March 20, 2007
EQUINE DENTISTRY: More Than Meets the Eye
by Jennifer Tipton, EqDT
American Equine Dental
I was almost blushing after listening to a new client's recent gushing on my voicemail:
"I just called to say thank you, Jennifer!...My horse is, like, ten times better...You were so good in handling him...You didn't leave his mouth open in the speculum for very long...Thank you! Again, I just want to thank you, Jennifer!" She actually said thank you several more times, and I have played the message to several acquaintances, smiling and kicking dirt every time, feeling bashful about it.
This particular seven -year-old horse is an upper level dressage horse that had been done by a reputable veterinarian whom I understand does quality dental work. The horse had been done only four months ago but had began fussing with his bit and was stiff on the left. (I appreciate the dressage riders for recognizing performance issues!).
I have performed over 2500 dental cases in the last four years, yet learned a valuable lesson on this day regarding the importance of a thorough examination in determining the need for equine dentistry. I'll tell you about it:
I drive to the farm, put the speculum onto the horse, open his mouth and feel around. My basic pre-evaluation that is more extensive then, say, sticking a finger in there and feeling the first premolar. Yes, that is still done. I don't think that there is any human with a finger long enough to reach into the side of a horse's mouth and feel the rear molars; the place where ulcers are most likely. There are three premolars and three molars, six in a row. That finger would have to be at least 10 inches long. So, if someone comes along and isn't even using a speculum to open the horse's mouth and get a good feel, well they are just lying to you if they say your horses is "okay".
Anyway, the horse is starting to get some sharp points , but no ulcers (similar to our canker sores that sting so badly). Honestly, I don't see anything offhand that would explain the issues the horse presents. I tell the client this and suggest that her gelding could wait another two months according to his six-month schedule, but she wants me to work on him today. She does not want any sharp points in her horse's mouth as show season is approaching.
I set up my work area; my vacuum, my cold sterilization, a bucket of fresh water, put my headrest together, pull out all my hand floats, my power hand pieces, electrical cords, head lamp, dental charts, etc.. We bring the horse into the station that I have created. I check the pressure points along the TMJ (tendo-mandibular joint) on either side. The horse jerks his head abruptly. I perform this a few more times to see if it is true TMJ pain. And, it appears so.
As the horse drifts into sedation I quietly lift his head into the stand, trying not to disrupt his state. I look at his front teeth, called the incisors, and lo and behold he has a two to three millimeter diagonal (the corners of the incisors on the left side or right side of the horse are longer than the other side); a clear indication of an imbalanced mouth. This might explain the stiffness on the left, I tell the client because the horse is actually having to compensate for this misalignment throughout his body. I did not see this during my pre-evaluation.
The chart drawn from the dental procedure done four months prior shows the client was charged for an incisor correction, but not the one I am now seeing. Of course, the greatest skill that a successful equine dentist can master is knowing how to do incisor work. It takes a trained eye that has seen many horse mouths. Just as a conformation judge needs to see many horses to truly understand that function follows form.
By this time I now have an audience. Although I have pre-stage jitters, I actually am a ham once all eyes are on me. However, everyone's attention is diverted to my sleepy friend's drooping lips while he rests in the head stand. They poke fun and laugh at him. It's really quite cruel, don't you think? It's like the one time in your life where you had a few too many and some wise-guy had to go and take pictures so that you could see what an idiot looks like. I spare the poor boy any more embarrassment and remove his head from the stand to put the speculum back on so that I can now open his mouth get a good lookey-see inside his gaping orifice with my blinding light.
It looks decent, but at a much closer look I see that the first premolars (that only teeth we can feel with our finger inside the cheek) are longer on one side that the other (I did not feel this during my pre-evaluation either...). It all makes sense to what I saw with the diagonal incisors. It also correlates with the stiffness to one side as the bit is contacting the mouth differently on either side. So, while the rider thinks that he/she is balanced in the hand, it might not translate that way inside the horse's mouth.
I float his molars with my power instruments and correct and balance the crown height of the first teeth where the bit makes contact. I remove the speculum and begin the address his incisors establishing a three-point balance; the TMJ, molars and incisors. I look along the inside of his cheek with my light and a retractor that allows me to see where his molar occlusion is. I now know what I have to work with on his incisors.
I change hand pieces and correct his incisors by removing about two millimeters from opposite corners. The diagonal is no longer there, and the molars are in complete occlusion. His mouth is balanced. Beautiful! I wish everybody could see and understand what I just did. I think I will go replay that message my client left.