsible for everything that is done to my boys. And many a time I’ve gone with my gut and not with the current trend and was proven right by doing so. I’m very thankful for you Doc. You strive to find a better way and you are willing to share it with us. You don’t just rely on the way it has been done forever. Thanks for keeping us informed.
Thanks Stephanie for being an advocate for your horses. As I said to Deb, it is hard to stand up against the “authority” but usually your gut feelings are correct.
Speaking of listening to authorities, what are we all doing when we listen to the news or the advertisers or the actors playing an imaginary character? We are listening without thinking so we have been conditioned to listen to authority instead of listening to our gut and common sense. Ugh… don’t get me started.
Dr. T, I’ve read this article several times, and so agree that medicine (human or animal) has elements of artistry and science. Personally, I am thankful to have both on my team. Thank You for being our horse’s advocate!! As a healthcare professional, I learn every time we talk. It takes artistry to put a puzzle together without seeing a picture first; looking at one piece of the puzzle at a time doesn’t always give a clue as to the whole picture. There is a place for Internist/General Practitioners and Surgeons to work together for the good of one under their care. Owners/caretakers must know whom to approach first for overall healthcare.
Thanks Deb – We do need surgeons but as you say, we also need an over-seer who can put the pieces together. Owners/caretakers need to avoid being spoon fed information. Rather they need an advocate to help them become responsible for the outcome. But it’s hard to question an authority and those with advanced degrees are hard to debate with.
You will always be #1 informer that i will listen to (after my horses,of course) I have found that vets are trying to move “outside ” the box but when push comes to shove it is back to what they learned in vet school..That is not helpful for our horses and usually very hard on our wallets. You keep on moving your way and know that a lot of us “have your back!”
Thanks Heather!!! It’s good to know people have my back on this.
It’s a much more hostile environment when it comes to hoof care…the leaders at most universities are clueless yet so guilty of “bullying non-vets from a stage” and I am so glad to here you say “this is not the type of people I want to associate”. It’s ironic…even with a DVM you feel you can’t be heard. Imagine my frustration…years dedication…multiple documented case studies of reversing major lameness most are after experts at teaching hospitals like Tuffs wanted to euthanize. To me it’s all about the $$$ and if the surgeons can’t cut, then they can’t help.
It is tough being a horseman in a world of non-horseman experts…. regardless of being a DVM. But I also think that there are a lot of “silent majority” DVM’s out there too busy to become a stage presenter and think more like me. Unfortunately most of the horse owners I talk to, especially the older ones, feel like it is a losing battle. That horsemanship no longer exists and why bother trying. We will always be frustrated, but for me, I will keep doing what is right until I no longer breathe.
Certainly par for the course regarding surgeons in the medical field whether human or animal related. The good thing is that there are always some Doctors that also don’t believe in cutting and removing everything just because it is what they are trained to and know how to do. However it really is luck of the draw finding them, so people/horsemen/animal owners have to make their own decisions on how to proceed given new information as it comes in. Thank you for taking the time and being dogged about keeping us informed Doc T.
Guess what?!? I have a few more things to say about this! In the mean time I’m just going to keep doing what I know works for the horses. Stay tuned…
Great perspective in the perils of compartmentalization. Keep at it! And thank you.
Thank you!