Dr. Sarah Metcalf, DVM

Dr. Sarah Metcalf, DVM

~ Equine Dentistry ~

A BRIEF BIOGRAPHY: Sarah Metcalf, DVM

My special interest in "performance horse dentistry" began about ten years ago, and has become my major area of interest. I am involved in expanding my dentistry practice, and am traveling outside my regular practice area to do this work.

While all horses benefit from good dental care, riders of performance horses are especially likely to notice a positive difference when their horses mouths are pain-free and well-balanced. In addition, horses that work hard, endurance horses for example, often lose weight during the competition season. Dental care can help increase feed efficiency enormously. The use of motorized instrumentation allows precise dental work to be done more easily, more quickly and more comfortably for the horse.

I graduated from vet school at WSU in 1982, putting myself through school working as a farrier. As a student, I had the job of shoeing lame horses for the WSU vet clinic. I have continued to teach a one-week short course for veterinary students every year, called "Farriery for Veterinarians.

I have been involved with endurance riding as a veterinarian, a ride manager and a rider since 1982, usually vetting at least three or four rides each season in the Northwest Region. In addition, I have traveled to the Southwest to be part of the veterinary team for the Outlaw Trail (a 5-day , 260 mile ride) and the AERC Championship Ride.

How can I tell if my horse's teeth need floating?

Myself, I can't tell without a thorough look in the mouth with a speculum. Put me out in a field of a hundred horses and tell me their life stories, and I still will not be able to tell you, without looking in their mouths, which one will have the worst problem.

If we wait until horses show us overt symptoms of pain and dysfunction (weight loss, abnormal chew, dropping grain, poor attitude, poor performance) very often we are WAY behind in terms of correcting the problem, sometimes too far to do more than mitigate the results of years of neglect.

How is it that some horses can stay fat, appear to be cheerful and even perform work competently....and still have dental problems?

1. Based on thousands of examinations, I find that sharp enamel points causing oral ulcerations are extremely common, even in horses with no outward clinical signs.

Some horses continue to eat with enthusiasm even with oral lesions that would certainly be painful if they were in our mouths. These horses have a strong commitment to eating (it does mean survival, after all). This doesn't mean that the lesions are not painful; these horses are eating in SPITE of discomfort.

A somewhat skeptical person who acted as my assistant last spring became convinced that even fat horses can benefit from dental care when she saw how many overweight horses had obvious sores in their mouths caused by sharp points that hurt OUR fingers when we felt them. Her conclusion about fat horses: "Dietary mis-management (overfeeding) is not an excuse for dental neglect!"

(At the other end of the spectrum, not all horses have this level of commitment. Some will stop eating efficiently, and demonstrate abnormal chewing, and/or weight loss, with even minor lesions.

One horse in my practice,("The Princess"), begins to decline to eat, and to throw her hay around, when she develops the most minor points. The first time this happened, the owner brought
me a video of the horse's behavior at feeding time. It was so weird that I thought it was a neurological problem and I was certain that I would have to refer the case to a specialist. However, it resolved within 3 days following dental care. This scenario has repeated itself four times now, at 9-18 month intervals. Give this horse few more neural circuits and she can just use WORDS to tell her owner that she would like a dental tune-up.)

2. Malocclusions (waves, hooks, ramps, etc.) are also very common, and again, some horses will be….for a while…. fat, happy and competent in spite of having malocclusions. These horses have "forgiving" metabolisms (like me: we can stay plump on the pine cone and snowball diet); tolerant dispositions/strong work ethics (unlike me: I'd be real cranky and go on strike).

Even in these tolerant horses, the problems will come home to roost as the horse enters
its teens and early twenties. FINALLY the horse begins to lose weight, gets an exam, and a serious situation is found. This can be very frustrating and sad! Many times the horse is still sound and usable; sometimes it is a beloved child's horse or long-time "family member". These serious malocclusions and prematurely expiring teeth don't just suddenly pop up; they have been gradually developing ever since the permanent teeth came in to wear at 3-5 years of age….. all those years that the horse was "asymptomatic". Whereas we could have easily corrected or prevented them early on and delayed the premature loss of teeth and masticatory function for many more years...now it may be too late to do more than mitigate the damage.

The problem is, it's so hard to see their teeth. It becomes…"out-of-sight, out-of-mind"

So imagine: what if there were transparent windows along the sides of my horse's cheeks? Now, when I go down to feed, I notice that sharp points on the back upper molars are starting to dig into the cheeks. Every day, that hook on the back lower molar is still there, in fact, it's bigger than it was a while ago. I am reminded that fat cheerful old Bucky has had a missing an upper molar since birth, and that the corresponding lower molar is getting too long again. Well, I am pretty busy, and I will maybe let this stuff slide for a little while. But it becomes harder to ignore as time passes; and I DEFINITELY won't put old Bucky to work without taking care of it.

