Sedating for 'dentists'?

Re: Sedating for 'dentists'?

Lwyalep - — Sun, 03 Jul 2011 12:28:20 GMT

This has been a very interesting thread to read as I am very interested in equine dentistry and am currently applying to jobs. However a number of them seem to say they dont do teeth as there are so many EDTs around they just work with them (which is a bit disheartening for me as I want to improve and work towards further qualifications in it etc) and so hearing peoples opinions on the situation has been very useful and informative!

Also the opinions on use of sedation etc has been good as well as I know a number of vets who have done hand rasping of varying degrees of "severity" (so to speak) and dremel use in both sedated and unsedated horses. From the placements I have been on (new grad here!) the impression I get is it depends on the individual horse... but if there is a smidgin of doubt or risk then sedate them. but its hard sometimes to ask why people do things at certain points and why etc etc. So its been good to read opinions on this thread!

Re: Sedating for 'dentists'?

bob lehner — Mon, 04 Apr 2011 10:04:48 GMT

Yes - for safety all round - vet, horse and not to be overlooked, the owner who may be holding the horse, sedation is advisable. A horse with a mouthful of heavy metal work which throws its head about is a serious danger to people nearby.

However there are plenty of nice well-behaved horses which will stand quietly for routine rasping. One arguement I have with some EDTs is that they definitely over-egg the pudding. A lot of horses I used to check routinely with their annual vaccines did just need a few sharp points taken off the cheek teeth and this can be done very quickly and easily without sedation in many cases.

It was my impression that some of those doing equine dental work seem to feel that they have to justify their charges by making a great song and dance out of the whole procedure and seem to find problems where none exist. Sadly the average gullible horse owner often laps this up and then sings the praises of the wonderful 'expert' concerned.

Of course the horse that is not totally cooperative, or needs more complex work, or use of power tools should be sedated in my opinion.

Re: Sedating for 'dentists'?

Evelyn Barbour-Hill — Sun, 03 Apr 2011 21:37:23 GMT

[quote user="Lucy K"]On a related topic: how many of you do routine rasping of teeth without sedation? We were told in our dentistry lecture not to even start a dental without sedating the horse. The main reason for this was danger of the horse causing an injury to vet or handler with the mouth gag.[/quote]

It's my opinion that you cannot even examine the mouth properly without sedation, and that sedation is simply a necessity for any equine dentistry. Others, some of them quite expert whose opinions I respect, feel differently.

I am very firmly of the opinion, and this is also official opinion of BVDA, that sedation is essential for the use of any kind of power tool. This is not to avoid persons being injured by the speculum, it is to:

1. Avoid injury to the horse from the instrument. This is by far the highest priority and extremely important.

2. Allow proper observation and control so that a correct job is done.

[quote user="Lucy K"]However I've seen practice with equine vets in Ireland who will rasp teeth without sedation.[/quote]

Yes, but what sort of rasping - just a little bit of a routine one? And to what sort of standard?

Re: Sedating for 'dentists'?

Lucy K — Sun, 03 Apr 2011 10:00:07 GMT

On a related topic: how many of you do routine rasping of teeth without sedation? We were told in our dentistry lecture not to even start a dental without sedating the horse. The main reason for this was danger of the horse causing an injury to vet or handler with the mouth gag. However I've seen practice with equine vets in Ireland who will rasp teeth without sedation.

Re: Sedating for 'dentists'?

Evelyn Barbour-Hill — Sat, 15 Jan 2011 18:06:14 GMT

[quote user="Wren"] I think that there are a lot of vets practicing poor or lazy dentistry so that when a pseudo-EDT turns up with a logo'd truck, mountains of shiny kit, power tools and personalised charts they are ready to fall at their feet. You try explaining that these guys aren't the real deal when they have a string of letters (imaginary or worthless) after their name and they spend 45 minutes with every horse.[/quote]

Well put.

