IAED CERTIFICATION GUIDE

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Revision 2.4.10 Copyright 2010, International Association of Equine Dentistry, Inc. Do not reproduce without the express permission of the IAED, Inc.

Table of Contents I. INTRODUCTION ............................................................................................................................... 1

2. MISSION STATEMENT. .................................................................................................................... 3

3. CODE OF CONDUCT. ....................................................................................................................... 3

4. CERTIFICATION REQUIREMENTS. ................................................................................................... 4

Prerequisites for participation in a Certification Examination: .......................................................... 4

Case Study Guidelines ......................................................................................................................... 5

Sponsor Requirements:....................................................................................................................... 7

Final Steps: .......................................................................................................................................... 7

Certification Exam ............................................................................................................................... 8

Part 1: Theory Examination ............................................................................................................. 8

Section 2: Practical Examination Overview. .................................................................................... 8

IAED Standards & Expectations ........................................................................................................ 11

Section 6: Some Reasons for Automatic Failure ............................................................................... 13

Written Examination Study Topics: .................................................................................................. 14

References: ....................................................................................................................................... 15

Appendices ........................................................................................................................................ 16

Dental Abbreviations ............................................................................................................... 17

Diagnostic Problems and their Codes ......................................................................................... 17

PREFIXES /SUFFIXES/ROOT WORDS ......................................................................................... 18

Illustration: Some Automatic Failures ..................................................................................... 20

Skull of adult stallion showing dentition, lateral view ............................................................. 29

Skull View of Dorsal Surface .................................................................................................... 30

Skull, Left, with sculptured maxillary and conchal sinuses ...................................................... 31

Skull, Left lateral view .............................................................................................................. 32

Dissection of the head and the adjacent part of the neck ...................................................... 33

Dissection of the head and adjacent part of the neckLeft View .............................................. 34

Skeletal topography of arteries of head .................................................................................. 35

Section through head at the level of the last molar tooth ...................................................... 37

Written Exam Examples ........................................................................................................... 38

PRACTICAL TEST POINT DEDUCTION GUIDELINES ....................................................... 40

PRACTICAL TEST SCORING GUIDELINES.......................................................................... 41

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I. INTRODUCTION

The Role and Contribution of the IAED Certification: The International Association of Equine Dentistry, Inc (IAED) Certification program is a reference benchmark consisting of a detailed set of standards for performing acceptable, proven, and recommended analysis and adjustment of equine dentition. Individuals who take the IAED exam voluntarily submit to be held to a higher standard of care and accountability. The overall process serves to document and critique an examinee’s essential topical foundation knowledge, depth of preparation for practice, and actual capability demonstrated for the daily performance of equine dental maintenance procedures. Independent of government and educational institutions, the IAED Certification Exam incorporates a blind practical testing procedure to insure the fairness of the exam process. Not all horse owners can effectively evaluate a practitioner under a similar professional microscope. To that end, the IAED represents the horse and its owner in critically appraising trained applicants per defined reliable standards, to approve or disprove each as an individually capable and proficient practitioner, regardless if veterinary or non-veterinary. Causing no harm is the most crucially relevant concern for the consumer, and is often the least observable, if not the least understood or appreciated aspect of dentistry for the average client watching and/or paying for an equine dental procedure: Buzzing through an equine mouth with a Powerfloat is far from a guarantee that the work is thorough, effective, entirely safe or that it always will improve and prolong the quality of equine life. While it may look impressive to the uninitiated, and has been widely advertised and promoted as an alleged credential by some, power tools can definitely be harmful if performed incorrectly, or to excess without appreciation for the full sum of biomechanical details that distinguishes quality work from marginal competence, and thorough dentistry from incomplete or ineffective partial work. The same holds true for proper hand tool use; though the immediate risks may appear on the surface to be somewhat less without powered amplification, the harm potential with unskilled, unproven hands is virtually equivalent. The IAED Certification process intentionally and specifically confronts these threshold criteria, for every candidate that it examines, and the process serves to winnow the dedicated kernels from opportunistic chaff in the profession. With defined goals, it raises the performance bar for all equine dental practitioners equitably. Some responsible entity, very familiar and proficient inside an equine mouth, needs to represent the voice of the horse that cannot readily complain of its own discomfort caused by undetected, untreated or mismanaged dental issues. There is no perfect testing regime for assessing every criterion flawlessly; however, the IAED’s rigorous Certification program makes an avenue available for committed practitioners who care enough to voluntarily subject themselves and their work to an independent and anonymous evaluation, conducted by experienced and previously Certified peers, that is as thorough, unbiased and critical as is practically possible, and with no inherent conflict of interest that might jeopardize or influence the outcome of their testing results. IAED Certification has become an acknowledged method for validating credentials in this specialty, the most comprehensive and demanding currently

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available worldwide, in an actively modernizing profession that is now centuries old, but still expanding. Both member veterinarians and equine dental technicians can apply and, if successful, achieve equivalent levels of a valid certification by this testing, though their formal secondary or higher education may vastly differ. The ultimate goal is to see what a practitioner knows and can do, and how well he/she actually does it, using the IAED’s standards and past experience as the reference points for comparison. The process has been honed over 20+ years, evolving with advancements in dentistry as they have been developed and it has gained considerable merited recognition, including use as professional criteria in various legal jurisdictions. Once certified, IAED members commit to maintaining their achieved status through continuing education requirements. Every IAED member is expected to comply with local laws for equine dentistry practice but, by taking the voluntary step to successfully Certify, that member not only verifies his/her professional credentials but also commits to remaining subject for the duration of their career to the Association’s own grievance process, which will address legitimate documented complaints from clients and communicate disciplinary actions back to local authorities as needed. This aspect of a workable global accountability, the vulnerability to professional sanction in perpetuity for willing committed practitioners anywhere, is the core that provides the essential value, the legal clout and the merited credibility that justifies the public’s placed trust. In combination, all these factors characterize the depth and scope of the IAED’s commitment not only to its certified member practitioners, and the client owners or responsible caretakers, but most especially to all of the deserving horses directly impacted by the integrity and maintained caliber of our profession.