Is my horse's dentist is doing a good job?

A currently hot political topic among veterinary licensing boards is the question "should non-veterinarians (i.e. technicians) be allowed to practice equine dentistry or not?"

The following is excerpted from an Oregon Board of Veterinary Licensing newsletter: "those opposed to the practice of equine dentistry by non-veterinarians contend that such practitioners are inadequately trained, skilled or supervised, and are causing serious damage to horses."

(Just for fun) Let's turn this around, and ask if veterinarians might not also be "inadequately trained, skilled, or supervised"; and might sometimes be guilty of actually causing serious damage rather than helping, or might be doing work that is inadequate.

The possession of a DVM, power tools, and tranquilizers does not instantly imbue a person with training and skill. This is especially true given that comprehensive equine dentistry is not being taught at every vet school. When this is the case, new veterinary graduates qualify as "inadequately trained". Old veterinary graduates, such as myself, are also inadequately trained unless we have specifically sought further education and experience at...where??...hmmm....a few schools that also teach non-veterinarians, a few intensive short courses with a very low teacher-student ratio in which actual animals are worked on, continuing education courses (the labs of which are great if one is already experienced but entirely inadequate if one is not....personal opinion/experience), or privately mentorship.

Perhaps it is thought that comprehensive equine dental care can be figured out by any person with a basic general veterinary education. For myself, I found that not to be true. Perhaps other people are better self-teachers, but I really needed the hands-on, one-to-one, intensive mentoring by an experienced individual in order to begin…….practicing. This work not only involves principles and concepts that can be confusing (indeed, that continue to be debated), it involves considerable physical skill that can only be developed through enthusiastically applied practice.

So what is the horse owner to do? Since the result of the work is not sitting out in the bright sunlight to be examined and commented on by every passerby, (as is the case with your horse's shoeing job, for example), the horse owner is pretty helpless unless armed with some information and education.

Here are my suggestions:

Certification
Now, that's an idea! Wouldn't it be grand if veterinarians and technicians could take an un-biased test, and emerge with a piece of paper stating that they have been examined and deemed to be competent by peer-review? Then horse owners could seek out a practitioner who has been certified in equine dentistry. Sorry, you'll have to wait a bit for that. Currently, the IAED (International Association of Equine Dentists) does offer a testing and certification program. However, this organization consists of only 25% vets; the rest of the membership are non-veterinarians. Because there is so much turmoil in the AAEP (American Association of Equine Practitioners) Dentistry Committee and state licensing boards about whether an appropriate role for technicians exists and if so, what it should be, the IAED is far from universally accepted as a "good" thing by the veterinary community. Unfortunately, the veterinary community does not have an equivalent certification/testing program of it's own to offer.

Training
Ask whether the vet or tech has had special training. This could be awkward! (It can also be an awkward question to have to answer, if you are on the receiving end!) But you ought to do it. Recently l received the following query from an Alberta rider: "I was just wondering if you could tell me what you charge for dentistry work - for example all costs associated with a basic float. Also if you don't mind me asking, do you have specific training related to equine dentistry? I'm asking, because vets from the vet college up here get very little education in terms of dentistry and must take additional training elsewhere." (italics mine) Good for her for asking!

Attitude
Choose a practitioner who is enthusiastic, and who has the time to get out and set up all that STUFF we seem to now require. It's not a quick little job anymore.

Instrumentation
*1. Use of a full-mouth speculum is required. It is impossible to do a thorough examination without one. Never let anyone check the outside upper first molars with a finger and tell you that "the horse is fine, it doesn't need anything."
2. Sedation, head support for the horse, and good light source are the next important considerations. I can't imagine doing without them, although non-veterinary technicians kept the basic skills of comprehensive dental care alive for decades……without sedation……..until the veterinary profession caught up.
3. Motorized instrumentation. Again, same thing. Technically possible to do with hand tools; much quicker and easier on both human and horse using power tools.

Communication
1. Ideally, clients are given a basic run-down on what to expect during the procedure, especially if they are new to it.
2. Before putting the horse in the speculum, lateral excursion, rostro-caudal excursion and molar occlusion are evaluated. In non-technical language, this essentially evaluates the ranges of motion in the jaw, and the ability to chew effectively. Additionally, the incisors are examined for abnormalities of occlusion and other pathology.
2. When the sedated horse is in the speculum, the owner is given the opportunity to look at the teeth. The pathology is almost always right there to be seen; it is not difficult to explain briefly to people what is wrong, what is going to be done to address the problems, and why that will help. It should make sense to you. It isn't mysterious!
3. Before closing the mouth, all teeth are palpated by hand to check for remaining sharp or rough places and the client is encouraged to look at the results: a chance to compare "before" and "after".
4. After closing the mouth, the incisors are re-evaluated, as is molar occlusion, and any incisor work necessary is done.

Note: Sometimes these things are done in a different order. But all of these issues should be addressed.

