The Equine Dentistry Debate Copyright Helen Ward August 2009

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The Equine Dentistry Debate
© Copyright Helen Ward August 2009
As conscientious as most horse owners can be about scheduling regular farrier appointments and annual vaccinations, unfortunately many are not as diligent about regular dental attention for their horses.
According to equine veterinarian of 35 years, power tool advocate and principal of the Cranbourne Equine Hospital and Referral Centre, Dr Graham Jeffrey, it’s a case of out of sight, out of mind for the vast majority of horse owners. “Obviously people who own or train performance horses understand the importance of regular dental care but it concerns me to think about how many horses in Australia need their teeth done.”
Horses evolved as grazing animals and their teeth are perfectly adapted for that purpose but there are many horses these days that have limited or no access to grazing, therefore regular dental care is a must.

The last two decades have seen a dramatic evolution in equine dentistry. The use of hand tools to rasp or file horse’s teeth has been the technique horse owners are most familiar with. Today there are new therapeutic dental options that claim to offer vast improvements over the traditional methods.

As a result horse owners now find themselves in the middle of what Queensland veterinary surgeon and equine dentist, Dr Alison Macintosh sadly describes as “a political issue” between the traditional or lay dentists and Whole Of Mouth (WOM) practitioners.
WOM equine dentistry is as the name implies. What sets this technique apart from a traditional dental float (rasp or file) is it involves a thorough assessment of a horse’s dental condition using tools not unlike human dentists use. WOM dentists require horses to be sedated as they use powered instruments, lights, dental mirrors and in some cases water and suction. Whilst some within the industry view this as the next generation of equine dentistry and the way of the future, others remain skeptical, are unsure about the practice and consider it high risk.
For Mark Burnell, traditional equine dental technician, past president and current vice president of the Victorian Horse Council, and director of the Australian Horse Industry Council, the greatest risk with this style of dentistry is the tools. “My concerns about WOM dentistry focus on the implications with the use of non water cooled power tools, the effect they have on horse’s teeth and the longevity of those teeth, which in turn relates to the longevity of the horse.”
With 29 years experience using both techniques, Victorian equine dentist Graham Farley says there is no corrective work done with traditional dentistry. “To do corrective work we need to have the horse sedated in order to do a more thorough job.”
President of the Australian Chapter of the International Association of Equine Dentistry (IAED), Graham realised five years ago there was a better way to perform dentistry on horses and sought to up skill and educate himself in the WOM technique. He firmly believes there is a shift, albeit gradual, towards this methodology. “About 60 percent of my work these days is WOM.”
Master equine dentist Ian Wharton used the traditional method for many years. He is now a total convert to WOM dentistry believing traditional dentistry does not work. “WOM is about balancing the horse’s mouth by reducing and aligning incisor teeth if necessary, removing ramps and wolf teeth all so the horse can chew more effectively with its molars
The importance of a well balanced mouth should not be underestimated. It ensures maximum nutritional intake and condition as well as impacting on performance and behavior.
Education helped Ian realise that everything he had done as a traditional equine dentist, using hand tools, knocking some rough edges off here and there just to keep a horse comfortable had been a complete waste of time because he didn’t understand the function of the horse’s mouth.
Graham Jeffrey (Need to keep the Jeffrey in because there are two Graham’s in this article & therefore we want to avoid confusion) acknowledges that traditional dentists can do less damage than WOM practitioners because of the tools they use. “I think it’s not so much about what they do but more often what they don’t do. The sharp points which are what traditional dentists treat are only the beginning of a problem which may include various forms of pathology that can develop over time in the mouth and if not rectified can result in infection, gingivitis, involvement of the periodontal ligaments and subsequent loss of teeth. The horse’s chewing cycle is compromised resulting in pain and discomfort for the horse, weight loss, poor digestion and poor performance. A WOM practitioner really needs to understand pharmacology, radiology and anatomy and how all these factors fit together.
“Whilst I’m not trying to put lay dentists down they are limited in what they can do.”
Even the Bureau of Animal Welfare1 have weighed into the debate with their draft Victorian Horse Welfare Code of Practice in which they are recommending the following:

  1. A person must not provide any dental treatment to a horse that causes damage or injury to the horse, or results in inability of the horse to eat.

  2. Use of motorised tools on horses' teeth must only be performed with the horse adequately sedated under veterinary supervision. Drugs used for sedation must be administered or dispensed by a veterinary practitioner.

  3. A person must not attempt a category of dental procedure that they are not competent to perform as defined in Appendix 5-Dental Procedures.

Such diverse opinions amongst practitioners has naturally caused confusion for horse owners. The debate about the use of hand tools over powered instruments is a contentious one with proponents of both methodologies highly critical of one another and others who agree that there is room for both.