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2. MISSION STATEMENT. The purpose of the IAED is to promote the advancement of equine dentistry throughout the world amongst veterinarians and non-veterinary dental technicians.

3. CODE OF CONDUCT. Membership in the IAED brings with it certain responsibilities and also a requirement to adhere to the following code of conduct. As members, we have chosen to work with integrity according to the IAED’s standards. Membership in the IAED can be suspended or revoked by the IAED Board of Directors if a serious breach of this code is confirmed through an investigation by the IAED Board of Directors. Members should:

1. Strive to perform equine dental procedures to meet the IAED standard of practice, as set out in our IAED Performance Guidelines.

2. Strive to help horses, their owners, trainers, and riders through the excellent performance of equine dentistry, by improving the horse’s health, comfort, and well-being.

3. Strive to help horses by educating horse owners and enthusiasts about the importance of equine dentistry.

4. Help horses, themselves, and our entire profession by continuing their education to improve their knowledge and skill in performing equine dentistry. Members must meet the continuing education requirements set by the IAED Board of Directors.

5. Promote fellowship among horse owners, equine dental technicians, and veterinarians by conducting a fair and honest practice, avoiding fraud, misrepresentation, or deceit, and by sharing our knowledge and horsemanship with a spirit of cooperation.

6. Not slander or unjustly injure the professional standing or reputation of their peers, other equine dental professionals, or their clients.

7. Avoid compromising a veterinarian-client or veterinarian – client-technician confidentiality relationship that they have entered.

8. Conduct their professional activities in accordance with the laws governing their profession, or accepted practices of the state, province, territory, or country in which they are working.

9. Avoid taking action that pressures, coerces, or achieves agreement among members to conform to a fee schedule or to fix fees.

10. Conduct their practice and dental procedures with the utmost humane consideration of the horse.

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4. CERTIFICATION REQUIREMENTS.

Prerequisites for participation in a Certification Examination: 1) Member of the IAED in good standing. 2) A sponsor* for basic certification:

a) Sponsor must have either basic or advanced certification or, b) Sponsor is an authorized representative of a legal educational body with a comprehensive

equine dental curriculum recognized by the IAED. 3) A completed application. 4) Application fee. 5) Requests for interpreters or translations must be submitted 8 weeks prior to published

examination date. 6) Basic Certification: 250 dental charts candidate's actual case work. Can be submitted via

electronic media*. 7) Advanced Certification : one detailed case study of candidate's actual work. . Can be submitted

via electronic media*.

* See sponsor requirements file ** See case study guidelines Legal note: When practicing dentistry every individual must adhere to all laws within the jurisdiction in which they are practicing. Required veterinary interaction described by this document is for IAED Certification purposes only.

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Case Study Guidelines Required: two (2) copies Bind hard copy in sturdy materials. Electronic media must be verified as compatible with IAED hardware 8 weeks prior to examination. As a rule, case studies should be typewritten, double-spaced, 12 point Times New Roman font, with 1" margins and left justified. Present your case studies with a • Title Page:

o Title (Case Studies) o Name o Address o Phone Number o Examination Date

• Table of Contents • Charts

Dental charts will be grouped according to the following age groups: • 0-2 years of age, • 2-6 years of age, • 6-12 years of age, • 12-20 years of age • > 20 years of age.

• Photos: All photos should have accompanying figure legends. The title page must include: • Name • Address • Phone number • E-mail address of author. • References, where applicable, included at the end of the text

• Included Information:

1. Summary Breed Age Weight Physical Condition

2. Complete history & current medications* 3. Clinical assessment and/or radiographic findings 4. Diagnosis* 5. Treatment plan & explanation of treatment plan 6. Description of procedure exhibiting understanding of proper techniques 7. Post procedure care including medications* and follow-up examination. 8. Results (whether successful or not) 9. Observations concerning future application of this procedure or suggested modifications

if the outcome was less than desirable

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10. Conclusion. * if applicable - in proper protocol Other Inclusions: • Applicable field dental chart and radiographs. • Photographs of the mouth before and after the procedure. • Document follow up examinations with photographs at the end of the document. • Label photographs and radiographs with figure legends. Notes pertaining to contents:

• Permission of owner / treating veterinarian: Get prior permission in writing from the horse owner or owner's agent to present the case to the public. Case records involving other individuals: use of sedation or other medications, and veterinary procedures; requires the written permission from the author of the record.

• Abbreviations:

Use of abbreviations should be kept to a minimum, and abbreviations should not be used to begin a sentence. If an abbreviation is used it must be spelled out the first time it appears. Abbreviations should not be used in titles and sub-titles.

• Product Descriptions:

Products, equipment and drugs should be identified by chemical or generic names or descriptions.

