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Equine Dentistry
Reality Demands A
Better Solution
By
Karen Brown, Staff Writer
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Equine Dentistry - Reality Demands A Better Solution
The legal battle by lay dentists for the right to continue practicing
their craft is working its way through the court system. The outcome of
this case is critical for horses because it will greatly affect the
field of dentistry in terms of the availability and quality of
practitioners.
Dr. Clay Stubbs, of Johnson City, TX is renowned throughout the United
States as one of the country’s foremost equine dentists. Clay Stubbs,
DVM, has devoted the past 18 years of his practice entirely to the
study and application of equine dentistry. As the Chairman of a Task
Force established by the Texas Veterinary Medical Association (TVMA)
created to develop guidelines for resolving the legal and ethical
issues pertaining to lay dentists, he has studied the issue
exhaustively.
Stubbs is one of the few people to study equine dentistry in depth. One
method of self- educating was to study the mouths of hundreds of
cadavers. Another was to re-examine horses at short intervals
rather than on an annual basis. “I made a habit of going back into the
horse’s mouths at frequent intervals after floating to see what changes
were occurring. When you track the changes every 2-3 months, over the
course of a year you can find out how effective your initial work was
and how long a ‘float’ really lasts. This is something that very few
people have done. They float the teeth and then won’t see the horse
again for another a year. It’s a lot of trouble, it costs you a lot of
money, but education isn’t free,” says Stubbs.
In Texas, the practice of dentistry falls within the broad scope of
veterinary medicine. Historically, dentistry has been practiced by lay
persons and animal doctors since the first floating tools were created.
In recent years, with the ever-increasing use of power tools and the
absolute necessity of sedatives, the veterinary medical community has
begun to object to the practice of dentistry by non-vets.
The impending court decision will only determine if lay dentists can
legally continue working. It will not address any of the issues that
ultimately affect the safety and welfare of horses. “Dentistry has been
perceived as a very simple procedure that anybody can do. It’s not. It
should be thought of as a series of complicated surgical procedures. If
it was thought of like that, most vets would think differently about
performing dentistry. It needs to be acknowledged as a specialty just
like surgery and treated as such by the American Association of Equine
Practitioners (AAEP) and the profession in general,” says Stubbs.
On the surface, eliminating lay dentists from the field of dentistry
appears to be a logical step in protecting horses. However, reality
demands a better solution. The Texas Horse Council reports there are
nearly 1 million horses in the state. The TVMA lists 133 members as
equine vets, yet only handful practice dentistry full-time. It is
physically impossible for veterinarians to meet the demand for equine
dentistry. There are simply not enough of them to perform all the work.
The odds of filling the demand through vet school graduates are nil.
Dr. Leon Scrutchfield, recently retired Professor from Texas A&M,
says few large animal vet students express the intention to focus on
dentistry as a full time occupation when they graduate. It is clear
that technicians will have to be used in order to fill the demand for
comprehensive dentistry.
According to Stubbs, there are 3 main issues pertaining to protecting
the health and safety of the horses. These are: 1) accountability, 2)
medications, and 3) initial and continuous education. Whether the
practitioner is lay or vet, there should be equal and quantitative
requirements in each of these areas. “Competency is a must,” Stubbs
emphasizes.
As to accountability, he says, “Veterinarians are licensed, so we know
who they are. Lay dentists are completely unregulated at this time. We
shouldn’t try to put the good dentists out of business; but we do need
to make them accountable in terms of verifiable knowledge, fiscal
responsibility to the owner, and for the health and safety of the
horse. Part of the problem is that horse owners don’t have a way to
know who is competent and who is not.”
“Dentistry has reached such a level of specialization that it is time
to regard it as a separate field, just like internal medicine, surgery,
or reproduction,” says Stubbs. “Every equine dentist, whether lay or
vet, should meet minimum standards based on up to date comprehensive
dental practice.” A certification process would provide testing with
minimum passing scores on theory and practical exams and a means of
keeping track of every dental technician. Continuing education could be
required as a means to keep these technicians updated on new
developments.
