Sedation and Equine Dentistry: Do We Need It?

Mon, 01/08/2024 - 10:00
Health Care
Vikki Fowler working on an unsedated horse. "Tilly is 27 year old and a long standing patient of mine. She has not been given any calmer or drugs of any sort. As you can see, she is perfectly relaxed and makes my job very easy. This horse would be more difficult to work on sedated than she is to work on awake. She’s an older lady and really doesn’t need any chemical assistance to be a gem. She is not alone in her angelic behaviour, many will stand just as well."

-- by Vikki Fowler, veterinary equine dentist

I’ve been thinking of writing this post for quite awhile, but I keep putting it off because it is a topic that raises a lot of opinions from a lot of different people. Vets and Equine Dental Technicians (EDTs) seem to struggle to get on the same page. So I would like to explain my take.

Before I get into it, just a little bit of housekeeping. I am based in the UK, I cannot speak for other countries. In the UK only vets are allowed to sedate, but anybody can do dentistry on a horse (Editor's note: different laws apply in other countries on who is allowed to sedate and perform dental procedures). We do have a recognised qualification/exam from the BVDA/BEVA however it is not a legal requirement in order to perform dentistry. When I talk about EDTs please be clear that I am talking about those that hold the qualification. I have already made my views very well-known in that I do not believe trainees or those without the qualification should be allowed to work on horses unsupervised…at all.

Sedated - Unsedated

Ok, back to it. Now I may be a vet, but my opinion on this may surprise you. I also hold the dentistry qualification and I stand with a foot in each camp most of the time. Personally, I do not insist on sedation for the horses I work on. I probably do 50:50 sedated versus unsedated. However I do not think this is representative of the population as a whole because a lot of people use me due to the fact that I can sedate and also carry the dentistry qualification. A lot of my BAEDT colleagues work on 95% unsedated horses, which is also unlikely to be representative of the general population. The figure of those requiring sedation is likely somewhere in between.

I hear two opinions that are given as though they are fact that I strongly disagree with. The first one is you cannot get to the back of the horses mouth without sedation, and the second one is, you cannot do a thorough examination of the horses mouth without sedation. When I hear these, I often think the person offering these opinions may not be able to, but it is rather arrogant of them to assume that nobody else has this skill. I personally do have this skill. And the other members on the BAEDT members list also have this skill.

It's a Skill

Working on an unsedated horse is a skill, a skill separate from that of working on a sedated horse. Just because you can work on a sedated horse does not automatically mean you have the ability to work on an unsedated horse. It is a separate set of skills that takes many many years and many thousands of horses to hone. To work on an unsedated horse you have to be absolutely precise. You cannot stray from where you should be, you cannot get away with touching the gum, the tongue or the cheek as obviously the horse will react where it wouldn’t when sedated. Also, you have to be ambidextrous, you do half of the mouth with your right hand and half of the mouth with your left hand. It doesn’t matter if you are left or right handed, they have to be a perfect mirror image of each other. This is probably the most limiting skill, one that those who do not spend 100% of their time doing dentistry often lack. You have to hold the head with one hand and hold the equipment with the other, which requires a lot of core strength, multitasking and dexterity.

You also have to have a very good level of horsemanship. You have to be able to predict the horses' movements and you must be able to work with the horses' movements rather than against them. You get into a rhythm with the horse, and how they move their tongue and cheeks, so that you use them to make your job easier, rather than fighting against them. And finally, something that is very overlooked is it requires training of the horse. You would not expect a never-seen-before young horse to immediately behave for the Farrier. And you cannot expect them to immediately behave for the dentist. It takes training from the owners side with regards to handling and manners, and it takes training from the dentists side to offer patience and give the horse a chance to understand what is being asked of them in what is a daunting procedure. A young horse sees the farrier from a very young age and far more frequently than they see the dentist, usually the owner has prepped the horse for the farrier and plies them with treats to keep them quiet. Yet often are expected to behave immediately for the dentist.

Is It Easier?

