A Natural Progression: Equine Dentistry at the University of Minnesota Veterinary Medical Center

A Natural Progression: Equine Dentistry at the University of Minnesota Veterinary Medical Center

Gary M. Goldstein, D.V.M., and Sara Wefel, D.V.M., DABVP (Equine Specialty):

In this, Northwest Dentistry’s third visit* to the Veterinary Dental and Oral Surgery Service at the U of M’s Veterinary Medical Center, we find ourselves again in the company of Dr. Gary  Goldstein**, with an introduction to Dr. Sara Wefel†. Our subject is horses – equine dentistry, in fact. In a state heavily populated with horses and the people who love them, this newest specialty has a near-perfect environment in which to start growing. It is a journey for clinicians, educators, and anyone who cares about the caring professions. And if you happen to meet a  musk ox with a sore tooth along the way, you will know who to call. 
The Editors

NWD: Please introduce us to this new focus in veterinary dentistry, and how each of you came to it.
Dr. Wefel: I am a graduate of the U of M School of Veterinary Medicine, and in a roundabout way came back for a residency in something other than dentistry, but my interests kept bringing  me to equine dentistry. I am a board certified in American Board of Veterinary Practitioners — Equine. My residency was through the American Board of Veterinary Practitioners. I am working  today mostly with our ambulatory service in the west metro. Primarily the cases we see are preventive medicine and equine dentistry and the basics. 
Dr. Goldstein: There is momentum now that is more and more active and more a reality, to recognize equine dentistry as a board certified specialty worldwide. This if successful will be the  first time that a recognized board certified veterinary specialty has become an international specialty. There is currently a Specialty Organizing Committee that has been formed with members  from around the world to make this a reality. I am one of the organizing members, which makes it as exciting for the University of Minnesota. Because equine dentistry is in its infancy as was  small animal dentistry when we spoke several years ago, when it does become a board certified specialty, my feeling is that it will explode the way small animal dentistry did. We need the  numbers a global community can provide, and with today’s technology that is feasible. 
NWD: Why should “people dentists” be interested in equine dentistry, aside from the fact that it is interesting to animal lovers? 
Dr. Wefel: The many correlations between equine and small animal dentistry and human dentistry are a matter of degree and variation, but for the sake of medicine, it is great to have a  collaborative approach to common knowledge of dentistry and oral medicine. There are challenges and problems in equine dentistry we don’t have answers to yet, and we don’t know where  those answers lie. Are there techniques or products from human dentistry we haven’t tried yet, new solutions we haven’t recognized yet? It’s exciting to be involved at this point in time with  a revival of the kind of interest in equine dentistry people had at the turn of the last century. It is still legal in some states for laypeople to practice dentistry on horses, but to us this is  surgery and medicine that only veterinarians should practice, with the client involved in discussing what is best for the horse. 
Dr. Goldstein: In the question of what can we learn from each other, while anatomy is certainly different in comparative medicine, there are definitely similarities in physiology and disease  process — periodontal disease, fractured or cracked teeth, caries, abscesses etc. There are also conditions more common in horses than in people. From our side of the equation, the question  is, “How can we use the knowledge and skills of human dentists to help us?” But for both sides, there is a potential for future collaboration. Right now our relationship with the School of  Dentistry includes Dr. Hinrichs’ residents and our dental residents partnering in reciprocal short rotations, graduate classes, and wet labs. 