It is a proven fact that regular dental care will maintain the condition of horse’s teeth and preserve its health and well being throughout its life.

Owners may catch a glimpse of their horse’s teeth as it nibbles on a carrot or apple and they would certainly notice its teeth when they insert a bit into its mouth. But unfortunately most horse owners don’t give much thought to their horse’s teeth until they discover an obvious problem or experience an inexplicable training setback or behavioural difficulty.

So why are horses teeth so important? “If you haven’t got a mouth, you haven’t got a horse,” says Julien Welsh, breaker of Thoroughbreds for several Victorian high profile racehorse trainers. “We break between 200-300 horses per year and undertaking an initial dental check before I start mouthing is an automatic part of the process.

“The easy part of the breaking in process is getting on the horse’s back. The hard part is getting their mouth subtle and achieving a proper head set so they can proceed with their career.”

It’s a known fact that the pain and discomfort associated with poor dental care contributes to performance and behavioural issues like head tossing and bit resistance. A comfortable horse is a more focused, better behaved and higher performing horse.
Like human’s, horses have two sets of teeth through their life; however unlike in humans, horse’s teeth continually erupt through the gum at a rate of about 1/8th inch per year or as tooth surfaces wear. Teeth are formed at an early age. All adult horses have between 36 and 44 teeth: 12 incisors (front teeth) used to tear or grasp feed and 24 cheek teeth (12 molars and 12 premolars) used to finely grind food prior to swallowing. Canine and wolf teeth may also be present.
The design of the equine mouth facilitates efficient chewing. Their upper jaw is slightly wider than the lower jaw, permitting the desired circular grinding motion required to break down forage and grain. Their teeth are not flat, rather the surfaces are at about a 15-degree angle, which means domesticated horses can develop razor sharp points along the outer upper teeth and inner lower teeth. These points lacerate soft tissue such as the cheeks and the tongue resulting in painful ulcers. This appears not to be a problem in wild horses because of the roughage they consume.
In a young horse what is visible as tooth is only about 10 percent of the total tooth with the remainder known as reserve crown located below the gum line in the jaw. Horses have enough reserve crown to last into old age; however in order to maintain a functioning mouth, this system of the teeth erupting and being worn away must remain in balance otherwise problems quickly occur.
The importance of equine dental care It can’t be overstated. Early professional attention, even with foals, can significantly influence the course of a horse’s career. So what are the therapeutic options available?

Traditional Dentistry – Hand Tools

When a practitioner “floats” or smoothes a horse’s teeth they file away common wear irregularities to maintain an even chewing surface and to prevent minor dental problems from escalating into major defects. A hand float is a straight or angle shaft or handle attached to a carbide plate used for rasping teeth. Dental technicians also use a speculum or gag, which is a mechanical device used to hold the horse’s mouth open. Cap extraction forceps may be used to remove caps in young horses.
Most effort is put into removing the enamel overgrowths called points that develop on the outside upper cheek teeth and the inside lower cheek teeth.
By smoothing these sharp edges, which are formed from the normal action of chewing, they are prevented from becoming a source of pain when they rub against the horses cheek or tongue as it eats or as pressure is applied with a bit.

In young horses up to the age of five, whose teeth are softer and easier to rasp, hand floats may be all that is required.

Hand floats cost between $60.00 - $80.00 per horse and should be performed six monthly on young horses up to the age of five, and yearly from then on.

Whole of Mouth (WOM)– Powered Instruments

WOM is an advancement that will benefit all horses according to its proponents but traditional dentist Mark Burnell asks where is the science supporting its use?
Some documented evidence exists questioning the use of powered instruments but equally evidence exists in support of the value of WOM dentisty. What horse owners must keep in mind is that with all scientific studies and documentation, methodologies and statistical siginificance are important factors in determining the validity of such data.
WOM dentists use powered instruments that rotate or oscillate at speed doing the work of a rasp, achieving better results quicker, more efficiently with less stress and jarring to the horse.
A WOM dental consultation involves sedating the horse, putting on a gag, and washing out its mouth because food can be stuck between and on teeth. A head light is used to make a visual assessment, a dental mirror helps check periodontal tissue for infection or inflammation and a dental pick cleans between gaps in the teeth and is used in the exploration of tooth surfaces. Water may be used to help cool the power float and suction equipment to remove liquid in the mouth.
Provided the procedure is performed by an experienced and knowledgeable practitioner there is no pain experienced by the horse.
Opponents of powered instruments site three main issues associated with their use:

  1. Heat .

The build up of heat whilst working on a tooth with power tools equates to the amount of time spent on that tooth. Whilst not all power tools include water-cooling devices, they are available. By way of example a human dentist doesn’t use water on teeth under 140,000 RPM. Equine dentists are using variable speed foot controls that range from 0-15,000 RPM.