 The
hottest issue in this battle is the administration of prescription
drugs. Without a means to educate technicians in pharmacology, Stubbs
proposes a workable solution, “Dental technicians, who have been
extensively trained in comprehensive dentistry, should be certified to
work in conjunction with a vet. The vet will be responsible for the
administration of drugs and assessing the overall health of the horse.
The dental work would be the responsibility of the technician under
reasonable supervision of a knowledgeable veterinarian.”
He continues, “You can also leave the drug issue between the owner and
the vet. If the vet feels comfortable with a particular owner’s ability
to use drugs safely, then the owner could be given the responsibility
for the use of the drugs. We now have intramuscular sedatives that are
just as effective as intravenous, and they don’t have to be given in
the vein.”
Inter-carotid injections are one of the biggest dangers in
administering drugs intravenously. It’s easy to miss the jugular vein
and inject into the carotid accidentally because the carotid artery
lies just beneath the jugular vein. With an intramuscular injection,
that danger is eliminated. The risk of adverse reactions to the IM
sedative is extremely small. It does take a little longer for the drug
to take affect.
“By allowing the vet to work with his clients he would have knowledge
and control over the situation. The owner can take responsibility for
his own horses and what is being given to them, and the dentist can do
work he is specially trained to do. It’s not an ideal situation but it
is a workable solution for the time being while better guidelines are
put in place,” explains Stubbs. There would need to be a
veterinarian/client/patient relationship with record keeping
requirements to prevent diversions or misuse of the drugs.
Continuing education is another issue, particularly in the case of vets
who may have graduated from school before power tools were in use or
before the latest procedures were developed. Most lay schools have been
in operation for less than 10 years, so those students should have been
exposed to some of the more recent developments.
Stubbs talks about one of the major changes in dentistry, “Power tools
have become very popular in the last few years. But several of these
power tools still don’t allow the dentist to do a good job, especially
in the back of the horse’s mouth. The tool can’t be positioned
correctly to grind the surfaces sufficiently to last more than a few
weeks or months. The goal of a floating procedure is to grind enough in
the right places to ensure that no sharp edges or points will reform
within a year’s time. If the dentist can achieve that, which is
possible only with the appropriate tools, then the owner or trainer can
expect the horse to perform without any pain or resistances due to
issues coming from the mouth.”
The teeth can cause many behavior problems, but current application of
dentistry doesn’t address the myriad of problems the teeth can cause in
behavior. Stubbs continues, “The problem with hand tools is that you
can’t remove enough enamel to get a long lasting effect. Points
are a function of wear, as the tooth wears away the points reform. The
most critical part of the mouth is the very back and it’s the hardest
to do. Dentistry is about pain management. We need to fix all the bites
and do all the proper things we can, but the main thing we do is
eliminate mouth pain.”
Stubbs talks about dentistry before the advent of power tools, “Back
when everybody had hand tools we didn’t do a lot of good, but we didn’t
do much harm. With the use of power tools, we now have the capability
to really do some damage. That is an inherent problem which is why we
need regulation for anybody performing dentistry.”
Stubbs believes a group of well-educated dentists need to come together
to develop criteria for teaching and applying correct dental
procedures. He states, “There needs to be a method of recordation about
what procedures work and what doesn’t. We need the AAEP to allocate
some funds to research dentistry problems and procedures for prevention
and repair. The teeth affect the overall health of the horse and also
can be a great source of pain which in turn affects performance.”
“There are not enough vets to do this work; we’ve got to work out a
situation where technicians can be used. This is only going to get
worse, not better. The more people get educated on comprehensive
dentistry, the greater the demand for quality dentists, but the supply
is going down. It’s going to have to become a field of its own. It may
take many years, but we need some way to protect the public and the
horses in the interim. In the long run, dentistry needs to be developed
as a separate field of medicine just like with humans,” he concludes.
Stubbs sums up, “The veterinarians and the lay dentists have to find a
way to work together. No good can come from fighting with one another.”
Anyone interested in commenting on solutions to the dental dilemma may
send comments to solitaireranch@indian-creek.net
or call 830-796-4764.
Dr. R. Clay Stubbs
2928 Flat Creek Rd.
Johnson City, TX. 78636
Phone: (830) 868-7544
Fax: (830) 868-9368
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