SAEVA Proceedings 2014 Dental Wetlab | Page 5

4 E Q U I N E D E N T I S T RY — A N I N T R O D U C T I O N Clinical Examination Examination of the equine dental patient Dental conditions in the horse occur frequently and have been identified as a leading cause of chronic weight loss, pain and infection in the equine patient. Dental disease has been shown to cause conditions such as early embryonic death and endocarditis in the horse. Failure to provide adequate dental care is a welfare issue. Like all aspects of equine care a thorough examination of the patient and relevant aspects of their environment is essential to maintain high standards of professional care with positive outcomes for both patient and client. Practitioners should have a detailed knowledge of dental anatomy and physiology and should utilise their skills as veterinary professionals to consider the interrelationship between pathology in the oral cavity and concurrent disease processes in other parts of the body. In order to raise the standards of dental care in Australia veterinarians need to allow more time for a dental examination than they may have done in the past. Equine Practitioners mu st change their way of observing dental problems. The aetiology of dental disease must be foremost in the process of evaluation. Proper diagnosis and therapy planning cannot be undertaken until the aetiologies of disease are identified. History The dental exam should begin with a thorough history from the owner and where this is not the person who rides or feeds this horse remember to try to gather information from these people as well. Like any aspect of veterinary science the more information gleaned here the more likely an accurate diagnosis and successful outcome is. Questions to ask include the age, breed, sex and use of the horse, and more detailed information about feeding habits and ridden or driven behaviour. This includes things like whether the horse spills feed when eating, how fast it consumes forage and hard feeds, history of diarrhoea, choke or colic, chewing of sticks or unusual objects. Obviously the accuracy of this information will depend on how observant the owner is so it is the role of vet to impart the importance of observing these behaviours to owners. Behaviours to look for in the ridden or driven horse include chewing the bit, resistance to signals from the bit, tossing of the head, failure to respond (no brakes) etc. The next step is to assess the horses feeding environment, is the horse stabled, do they feed with their head at ground level or elevated, and to examine the feed. Examination of the feed should include looking at the quality and quantity of feed available and assessing feed for things like sharp seed heads etc. Assessment of patient Information that has not been provided by the owner regarding the feeding habits of the patient may be able to be gleaned from observation of the patient consuming feed. Like all clinical skills this one takes time to develop as the practitioner must first have an understanding of what is normal before they can accurately assess what is abnormal. Some key points to observe; are masticatory noises audible, Is the movement of the jaw what you might expect i.e. is there both lateral and rostro caudal movement involved, does the horse spill feed and if so which types does the horse spill. At this point your skills as a veterinarian should be used to assess the patients overall health, what is their demeanour, heart rate, respiratory rate, hydration status and temperature. At this point sedation and analgesia should be administered; the drug combination chosen and the dose rate will depend on the size and temperament of the patient, the duration of restraint required and the likely use of the patient in subsequent days. Suggested choices and dose rates include a combination of Acepromazine IV 0.05mg/kg and Xylazine IV 0.5 – 1.0mg/kg exclude acepromazine in intact males due to link with priapism, the addition of butorphanol IV .mg/kg will aid with palpation of painful areas but needs adequate physical restraint of the patient as it can cause them to want to walk forward. Detomidine can be used in fractious horses or horses with serious pathology. An alternative combination for practitioners conducting examinations on fractious horses or inexperienced practitioners is