Artykuł: Wprowadzenie do stomatologii koni
Equine Power Dentistry I
Introduction, economic considerations and promotion of the equine dentistry service
By Ruedi Steiger DACVIM, Swissvet Veterinary Products
Until recently, equine dentistry was a part of equine medicine that had been vastly neglected by veterinarians. Many practitioners disliked the hard and poorly paid work and owners or trainers often did not request the service for their horses until obvious clinical signs urged them to do so. Non-veterinary lay dentists did most of the work with hand tools and often without the use of sedation.
With the introduction of compact motorized instruments such as the SWISSFLOAT about 10 years ago, the situation has changed entirely. Wet labs are offered, research is being conducted, dentistry books printed, papers published, and equine dentistry is a hot topic at almost every professional meeting. Forgotten for so long, equine dentistry is today an integral part of equine medicine.
Enhancing equine dentistry in a veterinary practice
The goal of this article is to describe
reasons explaining the need for equine dentistry today
how to promote equine dentistry in a large animal or equine practice.
In a natural environment horses do not receive dental treatments and they survive.
However, for horses in captivity the situation is quite different.
Cheek teeth are composed of multiple tissues with differing hardness (cementum, dentin and enamel) resulting in an irregular biting surface. Naturally horses should eat a course diet from the ground for most of the day. Under these conditions, their teeth show a balanced wear-attrition ratio and they rarely suffer from pathologies. However, if horses are bred and housed to satisfy human needs many factors change: horses eat a concentrated diet, do not have feed exposure all day long and they may receive hay from a rack high above the ground. In addition dental health is not a selection criterion for breeders, and a natural selection promoting dental health is absent.
Studies have shown that concentrated feed such as grain or grain mixtures result in higher crushing and less grinding action. Because of their higher energy concentration, the required calories are eaten more quickly and the normal wear of a horse’s teeth is impaired. If horses raise their head, their cheek teeth undergo a caudal-rostral motion. If horses eat off the ground their cheek teeth are not perfectly aligned resulting in fur-ther unphysiologic wear. All these factors explain why horses in captivity are more likely to have dental pathologies, and that horses greatly benefit from routine, system-atic, thorough examination and correction of dental abnormalities.
Floating is a term used in carpentry, describing the smoothening of a surface. In horse-men’s terms it is used to overall describe the grinding process in horse’s teeth, regard-less of how much or why teeth are rasped. In equine dentistry the terms are used more specifically: floating describes the reduction of sharp enamel points, while odontoplasty is used for the reduction of material on the occlusal or biting surface.
Floating = Reduction of sharp enamel points
Odontoplasty = Reduction of excessive tooth on the biting surface
Floating is aimed to prevent soft tissue damage by smoothening sharp points and will result in un-inhibited and physiological chewing action. Odontoplasty is aimed to achieve a balanced equilibration.
The end result should be a physiologically shaped occlusal surface with an even occlusion along the entire tooth row or arcade. The amount of odontoplasty needed is based on the careful evaluation of incisors and cheek teeth.
The goal of dental work in horses is to achieve physiologic eating behavior, to maintain a functional dentition and to prevent dental and soft tissue pathologies.
Goal of dentistry work in horses includes
achieving physiologic mastication
maintenance of functional dentition
prevention of dental and soft tissue pathologies.
Procedures that require more invasive techniques, such as endodontic treatment and extractions will not be discussed in these articles, since they require special equipment and knowledge, and are better done by specialized veterinarians in a hospital setting.
Medical indications for dentistry
Equine dentistry is performed either therapeutically when clinical signs are present, or preventatively in the form of routine dentistry. The clinical signs of dental disease in-clude difficulties eating, quidding, drooling, weight loss and riding problems. These signs will be discussed in detail in a future article. Routine dentistry, if done regularly, reduces the likelihood for unscheduled therapeutic interventions.
The advantages of performing routine dentistry are listed below. In addition to the pre-vention of dental disease it prolongs the lifespan of teeth; it optimizes a horse’s health and performance, increases the feed digestibility and reduces the incidence of gastro-intestinal complications such as colic and choke.
Regular dental work in horses:
decreases likelihood for serious pathologies
decreases likelihood for expensive procedures
prolongs dental lifespan
optimizes the horses health and performance
increases feed digestibility
decreases complications such as colic and choke
The advantages of routine dentistry must be discussed with the owner. Aside from the factors listed above, there are also financial benefits of routinely scheduled dental work. It may be emphasized how much a special diet costs for a horse with a severe dental condition and how quickly an extra visit outweighs the cost of routine work.