• Units of Measurement:

Body weights, temperatures, and drug dosages must be recorded in metric and traditional US units. All dosages must include route of administration and interval (e.g., 10 mg/kg [4.5 mg/lb), IV, q 12 h). (in proper protocol)

Note: Acceptable formats for the previously mentioned include CD, DVD, jump drive or hard copy.

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Sponsor Requirements: 1. Evaluate the candidate regarding their knowledge, ability and experience in actual supervised

work setting(s). 2. Evaluate and chart the sponsor horse(s) prior to the candidate performing dental procedures. 3. Have the candidate chart the horse(s) correctly and clearly, plan the work. 4. Monitor the candidate’s actual work. 5. Evaluate the candidate’s work upon completion. Advise the candidate of any

recommendations, perform corrections if necessary, stressing areas of concern. 6. Complete the Sponsorship Declaration provided in packet. 7. Return the completed packet documents to the candidate, including

• Sponsor’s horse evaluation and functionality chart(s) • Sponsor’s candidate evaluation • Sponsor Declaration

8. Candidate returns to the IAED: • Application forms • Equipment photos • Sponsorship documents • Required recommendations

9. Upon review and acceptance, the candidate submits their initial non-refundable payment deposit to receive the IAED Study Guide.

Final Steps: 1. Submit your final non-refundable payment for the scheduled examination on time as

indicated. 2. Receive verification of acceptance to the scheduled examination candidate list. 3. Attend the specified venue at the designated location, day and time prepared to test. Attend a

preparatory session with the certification committee at the venue for an explanation of procedures, schedule and answering of your questions.

4. Submit and receive approval of your case charts binder; /AC candidates submit their additional case study.

5. Attend the (1st part) written exam and (2nd part) skull evaluation sections to qualify for the final practical exam section.

6. Attend the scheduled (3rd part) practical exam venue and perform your supervised exam procedures on a live horse.

7. Receive your final overall test results from the IAED Examination team.

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Certification Exam

Part 1: Theory Examination R- The examinee will complete a two-part written examination.

1. Multiple choice theory section 50 to 70 multiple choice and true/false questions

2. Skull evaluation section 10 to 15 stations with displayed pictures and/or skull questions

Candidates must answer 80% correctly on each part to take the practical exam. * If an oral examination or translator is required by the examinee, he or she must submit a

written request at least eight weeks prior to testing.

Section 2: Practical Examination Overview. NOTE: Legal Disclaimer for non-veterinary equine dental practitioners: Legal requirements pertaining to equine dental technicians differ throughout the world regarding the acceptable or allowable dental procedures that can be performed in compliance with defined local laws and codes. To accommodate this regional variability, it is the responsibility of each candidate to advise IAED Certification Officials of any conflict regarding the allowable procedures in their respective area(s) that applies to IAED standards or the testing requirements. Candidates are expected to be knowledgeable regarding complete equine dental maintenance, therefore, if confronted with a procedure that is in conflict with their own legal requirements during the practical testing, they must be prepared to give an acceptable, detailed explanation of the procedure called for, and explain what they would do in the field to comply. General Candidates taking the IAED Certification Examination will have to demonstrate their competent ability to perform appropriate dental maintenance to current IAED standards on a pre-evaluated horse during the final section of the exam, the practical test. The candidate’s testing horse will be picked by lottery from the group available on site. All performed work will be supervised and evaluated by designated IAED exam personnel and the attending veterinarian. Supervision Attending veterinarians and stewards are present to supervise and protect the horse’s welfare, and to help assure a fair and thorough evaluation of the candidate’s performance during the practical exam. Handlers Handlers are to assist only in stabilizing the horse for the candidate and must not inspect, discuss, advise or evaluate the candidate’s work during the practical exam. This is grounds for immediate failure.

EVALUATION of the Practical EXAMINATION:

• Each testing horse will be evaluated and given a point score by the Examiners prior to the practical exam.

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• Examiners will not be present during the practical exam procedures to assure candidate

anonymity.

• The stewards and the attending veterinarians only are the only supervision allowed during the practical exam procedures.

• At completion the anonymous candidate’s work will be inspected and receive point deductions for results or procedures deemed not to IAED standards per the Examiners’ final overall evaluation.

• Three (3) Examiners will evaluate each horse and determine candidate’s test score.

• Upon successful completion, the candidate will have achieved the “Certified” or “Advanced Certified” level of IAED membership and, upon acceptance, be subject to the entitled rights and recognized obligations that the association conducts in the interest of our profession.

Examination Procedures: 1. Examinee will be given sixty minutes excluding mandatory rest periods to complete practical

testing. 2. The examinee must display a clean, organized and professional work area for the practical

test. • Required equipment included a GFI, cold sterilization chemicals. • Safety glasses mask and/or some form of dust control, high quality head light,

surgical gloves, ear plugs (when dealing with decibels over 100), etc are suggested. 3. The examinee must complete a chart provided by the IAED identifying the dental conditions

found in the oral cavity and any other observations characteristic of the horse being evaluated.

4. The head steward will compare the “Official’s Chart” with the examinee’s chart. 5. The examinee has the right to request one new horse during the first 5 minutes of work.

• Acceptable reasons to exercise this right are: i. overly fractious horse

ii. horse sedates inadequately iii. pre-existing health problems which would endanger the animal should it be

used for testing. • The Head Steward and/or Certification Veterinarian must approve the request.

6. The examinee must notify the Steward if a pulp is accidentally exposed by a dental procedure. 7. The Head Steward may interrupt the examinee's work periodically for observation purposes,

this is a normal protocol, and the examinee should not be alarmed. 8. If there is a question about safety and/or welfare of the horse the head Steward can require

that the dental procedure cease. Some examples are unsafe or inhumane horsemanship, incorrect use of instrumentation, and prolonged intra-oral procedures.

