Thursday, April 6, 2017

6th April, 2017 Pulp Fiction, Pulp Fact

Last night went to a talk by World Renowned and Pet Plan Vet of the Year, Chris Pearce, and his new colleague Nicole du Toit, who has more letters after her name than the alphabet. Chris's practice is based locally, and is the first clinic to specialise in Equine Dentistry. The receive referrals from other vets and Equine Dental Technicians, and also attend many other veterinary hospitals and faculties to carry out complex dental work. Their aim is to carry out dentistry to a human standard and this starts with diagnostic techniques which include the use of an oroscope, x-rays, CT scanning and MRI as well as careful examination using sedation, a speculum, a tiny mirror, and a probe.

Supernumary tooth - easily missed without a proper examination
The only way of checking a horse's teeth is under detailed examination since horses are extremely good at hiding pain and will simply chew with the other side of their teeth if they are in trouble, and the only clue might be a shear mouth where the two arcades of teeth are unevenly worn. The signs of problems in the mouth may be invisible to the owner or so subtle or gradual that they go unnoticed.

To me there is no virtue in a dentist or dental technician who under the pretext of being kinder to the horse, claims to be able to do their work properly without a sedation, or even a gag.

Nicole explained that horse dentistry stagnated and receded after 1920 when the need for working horses diminished. At that time, a man called Becker, has already developed many of the tools and techniques for equine dentistry including water cooled power tools. It has only been since the 1970's that dentistry for horses has picked up again and at last moved forward.

Chris demonstrated that horse dentistry now goes way beyond just removing the sharp edges of horses teeth and now includes many of the techniques used in human dentistry including the ability to fill horses teeth, prevent further deterioration, and take away a horse's pain.

The teeth of the horse, they explained, differ greatly from those of a human for two keys reasons:
  • Hypsodont - the horse's teeth continue to erupt throughout their lives until there is no more left;
  • All three dental tissues are exposed exclusally - dentine, enamel and cementum - which make ridges with enable the horse to grind their food
Hypsodont - only the section above the green line is visible in the mouth
Horses have 36 to 44 teeth in total depending on whether they develop canine and wolf teeth which are more prevalent in males. Horses wear their teeth down more quickly than ponies, one of the reasons they tend to die younger.

The shape of the teeth which don't match up top and bottom, often causes the outer edges to be sharp in the top teeth (causing ulcers which can be exacerbated by nosebands of bridles and headcollars) and the inner edges to be sharp on the bottom teeth.

Evidence shows that horses over the age of fifteen began to develop serious gum disease and periodontal disease which go beyond just having sharp teeth. Chris talked about hooks, steps, ramps, periodontal pockets (where food can be trapped), fractures which could have been foreseen and forestalled if the underlying cause had been addressed at the time, EOTRH, and supernumary teeth.

Like all vets, Chris delighted in showing us some really gory photos involving large quantities of pus and even blood, but the outcome for these horses was always positive, and to see how well they recovered was very reassuring. He did at least have the good grace to forewarn us of particularly 'nasty' pictures but no one was really looking through their fingers - it was fascinating. All of the procedures are now carried out under standing sedation or anaesthesia, making it far easier for the horse and the vet. Even horses that had all of their incisors removed to alleviate the extreme pain of Equine Orthodontic Tooth Reabsorption and Hypercementosis (a phrase I came to know well with Théoden) were completely healed and happily eating grass within six weeks.

It was clear that through Chris, and other teeth geeks, huge advances have been made in horse dentistry from diagnosis through to treatment and prognosis.

These teeth had the pulp exposed - they were repaired

To see more of Chris's amazing work go to his Facebook page: The Equine Dental Clinic