[quote user="Wren"] It kills me to stand and sedate horses for non-BEVA/BAEDTs, but as a practice we have always done this and will continue to do so unless someone (me?) makes a major change in policy and I'm not sure that so much rocking the boat will be tolerated.[/quote]

Well, only you know how much boat-rocking you could do! Suppose you started by quizzing the bloke about his qualifications as you stand by the horse; then ask him to point out to you exactly what he has found in the mouth and to explain exactly what he is planning to do about it. If you disagree with his plan; if you think his plan is positively bad; if you think he will be exceeding his powers by attempting it (if he wants to extract a tooth for instance): then say so, and refuse to sedate. Explain politely but firmly to both technician and owner. If you think his plan is a fair one, sedate and stay there while he does the work to supervise it...... in any case, the sedation may need topping up or repeating.

There was a case quite recently where a fairly young female veterinary surgeon, who happened to know a good deal about dentistry, was sent "to sedate for the EDT". She felt that what he wanted to do was wrong, declined to sedate and offered alternative treatment. This brought a torrent of the foulest, vile and threatening verbal abuse. I believe she came away all right but was a little emotional when she got back to the practice. Fortunately her employers did the right thing and defended her. On the other hand, there was another case......... no, I could go on for ever.

Another EBH semi-relevant anecdote. I was once doing something or other with one horse when the owner said "By the way, leave me some bute. The back man is coming to one of my other horses tomorrow and he wants it to have a course of bute". I see the owner ringing up to demand that you sedate for the "dentist" as being on much the same level.

[quote user="Wren"]Education seems to be the key, but how? And how to educate without just sounding like you're touting for business?[/quote]

I don't think you can, altogether. Just try your best. Practice evenings to which you invite all the clients can help, I believe.

Small point of information. It's the BEVA/BVDA exam and qualification. Passing this allows the successful candidate to join BAEDT.

Re: Sedating for 'dentists'?

Joyce Whitehead — Sat, 15 Jan 2011 17:43:39 GMT

We as a practice have a policy of only sedating for EDTs on the BEVA list - quoting the VDS guidelines, and the fact that (I think) that those on the BEVA list have to have professional indemnity insurance. We have a very good relationship with a local EDT, who often brings cases to us for further treatment of (for instance) damaged teeth that require removal. There are also lots of "cowboys" around though.

Re: Sedating for 'dentists'?

Michael Woodhouse — Sat, 15 Jan 2011 13:40:54 GMT

[quote user="Hannah Wynne Richards"]

If RCVS were doing their job properly, and protecting animals from unqualified "treatment", they would be actively looking for, and prosecuting unqualified "horse dentists" who are committing a criminal offence under the 1966 VSA-if they did,then the problem would go away

Wynne

[/quote]

I thought the only people who could bring a prosecution was the CPS and the RCVS has no jurisdiction of anyone who's not an MRCVS?

I fully agree something should be done. Don't start me on the lay scan men

Re: Sedating for 'dentists'?

Hannah Wynne Richards — Sat, 15 Jan 2011 11:52:58 GMT

Wynne

Re: Sedating for 'dentists'?

Wren — Sat, 15 Jan 2011 10:44:51 GMT

Evelyn - I am with you on every word. I have a real interest in dentistry, am collecting the requisite 300 case studies with the idea of sitting the BEVA/BAEDT exams myself in the next couple of years and personally chart and fully examine/treat every dental I do. It kills me to stand and sedate horses for non-BEVA/BAEDTs, but as a practice we have always done this and will continue to do so unless someone (me?) makes a major change in policy and I'm not sure that so much rocking the boat will be tolerated. I apologise if some of the terminology in my original post was a bit vague but I shall blame the after-effects of the flu combined with a long, long day (I did put 'dentists' in inverted commas though!).

Always having a particular policy is one thing but suddenly implementing a new one is another kettle of fish and I shall need to tread carefully. We only have one proper EDT covering the area who comes in from about 80 miles away. There is another one listed closer but I have never come across anyone who uses him so am not even sure whether he is currently working.

I would love to play the evangelical BEVA/BAEDT card but think that clients accept the status quo and don't really appreciate the difference in qualifications, even after explanation. The volume of anti-vet feeling in the equine press is enormous - plenty of magazines recommend not letting vets do your horses' teeth 'after all - you get a farrier to see to their feet'. I think that there are a lot of vets practicing poor or lazy dentistry so that when a pseudo-EDT turns up with a logo'd truck, mountains of shiny kit, power tools and personalised charts they are ready to fall at their feet. You try explaining that these guys aren't the real deal when they have a string of letters (imaginary or worthless) after their name and they spend 45 minutes with every horse.