9. The horse will be relieved of dental procedure every 10 minutes (examinees discretion) for 2 to 3 minutes. At commencement of the break the clock will stop and restart when horse is ready for dental procedures.

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10. All extractions, including the removal of wolf teeth and deciduous teeth or fragments of teeth should be discussed with the steward and approved by the certification veterinarian prior to work being performed.

11. All extracted teeth and fragments are to be retained for the examiners and owners. 12. The examinee can pre-examine the horse for 3 minutes prior to sedation.

• After the horse is sedated; o The handler will hold the horse. o The examinee must wait 5 minutes before any further interaction occurs with

the horse. This time is to be utilized to

• Compile notes on recognized pre existing conditions • Create the dental chart • Prepare to work.

13. It is expected that the majority of the charting of the oral cavity will be done prior to commencement of the dental procedure. If the examinee’s chart differs significantly from the examiners’ official chart, the Steward may request further explanation or documentation by the examinee before allowing the dental procedure to continue.

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IAED Standards & Expectations Requirements of Maintenance and Rehabilitation of the Dental Arcades 2mm rule: A reduction should not remove more than 2mm of tooth beyond the most proximal point of natural occlusal surface. In this statement, the word “proximal” refers to the part of the crown that is closest to the pulp of the tooth (see illustration in appendix).

A. Incisors (see illustrations) 1. The incisors should not prevent or interfere with the lateral excursion or rostral-caudal

movement of the mandible. 2. The incisors should not displace the mandible from a neutral position. 3. The incisor length should not prevent functional cheek teeth occlusion. 4. Malocclusions should be corrected using the 2mm reduction guidelines. 5. When assessing the incisor occlusal plane from the front, a line drawn from left to right along

the occlusal surface of the incisors should be parallel to an imaginary line drawn to connect the two temporal mandibular joints (TMJ’S).

6. Note if the temporal mandibular joints (TMJ’s) are offset (asymmetric) to each other they will have individual horizontal (parallel) planes.

7. When viewed from the side, an imaginary line drawn along the incisor occlusal surface should end at or near the TMJ where possible.

B. Canines (see illustrations) 1. Canines are the exception to the 2mm reduction guideline. Due to the inherent differences in

length of exposed crown and various age groups, it is difficult to use a specific measurement for acceptable reduction of canines.

2. If the canine has been addressed prior a maximum reduction of 2 mm is suggested. 3. If the canine has not been addressed prior than a maximum reduction of 5 mm is accepted. 4. It is expected that the canine will be buffed and rounded.

C. Wolf Teeth (see illustrations) 1. Wolf teeth are to be extracted with approval of the steward and certification veterinarian only.

D. Bit Seats (see illustrations) 2. The shape of the bit seat must not compromise the integrity of the tooth. Ideally there should

be minimal loss of functional occlusal surface. 3. Correct table angles are to be maintained and the finished bit seat should be smooth.

E. Cheek Teeth (see illustrations) 1. Floating to remove sharp points protuberant to soft tissue on the buccal and lingual aspect of

the cheek teeth. 2. Malocclusions

a. Establish, restore or maintain optimally functional molar arcades correcting malocclusions protuberant to the opposing occlusal surface or anything impeding mastication, lateral or rostral-caudal movement, while preserving the maxim natural occlusal surface possible for the horse in question.

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b. Malocclusions should be corrected using the 2mm reduction guideline. c. Functional table angles and planes should be restored and /or maintained.

3. Functionality a. The inter-occlusal space of the cheek teeth (at rest on a mandible support, such as a

suspension halter or head stand) should be no greater than 2mm. b. Lateral excursion before cheek tooth occlusion (at rest on a mandible support), should

be no greater than the measurement taken prior to dental procedure.

Other Conditions to be Identified and/or Addressed 1. Removal of Teeth

a. Removal of retained fragments, permanent teeth and deciduous teeth should be discussed with the steward and approved by the certification veterinarian prior to their removal.

b. The steward’s decision concerning the above will be final. c. If the examinee disagrees with this decision it should be noted on their dental chart by

the examinee. d. Appropriate removal technique should be displayed, i.e. elevation of the gingiva,

placement of forceps etc. e. Nerve blocks may be requested, (the certification veterinarian’s decision will be

final).

2. Bone Spurs a. Bones spurs and the possible treatment of bone spurs are to be documented on the

dental chart but no further action is to be taken.

3. Malformations and Pre Existing Conditions of the Teeth and Oral Cavity a. Malformed teeth b. Periodontal disease c. Decay d. Openings in the occlusal surface, i.e., open pulp chambers etc. e. Buccal and or lingual lesions f. Damaged bars, damaged tongue g. Fractured teeth

Note: When present, these conditions and others, should be noted with an appropriate treatment/observation plan. This could be as simple as referring the patient to another practitioner.

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Section 5: Advanced Certification– CASES (In addition to the preceding test guidelines) • Correct or compensate for advanced or compromised dentition and oral cavity disorders • Correctly achieve/maintain the best possible appropriate occlusion and lateral excursion of

the mandible when considering the well-being of the horse, its age, and the conformation and/or existing deformity/pathology of the arcades;

• Maximize comfort during mastication, prevent or delay further tooth loss, and preserve arcade /oral cavity integrity to the best extent possible.Identify and chart clinical signs of periodontal disease;

• Estimate and grade the severity (see Baker and Easley, 2nd edit., pages 117, 165-166). • Identify and chart periodontal pocketing. • Identify and chart possible dental caries; estimate and grade severity (see Baker and Easley,

2nd edit., page 166).

