The Horse's Advocate Podcast by Geoff Tucker, DVM

May 15, 2024 Should Non-veterinarians Be Allowed To Float Horse Teeth? - #126 The Horse's Advocate Podcast

There is a turf war between veterinarians and non-veterinarians, both wanting to provide horses with preventive dental care. It started in the late 1990s and has gained protection behind laws meant to protect horse owners. But is there proof that any approach to floating is better than another? Or is it just positioning based on territorialism? I used the following script to make this podcast, but I also added to it freely to emphasize several points.

This podcast is more formal than usual because I am reading a script I wrote in response to a graduate of my dentistry school challenged by the Veterinary Medical Association of her area. She is a non-veterinarian working in equine dentistry. Most of the United States allows individual states to determine what a profession is, and most states broadly state that veterinarians are the ones to perform medicine, surgery, and dentistry on any animal. This statement includes fish, reptiles, birds, and any other animal other than humans. It is the prerogative of the veterinary board to investigate anyone who does any work on any animal in their state. However, routine care of animals, including preventive medicine, is usually avoided. You can purchase and administer vaccines and dewormers, adjust angles on hooves, apply therapeutic shoes, prepare any mixture of medicinal supplements, breed horses, deliver foals, apply linaments, clip the hair of horses not shedding, splint crooked legs of foals, adjust bones, massage muscles, use red light, PEMF, and a dozen more things to a horse without being a veterinarian. But you cannot remove the unworn parts of the cheek teeth in horses, digging their sharp edges into the tongue and cheeks and causing pain with every movement of their jaw and tongue.

I have been training veterinarians and non-veterinarians in the technique of Horsemanship Dentistry. My definition of this form of working on the teeth of horses is as follows:

1) Removing sharp points from horses' cheek teeth by filing them to a smooth edge is commonly called "floating teeth" but is also known as odontoplasty. The root cause of most dental problems is pain in the tongue and cheeks caused by sharp enamel points. Therefore, routine maintenance of the horse's teeth removes pain from these sharp points. Secondary to the removal of sharp points is finding pathology and addressing this.

2) Administering sedatives to horses for routine floating is unnecessary; instead, horsemanship skills are used for 97% of horses (from annual data consistent over the past decade). The remaining 3% are horses that are reactive to pain, fear the process, or have a painful procedure done, such as extracting a fractured cheek tooth. With those, I administer pain and anxiolytic medications.

My name is Geoff Tucker, and I am a veterinarian who graduated from The New York State College of Veterinary Medicine (Cornell) in 1984. I have worked professionally with horses since 1973, starting on a Saddlebred farm in Ohio and moving to a Thoroughbred breeding and training farm in New York that same year. I completed my undergraduate degree at Cornell University in 1979 and graduated from veterinary school in 1984. In my autobiography, I tell my story: "Since The Days Of The Romans; My Journey Of Discovering A Life With Horses." It's available on Amazon, and I have also read it here on "The Horse's Advocate Podcast."

While in veterinary school, my mentor told me the importance of maintaining horses' teeth. With him, I floated my first horse in 1983 and made this a part of my practice in 1984. Since then, I have logged the number of horses I have worked on or who I have taught. In February 2024, I recorded my 80,000th horse. But I always continued learning about horses' teeth and oral cavities. I have attended many continuing education courses offered by veterinary professional organizations in person or online.

The New York State Equine Practice Committee invited me to join them in 1996. The reason for this invitation to the board, they told me, was because I performed more dental care on horses in NY than any other vet at that time, and veterinarians were becoming interested in claiming this aspect of horse care for themselves. Non-veterinarians did much more, including all the racehorses at Belmont, Aqueduct, and Saratoga. As one board member stated, this discrepancy between veterinarians and non-veterinarians floating horses was because no good horse vet has time to add floating teeth to their busy schedule. There was one practitioner on the board who, at that time, was stating that only veterinarians should be floating horse teeth. I and the others were somewhere in the middle of these two thoughts. We could not reach a consensus, and we dropped the discussion, knowing it would require much more work than anyone wanted to do for an issue being done well by non-veterinarians.

The interest of the practice committee and the NY veterinary board came from the introduction of sedation and power floating equipment, and veterinarians started claiming their position from the non-veterinarians to broaden their base. There was no discussion that a non-veterinarian was less able to float teeth, nor were non-veterinary dentists cheating owners with poor quality of service. Cases of lapses in integrity came from both sides, mainly because floating horse teeth is hard work and requires horsemanship skills, and visualization of the finished float by the horse owner is within the depths of the mouth.

