The primary aim of equine dentistry is to maximise comfort and function of the horse while eating and when bitted.

This paper includes guidelines for materials and equipment, oral evaluation and cleaning, client communication and ongoing patient care.  The guidelines are the minimum standards expected from practitioners of equine dentistry.

This document is believed to be current at the time of writing with regard to acceptable practice in Australia.

The purpose of this document is to provide guidelines to ‘practitioners’* performing dental examinations and treatment procedures in the equine.
 
By this, we are referring to the necessary steps in performing an initial oral assessment, an assessment under sedation and/or general anaesthesia of any oral pathology present, the recording of findings and the development of a treatment plan; followed by the appropriate treatment/s of these findings.
Finally, the formulation of guidelines for appropriate husbandry and follow-up management.

This document does not attempt to include more advanced treatments, which may include oral surgery, complex periodontal therapy, endodontics, orthodontics or other dental/oral disciplines.

Practitioners are encouraged to be able to recognise whether their dental equipment and skill level allows them to fully treat the oral pathology present or whether referral to an appropriately trained and equipped practitioner is required.
 
*The term ‘practitioner’ refers to any person wishing to provide such a service.

Definitions

• Dentistry – the evaluation, diagnosis, prevention or treatment of abnormalities and pathology of the oral cavity, maxillofacial area and/or associated structures; non-surgical, surgical or related procedures may be included.
  
  
• Dental record – a completed dental chart filled in indicating periodontal indices, any oral pathology present and procedures planned and/or performed at the time of examination.

• Dental ‘floating’ (a term synonymous with the terms: filing, rasping) – a procedure including oral assessment for the purposes of diagnosis and formulation of a treatment plan under appropriate and humane chemical or non-chemical restraint, the removal of inappropriate dental spurs and any subsequent advice and/or follow-ups.

• Gingivitis – the reversible inflammation of the gingiva without the loss of the supporting structures that may or may not be visible to the eye.

• Periodontitis – the irreversible destructive process involving the loss of the tooth’s supporting structures (the periodontium) which include the gingiva, periodontal ligament, cementum and the alveolar bone.

• Periodontal pocket – a pathological space between supporting structures and the tooth, extending apically from the normal site of the gingival epithelial attachment.

• Periodontal therapy – the treatment of chronic gingivitis and periodontitis.  Depending on the degree of periodontitis, this may require multiple examinations, treatments and disciplines.  Therapy may include periodontal surgery.

• Periodontal surgery – the surgical treatment of periodontal disease.

• Oral surgery – the surgical invasion and manipulation of hard and soft tissues to improve/restore oral health, function and comfort.

Equipment, instruments and maintenance.

1. Facility.

The working area should involve the provision of an appropriate facility with adequate patient, handler and operator protection.  

2. Hand instruments

The minimum set of equipment and instruments required for dental examination and treatment includes:

• Full mouth speculum
• Flush syringe and bucket
• Light
• Mirror and Dental Probe
• Various rasps including straight and curved heads with tungsten carbide floats
• Wolf-tooth extraction instruments
• Forceps appropriate for removal of caps or loose teeth
• Appropriate sedatives and head support system
• Dental charts  

Dental power equipment

To competently, adequately and rapidly perform some dental treatments, power equipment may be used with the proviso that operators follow all of the manufacturer’s directions on use and the operator is skilled in the use of the equipment. 

Power equipment should be maintained in good working order on a regular basis including cleaning and lubricating of handpieces after each use according to the manufacturer’s instructions.

It is recommended that horses are sedated for procedures involving the use of power equipment under most circumstances for the safety of the horse and operator.

Oral examination, diagnosis and treatment planning

A full patient history is part of any oral examination.  A preliminary physical examination of all body systems is to be conducted.  The extent of this initial examination will depend on the temperament of the animal with a subsequent full oral examination performed under sedation or general anaesthesia if necessary.

Considerations to be included here will be the temperament of the animal and the commitment of the owner as these will influence the treatment plan.

Complete oral examination may not be possible in the unsedated animal. A complete oral examination may require the taking of extra or intraoral radiographs.

All findings should be recorded on a dental chart which then becomes part of the animal’s medical record.

Based on the findings of these examinations, diagnoses will be made.

Consideration of the diagnoses, patient issues such as co-operation, value and prognosis, and the owner’s commitment, will permit the development of an appropriate treatment plan.

