Word of mouth based on a strong reputation is most important, and that requires a commitment to continuing education and the best tools for optimal treatment.
The Right Way
A thorough oral examination requires sedation, a full-mouth speculum, rinsing feed from the mouth, a headstand or head support, a good light source, a dental mirror, a dental periodontal depth probe and a dental explorer, according to Dr. Limone, of Northeast Equine Veterinary Dental Services LLC, Topsfield, Mass. Without the proper tools and education, she added, “we really are missing a lot of pathology that is very treatable and very manageable.” Dr. Limone recommended starting by asking the client about the horse’s history and eating habits, and then breaking the examination down into five parts: external oral exam; occlusion (orthodontic considerations); oral soft tissue exam; endodontic status; and periodontal status. The external examination entails looking for any external signs indicating oral or dental problems. This can include bony or soft tissue swelling, draining tracts, possible fractures and nostril odor or discharge. When evaluating the occlusion of the incisors, Dr. Limone recommended looking with the horse’s head aimed downward. “If you extend the head and neck out straight,” she said, “everybody is going to look like they have an overjet.” If malocclusion is found, it is important to determine whether it is skeletal or dental before deciding how to treat it.
A Practical Oral Examination • General physical exam and history—watch them eat • Sedate horse, rinse mouth, set up headstand, put on headlight • External exam • Swellings, symmetry, nasal odor/discharge, wounds • Examine incisors and canines • Occlusion, soft tissue, periodontal, endodontic • Place speculum—examine oral cavity • Occlusion, soft tissue—overall view of the mouth • Examine each arcade—100, 200, 300, 400 - Count teeth, use mirror to examine occlusal surface of each tooth - Periodontal status—mirror and periodontal probe - Endodontic status—mirror and pulp explorer • Chart findings—take photos, or record endoscopy • Treatment plan—or additional diagnostic plan (radiographs) • Follow-up recommendations, plan for recheck examinations Source: Slides from Leah Limone, DVM, during “Developing Dentistry as a Core Client Service” at the American Association of Equine Practitioners (AAEP) Annual Convention 2017
For the soft tissue portion of the examination, Dr. Limone said to consider that clients often understand floating more than anything. “What the owners tend to appreciate the most is just looking for buccal mucosal ulcers and abrasions, secondary to sharp enamel points,” she said. The endodontic portion of the examination involves looking at pulp horns and infundibulae of each tooth and evaluating fractures, which can cause apical disease. Dr. Limone recommended using a dental explorer. “You really need a mirror or endoscopy unit to be able to see these things,” she said. “These are things that you’re going to miss if you’re just trying to feel.” Prior to evaluation of the horse’s periodontal status, feed should be rinsed from the mouth.
If feed still can be seen in certain areas after that, Dr. Limone explained, a probe or picks should be used to clean out those spaces for closer examination. Gingival recession, gingival hyperplasia, draining tracts and subgingival swelling are all symptoms that warrant a radiograph, she said. If an oral examination or a subsequent radiograph reveals problems, then treatment is an opportunity to both boost business and improve the patient’s health. Even if it is necessary to refer to another veterinarian for the procedure, the client likely will appreciate it. Whether problems are found or not, oral examinations should be a staple for every veterinarian, both veterinarians agreed. “A dental record is absolutely the best thing that you can leave a client that will stimulate more dental work for you,” Dr. Easley said. MeV
For more information: Dixon PM, Tremaine WH, Pickles K, et al. Equine dental disease Part 4: a long-term study of 400 cases: apical infections of cheek teeth. Equine Vet. J. 2000;32(3):182-194. http://www.vetequine.theclinics.com/article/S0749-0739(13)00026-6/abstract ModernEquineVet.com | Issue 1/2018
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