TACKBOX: DENTISTRY

ON MY TACKBOX

The download on equine dentistry

How do you know if you’re getting value from your equine dental service provider? DR OLIVER LIYOU, from EVDS in Grafton, runs his professional eye over what’s involved.

Value for money is one of the key parts of choosing any product or service, and this article is done to help you, the horse owner or trainer, decide whether you are getting value or not from your service provider.

Let’s break down every step of what is involved in having your horse’s ‘teeth done’ by a professional person.

1 • They turn up to do your horse, and they inform you if they’re running late etc. This is part of any professional service, and the cost to any business of running a schedule requires significant time and investment, so let’s give this $10 value. Total so far = $10.

2 • They have clean, well-organised, modern equipment that will allow them to do the job properly (PIC 1). The equipment will allow them to show you what is going on in your horse’s mouth. Failure to have good quality and clean equipment may result in them spreading viruses and bacteria between horses, and could also result in injury to your horse, you or the dentist.

Investment in good equipment is an essential part of the science of equine dentistry, so this value could vary from $2 – $50/horse – depending on the number of horses they do and the level of equipment they will use for the range of conditions they encounter. So let’s give this an average of $10 value. Total so far = $20.

3 • They examine the horse holistically for you prior to looking at the teeth. This could involve them asking how the horse has been going, has it had any problems, do you have any queries that need specifically investigating. It could even involve a brief clinical examination if the practitioner is also a veterinarian, perhaps looking at the eyes, nose, skin, listening to the heart and lungs, assessing hydration and more if desired. Maybe they check out a problem with the horse that has been worrying you for a while. Obviously there is a large range in skill and qualification levels here, ranging from no examination before putting the gag on (zero value), to a proper clinical examination by a skilled and University Degree qualified equine veterinarian (value of $99). So on average, let’s give this an average of $30. Total so far = $50. 4 • They sedate the horse so that they can thoroughly and safely examine ALL of the teeth and mouth structures (gums, cheeks, palate & tongue). With sedation, the horse will be less stressed about it, have little or no memory of any painful experience encountered during the procedure, and most importantly will co-operate with a thorough examination process. Most mouth pathologies are painful, and need to be addressed to investigate them and treat them, so pain is an inevitable part of dentistry in humans and horses. Allowing the patient to experience and remember the painful experience is the choice of the owner/trainer, so choose wisely!

5 • Remember that it is a criminal act for a non-vet to be providing and sedating your horse, and if you choose to ignore this law, any adverse effects or accidents/injuries incurred in this illegal dental service will not be covered by insurance, and veterinary treatment (essential in an insurance and public liability claim) may not be available. The value of a qualified, insured and licensed veterinarian sedating and doing nerve blocks if necessary to your horse, so all of the mouth can be properly examined, demonstrated and treatments offered is in the range of $30-90, so let’s give it an average of $40. wwwTotal so far = $90.

6 • Some veterinarians use mobile crushes, and some of these have scales on them. Accurate weighing of your horse carries various benefits, including allowing for accurate deworming, monitoring and comparing weights from year to year, monitoring growth of young stock etc. Maybe a height stick is available as well.

Value of horse being weighed on digital scales – $5-15, so let’s average it at $10. Total so far = $100.

7 • The mouth is properly examined through both feeling and looking, after the dentist has flushed the mouth out with clean water. Some problems like sharp teeth are best detected by feel. But others, like a diseased and discoloured tooth, or an exposed pulp/nerve chamber, cannot be felt by fingers, so the horse’s head must be very still, and a bright light and angled mirrors should be placed right to the back of the mouth, so that every surface of every tooth can be examined (PIC 2). If a problem

Pic 1: Clean, well organised equipment.

Pic 2: All aspects of the mouth need to be examined and palpated. Here the probe is showing an open pulp or nerve chamber, which could be painful and possibly cause root infection.

is sighted, it may be necessary to use very sharp pulp explorers or periodontal pocket probes to further investigate the problem. This problem should be shown to owners to help educate them so they can understand the magnitude of the problem and best decide which treatment option to go for.

Value of a thorough oral exam – using a full mouth speculum, a well washed-out mouth, a sedated head that stays still and not tossing and moving about, use of a very bright light, mirrors, probes. Range of $20-80, so let’s give an average of $30. Total so far = $130.

8 • Odontoplasty is performed, so that the sharp points are filed back, and bevelled in order that they will not return for 6-12 months, and any elongations (hooks, waves, ramps, excessive ridges) are addressed. Knowing how much to take off is essential for both not harming the horse, (by taking too much off), and ensuring that the sharpness doesn’t return too soon (by not taking enough off). Being able to remove all of the sharp points, and not just those on the teeth in the front half of the mouth is essential for the comfort of the horse.

9 • Evaluating and safely modifying the height and angles of the teeth to bring them closer to a normal mouth is another essential skill in proper equine dentistry. It must be remembered that horses teeth are living organs, have nerves, and so if too much tooth is removed, it can be very painful, which can eventually lead to painful tooth root infections etc. When reducing a tall tooth (e.g. hook, ramp, waves etc), it is very important that your dentist files some tooth, then rinses with water, then examines the tooth surface again, so they can see how close they are getting to the nerve (PIC 3). To reduce a tall tooth blindly, with no looking or intermittent cooling with water, is not only lazy, but is also dangerous to the tooth and the horse.

Value of odontoplasty – varies from $10 if done poorly (sharp points left untreated) to $150 if done very well in a bad mouth. So for an average value say $50. Total so far = $180.