Operator and assistant protocols

• To perform an initial oral examination on the animal and if necessary to complete a thorough oral examination under appropriate sedation and/or general anaesthesia.
• To formulate an appropriate treatment plan.
• To oversee the recording of all findings and give written or verbal instructions to the appropriate persons re the implementation of the treatment plan.
• To formulate a management plan and to liaise with the client re the implementation of any such advice.
• Recommend to the client that the animal be referred to an appropriately trained veterinarian when the practitioner does not have the training and knowledge, skills, equipment or facilities to perform a given procedure or treatment.

Procedures

All dental procedures performed must have a sound foundation in science.

Sedation of horses for dentistry must be performed by a veterinarian, and procedures requiring sedation, including dental procedures using power instruments, must be performed by a veterinarian or under direct veterinary supervision.

Client communication is fundamental to ongoing (oral) care.  At the time of examination or treatment, the operative procedures and existing or potential complications (e.g. bleeding, coughing, dehiscence, infection, neurological signs, diarrhoea, anorexia and/or signs of pain) should be discussed. 

Discuss immediate postoperative care including medications and their side effects.  Provide antibiotics and medication for inflammation and pain only as indicated.  Discuss any change in management and/or diet regime that might be necessary.  Provide individualized oral and/or written instructions at the time of examination. 

Establish any appointments for follow-up examinations and further discussion.

Diagnostic assessment of horse teeth

• A brief clinical examination of the horse shall be undertaken prior to undertaking any dental procedure or administration of sedation.
• A thorough oral and dental examination on every horse is paramount to early detection of problems so they can be treated before they become irreversible.
• All findings and abnormalities should be recorded using dental charts. Where possible, abnormalities should be demonstrated and explained to the owner.
• Examine incisors including lateral excursion test, assessment of angles, occlusion tests, rostro-caudal movement and abnormalities of the teeth. Canine teeth need to be checked if present.
• Examine cheek teeth using full mouth speculum, light and mirror
• Perform diagnostic tests when indicated including radiography, ultrasound, biopsies and blood tests etc.  If unable to perform these tests, the horse should be referred to an experienced veterinarian who has the capabilities to perform them adequately.

 Undertake high levels of hygiene

• Clean equipment and disinfected after each procedure
• Wash horses mouths before, during and after each dental examination
• Maintain a professional and clean appearance

 Dental procedures shall be safe for horses and their handlers

• Equine dentistry requires a competent level of horsemanship
• When painful procedures are to be performed ensure horses have appropriate analgesia and sedation. 
• Owners or horse handlers should be advised as to risks associated with the use of heavy (full-mouth) speculums. Measures must be taken to minimise these risks to the horse, owner and vet.

 Maintain a high degree of competency and professionalism

• A thorough examination of the soft tissue structures of the mouth shall be performed prior to any procedure. Special consideration should be given to the gums and any pockets or trapping of food needs to be addressed.
• Routine teeth filing for normal mouths will involve removing the sharp enamel points on the buccal surface of the upper arcade and lingual surface of the lower arcade. The other areas of the dental arcades will also be checked for sharp points that may cause discomfort.
• Assessment of the mouth for symmetry, balance, function and occlusion should be performed. Depending on the age of the horse, the correction of any abnormalities should be discussed with the owner and undertaken if possible. Correction may take more than 1 visit to the horse.
• Geriatric horses with lack of reserve crown need special consideration when attempting correction of abnormalities.
• 1st upper or lower premolars (wolf-teeth) will be extracted when considered necessary
• Horses with retained deciduous teeth (caps) will be removed when they are loose, retained or impacted.
• Tetanus vaccination status needs to be considered if tooth extraction or any laceration of gums is noted.
• Riding horses should have their lower and upper 1st cheek teeth rasped so that they are carefully and specifically contoured to maximise comfort with the bit.
• Cases requiring extraction of diseased teeth and endodontic treatment shall be referred when the examining practitioner has not had training to undertake such procedures

Husbandry / preventive plans

Effective animal husbandry, including appropriate nutrition, is vital for the prevention and control of oral disease.

The assessment of the amount of disease present, the owner’s compliance and facility and the co-operation of the animal to husbandry are imperative in the formulation of any ‘homecare’ plans.

These plans may need to be reassessed at follow-up evaluation visits.

This document has been developed on behalf of the Australian Veterinary Dental Society; with the intention that it is accepted as a guideline for use by veterinarians and laypersons in practice and by their controlling bodies.