Education seems to be the key, but how? And how to educate without just sounding like you're touting for business?

Re: Sedating for 'dentists'?

Evelyn Barbour-Hill — Fri, 14 Jan 2011 23:41:36 GMT

[quote user="nikki"]

[quote user="Michael Woodhouse"]

Has anyone tried Domosedan Gel?

[/quote]

I have bought a tube for my naughty old horse for when he has the EDT next week (yes, BEVA trained and qualified). Will hopefully save me having to inject him IV as normally he needs a nice dose of domo/torb to keep all 4 feet on the ground and injecting him IV is somewhat risking my life so hoping the domo gel might make life easier for all of us.

[/quote]

Keep your mouth tight shut while dosing him in case he spits it back.....................

Re: Sedating for 'dentists'?

nikki — Fri, 14 Jan 2011 23:37:37 GMT

[quote user="Michael Woodhouse"]

Has anyone tried Domosedan Gel?

[/quote]

Re: Sedating for 'dentists'?

alan hough — Fri, 14 Jan 2011 23:03:38 GMT

I have used it a few times so far, varied response from very profound sedation to mild sedation on similar sized horses, albeit the one it had least effect on is a very highly strung horse even at the best of times. Main issue is owner being able to ensure it is placed sublingually rather than horse swallowing it like a wormer.

Re: Sedating for 'dentists'?

Evelyn Barbour-Hill — Fri, 14 Jan 2011 23:02:45 GMT

To explain the whole thing all over again from the beginning would require a post of unconscionable length which would bore you all and anyway I haven't got the energy any more, so let me just throw (shoot?) a few bullet points at you.

There is no such thing as an equine dentist.

The Veterinary Surgeons Act says that only veterinary surgeons may do veterinary surgery. Doing anything to a horse's teeth, beyond hand rasping of sharp enamel points, removal of supragingival calculus, and mild rounding of the rostral aspects of the upper and lower 6s (so-called "bit-seating" - what a ridiculous misnomer), is veterinary surgery.

The people, not veterinary surgeons, who operate on horses' teeth are, strictly speaking, every one of them operating illegally if they do any more than hand rasp enamel points, remove supragingival calculus, and do some moderate rounding of the rostral aspects of the upper and lower 6s.

However we recognise that there are not enough equine veterinary surgeons in the country to give every horse the dental attention it ought to have at the frequency it ought to have it; also that some equine veterinary surgeons have poor dental knowledge and skill and are not inclined to acquire them; also that some non-veterinary operators have considerable knowledge and skill, work professionally and deserve respect.

A veterinary surgeon is forbidden (it's in the Guide) to co-operate with a non-veterinary surgeon illegally engaging in veterinary surgery. However RCVS Council have declared that no disciplinary action would be considered against a veterinary surgeon co-operating with an equine dental technician who has undertaken BEVA/BVDA approved training and passed the BEVA/BVDA examination, as long as they confine themselves to the range of operations, known as "Category 2" , that is suitable for derogation to a qualified EDT. (The same applies for the very few who have done WWAED training and passed the WWAED exam). (You will find Category 2 in detail on both the BEVA website and the RCVS website). This sounds rather strange and legalistic but it is the only way RCVS can give a sort of derogation to those who can be truly regarded as qualified EDTs.

This odd quasi-legal status for the BEVA/BVDA is intended to deal with the situation until something better and more legal can be arrived at...... something that I and colleagues have been working at for around thirteen years.

There is no compulsory professional body for EDTs. The nearest thing is the British Association of Equine Dental Technicians; which is open only to those who have passed the BEVA/BVDA exam, has impressive CPD requirements andhas a disciplinary mechanism.

BEVA and BVDA firmly recommend that veterinary surgeons should collaborate only with EDTs who are members of BAEDT. To which I would add that one should at least think very hard before collaborating with any other.

It is wise, before providing sedation for an EDT, to at least find out precisely what it is he or she is proposing to do to the horse and why, and to be sure that you approve of the plan. It is sensible to remain while the work is done; in other words make this a proper collaboration.