Some Reasons for Automatic Failure Examiners will make the final decision, after considering the recommendations of the Head Steward.

1. If a reduction removes more than 2mm of tooth beyond the most proximal point of natural occlusal surface. In this statement, the word “proximal” refers to the part of the crown that is closest to the pulp of the tooth.

2. Incorrect altering and or doming of the occlusal table surfaces. 3. Excessive and or unnecessary reduction of cheek teeth occlusal surfaces 4. Premature or single tooth strike, causing undue pressure. 5. Improper and destructive dental procedures observed by the attending Stewards. 6. Failure to document and advise the steward of an exposed pulp cavity. 7. Inability to plan and explain a procedure for protecting an exposed pulp cavity. 8. Evidence of excessive trauma in the oral cavity. 9. Gapping of the incisors. 10. Creating a malocclusion or irregularity for example, creating a ventral curvature, diagonal, or

dorsal curvature. 11. Handler having input either verbal or physical outside the immediate requirements for

supporting the horse. 12. Premature removal of deciduous teeth.

Please be advised of the following notes as they are expected to be adhered to all matters: • If any aspect of the examination requirements are not fulfilled the examinee will not be

allowed to continue. • This interruption must be documented on the dental chart by the steward and identified for the

examiners. The examiners will consider the observations of the steward and will have the authority to declare an immediate failure.

• If the examinee has any questions or feels that a particular issue should be brought to the attention of the Steward they should do so immediately.

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Written Examination Study Topics: 1. GROSS ANATOMY - of the Equine Head Identification - Location - Function

a. Bones b. Muscles c. Veins and Arteries d. Primary Facial Nerves e. Salivary Glands

2. TOOTH STRUCTURE 1 Identification - Location - Function

a. Dental Nomenclature b. Dental Structure c. Gross Anatomy of Equine Teeth d. Pulp Horn Numbering

3. PRINCIPLES OF MASTICATION 1 4. MAJOR ABNORMALITIES - found in the oral cavity 1, 2

a. Congenital b. Disease c. Developmental.

5. TERMINOLOGY 6. AGING 1 7. DENTAL PROPHYLAXIS 1, 2 Reading Material 1. Equine Dentistry - Edited By Gordon J. Baker and Jack Easley 2. Manual of Equine Dentistry - By Tom Allen, DVM 3. Glossary of Equine Dental Terms, p 329 Equine Dentistry - Edited By Gordon J. Baker and Jack Easley 2nd ed. 4. EquiMation 3-D – by Equine Animations 5. Equine Dental Abbreviations (Appendices) 6. Anatomical Study Guide (Appendices) 7. Charts (Appendices) 8. Standard Triadan Nomenclature & Terminology (Appendices)

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References: Michael Q Lowder, DVM, MS and P. O. Eric Mueller, DVM, PhD: Dental Embryology, Anatomy, Development and Ageing, The Veterinary Clinics of North America, W. B. Saunders and Company 1998 Baker, Gordon J DVM and Easley, Jack DVM: Equine Dentistry, W B Saunders Company, LTD, London, Edinburgh, New York, Philadelphia, Sydney, Toronto, 1999 P. M. Dixon, MVB, PhD, MRCVS: Dentistry, The Gross Histological and Ultrastructual Anatomy of Equine Teeth and Their Relationship to Disease, American Association of Equine Practitioners Conference 2002. S. R. Mitchell BSc; S.A. Kempson, BSc PhD; P. M. Dixon, MVB, PhD, MRCVS: Structure of Peripheral Cementum of Normal Equine Cheek Teeth, Journal of Veterinary Dentistry, Volume 20, Number 4, December 2003 Shoemaker Judith DVM: Equine Dentistry; A Major Influence on Biomechanical and Neuralgic Function, Wild West Veterinary Conference 2003 Shoemaker Judith DVM: Gait Analysis: Diagnosing The Dance, Wild West Veterinary Conference 2003 Allen Tom DVM: Manual of Equine Dentistry, Mosby, St Louis, Missouri, 2003 Jeffrey, Dale: Equine Dentistry Manual III, World Wide equine Dental Supply Company, Waverly, Nebraska, 1989 Mosby’s Dental Dictionary, Thomas J Zwemer Baker, Gordon J DVM: Equine Temporomandibular Joints (TMJ): Morphology, Function and Clinical Disease, AAEP Proceedings 2002 I.T. Dacre, BVSc MRCVS and P.M. Dixon MVB. Ph.D. MRCVS, Clinical aspects of the Dentino-Pulpal Complex in Equine Dental Disease. Lynn A. Caldwell, DVM, Canine Teeth in the Equine Patient - The Guide to Eruption, Extraction, Reduction and Other Things You Need to Know, AAEP Focus on Equine Dentistry 2006. Nickel, R; Schummer, A; Seiferle, E: The Viscera of the Domestic Mammals. Verlag Paul Parey, Springer-Verlag, Berlin, hamburg New York, Heidelberg. 1979 Fortkamp, John, Simultaneous Occlusion. Horse Dentistry & Bitting Journal, Vol 6 Issue 3. August 2005 S. J. Goss DVM/ Dale Wearing: EquiMation 3D, Equine Animations

