THE DENTAL DILEMMA: AN ACADEMIC PERSPECTIVE By Karen Brown
Layman equine dentists continue their legal fight for the right to continue working.
More lay persons have recently filed suit against the Texas State Board of
Veterinary Medical Examiners. While these cases are working through legal
processes, battle lines have been drawn throughout the horse community. There
appears to be an equal number of constituents on either side of this argument
and both sides have salient points. As with many issues arising from seemingly
nowhere, each side also claims numerous cases of unsatisfied customers of their
opponents.
The initial problem, as perceived by the layman camp, is the lack of a sufficiently
trained and willing force of veterinarians to perform all the work available in
Texas; hence, the significant increase in the number of lay dentists in recent
years. Veterinarians stand by the verbiage of Texas State law that forbids any
person from practicing veterinary medicine without a license. Dental work falls
under that category.
As a group of equine specialists who stand outside this situation, the professors
at Texas A & M College of Veterinary Medicine (TAMU) hold the unique position
of having the expertise with which to assess the situation and also be able to
offer unbiased observations.
Leon Scrutchfield, DVM, Professor Emeritus, has been studying and teaching
equine dentistry since 1990. As a professor at TAMU and in Continuing
Education in the United States and abroad, he has been at the forefront of new
technologies and protocols in the field of equine dentistry.
Dr. Scrutchfield wishes to clarify statements printed in an earlier article on this
subject. With regard to students currently attending veterinary school, he would
like to emphasize that, “Most [students] do not intend to make it a full time
specialty, but many want to make dentistry a large part of their practice
activities.” In addition to required courses in large animal dentistry, TAMU
provides a number of elective courses and field studies specific to equine
dentistry.
He continues, “The curriculum is revised each year as new information and
instruments become available. We attend wet labs both nationally and
internationally to keep current on the latest developments in equine dentistry. Dr.
Cleet Griffin is continuing this tradition and has recently returned from meetings
in Minnesota and California for specialized training in equine endodontics.”
As for the question of what to do about lay dentists, members of the TAMU staff
have this to say.
Cleet Griffin, DVM, Clinical Assistant Professor, says he is personally unaware of
the shortage in qualified equine dentists in Texas. He says, “The American
Association of Equine Practitioners lists about 500 member practitioners in Texas
as of May 9, 2008. I am not saying that this fills the void or shortage that has
been suggested in previous articles; I just think the number of equine vets might
be underestimated a little bit.” One difficulty he sees is the ability of policy makers
to define the extent/locale of the shortage of dental practitioners.
Griffin agrees that graduating students intend to make dentistry a large part of
their practice. He states, “The number of veterinary students from all schools that
intend to make equine dentistry the sole component of their practice is probably
very, very small. However both Dr. Scrutchfield and I agree that many students,
including many graduates from Texas A&M University College of Veterinary
Medicine, intend for dentistry to be an important part of their practice and career.”
With regard to the viability of utilizing lay dentists, Griffin feels that there could be
a place for them in veterinary medicine if the need for such were determined.
But, he is not in favor of lay dental technicians working autonomously or apart
from the veterinary profession. “In my limited interactions with lay dental
technicians, I think that there are probably a number of them that are very
experienced, skilled, and do a darn good job at what they do; and in my
estimation there should be a place for them. My opinion is that it would probably
be safest and in the best interest of the horse and the owner if the layman
worked under direct supervision of licensed veterinarian. The veterinarian is the
one qualified to determine the overall health status of the horse. The veterinarian
would perform physical examination, perform and interpret appropriate
tests/radiographs, administer appropriate medications, deal with adverse
reactions or complications that occur from time to time during or after a
procedure. This is one arrangement which could provide some form of
accountability,” he says.
William Moyer, DVM, Head of the Department of Veterinary Large Animal Clinical
Sciences, has practiced in many of the United States as well as several countries
around the world. He feels that it is not easy to identify, agree to, or even verify
the shortage of qualified dental practitioners. Part of the difficulty lies in how one
describes such a shortage, i.e. number of practitioners, location or availability, or
the skill level of existing practitioners.
Another variable in a supply/demand economy pertains to the ability to pay. Dr.
Moyer states, “I have no earthly idea how many good, solid, caring horse owners
exist (with a population 9 million in the USA!) that either cannot or will not pay for
that kind of work up - but I assume it to be many!!! Thus the need and requests
for any veterinary service, if one is a practitioner, is highly dependent upon the
'market place' and thus is dependent upon the geographic area, quality of the
horse population, and the ability to pay for such services. The equine
practitioners I know have enormous skills based on the whole animal and thus
the ability to provide varying degrees of health care with regard to what the
owner/trainer/client requests.”
Scrutchfield believes that general veterinary practitioners can do a good job of
routine care and can refer complicated cases to specialists. These practitioners
will know more of their patients’ general health, i.e. which ones have Cushings,
etc., and proceed appropriately. “I do believe there is a place for lay technicians.
In a perfect world, lay techs would be working under direct supervision of a vet so
the vet could provide knowledge of general health, pharmacology, and hopefully,
knowledge of dental safety as provided by research done by Dr. Paddy Dixon,
and carry professional liability insurance, etc. much like in the human dental
field.”
Moyer says the ability to fulfill the demand for dental expertise is a wonderful
challenge for the veterinary medical community. He concludes, “In view of all the
collective needs or wishes of horse care providers, equine dentistry is just one
piece of a huge jig saw puzzle spread out on our carpet. The answer or answers
to a perceived growing need in equine dentistry (just using this one example) will
require support, understanding, regulation, training/training/training, as well as
other aspects.”
Copyright, 2008. Karen L. Brown