In 1999, I attended the Ocala Equine Conference, where a non-veterinarian spoke about filling cavities in horses' cheek teeth. I was shocked when he stated, without any evidence, that horses would live, on average, five years longer if we all started performing this procedure. This same man was later banned from working on horses in several states, became the president of the IAED (International Association of Equine Dentistry), and became the director of equine dentistry at the University of California - Davis veterinary school. While this non-veterinarian was working at this vet school teaching veterinary students, he caused injury to a client's horse. According to her (she emailed and called me all of this information), the man was sued, and then he and the director of the veterinary hospital who had hired him were fired from the school.

On another front, a non-veterinary equine dentist taught non-veterinarians how to float teeth in South Dakota in the late 1980s and 1990s. He was vocal that veterinarians should not be allowed in the horse's mouth because they had no training. His voraciousness upset the veterinary board, forcing him to leave the state and reestablish his school in Idaho.

Throughout the turf battle of who should be allowed to float teeth, I continued to apply and improve my skills throughout New York. In 1984, no textbooks on equine dentistry were available except one written by a non-veterinarian: "Sound Mouth, Sound Horse," by Ed Gager (published in 1983). Toward the end of the century, more veterinarians started to stand for horse owners' protection by demanding that only veterinarians work on horses' teeth. More textbooks by veterinarians came in 1998 through 2011, but few have come since. In the United Kingdom, veterinarians and non-veterinarians made up an exam so that non-veterinarians passing the exam would be listed officially and allowed to float horse teeth.

In 2002, I flew to Glasgow, Scotland, to attend the annual BEVA (British Equine Veterinary Association) conference, which focused on horse dentistry. I attended because of this subject, but I was one of only two veterinarians interested in equine dentistry traveling from the United States to attend. When the conference coordinator heard about my presence, she arranged for me to have a one-on-one lunch with Professor Paddy Dixon of the Veterinary College at Edinborough, Scotland. He has authored or co-authored more published papers and textbooks on Equine Dentistry and the teeth of horses than anyone. He presented the Frank J Milne State Of The Art lecture to the AAEP (American Association of Equine Practitioners), the highly prestigious, invitation-only lecture, where he discussed the evolution of the horse and equine dentistry. The interest could have been better, as seen by the mostly empty seats in the 1000+ seat lecture hall. The following day, he joined a panel discussing equine dentistry, which maybe had 80 people attending. Only the best get invited to give this talk at the AAEP conference, yet very few attended. This is because (then and now) only a few equine veterinarians are interested in equine dentistry. Let me address this.

There is a crisis in equine veterinary medicine, where only 1.4% of all veterinary graduates in the United States (58 out of 4000 in 2023) go into a practice limited to horses. Of these, 50% quit within five years (these statistics are found on the AAEP and the AVMA (American Veterinary Medical Association) websites. The number of new veterinarians entering horse practices is less than those leaving, and the AAEP and the AVMA are moving fast to entice new graduates to join our ranks and, more importantly, stay. They do this by increasing the starting salaries, among other incentives. The cost of employing veterinarians or maintaining the horse practice places more pressure on owners to generate an income. Some look to dentistry to help with their profits, which is a good plan, but there are drawbacks.

One of the first hurdles to becoming good at equine dentistry is becoming good at doing this. It is a skill that takes time to improve and becomes more challenging when the patient moves or objects. The solution for many is to sedate the horse automatically, doing nothing for the pain they are experiencing. Is this the best option for the horse? How does any medication affect horses that are healthy or who have underlying conditions, such as metabolic syndrome or gut ulcers? All medicines, such as antibiotics, antiinflammatories, and sedatives, cause a change in the gut microbiome (dysbiosis), leading to malabsorption and even ulceration. Would a technique that floats the horse while minimizing their pain without medication be better?

Another hurdle is the lack of scientific evidence proving the causation between any dental disease espoused by the American Veterinary Dental College—Equine and their solution. For example, recently, a board-certified veterinary equine dentist suggested that removing all incisor teeth is an acceptable treatment for a disease (EOTRH) they don't have a cause for, nor any proof that tooth removal is more than palliative. Worse, alternative options with a history of helping these horses are not only not mentioned but laughed at publically, as I heard several times at the AAEP meeting with Dr Dixon—laughed at!

An even more complex problem exists in areas where only veterinarians are allowed to float teeth. This limitation prevents horse owners from choosing what is best for their horses without evidence of a superior technique (hand floating without medication versus power equipment on restrained and sedated horses). Many owners do not want their horses automatically drugged, often to the point that they fall to the ground. They don't want their horses immobilized through medications, speculums, braces, stocks, and helpers holding their heads. However, with the restrictions imposed by government regulations, the horse owners have only three choices:

They don't have their horses' teeth maintained.
Suffer through a technique they don't like.
Ship their horses to a place where floating is legal.