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Appendices

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Dental Abbreviations Diagnostic Problems and their Codes

Incisors: TO Tooth overgrowth, overlong: Determination usually made after cheek teeth reduction that incisors need to be reduced to achieve balance. MAL2 Class II malocclusion, overbite, brachygnathism, mandibular brachygnathism: Extension of upper teeth vertically beyond lower teeth, i Defined by the term "distoclusion", where some or all of the mandibular teeth are distal in relationship to their maxillary counterparts. MAL3 Class III malocclusion, underbite, prognathism, mandibular prognathism: Defined by the term "mesioclusion", where some or all of the mandibular teeth are mesial in their relationship to their maxillary counterparts. CV Ventral Curvature: Upper central incisors extend beyond the level of the upper intermediate and corner incisors, "smile". CD Dorsal Curvature: Lower central incisors extend beyond the level of the lower intermediate and corner incisors, "frown". DGL Diagonal: Lower incisors longer on either the left side or right side. Defined with respect to mandibular incisors longer on arcade number 300 or 400. DGL/4 400 arcade longer DGL/3 300 arcade longer

Cheek Teeth: HK Hook: Excess crown longer than wide.2 RMP Ramp: Excess tooth wider than long.2 WV Wave: More than one tooth with excess crown.2 STP Step: One tooth only with excess crown.2 ETR Excessive Transverse Ridges: Ridges in excess of 3 mm in height.2 PTS Sharp Enamel Points: Buccal cusps on maxillary cheek teeth and lingual cusps on mandibular cheek teeth sharpened from wear (attrition). CUPD Cupped: Crown worn past infundibulum. Still has crown above gingival margin. Can also be seen in lower teeth. EXP Expired: Attrition to gingival margin with crown connecting all roots. EXP/RTR Expired/ Retained Tooth Root: Attrition to gingival margin with no crown present O Missing/Absent RD Retained Deciduous: Caps FX Fracture FX/SAG Sagittal: Below gum line (subgingival) through infundibulum. FX/WDG Wedge: Outside infundibulum. FX/CHIP Chip: Occlusal margin only. Not fractured down to gingiva. IPM or D Interproximal: Between teeth. Mesial or distal. B Buccal P Palatal L Lingual

Example: Fractured 109 palatal aspect of tooth, does not extend to gingival margin: 109 FX/CHIP/P. This fracture is possibly reduced with normal odontoplasty.

Example: Wedge fracture of 209 on distal interproximal surface extending to gingival margin: 209 FX/WDG/IP. This fracture cannot be reduced completely with routine odontoplasty, may be restored, and periodontal disease treated if present.

TI "Tooth impacted", "Blind": Not completely erupted. Partially or fully covered by bone or soft tissue. Commonly seen with wolf teeth. RRT Retained Root Tip: Portion of root or tip retained. RTR Retained Tooth Root.

Soft Tissue: LAC/B Buccal Laceration LAC/L Lingual Laceration AB Abrasion PD Periodontal Disease Stage 1 - 4 PP Periodontal Pocket

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Other: INF/CA Infundibular Cavity CA Caries

Procedures: OD Odontoplasty: Reduction of excessive crown of occlusal surface. FLT Float: Reduction of lingual and buccal enamel points. BS Bit seat: Rounding of rostral margins of 2ndpremolars. X Extraction, simple XS Extraction, sectioned XSS Surgical extraction 506X,606X,etc Cap Extraction or Retained Deciduous Extraction 105X,etc Wolf tooth extraction I/OD Incisor Odontoplasty: Incisor reduction

For other abbreviations see AVD list of dental abbreviations.

1. Wiggs RB, Lobprise HB. Veterinary Dentistry: Principles and Practice. Lippincott Raven, 1997. 2. Greene, S. Personal communication.

PREFIXES /SUFFIXES/ROOT WORDS a- or an: lack of (Aplasia - not growth) -al: referring to, pertaining to (Gingival = pertaining to gums) bi-: two, double (Bilateral = relating to or having two sides) -blast: to form; to produce (Osteoblast = bore formation) brachy: shortened (Brachygnathism = shortened jaw) -dont: tooth (Lophodont = cheek teeth with lophs) dys-: faulty or incorrect (Dysfunctional = incorrect function) endo-: inner, within (Endodontic = referring to inner part of tooth) -ectomy: surgical removal of (apicoectomy = removal of apex or root of tooth) epi-: upon, following, subsequent to (Epiglottis = cartilage flap that is located behind the tongue which folds back over the larynx during swallowing) -genesis- to create or form (Osteogenesis = bone formation) -gloss- tongue (Glossitis = inflammation of tongue; Hypoglossal under tongue) -gnath: jaw (Brachygnathism - shortened jaw; gnathoplasty = reparative surgery of the jaw) hyper- : increased; more than normal (Hyperplasia = overgrowth, as seen in epulis, known as gingival hyperplasia hypo-: decreased; less than normal (Hypoplasia - undergrowth as seen in infundibular cemental hypoplasia) infra-: denoting a position below the part denoted by the word to which it is joined (infraorbital = below the orbit of the eye -ism: condition of (Anisognathism = condition in equine where the maxillary arcades are wider than the bmandibular arcades) -itis: inflammation of (Gingivitis = inflammation of the gums) mal-: faulty or incorrect (dental malocclusion = incorrect occlusion of the affected teeth) -odonto- : denoting a tooth or teeth (Odontectomy = removal of a tooth or teeth; Oligodontia = abnormally reduced number of teeth oligo-: few or little (Oligodontia = abnormally reduced number of teeth) oro-: mouth (oral = or-mouth/al-pertaining or referring to, thus oral surgery is surgery pertaining to the mouth) -osteo-: bone (osteotome - bone cutter: periosteum - the fibrous membrane covering bone)