The recommended frequency of routine dentistry in horses depends on various factors such as age, breed and use of the horse. Horses that are competing on an advanced level may benefit from frequent visits up to every six months and so do older horses, while a younger pasture horse might be fine with a treatment every few years. Intervals of more than a year are not recommended, but often the reality, especially in financially less privileged areas and for ‘low-budget’ horses.
A more economical solution for these horses is a less expensive dental examination to make sure no severe pathology is present. An honest assessment will help to ensure owners compliance for routine examination.
Non-Medical indications for dentistry
Earning money in large animal practice is not always easy, and the working hours are generally very long. Equine dentistry is different. There is the potential to schedule a visit for multiple animals at the same farm. In addition, the visits can be scheduled for the most convenient time of the day or the year and the work can be optimized with additional helpers on the farm, pre-filled examination forms or an extra technician as-sisting the veterinarian.
The overhead operating cost for equine dentistry is relatively low. Once the equipment has been purchased there are only a few reoccurring expenses. The cost for sedation, pain medication, and replacement blades are very low compared to the earned reve-nue. In a well organized operation, it is not unreasonable to create several hundred dollars an hour, with very few expenses. This is a ratio that is unique to a large animal practice and many veterinarians realize that motorized equine dentistry is the best money maker in their practice.
Advantages of routine equine dentistry:
multiple animal visit
high gross income
low operating cost
A similar favorable income is not possible with hand instruments where the job is done at a much slower pace and for a lower charge, and where the case load is limited by the physical restriction of the veterinarian.
For some practitioners equine dentistry has even become a passion. They acquire special instruments, attend meetings and educational seminars and become special-ized in the area of equine dentistry. The advantage of being a specialist is the exposure to unique cases, either directly from clients that prefer to have their animals seen by an expert or via referrals from colleagues. Any unique case seen as a specialist is a nice change from the daily routine - which helps to increase the job satisfaction along with increased revenue.
Equine dentistry can also be a special area of interest for recent graduates. The special skills help them to find a niche in a new practice and they will be more easily accepted by their colleagues and their clientele.
How to promote equine dentistry in your practice
Especially today with a struggling economy, veterinarians are looking for additional income for their practice. Unfortunately this is also the time when it is harder than ever to be successful, because consumer spending is low and many preventative treat-ments are likely to be postponed. Under these circumstances it is important to have a good strategy to promote a specialty service.
Strategy for success in equine dentistry:
have the right equipment
Clients appreciate knowledge and dislike unprofessional work. Every year the AAEP and other veterinary association organize wet labs or meetings with special sessions
on equine dentistry. Even if it is an investment to attend a meeting, the special knowledge usually pays off.
Another option is to spend some time with an equine dentistry specialist, which has the additional advantage of providing a consulting partner for future dentistry cases.
Companies such as BUTLER AHS sell power instruments for equine dentistry. Their website or catalogue as well as their trained sales representatives can help find the right instruments for equine dentistry. While new instruments cost money to purchase, they provide a competitive advantage over colleagues in the same practice area.
Every horse is a potential patient and enthusiasm helps to attract new patients. Most clients appreciate a thorough exam with explanation as well as being shown the lesion in a horse’s mouth. This is a time consuming process, but one that reveals the knowledge and enthusiasm of the veterinarian.
It is crucial that clients know about a veterinarian’s special interest in equine dentistry. A veterinarian with special training and advanced power instruments should advertise that information with a foot note on the invoices.
The AAEP has educational material and these flyers can be displayed in the waiting area of the practice or sent out with each invoice. The special interest in equine dentis-try can be mentioned on a business card or on a phone recording while customers are on hold. Post cards reminding customers of yearly dentistry examinations will create business as well. There may be an opportunity to write an article for publications, or to give lectures or presentations for equine organizations.
Clients are very sensitive regarding financial expenses today and it is important to provide accurate financial estimates. While low charges are appreciated, it would be wrong to offer professional work for unreasonably low prices.
With the financial problems today, clients that prefer a cheap service likely have stopped dentistry for their horses already. However, an enthusiastic veterinarian that offers an excellent work with professional instruments will always have clients that are willing to pay for the service.