Horsemen, Surgeons And Equine Dentistry

Horsemen, surgeons and equine dentistry have a major flaw that was made evident at the AAEP in San Antonio, Texas in 2017. The flaw isn’t easy to explain and has taken me decades to understand.

This year Dr Jack Easley (treasurer of the AAEP, author of several text books on equine dentistry and world wide lecturer on equine dentistry) invited Dr Paddy Dixon (director of surgery at the Royal (Dick) College of Veterinary Medicine, prolific researcher and publisher of equine dentistry research, and world lecturer) to be the guest feature speaker from Edinburgh Scotland. His 2 ½ hour lecture was titled “The Evolution if Horses and the Evolution of Equine Dentistry.”

During the first half of the lecture Dr Dixon not only did a splendid job describing the development of the horse over the past 55 million years but he also presented relative new information on the identification of the microbes within the gut of the horse. Called the microbiome, microbiota and holobiome, these words are becoming the catch phrases among health professionals and equine gut health products. I was delighted, as many of you know I would be, because of my previous blogs on grain, protein and lectins and their effects on horses health via their gut microbes.

The rest of Dr Dixon’s lecture were case presentations of mouth disasters.  He peppered the talk three times with disrespecting words about  non-veterinary equine dentists, one of which brought cheers and applause from the large audience of veterinarians. Later that day Dr Dixon presented to a very small group of us interested in asking questions which he and Dr Easley answered for almost 2 hours. It was at this small meeting where I discovered the flaw that is dividing veterinary medicine and all horsemen.

Dr Easley is an excellent presenter of good information who has decades of experience. His cases are detailed and are compelling to listen to and if I were a person with a personality of a surgeon, I would be hooked. But I am not a surgeon or even a scientist at heart.  I am a horseman who is more of an artist than a scientist.  Back in the Renaissance period Leonardo da Vinci blended art and science and without question is considered one of the greatest thinkers of all time.   When questioned about the gut microbiome, Dr Dixon said, “Hold on. I’m a surgeon. I only just read that stuff and as a surgeon, I don’t really understand it.” That’s when the flaw became glaring to me.

Sagittal palatal fracture of #106. Before removal.

The Divisions

Veterinary medicine has divisions we all know about: medicine, surgery, anesthesiology, neonatology, theriogenology, immunology, epidemiology, and others. The medicine and surgery departments are compartmentalized and it is a standing joke in veterinary and human medicine that these two parts (medicine and surgery) are not only totally different, but the people in those departments are fundamentally different. Surgeons are usually brilliant in intelligence and have great connections between their brains and the words coming out of their mouths as well as dexterity in their hands. They are very organized and detailed as they need to be to cut into a body without cutting a vital part. However, surgeons also do things by the book because they are there to “fix” something. In fact unless your neighbor is a surgeon who invites you to a bar-b-q, you probably will never meet a surgeon unless you need their services. In other words, if you are broken, you will need the services of a surgeon. And surgeons are great technicians like very smart car service technicians. They are troubleshooters and problem solvers.

Horsemen are not troubleshooters or service technicians. They are relationship builders which is an art form (most surgeons are poor relationship builders).  Horsemen are only interested in what is in the horse’s best interest. Unfortunately surgeons have hijacked this expression (“In the best interest of the horse”) and in their mind, they believe that fixing things that are wrong IS in the best interest of the horse. In other words, horsemen are talking about the whole horse and surgeons are talking about a single problem.

The flaw goes deeper than just dentistry. Most lecturers and college instructors are fixers of problems and do very well in teaching or lecturing on how to fix things. For example, most vets draw blood to look for a problem. Diagnosis of a problem is essential for their existence such as Cushing’s disease, gastric ulcers, lameness or colic. However few of these health care professionals are interested in finding the root cause to prevent these from occurring in the first place. If they did, they would be out of a job.

Researchers are looking for answers but they are dependent on funding and there is no funding for equine dentistry. A few have done retrospective studies or limited studies but none have been conclusive in a way that has determined the root purpose for routine dentistry in horses. This void has left the surgeons in charge of the development of dentistry in horses practiced today. This includes standards of surgery that include immobilization, adequate visualization, and specific instrumentation. Their view of the horse is one with a problem and they are going to fix it using acceptable surgical procedures.  Horsemen only want to relieve the pain in the horse's mouth which exists even when there is no visualized problem.

The movement of the tongue has worn the upper outside incisors of this horse.

Who Is Leading?

Where does this leave horsemen with horses not having a problem but with a specific need for routine maintenance? In all of the discussions in all of the lectures and in all of the articles I have read on dentistry in horses, no one is mentioning the threshold of pain, the importance of the tongue or the skills of approaching a horse without drugs. Is immobilization and visualization really important in routine dentistry? Furthermore, are the issues found in the mouth such as exposed pulp, apical root abscesses, peripheral carries, diastema (space between 2 teeth), enamel fissures and other findings really affecting the horse (pain, tooth loss, general health demise)? While surgical and medical intervention seems to be effective, where are the studies that also look at the progression of these problems in the overall health of the horse?  There are none but we are lead to believe that if we don't "fix the problem" seen in a vizualization of the teeth that the horse will lead a life of misery or worse.

Equine health care in general and specifically in dental care has been limited by the views of the people teaching it. They believe that through them, care for horses is coming out of the dark ages. Maybe so, but they are only using a spot light and the need to flood the stage with light is desperate. But like most people, surgeons believe that they are right and everyone else is either wrong or stupid. The arrogance of bullying non-vets from a stage without their input is not the type of people I want to associate with (unless they are willing to apologize). We can learn from everyone and it is the reason I attend these meetings and listen to everything about dentistry. It is also why I blog and teach directly to horsemen. While I may never be recognized by my profession as a valuable source of experience in equine dentistry, I do know who I am and my mission in life. I was left out of the box when they built it so I always think outside of the box (See my autobiography “Since The Days Of The Romans - my journeys of discovering a life with horses”).