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peri-: around (periodontal = pertaining to structures around the tooth) -plasia: formation (Infundibular cementyal hypoplasia - under formation of cemental layer) pre-: before or in front of (pre-existing = occurring before now: premature = too early, occurring before usual or expected time) pro-: before or forward (prognosis = foretelling of an outcome; prognathism = abnormal forward projection of jaw) rostral: towards the nose; beak-shaped (The incisors are more rostral than the canines.) stom- : mouth (stomatitis = inflammation of the mouth) super-: above, excess (supernumerary teeth = exceeding the normal number of teeth) supra-: denoting a position above the part indicated by the word to which it is joined (supraocclusion = an occlusal relationship in which a tooth extends beyond the occlusal plane; supraorbital = above the orbit of the eye) -tome: cutter (osteotome = instrument to cut bone) uni-: one, single (unilateral = confined to one side)

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Illustration: Some Automatic Failures 1. If a reduction removes more than 2mm of tooth beyond the most proximal point of natural occlusal

surface. In this statement, the word “proximal” refers to the part of the crown that is closest to the

pulp of the tooth.

2mm

Most proximal point of natural occlusal surface

pulp

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2. Incorrect altering and or doming of the occlusal table surfaces.

3. Excessive and or unnecessary reduction of cheek teeth occlusal surfaces

4. Premature strike, causing undue pressure on a particular tooth.

After Small Correction

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5. Failure to document and advise the steward of an exposed pulp cavity.

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Corrections all done in accordance with the 2mm rule while maintaining maximum natural occlusal surface.

Maximum allowable incisor correction or reduction.

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Maximum allowable canine reduction.

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Float does not greatly alter the width of the occlusal surface.

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Reduced in accordance with the 2mm rule. Note corrections done while maintaining maximum natural occlusal surface.

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Corrections incomplete or not done in accordance with IAED standards.

Incomplete corrections, ETR still impedes anterior, posterior movement of mandible.

Failed to address table angle causing a single tooth contact upon full lateral excursion resulting in loss of functional occlusal surface.

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Upper incisor table angle altered causing single tooth contact resulting in loss of occlusal surface contact.

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Diagrams form the Equine Head Anatomical Study Guide -prepared for the use of IAEDT/IAED Certification

Skull of adult stallion showing dentition, lateral view

1. First Incisor 2. Second Incisor 3. Third Incisor 4. Canine 5. Second Premolar 6. Third Premolar 7. Fourth Premolar 8. First Molar 9. Second Molar 10. Third Molar 11. Rostral Compartment of maxillary sinus 12. Caudal Compartment of maxillary sinus

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Skull View of Dorsal Surface

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Skull, Left, with sculptured maxillary and conchal sinuses

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Skull, Left lateral view. Bone outlines demarcated by color

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Dissection of the head and the adjacent part of the neck; left view, First Layer.

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Dissection of the head and adjacent part of the neckLeft View, Third Layer

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Skeletal topography of arteries of head. Superficial vessels, Drawn from corrosion specimen

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Section through head at the level of the last molar tooth View of rostral surface

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Written Exam Examples 1. Edema of the hard palate mucosa, which is a normal local circulatory consequence of incisor eruption is called:

a. lymphosarcoma b. lophodont c. lampas d. lingual frenulum

2. The long curved root of the lower canines (304,404) is deeply imbedded in a curved socket. This prevents simple elevation of these teeth in most cases.

a. True b. False

3. The grinding of food by the teeth is called: a. malocclusion b. mastication c. molarization d. maxillary

4. The presence of wolf teeth (05’s) may cause bitting problems because: a. a sharp or displaced wolf tooth can be painful when pressure is placed on the bit b. a proper bit seat can not be created c. occasionally a loose or diseased wolf tooth can lead to head shaking d. all of the above

5. In the Universal/Triadan System, the lower left third premolar is known as:

a. 307 b. 207 c. 308 c. 408

6. The periodontal ligament: a. functions as a shock absorber for occlusal forces b. secures the tooth to the alveolar bone c. is under continual remodeling as the tooth erupts d. all of the above

7. The muscles of mastication are supplied by the 5th cranial nerve (trigeminal). a. True b. False

8. If a 12 mm beveled elevation is noted on the 308, 309, and 310, one should: a. wait until the elevation is 25mm tall before cutting it b. remove the elevation with an equi-chip tool and float c. remove the elevated teeth and the opposing teeth d. reduce the elevated teeth with an electrical burr and/or float

9. A horse with sharp buccal points on the upper arcades: a. may resist the full mouth speculum and floating may be beneficial before the speculum is applied b. often have adjacent ulcerated buccal mucosal c. perform better when the noseband is tightened on the bridle d. both a. and b are correct.

