by Drs. Stephen Galloway and Lynn Caldwell
(excerpted and printed by permission)
It is fair to say that many people within the horse industry, as well as within the veterinary profession, are confused about the current standards of equine dental care and who the proper providers of this care should be. Many horse owners and veterinarians perceive that equine dentistry is nothing more than benignly rasping the points off of a horse’s teeth and that the practice of equine dentistry falls below the professional practice of veterinary medicine.
However, equine dentistry is not, and never has been, synonymous with floating teeth. Dental practice includes the evaluation, diagnosis, prevention and treatment of diseases, disorders and conditions of the oral cavity, maxillofacial area and the adjacent and associated structures as well as the evaluation of the contribution of oral conditions to the overall health of the individual patient. Dental practice is provided by a veterinarian, within the scope of his or her education, training and experience, in accordance with the ethics of the profession and applicable law.
Oral conditions can be the cause of systemic disease such as bacterial endocarditis caused by periodontal disease as well as an indicator of systemic disease such as renal failure or hyperparathyroidism. To practice within the current standard of veterinary care, sedation is required for thorough examination of the oral cavity. Additionally, the diagnostic evaluation of orofacial tissues necessitates the use of imaging modalities, such as radiography or computed tomography. Most dental procedures, including basic tooth floating, are irreversible with potentially significant iatrogenic consequences.
Based on veterinary research and the application of dental science, dental practice has advanced significantly over the past decade. We now know that many aggressive dental practices performed during the past half century such as severe “bit seating” and “performance floating,” are either unnecessary or detrimental. The treatment of many dental conditions requires the management of pain, inflammation and infection, and possibly the treatment of concurrent systemic disease. Veterinary training is a prerequisite to the practice of equine dentistry within the current standard of veterinary care, and the practice of equine dentistry by autonomous non-veterinarian dental care providers (NVDCPs) jeopardizes the health and welfare of horses.
The risks of non-veterinary dental care providers
While a few states allow limited dental services to be provided by the employees of veterinarians or by licensed tooth-floaters, autonomous, unlicensed NVDCPs are providing equine dental services ranging from floating sharp enamel points to major dental surgery throughout North America. Most NVDCPs begin their practice with good intentions, ignorant of veterinary practice regulation; however, except for a handful of individuals in certain states, all are fraudulently practicing veterinary medicine without a license and none have the veterinary training or resources to properly diagnose and treat dental conditions. These NVDCPs claim certifications and professional titles, such as “Certified Equine Dentist” or “Equine Dental Technician,” based on completion of non-AVMA sanctioned “dental schools,” which include the Academy of Equine Dentistry, the American School of Equine Dentistry and the Texas Institute of Equine Dentistry or membership in non-professional associations such as the National Association of Equine Dentistry (NAED) and the International Association of Equine Dentistry (IAED). Through aggressive marketing, NVDCPs have created the public perception of professional competency and have convinced numerous equine health care decision-makers, including some veterinarians, that NVDCPs provide superior dental services as compared to licensed veterinarians.
While NVDCPs advertise their superior health care services to the public, their political and legal challenges attempting to exempt equine dentistry from veterinary practice are based on the NVDCP’s “right to work” and allegations that the veterinary profession is trying to create a monopoly. These arguments are based on economics and not health care. If NVDCPs desired a legitimate health care solution to this issue, they would seek a position within the veterinary profession. Legal testimony given by NVDCPs clearly establishes that they admit to breaking state laws, that they have no desire to pursue professional education and the majority of NVDCPs do not have, nor do they desire to have, a professional relationship with veterinarians. Veterinarians who work with NVDCPs are encouraged to review the legalities and liabilities of this relationship. Testimony also establishes that the referral of equine patients by NVDCPs to a veterinarian is rare, even in cases where veterinary care is clearly indicated. While NVDCPs claim to be providing a vital health care service to the horse industry, their lack of professional oversight places horses at increased risk of undiagnosed or misdiagnosed dental and systemic conditions as well as inappropriate treatments.
Health care solution – Education
Ultimately, the only way to protect horses and to ensure that horses receive proper dental health care is through education. Since health care issues are complex, health care education takes time and veterinarians must be proactive and persistent about the delivery of this education. Veterinarians must educate everyone involved in making equine health care decisions or the practice of equine dentistry will continue to be systematically challenged in every state in North America. Included in the list of equine health care decision-makers are state legislators, state BVMEs, state VMAs, veterinarians, trainers and horse owners.
The practice of veterinary medicine is regulated at the state level. State legislators define the scope of veterinary practice for each state and therefore determine if equine dentistry is included within or exempt from the Veterinary Practice Act. Since state legislators ultimately decide who can legally practice veterinary dentistry, these representatives must be educated about the practice of dentistry before they are asked to make a legislative decision. Public officials should be reminded that the veterinary profession is the advocate for and the authority on animal health care and welfare issues, and appropriate proactive education could prevent an uneducated legislator from siding with a vocal minority to end a public dispute. These representatives are primarily concerned with public (human) health, safety and welfare and with the economic protection of animal industries. Discussions with this group of decision-makers should focus on the consequences of unregulated veterinary practice on voting constituents. Common practices by NVDCPs that threaten the safety and welfare of both humans and horses include the illegal use of sedatives and other prescription medications and having horse owners participate in dental procedures by giving injections, restraining the horse or assisting in dental extractions.