  1. The potential to file or cut away too much of the tooth, exposing the pulp cavity and ultimately killing the tooth.

  1. Sedation and the associated risks. If carried out by a veterinary surgeon the risks associated with sedation are minimised. Should a situation arise a vet can reverse the sedative effect or take the necessary measures to save a horse experiencing a reaction therefore it is essential that only veterinary surgeons administer sedatives.

Ian believes there are those in the industry who cherry pick information and use it in a very misleading way. “Take the heat debate. You will hear that heat kills teeth. If you read the entire heat study it says you have to power grind a tooth for two minutes to achieve the result that the tooth may die. To work on a tooth for two minutes would leave no tooth remaining. We work in managed time intervals with our equipment, on and off the teeth.”

The horses ability to eat normally immediately following a WOM treatment also appears to be a bone of contention amongst dentists with some saying it is quite normal, given the adjustments made to the mouth following treatment for eating patterns to be disrupted. Others say this is totally wrong and suggest that if the work has been performed properly by a competent and well trained equine dentist, a horse should be able to eat normally following a treatment.
The cost of power floats starts at around $145.00 (including sedation) when performed by a vet and can exceed $250.00 when performed by a dental technician who must use a vet to sedate the horse. They should be performed every six months on young horses up to five and yearly from then on.

To summarise, the main differences between the two methodologies are:

  • sedation,

  • equipment used,

  • level of skill and expertise required,

  • cost, and

  • the final result.

What do horse owners think?

Following a lifetime involvement with horses in a variety of disciplines and current Victorian Thoroughbred owner/trainer, Miranda Cox is convinced that a well maintained mouth is essential to a horse eating efficiently and maximising its performance under saddle. “ I have always used equine dentists who use hand tools because I have found this to be an effective way of achieving a well maintained mouth with the least intrusion to the horse both mentally and physically.

“I would not try WOM as I am not interested in switching to a method requiring sedation, more time and more expense than the method I currently use.”
Sharen Gotts, Victorian breaker and pre-trainer of Thoroughbreds and equestrian horses agrees. “I have personally felt radical improvement in certain horses following WOM treatment. Within a short period of time these horses were happy to drop their heads down into a nice connection. They were straight and responded to the right and left rein willingly”.
Sydney 2000 Olympic eventer and current equestrian eventer and coach, Amanda Howell says equine dental health is extremely important in maintaining the health and well being, and ultimately the performance of your horse. Whilst she still uses a traditional equine dentist, in the last two years she has started to use the WOM methodology more often, but only performed by a vet. “My vet and I discussed the pros and cons of both methods and I now believe that the use of power tools in combination with sedation performed by a vet who specializes in this form of dentistry is my preferred choice.”

Education is the key

Now more than ever horse owner education and improved communication is the key to better equine dental care.
Dr Alison Macintosh advises confused horse owners to educate themselves by attending dental procedures performed by as many practitioners as possible to gather an insight into each one’s knowledge and expertise. “Reading about it is useful but experiencing it firsthand means much more.”
Graham Jeffrey believes, as human beings, our resistance to change is what is holding horse owners back from embracing WOM dentistry. “Power floats are different and there are those that will never accept them and those who, over time will come to realise the very real benefits,” he says.
The bottom line is that an informed horse owner will benefit significantly in the hip pocket, but most importantly have a healthier and happier horse.

Future of equine dentistry

Ongoing training and education of equine dentists currently is available and must continue to keep pace with developments in the industry and changes in community expectations. Equally, equine dentists have a duty to keep pace with these developments and to ensure they perform at best practice standards at all times. Development of a national accreditation package for equine dentists designed to regulate the industry is desperately needed and is currently being pursued by the Australian chapter of the IAED.
Graham Farley says this is a vital step forward to legitimise the industry. It will mean is that horse owners can be confident they are using nationally accredited and recognised service providers who have undertaken a certain level of education and training to achieve their accreditation.
The industry needs to take a good hard look at itself and the image it projects. It should unite and in doing so the industry will have a more professional, stronger and credible voice as a lobby group and be capable of scaling heights and achieving results previously considered unattainable.
For further information visit:

Equine Dental Association of Australia Inc

College of Equine Dentistry Australia

International Association of Equine Dentists

Department of Primary Industries (for Draft Horse Welfare Code)

Advanced Equine Dentistry

1 Bureau of Animal Welfare, Draft Code of Practice for the Welfare of Horses, Revision Number 1, Sept 2008.

Equine Dentistry Story Hoofbeats final Helen Ward

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