How We Perform Equine Dentistry Matters
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
Dr. Tucker & Melissa, Eric and I and our horses are so pleased with your dentistry method. Melissa came and did our two horses teeth last week and we were absolutely amazed that there truly was no drugs no drama. Our horses willingly cooperated with Melissa and seemed pleased that she was making them feel better. The look on them was as if to say, “wow, thanks, that feels much better”. Melissa was a pleasure to have come here and she does a wonderful job!
Thank You,
Eric & Cindy
I passed this on to Melissa. We are both grateful that you took the time to comment here so everyone can see your thoughts. As the owner of this practice, I am honored to have Melissa as a partner in horsemanship and in dentistry. When I hear all the positive reviews about her I become so grateful that others get the opportunity to see in her what I see.
We come across skeptics who, until they see what we do with their own eyes, don’t believe Horsemanship Dentistry is possible. Through the words here from you and others, the story is told that horsemanship is really more effective than automatic sedation. What is untold is that you choosing to have dental care performed on your horses makes you an advocate for your horses.
Thank you again for these words and for calling us to care for your horses teeth.
My mare is 16yrs old and her teeth are done once a year. I have used Hippologic i think from Kentucky. I was introduced to them by a fellow horse lover concerned about her horses mouths after having had bad results from former dentistry. This company is veerrry expensive and it takes my mare a week or more to want to eat and to learn how to eat again, spitting out wads of cigar shaped chewed grass for quite a long time. I was told to expect this. They are not Veterinarians.
They advised me the teeth had been over trimmed on one side, from the cheek toward the gums, likely due to too much pressure by electric equipment and the dentist being one sided in his use of the equipment.
I’m not knocking them, but if you know their methods, am i paying more than is necessary, $250? My previous vet charged around $70 for uncomplicated treatment . Both use electric equipment and sedation. The previous Veterinarian cranked her head way high which resulted in the horse taking very strange hard loud big labored breathing. It was difficult for me to watch. I said to him, she’s having trouble breathing. He answered, that’s her choice how she wants to breathe. And when Hippologic was presented I went to them to get away from what I considered unkind treatment, but at a great cost increase. However, they use sedation too and speculums. After completion, I receive a chart of her teeth diagraming what had been done in her mouth. Not knowing anything about dentistry, I’m just looking for the correct and best way to keep her mouth healthy without breaking the bank. Whatcha think?
I forgot to say, the $250 covered anything, anything that needed to be done, extraction, whatever.
You have several issues here: value, effectiveness, legality, ethics. Let’s start with this last one,
Anyone with a callous attitude to anyone or any animal should leave this business. His or her reply to your concern about your mare’s difficulty in breathing when her head was positioned reflects their core ethics and integrity. Horse professionals should have an attitude of service to each owner through their horses. It should drive them every morning to wake and to do better than the day before. When working with horses becomes a chore and a burden with the only outcome the collection of money then they should find another occupation.
Ethics also applies to the law. Every state limits the use of medications to licensed veterinarians only. Non-veterinarians carrying and administering medications restricted to a veterinarian is breaking the law and so is the veterinarian who sold them this vial. But the use of sedatives for dentistry is inappropriate even though it is common. When a horse balks at a dental procedure it is most likely from pain. Yet most dentists use a sedative with no pain killing properties. Using only a sedative is like getting a date drunk so the work of creating a relationship can be avoided. In other words, the use of sedatives for dentistry avoids the skills of horsemanship needed to make a connection and build a relationship. It is the relationships made with horses that drives us across this country to float teeth. It’s FUN!
Quidding hay after floating happens to all of us but seems more common after using power floats. You should be warned that this is a possibility and it should improve quickly though some take up to a week.
Floating teeth is an art form. Music is an art form with many types (rap, folk, opera, etc). Not all floating is the same. Horse owners look for two or three things from the dental experience. The first is that they are happy when the job is done. The horse seems happy too. Second is usually found during the next ride when the horse seems more comfortable in a bit or maybe chews more purposefully and without restrictions. The third is that the owner learns something about their horse which makes them a better horse owner.
It sounds like you have not had your expectations met in any of these three areas. The only reaction you have is that you do not feel value. This is where you spend your money and smile when doing so. This applies to everything from a car to a restaurant meal. It is not the amount you spend but how you feel once it is spent.
Unfortunately we hear stories like yours all the time. There are few professionals being taught horsemanship and the horse owners who know the difference are noticing this. Those who do not know the difference don’t see the problem which allows these professionals to continue to give horsemanship-less care. Thank you for noticing and reaching out here. Keep looking or find someone to take our school on equine dentistry at HorsemanshipDentistrySchool.com
Thanks, Doc T
Yeah, Sally and Doc!! Nice to see my two favorite vets in communicado.
I have to say was very concerned Doc was proposing some fancy new equipment he was going to have to buy (and we were going to have to pay for). Kind of like vaccinating a dead cat. I should have known better. No real need for complexication in the realm of mastery.
Very well said and thank you so much. Doc T
Sad but not uncommon for the medical industry to have a solution looking for a problem, and the money to market and pay for studies until they find one…
Yup!
All of the subjects of the lectures from the conference are the reasons I went looking for a” Dr Tucker” and thank heavens I found him. My horses certainly thank him.!
Thanks Heather! I’m glad we met too!
Mind boggling! The lengths some people will go to to make people feel guilty. It’s not only the horse owner, but the brain washing of veterinarians, especially the young and up and coming veterinarians. Leaving imprinted in their thinking that this is the only path to proper equine dentistry. The peer pressure of fellow veterinarians.
So now they are committed to using this rather narrow minded learning on the unsuspecting horse owners.Complexicating things only moves people further from the simple truths of horsemanship and equine dental care.I had an owner who refused to let me float his horses´ teeth because I would not use a speculum. Eventually he came to his senses realizing that his horses’ care mattered more. Keep on sending out the message Doc. Thanks
Thanks John – it is mind boggling.
I had to do a double -take on the picture of Melissa floating the chestnut with the white blaze ( top picture)
It could have been my beloved “Boo” , who you floated many times during his 34 years. Just dreamed about him last night! I sure miss him.
Still enjoy reading your blogs, though I have been horseless for 4 years now.
We miss you. Though that isn’t Boo in the picture, it is nice to remember him and think back on the good times. Thank you Marie for continuing to read my “stuff.” Doc T
I am so grateful that your main concern is the best interest of the horse. Keep up the good work.
Your blog gave me the backup I needed to seek other answers when my horse was facing tooth extraction. I kept looking and finally found a vet who took a conservative approach and did a hand float, only using a mild power float on a back tooth that was hard to get at. It improved his chewing a lot. He can eat his hay again without spitting out wads. It probably should have been done sooner, but at least I found the right person for the job in the end.
I am so grateful that there are honorable people like you and Melissa educating us about what is the best solution for are horses. Thank you!!!
We are grateful that you noticed and read the blogs. Thank you. Doc T
Sounds like a perfect example of complexication. I use your word daily! It’s a major problem in all of veterinary medicine. Directions of how jump on board the train driven by the MBA’s… all in the name of “good medicine”. Oh, I mean “standard of care…”
Hey Sally! Good to hear from you! Hope all is well.
Glad you are using complicate – I am honored.