Note: if either an owner, or a practitioner, find all this "communication" to be tedious and time-consuming, keep in mind that the vet/dentist really only has to explain the basic principles on the first visit; and once the owner has confidence in the dentist they often do not have the need or desire to see every little detail. But they should be given the chance! After all, it is the one time each year that they get to take a look in their horse's mouth.

Written records
I am a firm believer in the value of a written record. A dental chart is kept for each horse; it is explained to the owner, who is given a copy. From the practitioner's perspective, accumulation of annual charts on individual animals is a fabulous learning tool. It allows us to track the effectiveness of our techniques, as well as monitor the ongoing well-being of the animal.

2009 FEE SCHEDULE

Cash
or
Personal ~ Business
Checks
Accepted

All horses are given a complete oral examination. At that time, the owner is shown everything that is going on in the horse's mouth, I explain what the horse needs, and give a cost estimate.

FEE SCHEDULE

Minimum dentistry cost: $125
Details:
Sedation/exam....$35
Floating/balancing....$90
This includes:
Bit seat/Reduction of Canines
Analgesics/Reversal

Average dentistry cost: $155-195
May include:
Wolf tooth extraction....$20 each
Blind wolf tooth extraction……$40
Waves, hooks, ramps.... $15-45 (each)
Incisor reduction/realignment.....$30-50
Retained caps (deciduous teeth)....$10-30
Additional sedation.....$20/35/42
Extraction of loose/infected teeth....variable depending on difficulty
Other medications (antibiotics, etc.)…. variable

The travel fee is usually $17/horse, outside of my local practice area.

Sheath cleaning……..$22

Severe malocclusions
Incisor reductions
Extractions
Periodontal disease treatment can bring total cost to: $250-300
(Estimates can be given after the exam)

Remember, many of the extra initial costs in dentistry care involve correcting problems that have taken years to develop; once these problems are corrected, subsequent annual maintenance is simpler and less costly.

Prevention is less expensive than treatment! And it keeps the horse comfortable….

THE STORY OF "HANK"...an 11 yr. Curly Stallion

Hi Pam,

Thank you for having us up.....your horses are great patients and I had a really good time with them.

Treeva's horse Hank...have you seen him? Very cute! 11 year old stallion. Black, sweet, and absolutely Rastafarian. Even the hair inside his ears is tightly curled. His mane and forelock look as if they have had one of those very expensive permanents, and his whole body coat is a short Afro.

He has a history of having been kicked in the jaw by a mare as a two-year old; and since then has intermittently dribbled food, and been a hard-keeper, requiring supplementation. Recently however, he seems to be eating normally and maintaining weight on just grass hay. A veterinarian at the boarding stable had told her that that Hank was "OK" and "didn't need to be floated".

I wasn't sure if she wanted me to just examine him, or actually work on him. When we got there, I was tired enough that I almost hoped we'd get away without setting everything up and going back to work, and be able instead to head down the road towards bed.

A brief exam without sedation showed normal incisors, moderately sharp points on upper first premolars; looking into mouth with tongue held aside revealed the usual deep dark cave, blurred by motion, and obscured with gloppy food material. I gave Treeva the choice: while nothing looked too bad on a cursory exam, we really couldn't tell for sure if the teeth in the back 2/3 of his mouth were OK.

She chose to have a complete exam done.......good choice!

The horse had a very long wedge-shaped step at the junction of the upper 8-9's (the cheek teeth are numbered 6 to 11 in each arcade). This step was so sharp on the lateral side that it created ulcers on his cheeks the size of quarters. It also had wedged apart his lower 8-9's so that a diastema extending down to the gum was created. Worst of all, his lower 11 had a very sharp hook that was literally an inch tall. It was digging a hole into his soft palate. I have never seen anything quite like it.

So...upon seeing THIS...all those nice neurotransmitters that temporarily defeat fatigue kicked in; Lynn and I forgot about going home in the near future, rolled up our sleeves, and went back to work.

The good happy thing is that all problems were fixed in the end; Hank is no longer in pain, and he is young enough for all this to be corrected and then maintained. I plan to re-examine him in 6 months. I believe that the lower molars that had been wedged apart will move back into place now that the cause of the problem is gone.

The horrible thing is that he had endured this for so long...and what if no one had ever looked? This haunts me. I am so grateful to Treeva for choosing not to just let it slide.

Lesson of story for me:

ALWAYS do COMPLETE exam of ENTIRE mouth, UNDER SEDATION...before even remotely telling the owner that "things are probably OK".

So thanks to you and your ponies...from Hank and me....for getting us up there and facilitating the connection.

PS. He tolerated the work with an amazingly small amount of drugs, and need only one bump-up dose.

PPS. Hank's dental problems were bilateral and had nothing to do with the history of having been kicked in the jaw when he was a 2 year old.

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Equine Dental Clinic
(November 7-10, 2009)