NWD: Is it true that Minnesota has the highest rate of horse ownership per capita in the country? Talk about Minnesotans and horses …
Dr. Wefel: We are at least in the top five — certainly very “horse dense” around the metro area, and of course our clients come from all over the state. As well, our horse population is very  diverse by breed, from minis to draft horses; by discipline from English to Western. Certain breeds are predisposed to certain problems or challenges. The more mouths I look in, the more  things I start to notice or to look for. If I see something I can’t explain, I file it away until I can find a reason. 
NWD: How did you go about getting the training you needed to perform equine dentistry? What need did you see to want to do this?
Dr. Goldstein: This University-level veterinary dentistry program has the obligation to teach its students and to offer veterinary dentistry diagnostics, treatment, and prevention for all species. After growing the small animal dentistry service, the next logical step was the equine dentistry program. We need to create and develop a program to address the needs of the equine community, both clients and horses. The most important thing we have to offer right now is advanced diagnostics and treatment for the sake of the horses. Often, and unfortunately,  we find our equine patients where we were 30 years ago with dogs: A fractured tooth is treated with antibiotics, or worse, ignored. It abscesses; more antibiotics are given, oftentimes the  infection returns and the horse worsens, causing more pain, bone destruction, secondary infection such as sinus drainage and disease, affecting eating, training, riding, running — and this may go on for years. This just has not been recognized, nor deemed important enough to treat urgently and appropriately, so I feel obligated to do what I can to offer this service to the equine community. As with human medicine and dentistry, everything we do has to involve the whole patient. But we have a lot of convincing to do about this need.
Dr. Wefel: I am a horse owner, and my interest in horses goes back many generations in our family, but there also must be some element from dentistry — my mom is a dental hygienist. She’s  the only person on the planet who can understand me with instruments in my mouth! As with people, a horse’s reaction to dentistry carries from experiences it has had. Seeing my mom at  work when I was little helped me understand that. And now, unlike small animal dentistry, I work with the client/owner right there with the patient, which is a fantastic learning tool. Most  often the animal is lightly sedated, and the client/owner can see the value of what we are doing as we work. 
Dr. Goldstein: My route to training in equine dentistry was more an interest, as formal classes weren’t available when I was in school, or even recently. It’s exciting to learn something  different. I am not a horse person the way Sara is, but as a boarded veterinary dentist I understand the importance of this care. What continues to engage me is the possibility that in four to  five years equine dentistry could be a boarded specialty, that there could be a handful of equine dentistry residencies where none exists now. The U of M Veterinary Medical Center will once again be in the forefront of this new specialty.
Dr. Wefel: I was so lucky to go to vet school here because the equine dentistry courses and hands-on opportunities were here. With those, students can develop an interest if they don’t  already have one. As for me, it was a perfect fit; I just wanted more, more, more. Even since I graduated, the evolution in techniques and knowledge is amazing. 

NWD: Did you ever have any difficulties turning from the horse to the owner?

Dr. Wefel: It can be tricky, because owners don’t want to hear that something has been going on, don’t want to feel that they have been negligent. But often it takes trained eyes to pick up  on a problem, diagnose properly, and offer treatment options to the owner. 

NWD: So this is part and parcel of the evolution of veterinary medicine and dentistry. 

