Today’s more practical and portable direct and computed radiography units top the must-have lists of equine dentists. “If you’re in the field and you see something else, or need to change an angle or get a different shot,” says K. Jack Easley, DVM, MS, “you can take retakes right then, rather than having to make a return trip to the farm.” Dr. Easley, Dipl. ABVP (Equine), has a special interest in equine dentistry. He is the owner of Equine Veterinary Practice LLC in Shelbyville, Ky., and is also on the American Association of Equine Practitioners’ Dentistry Committee. Easley considers the technological advances in X-ray equipment over the past 10 years some of the greatest improvements to diagnosing and treating equine dental disease. He says the high quality of today’s radiographic images adds to this greater basic understanding. “Technology has put 80-90 kV portable units in the field,” he says. “Veterinarians have become even more efficient–we are finding more dental disease earlier, including under the gum, rather than waiting until problems become much worse. “In the past five years,” Easley says, “advances in equipment technology have allowed researchers to look at horse’s teeth and heads even closer, helping us to learn to diagnose all kinds of dental disease.” If it seems that there are more equine dental problems today, he says, it is because more radiographs are being taken. “Disease pathology is more frequent than we thought,” Easley says. “Horses are often suffering from dental disease longer than we think because we couldn’t see it.” Horses that are head-shakers, have problems eating or just generally have bad attitudes are turning out to have dental disease long before clinical signs are visible, he says. “Ten, even five years ago, we didn’t have the knowledge about equine dental disease,” Easley says. “Today, if a horse has an abnormality or unexplained behavior, we take an X-ray. And we can diagnose and treat the problem efficiently and effectively.” Radiographs pick up swelling or diseased and damaged teeth before, say, an abscess erupts. They are also used for comparisons and preventive care. “With dental disease, we are finding that when the right side has a problem, the left side is involved too,” Easley says. Radiographs are helping veterinarians uncover developmental problems that are often not visible until swelling, rupture or illness occurs. Much more research into equine dentistry has been conducted overseas, in England and Sweden, for example, Easley says, than in the United States. “We are lagging behind,” he says, “though in the last couple of years, we have become more thorough in our oral dentistry procedures.” Better combinations of sedatives and tranquilizers have helped make examinations and treatment of horses easier. He also notes that new improvments in dental speculums and dental mirrors designed specifically for equine dentistry let practitioners see inside the mouth better. Oral endoscopes and fluoroscopes give today’s veterinarians a better view than using just a headlamp to look into the mouth. Last year’s breakthrough equipment was 3D imaging for CT, Easley says. As technology improves, he notes, prices should come down, making the equipment more accessible to more practices, which is what he sees with MRI machines–more accessible and less expensive. Robert M. Baratt, DVM, MS, FAVD, also sees the importance of today’s radiographic advancements. Dr. Baratt founded the Salem Valley Equine Clinic in Salem, Conn., which has since expanded to include companion animals as Salem Valley Veterinary Clinic. He was the first veterinarian to obtain a fellowship in the Academy of Veteterinary Dentistry in both small animal and equine dentistry. “Portable digital radiography has greatly improved the veterinarian’s ability to routinely obtain diagnostic images of the horse’s head,” Baratt says. “CT may be indicated for the assessment of complicated facial fractures, tumors of the jaws and sinuses, and evaluation of the temperomandibular joint.” Baratt says other areas of research have bettered practitioners’ understanding of periodontal disease and the relationship between tooth fracture and apical disease. “With our ability to perform better oral exams and take high quality radiographs,” he says, “we are recognizing more cheek tooth fractures and apical disease of cheek teeth.” He says that motorized equipment to treat cheek tooth malocclusions has greatly improved the ability to perform adjustments by sight—visual dentistry—rather than by feel. “In combination with high quality surgical headlamps,” Baratt says, “procedures that were previously laborious to perform, and often not done well, are now performed with ease.” Case in point: many practitioners are using power floating equipment over hand rasps and files. The Flexi-Float is Baratt’s everyday go-to tool. The motorized equine dental float uses water irrigation and vacuum suction. Lightweight, portable and durable, it is practical for a mobile equine practice. Though the last 10 years have brought a lot of research, Easley says we are just scratching the surface of discovery in equine dentistry. “Horses’ teeth are so much different than humans’ or cats’ and dogs’,” he says, “so not as much research can be shared. We are still far behind in our knowledge about equine teeth compared with what we know about human teeth. “We are just now gaining the understanding of the developmental, nutritional and metabolic problems that can affect the horse’s mouth and teeth,” Easley continues. “Radiographs have shown, for instance, that as as young horses mature and their permanent teeth come in, if they don’t fill in right, a change in nutrition has often occurred. Or weanlings may have a metabolic bone problem when the film shows calcified tissues, which reflect an abnormal mineral balance.” As discovery and understanding continue to grow, equine practitioners seem to be eager to increase their knowledge of dentistry. Veterinary schools and professional organizations are adding classes and courses to their curriculum and continuing education programs. Easley and Baratt were scheduled presenters, along with six other veterinarians, at the American Association of Equine Practitioners’ meeting, “Basic Dentistry: Seeing Dentistry in a New Light,” in College Station, Texas, Aug. 7-10, 2012. Easley would like to see next the development of a portable oral endoscope that can be taken into the field. “Most of them now are fairly cumbersome and suited best for use in clinics,” he says. “Though the quality of portable oral cameras is improving. I’d like to get a good scope I can use in the field on a daily basis.” “Presently, we depend on the use of a large dental mirror to examine the horse’s oral cavity,” says Baratt. “The intraoral camera would greatly improve our oral examinations and ability to demonstrate pathology to the horse owners. Oral endoscopes that are presently available are too expensive for general use; pricing in the $200 to $500 range would make this technology feasible for all.” Easley’s dream tool is the standing CT scanner, which was developed and is in use today in Europe. The scanner allows the examination of the head of the standing conscious horse. Easley also would like to see improvement in endodontics and restoration. “Some new techniques have been tried, but nothing has proven to be long-lasting,” he says. He hopes that research discoveries continue and lead to better extraction and salvage techniques, as well. He notes that there has been some grafting of synthetic glass, coral and cow bones but no definite solution to many endodontic and restoration challenges yet. Want more Veterinary Practice News? Go here. <HOME>