So given all of this, wouldn’t it be easier just to sedate everything? I have that ability, so why wouldn’t I? Honestly, and primarily, because it is usually harder to work on a sedated horse than a well-behaved unsedated one (for me). They don’t get needle shy, they don’t wobble, they often help me by holding their tongue to the side or holding their head to a comfortable height. I can safely use mirrors, probes and the burr reaching all areas of the mouth without stress to the horse or difficulty for myself. I don’t understand anybody that wants to sedate these angels of horses.

Aside from this personal opinion we must remember that sedation is a veterinary procedure. Whilst it is very safe, there are the rare risks of needle reactions and drug reactions. I’m not going to list them and scare people, on the whole sedation is very safe but veterinary medicine is about weighing up the risks vs the benefits. If I do not feel it is necessary to sedate a horse for routine dentistry, and all that is required is further skill on my behalf, why would I.

That being said, for those that do not do large numbers of horses and have not dedicated years of their lives to training themselves to work on unsedated horses, the benefit does indeed outweigh the risk. In such a situation it is essential that these vets do sedate in order to do a thorough job. There is no shame in this at all, all that matters is the horse walks away with a thorough job done. But also don’t assume it is the only way to get a thorough job done.

When to Sedate?

I’m often asked when do I decide to sedate?There are a few reasons I sedate, firstly if the horse is in pain, or if what I am going to do is likely to cause pain, secondly if I need the horse to stay absolutely still and the other reason is the horse's behaviour.

Not every horse will stand to have dental work done without sedation. Just as some people have very sensitive teeth and can’t stand the vibration of the ultrasonic descaler at the hygienist, some horses feel the same way and it is unfair to try and force these horses to stand unsedated. Quite frankly, it’s impossible to force them, they are half a ton of adrenaline fuelled animal. If the horse is fighting the professional, they cannot do a thorough job and are at risk of injury. Being stood in front of a violent horse is a very dangerous place to be. It’s a little different if a new horse is worried or scared, often you can take your time and win them around. Sometimes I start off with sedation and each time I see them I reduce the amount until they no longer need it at all. But if a horse hates it, they need sedating, and will always need sedating.

From a Young Age

Starting horses young really helps. Have your dentist look in their mouth even before they need doing. Teach them to have their lips lifted to see the incisors, teach them that humans are allowed to touch their tongues (obviously in the bit space, don’t get bitten!) and teach them to have their heads lifted and moved around. All these little things really help. Also keep up with the your routine visits! If you always allow your horse to go overdue so it’s a bigger job or they have ulcerations every time, they will start to have negative associations with the dentist visits and become difficult. Make sure you stick to whatever interval your professional recommends so it remains a positive experience.

It seems obvious to say sedate if the horse is in pain, but actually there are plenty of horses that will stand and allow you to work on them despite their pain, but this isn’t fair and is ethically wrong. Your professional may ask to sedate even though the horse appears to be behaving very well, but if the horse is in pain they should be sedated until the pain is relieved. It may be that after the cause of the pain is removed, the horse can be done awake in future. If I find a train wreck of a mouth I will always sedate before making any attempt at all. It isn’t fair to expect a horse to stand for 1+hours with their mouth open wide while treated. Consider the jaw ache you get when you visit the dentist and you’ll understand why. Again we don’t want to give the horse a negative association that will affect their behaviour in future.

Some work requires the horse to stay absolutely still, for example diastema widening, wolf teeth extractions or infundibular fillings. Where even a few millimetres of movement could result in potentially dangerous injury to the horse. Obviously chemical restraint is an absolute must in these situations.

Careful Consideration

I’m hoping those that read my post to the end will walk away carefully considering whether sedation is necessary or not for their horse. And remember a horse that needs sedation for dentistry is not a failure or a naughty horse, they simply have a sensitivity that should be respected.

Equally, I hope the reader walks away, understanding that those capable of working on unsedated horses deserve extra respect not degradation. There is a place for both EDTs and vets with a passion for dentistry in the equine world. Both play a vital role and should not be arguing amongst themselves but rather trying to educate the public.

And above all else remember that dentistry is basic care essential for all, it is not a luxury for some.

-- by Vikki Fowler, veterinary equine dentist

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