This last choice places a financial and time burden on the horse owner and increases the horse's risk. The first choice neglects the pain the horse suffers from sharp teeth but addresses the suffering the owner goes through as their horse becomes an object. Further, what if the horse owner feels that the veterinarian isn't good at this job? They can't mention this observation because there are too few veterinarians willing to come to their farm as it is without offending the floating veterinarian with their concern about their competency. Worse, many veterinarians include dentistry in their annual wellness visit, forcing the techniques veterinarians use on the horse and owner because of the discount given for the wellness visit package.

In other words, forcing horse owners to use a veterinarian for routine dental maintenance performed for over 100 years by non-veterinarians is unfair to owners wanting to use a time-tested approach to dentistry for their horses. But let's look at time-tested, observational, anecdotal evidence and ask if it is better or worse than peer-reviewed, randomized, controlled trials (RCT). The first thing to do is find quality RCT papers in equine dentistry; none are available. Quality comes from various factors including, but not limited to, confounding variables, the power of the study (how many horses), the statistical analysis (significance), and bias of the subjects and the study in general.

The papers and texts I read on dentistry in horses published in veterinary journals or presented at veterinary conferences are mostly case reports or collections of case reports to establish a pattern. These collections often have dozens to hundreds of horses nicely grouped by age, breed, or pathology. Occasionally, an RCT appears with 10 to 20 horses selected due to age or breed, and an attempt to show causality made using poorly formed statistics for all horses on the planet. It is ridiculous to think that a dental disease studied in Thoroughbreds stabled at a race track eating pounds (kilos) of grain will have any association with the outcome of horses living in another country fed differently with a different use.

No RCTs determine the long-term outcomes of floating teeth using any technique. This statement means no person can accurately say what is best for horses regarding their dental care. All there is is anecdotal evidence and observational studies. Yet, in the past 25 years, no governing body has asked me to contribute my accumulated knowledge from 41 years of looking at 80,000+ horses. Instead, they say I do not "fit the standard of practice," according to a handful of people unwilling to find the answers needed to help the horse. These same few people determine the laws based on no scientific evidence of what they say.

There are good and bad equine dentists, regardless of having a degree in veterinary medicine. What counts is experience, but more importantly, sharing this experience. I have done so since 2007 on all social media platforms, several websites, and my podcast. Horse owners know there are other approaches to dentistry, but because of laws, they cannot use them. Veterinarians are worried about their practice, either in the solvency or their credibility, if non-veterinarians float teeth. However, we became horse vets to help horses, and we can do this by using non-veterinarians to be our eyes on the dental issues of the horses we care for. Legislation in the US states where non-veterinarians are allowed to work on horses' teeth states that they only use hand floats and do not give any medications. Allowing them to work frees up the veterinarian's time. They can even be part of the practice, bringing in a portion of that income without the time needed to perform the routine float. With training, non-veterinarians are sentinels for further problems, and the veterinarian can apply the training and skills required to address the pathology. This approach of working together becomes a win-win for the horse, the horse owner, the non-veterinary floater, and the veterinarian. Further, in an age where the supply of equine veterinarians is shrinking, and their location of care is focused on urban areas, the following can occur:

Horse owners will be more willing to provide their horses with the necessary routine care, which is a win for horses.
More people can make a living income in the horse industry by providing horse maintenance, which farriers have done.
The vet can employ a non-veterinarian to increase their income by offering floating through their practice. The owner can choose between the non-veterinarian's hand floating or the veterinarian's "advanced" approach.
The horse owner can feel confident that if pathology is discovered by the routine floating, the veterinarian can follow up.

After 51 years of working with horses and 41 years of floating their teeth, it is becoming evident that the turf battle between the veterinarian and the non-veterinarian over who should be floating horses is doing nothing but making it difficult for horse owners to get the routine care they need. We can create a better solution for our horses if we all start working together. More horse vets are needed, especially in rural areas, to provide basic care, but the number of them is growing smaller. Owners cannot afford the time or money to ship their horses to a clinic for this routine care, and they don't have the skills, and possibly the physical ability, to float horses. Horsemanship dentistry is teachable and can be done effectively without medication. I know this because of my experience with the number of horses I have floated and the success of students learning this technique.

A simple fact about horses' teeth remains: If a horse is chewing, the teeth need doing (floating). With the decline in available horse vets in rural areas, their work is spread thin among the horse population. Non-veterinarians are performing a needed service, and veterinarians can learn to work with them as they have with other non-veterinary horse professionals. They are not there to diagnose, but as primary service providers with eyes and ears, they can help promote the local veterinarian for things they are well trained for.

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