10. The occlusal surface of an equine molar is composed of: a. enamel, dentin and cementum b. calcified dentin interconnected with calcified collagen fibers c. enamel prisms arranged in a parallel manner d. enamel and cementum

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11. Which of the following is not one of the three components of the chewing cycle, a repetitive pattern of mandibular movement: a. Opening stroke b. Power stroke c. Infarcted stroke d. Closing stroke

12. Oral neoplasia can involve tissues of teeth, bone, and soft tissue. a. True b. False

13. A condition where one or both molar arcades wears at an extremely steep angle resulting in limited lateral jaw movement is called: a. Smooth mouth b. Shear mouth c. Sow mouth d. Supernumerary mouth

14. Rostral and caudal hooks can: a. Limit rostrocaudal jaw motion b. Be left in place if the horse is floated by hand c. Aid in cutting course hay fibers d. Be saved for unexpected fishing trips

15. A root meaning pertaining to the tongue:

a. ‘stom’ b. ‘tome’ c. ‘gloss’ d. ‘brachy’

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PRACTICAL TEST POINT DEDUCTION GUIDELINES 1. The examiners must know all points allocated throughout the arcades. 2. If a tooth had a value of 10 points, the examiner deducts the percentage that was left unattended. i.e. 70% of the procedure was completed = 3 point deduction. 3. Altering Table angles – point deduction to immediate failure. 4. Rounding occlusal surface - point deduction to immediate failure 5. Incisor - Point deduction to immediate failure

• uneven horizontal plane • incorrect occlusal angle • gaping incisors

6. Canine Point Deduction Leaving sharp edges – over reduction of canine.

7. Floating Point Deduction.

• Deduction no less than ½ point and no more than 10 points per arcade considering the overall finish and clinical correctness.

• If the float is clinically significant the examiners will deduct no less than 3 points.

8. Bit seat Point Deduction

• Deduction no less than ½ point and no more than 10 points per arcade considering overall finish and clinical correctness.

• If the bit-seat is clinically significant the examiners will deduct no less than 3 points.

NOTE: A CANDIDATE CAN RECEIVE FULL POINTS PER ARCADE FOR THE FLOAT AND THE BIT SEAT

9. Wolf Tooth Point Deduction

• If a wolf tooth is broken off – deduct for sharp edges left 3 to 5 points. • If the remaining root can be removed deduct 5 to 10 points.

10. TOTAL POINT DEDUCTION – if problem is missed by candidate.

11. Presentation Deduction

1 to 10 point deduction can be given by the head steward.

IMMEDIATE FAILURE

• Over floating – over aggression- of singular reduction • Gapping of Molars – over reduction of clinical crown • Gapping Incisors – over reduction • Altered Table Angles – inverting angle or rounding occlusal surface • Excessive Trauma – tissue damage • Lack of concern for the safety and well being of the horse – reckless procedures • Improper use of instrumentation – creating a dangerous environment for all concerned. • Any candidate displaying lack of professionalism will be excused from the testing process. • NO BONUS POINTS WILL BE GIVEN

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PRACTICAL TEST SCORING GUIDELINES MOLARS

10 point maximum per tooth that requires correction adjustment 240 point maximum

(ie. Two tooth wave could score a maximum of 20 points) (60 points per arcade)

FLOATING

Maximum 10 points per arcade 40 point maximum

BIT-SEATS

Maximum 10 points per arcade 40 point maximum

CANINES

Maximum 2.5 points per canine 10 point maximum

INCISORS

Advanced Certification 60 Points maximum

Basic Certification 20 points maximum

WOLF TEETH

• Upper wolf teeth (normal placement) 10 pts per tooth maximum

• Wolf teeth – set adjacent and lingual to the 106, 206 306 and 406 15 pts per tooth maximum

• Lower wolf teeth – (normal placement) 15 pts per tooth maximum

• Wolf tooth fragments all locations 10 pts per fragment location

• Unerupted wolf teeth (blind wolf teeth) 15 points per tooth

DECIDUOUS MOLARS and INCISORS (cap removal)

• All deciduous (caps) removed 10 pts per tooth maximum

• All deciduous (cap) fragments regardless of size 5 pts per fragment max.

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Suggested Reading 1. GROSS ANATOMY – of the Equine Head

• Identification – Location – Function • Bones, Foramens, Sinuses, Fissures, Canals, Crests, Arches, Teeth, Sutures, • Muscles, Arteries, Veins, Nerves, Glands

Source: Study Guide p. 29

2. TOOTH STRUCTURE

Identification – Location – Function

• Dental Nomenclature Equine Dentistry pp. 25 • Dental Structures Equine Dentistry pp. 30 - 38 • Gross Anatomy of Equine Teeth Equine Dentistry pp. 38 - 39 • Pulp Horn Numbering Equine Dentistry pp. 93

3. PRINCIPLES OF MASTICATION

• Equine Dentistry pp. 44/50 - 54 • Manual of Equine Dentistry pp. 2/55/79

4. MAJOR and COMMON ABNORMALITIES – found in the oral cavity

a. Common Dental Abnormalities Manual of Equine Dentistry pp 71 – 107

b. Congenital Equine Dentistry pp. 166

Manual of Equine Dentistry pp. 93

c. Periodontal Disease Equine Dentistry pp. 115 - 119

d. Developmental Equine Dentistry pp. 69 - 77

5. TERMINOLOGY Equine Dentistry pp. 329

6. AGING Equine Dentistry pp. 55-56

7.DENTAL PROPHYLAXIS Equine Dentistry pp. 222

7. TRIDENT SYSTEM Manual of Equine Dentistry pp. 80

READING and STUDY MATERIAL

1. Equine Dentistry – Second Edition Edited by Gordon J. Baker and Jack Easley 2. Manual of Equine Dentistry – By Tom Allen, DVM 3. Equine Dental Abbreviations 4. Prefixes/Suffixes/Root Words 5. Anatomical Study Guide

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