10 • Assessment of the soft tissue of the mouth including gum lines, cheeks, tongue and palate. These can only be done if the horse is sedated and bright lights, mirror and probes are used. Gum disease is very common in horses and causes short-term pain and long-term premature loss of teeth. Rigid endoscopes are now being used by some veterinarians in more complex cases, to help visualise and demonstrate the dental and soft tissue problems to the owner, and also to be able to ask opinions from other equine dental vet experts around the world. Value of assessment of soft tissue, including endoscopic exam – range of $11-144, so an average of $20. Total so far is $200.

11 • Sometimes x-rays will be needed to further investigate a problem, as is common in human dentistry. If your vet has their x-ray machine ready to go, you can save additional call out fees and extra travel fees by simply having this service whilst the dental must be worth, on average over all of your horses at least $10? Total so far = $210.

12 • Your service provider gives you a tax invoice, which means they will be paying income tax from their earnings, so contributing to the ambulance, hospital equipment, staff, medication etc needed to save your life when you or your family and friends next need medical attention. Without a tax invoice, you can assume they are using all of what you pay them to help finance their next holiday or home improvements etc. Value of income tax ranges from 20-45 %, so let’s give it an average value here of $20. Total so far = $230.

13 • Your service provider has shown you the mouth BEFORE and AFTER the work they have done, so that you, as a responsible owner, can understand what your horse is going through, pain and functionality wise in their mouth (PIC 4). It is also proof that your service provider is trustworthy and transparent. Value of this 3-5 mins of showing and explaining to you range of $3-30 – average of $10. Total so far = $240.

14 • If your horse is a gelding, it gets its sheath and penis cleaned and checked for beans and tumours (PIC 5). It is difficult to do this without sedation, and some vets will do it as a complimentary service with a dental. To have it done separately, it would cost between $25-50, so let’s give it a value here, across all horses of $20 per horse. Total so far = $260.

15 • You receive a dental chart for your own records, and as a statement to your

Pic 3: When filing down a tall tooth, it is important to intermittently stop, flush the surface and examine to see how close you are getting to the nerve. As your dentist files down a tall tooth they need to be watching the colour of the dentine (as illustrated by arrows) to avoid exposing the nerve.

Pic 4: By inviting you to look and feel inside your horse’s mouth, before and after the work is done, you will understand better what dentistry means to your horse.

Pic 5: Sheath clean is an additional benefit of having your horse sedated for a dental.

friends and potential purchasers of your horse in the future that you are a good caring owner, prepared to invest in the long and short term health of your horse. Value of a dental chart – range $2-20 – average of $10. Total so far = $270.

Your service provider will send you a reminder via mail or email or text, that your horse’s teeth are due to be checked again. Value of reminders – $5. Total so far = $275.

16 • Your service provider is registered for GST, which goes towards improving the national economy, building of new roads, schools, hospitals etc, and is approximately 10 % of each service, so you can add on $27 here. Total so far = $302.

17 • Are they insured with public liability and professional indemnity in the case of injury/accident/death to your horse, yourself or them whilst working on your property? Average range of value – depending on what type of insurance, how much work they do etc $2-20 – average of $10. Total so far = $312.

18 • Travel to your horse. In order to save you the time to float your horse to them, they have invested in a vehicle, continue to register and maintain it, paid for fuel, and have given up their time to drive to you. What does that cost them in time and money, and what does it save you? Be honest now! If it is not an acceptable travel fee for you, ask if you can float your horse to their property or somewhere to meet them, e.g. at another property where they are already working so you can share the costs of travels, setting up, cleaning up after etc.

On the right is a table to help you decide if your equine dental service provider is giving you value for money.

PROCEDURE: AVERAGE

VALUE OF VALUE Y N DEAL SO FAR?

1. Easy to make an appointment and they show up when $10 they say they will or let you know if running late.

2. Clean, well maintained, modern equipment. $10

3. Holistic clinical examination of the horse prior to looking at the teeth, and opportunity for you to ask questions about dental and non dental issues etc. $30

4. Legal use of sedation and nerve blocks (must be a vet) $40 with a range of sedatives available to be able to tailor the anaesthetic to the health of your horse and type of dental work to be done.

5. Weighing of your horse on digital scales +/- height stick. $10

6. Thorough examination of all structures of the mouth, $30 using water flush, bright light, mirror, probes. Feeling AND looking for problems.

7. Proper and safe filing of ALL sharp points, especially $50 right up the back of the mouth, and safely correcting overgrown teeth etc if necessary. Safe reduction of tall teeth required periodic flushing of the filed surface, and then looking at that surface, using light and mirror to check how close you are getting to the nerve.

8. Proper looking and using probes to assess the health $20 and diseases of the gums, tongue, palate and cheeks. Possibly using a scope as well.

9. Having X-ray machine on hand in case x-rays are needed $10

10. They give you a proper tax invoice as proof that they $20 pay their taxes to contribute to your medicare hospital and doctor costs.

11. They show you and maybe invite you to feel inside $10 the mouth before AND after the work being done, so you become more educated.

12. Sheath/penis clean done on geldings and stallions $20 after each dental.

13. They give you a dental chart for each horse. $10

14.They send you a reminder for when your horse is $5 due again.

15. They are registered for GST which goes towards improving your public services. $25

16. They will readily email you a copy of their public liability and professional indemnity insurance policy to ensure both you, your horse and they are covered in case of any accident/injury or death on your property. $10

17.They will travel to your horse, using the vehicle they As decided bought and maintained, the fuel they used, the time by your they gave up to come to you, and the time it saved you Equine having to float your horse to their business place. dentist

TOTAL VALUE OF YOUR HORSE’S DENTAL FROM YOUR SERVICE PROVIDER: $ 312

(plus travel)