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Equine Dentistry- An Open Letter To The Oklahoma State Senate

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Please vote against the "equine dentist" bill that has just passed the house (3202).

I am a veterinarian (Cornell 1984) who has incorporated equine dentistry into his practice since graduating plus the year before in vet school.  Since 1998 I have limited my practice to exclusively equine dentistry.  My totals then are 27 years of performing equine dentistry with an estimated 43,000 floats to my name (36,000 documented, the rest estimated in the early years including the year in vet school).

Due to client confidentiality I can not list current clients, however, I have floated all types of horses from miniature to draft and crossed all disciplines.  From back yard geriatric to Olympic to the Thoroughbred horse of the year and Kentucky Derby winners.  I have also served on the New York State Equine Practice Committee in the late 1990's where this issue of lay dentistry was thoroughly discussed.  Because of this experience I would like to address the flaws in your legislation.

There are two key important issues.  First is that there is no accredited equine dentistry school and there is no clear agreement as to what constitutes an adequate equine dental procedure.  Without accreditation and independent oversight, how can a lay dentist be adequately and effectively trained?  Second is that there is no clear veterinary/client/patient relationship when giving a legend drug by a non veterinarian.  This relationship is a basic and fundamental principle of the American Veterinary Medical Association as well as a federal regulation of the Food and Drug Administration.  In other words, for a vet to sell a bottle of legend medication to a lay dentist for that person to administer at will to his clients is a clear violation of law.

Equine dentistry is really an art form that has been neglected in the veterinary schools.  It was only through my mentor that I learned it in my third year and practiced it during the summer before my forth year at a veterinary clinic.  There were no schools of equine dentistry then.  In the late 1980's a school was formed by a non veterinarian and since then many schools have evolved owned by veterinarians and non veterinarians.  From this there developed an association which "grants" degrees that are applied to the member's name.  Through their certification program members can rise in the ranks to become "masters" at what they do. However, there is no outside oversight by anyone who is there to protect the public from fraud as there is with licensing boards in each state.  No one is verifying that what they are teaching is safe or harmful to the horse.

From a scientific stand point, using any and all standards as to what good science is, there is no substantiation for what these schools are teaching.  Theories grow like weeds in the equine dentistry community with little to no substantiation for their proof.  As you may know, all theories are just thoughts that are then tested against facts until proven.  To date, there is no effort to prove these theories accurately.  Only the facts are twisted to fit the unproven theories.  Thus, the theories promoted now in equine dentistry are only ideas made up without proof. Further, because most of these theories are benign, through eloquent people they become dogma and accepted as truth.  

Until theories can be accurately and scientifically proved, there is only evidence based medicine to justify techniques and goals in equine dentistry.  With 27 years and 43,000 floats, my evidence appears to fly in the face of these new methods that are heralded as the "only way" to float teeth.

In my practice I statistically use drugs on approximately 1 in 10 horses (360 uses in 3400 horses over the last 12 months).  This includes all extractions and procedures that are not routine floats. The rest are effectively floated using horsemanship skills.  Size and strength of the dentist does not matter, only their ability to handle a horse.  This has been going on for centuries yet the old picture of the horse with wild eyes and a twitch applied to the nose has become seared in our memory.  This graphic along with drugs overcoming the lack of horsemanship has allowed both vet and non vet equine dentists to promote the use of drugs in every horse they touch.  The reasoning used is that a more complete and accurate job can be performed.  This is pure nonsense and it is proven daily in my practice.

So what is the "correct" use of drugs?  Simply for the removal of pain and on occasion for overcoming anxiety.  In my practice the threshold of pain of the horse is the limiting factor.  If the sores from the sharp points are too much pain for the horse to stand still, then a combination of a sedative plus a potent narcotic is used.  The narcotic is a controlled substance which is absolutely not allowed to be dispensed to lay dentist for use in any horse.  On rare occasions some horses are fearful and require an additional drug which then allows the horse to relax enough for the sedative and narcotic to become effective.  This anxiolytic drug is also a controlled drug.

To summarize the drug use in my practice, I use two controlled substances and one non controlled substance for the relief of pain in the horse and not for the convenience of the one doing the work.  Drugs are unnecessary for 9 out of 10 routine floatings and when drugs are required, the use of controlled substances are effective in the elimination of pain.

Finally, I would like to mention that certifying equine dentists was tried in the United Kingdom in 2003.  By 2005 it was considered a "total failure" (personal communication with the British Equine Veterinary Association - the equivalent to our American Association of Equine Practitioners).  Enforcement is the key to control and frankly, no one is willing to enforce the laws.  In Florida in 2008 horse owners were allowed to hire lay dentists as long as they did no extractions and used no drugs ( http://www.leg.state.fl.us/STATUTES/index.cfm?App_mode=Display_Statute&Search_String=&URL=Ch0474/SEC203.HTM&Title=-%3E2009-%3ECh0474-%3ESection%20203#0474.203 ).  Any lay dentist using power tools was doing so against the laws of the state.  Yet today lay dentist are using power tools without fear of any enforcement in Florida.

This concludes my brief discussion on traditional versus modern equine dentistry.  More information as well as pictures and videos can be found on my web site ( http://www.theequinepractice.com ).

If it were asked of me, lay dentists should be allowed to work under the guidance of a veterinary practice where the veterinarian has a vested interest in the result.  Horse owners should be allowed to use non controlled drugs as long as the vet is aware (the vet has prescribed it for that horse) and the owner administers it taking full responsibility for any reactions.  Preferably, the horse would be rescheduled for the vet to administer the appropriate medication.