Dr. Goldstein: This is a natural progression of the basic model for care: Diagnose early and appropriately; treat for best outcome — it’s as simple as that. Recognize disease; then examination, charting, radiographs. That’s how it will evolve, even as we are actively working on improving earlier opportunities for our students. 
NWD: What is happening atthe VMC? How are veterinary students involved in equine dentistry?
Dr. Wefel: Equine students have to acquire a different skill and knowledge, but there is something about working in the horse industry — you have to be very savvy, confident, and ready for  certain challenges that are a part of the work, so the more prepared the students are, the better off they will be “day one” when they graduate. If we teach them about equine dentistry in a way that they see the value, they will pursue the continuing education in equine dentistry later on their own. 
Dr. Goldstein: We want this part of their education to happen not only earlier, but throughout their four years. We have an equine dentistry rotation that is quite new, and a year from this fall we will have an equine dentistry elective for the third year students. The equine clubs are more and more active and have an interest in dentistry. We have established a student chapter of the American Veterinary Dental Society at the veterinary school which includes many equine students as well. Our long-term goal is to create an equine dental clinical service. I am 100%  convinced we can develop a strong referral practice service in equine dentistry – it is out there; we just need to convince the people who make the decisions that it is important. That’s my BHAG – Big Hairy Audacious Goal — to be the leader of that. There’s no reason why we can’t educate nationally or internationally again. But the next step after the courses we offer to our students is working on developing a referral practice in equine dentistry here. 
Dr. Wefel: We need a medicine/surgery/dentistry team approach to the whole animal, because often there is a lot of medicine behind oral and dental problems. I am a teacher as well as the client’s primary care veterinarian, and I deal with different levels of education, including the two-week rotation for equine dentistry. 
NWD: Including students who have never been near a horse … 
Dr. Wefel: We have some students coming from a horse-savvy background for whom this is almost a second career. Most of our students are primarily equine or equine emphasis with small  animal in a mix, reflecting a growing view of the horse as a companion animal. For those who don’t anticipate having horses in their practices, we still make sure that they are exposed to them  over the course of their four years, and establish some confidence at the starting point. Horses are like lightning rods for the emotions of the people around them, so this has to be part of  their education. We track here to decide what a student’s species or specialty focus may be well before the fourth year. Doing that, we can make exposure to something new as comfortable  as possible while being as educational as possible. 
NWD: What animals other than horses are part of the equine dentistry group? Any exotics? 
Dr. Wefel: Not a lot of other species currently, but if there was a need or a concern, “it could happen”. You need different drugs and equipment for llamas, for example, but if there is an  animal in need, we will find the resources. I did get a request from one of the area zoos about a musk ox. Who knows what might be waiting in the wings. 
Dr. Goldstein: We will work on any animal if there is a dental or oral problem. I did all the dentistry for the Houston Zoo when I practiced in Houston, Texas, so I do have experience with  exotics. Here I have not. They bring in people dentists, which from our standpoint is not the best thing — they should be calling us first. While the anatomy is different among the species, the  physiology and the process are pretty much the same: diagnostics, anesthetize safely, perform the necessary procedures. 
NWD: You mentioned the “horse industry”. How about race horses?
Dr. Wefel: They have their own veterinarians who work on the back side, and I am not licensed to practice there. Some horses only receive dental work with hand tools. Considering the expectations for those horses as athletes, it is important they receive quality dental care, including preventive care. Optimum racing age is also the age at which a horse’s mouth is going through considerable changes as the dentition matures, so with the stresses placed on a race horse’s mouth, this should be a focus in their care. 
NWD: Are you associated with any of the rescue organizations?
Dr. Wefel: Not directly, but just as a function of our large animal hospital there are times such as a rescue or a seizure when we are part of the care those patients receive. 
NWD: How would you characterize the position this element of dentistry, not just veterinary dentistry, holds right now, and potentially for the future? 
Dr. Wefel: I came back to work for the University in 2008, which was a watershed year for our national economy. Horses are a huge investment and a huge commitment, yet even with the  drop in the economy, our equine dental cases declined only slightly, and have steadily rebounded and grown since that time. Our practice on the west side has expanded. I think this says that people who are looking to spend their money wisely are seeing the value in what we do. I am in a very good place to do what I do, but that only serves to raise the issue of how do we build the networks and relationships to get the care and education elsewhere to areas that need it.
Dr. Goldstein: From where we have been through where we are to where we want to go there is a timeline that runs from the hospital student to the community vet to an equine specialist nationally and internationally. We are trying to develop a reputation here as an international leader in the advancement of equine dentistry both from a teaching standpoint as well as a service to the many equine clients in the seven-county metropolitan area. Recognizing the importance of equine dentistry, along with the fact that we are at the very beginning of its growth  and development, is important to raise the level of importance of equine dentistry similar to what we did for small animal dentistry several years ago.
* “A Shared Spirit”, Northwest Dentistry, Volume 83, Number 5, September-October 2004, pages 12-17. 
“Promise to Presence”, Northwest Dentistry, Volume 89, Number 1, January-February 2010, pages 19-23. 
**Dr. Goldstein is Associate Medical Director-Veterinary Medical Section Chief of Dentistry, and Oral Surgery Professor, Veterinary Clinical Sciences College of Veterinary Medicine, University  of Minnesota. Email is golds034@umn.edu.
†Dr. Wefel is veterinary clinical instructor, University of Minnesota West Metro Equine Practice, Maple Plain, Minnesota. Email is wefe0100@umn.edu