If you are determined merely to sedate the horse and go away, and take no further interest in the proceedings, make sure that the horse keeper understands that this is your plan and confirms (preferably in writing) that you are in no way responsible for what the EDT may or may not do.

If some EDT claims they are "American Qualified" I would not touch them with a bargepole. Apart from anything else, if they claim that they are obviously trying to avoid the need to be BEVA/BVDA qualified. More importantly perhaps, they will probably be applying the brutal theories and methods that are current in American non-veterinary equine dentistry circles. In the interests of horse welfare, not to mention a desire for the best treatment, if I were a horse owner I'd keep 'em away with a shotgun.

Example of commonplace American-style advice: "It's quite normal for a horse to have difficulty eating for up to six weeks after dental attention".

Example of BEVA/BVDA/BAEDT advice: "If a horse is having trouble eating even two hours after dental attention, there's something wrong".

Which do you reckon is right?

Horse owners and keepers might care to bear in mind that the Animal Welfare Act puts a responsibility upon them to check the qualification or competence of any operative they unleash upon their horse.............

The legal position and the advice of RCVS, BEVA and BVDA has been well and repeatedly publicised for years, not only on websites but in the newsletters or journals of those bodies.

>[quote user="Wren"]I felt sure that someone (BEVA/RCVS?) recommended that we didn't sedate for anyone not correctly qualified, but I've never heard whether anyone follows this recommendation. I agree with your sentiments though (being a horsey person myself!).[/quote]

I can assure you that many equine veterinary surgeons do indeed proceed as recommended by RCVS, BEVA and BVDA. I imagine that, as with many other things, they get protests from some owners, but explanation and diplomacy combined with a firm stand upon principle should often settle protest.

And then we hear the horror stories of things done to horses by un-approved EDTs with the tacit permission of complaisant veterinary surgeons....

Oh lor'... I've started now Well, here are a couple more home truths. You hear of EDTs and of EDT associations claiming to be "DEFRA Approved". This is nonsense. DEFRA have no powers to "approve" anyone in this context. Some also claim to be "NFU Approved" which is also complete nonsense. All it means is that they have got their insurance from NFU.

A final thought for horse owners. Nobody can get indemnity insurance for something they are doing illegally. Moreover, your horse insurance will not pay out for the consequences of an illegal act which you permitted.

Re: Sedating for 'dentists'?

Michael Woodhouse — Fri, 14 Jan 2011 22:58:46 GMT

Has anyone tried Domosedan Gel?

Re: Sedating for 'dentists'?

bob lehner — Fri, 14 Jan 2011 21:19:45 GMT

The VDS has an information sheet on its website - 'Sedation of horses for dentistry/shoeing/clipping etc.'

Re: Sedating for 'dentists'?

alan hough — Fri, 14 Jan 2011 19:39:43 GMT

I am in complete agreement Wren with what you are doing and as I have just set up my own equine practice recently I am implementing the same policy you are considering. I am very keen on equine dentistry and it composes a great deal of my workload but I also have a good working relationship with the BAEDT registered EDTs locally and am happy to provide sedation for their clients.

I may be incorrect on this but I have a feeling that according to the VDS they will not cover you to sedate for non BAEDT registered technicans, this is the reason I give to clients as to why I wont sedate for non-registered technicans. This policy would be easier to implement still if there weren't vets out there who dont care about the legailities surrounding the different categories of dental work and who should legally be doing what work. But thats another hornets nest.

Re: Sedating for 'dentists'?

Wren — Fri, 14 Jan 2011 17:27:32 GMT

I felt sure that someone (BEVA/RCVS?) recommended that we didn't sedate for anyone not correctly qualified, but I've never heard whether anyone follows this recommendation. I agree with your sentiments though (being a horsey person myself!).

Re: Sedating for 'dentists'?

Mark Holmes — Fri, 14 Jan 2011 17:14:43 GMT

I think you risk your equine clients going to someone who is prepared to sedate them. Its a long time since euine work but I seem to remember horsey people would be more likely to keep the Dentist, Horse whisperer, Osteopath, Witch Doctor then the Vet.