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On course
  1. Sam Luis Hole, equine dentist

Abstract

Having recently completed a certificate in equine dentistry, Sam Luis Hole attended BEVA's advanced dentistry course for veterinary surgeons, a two-day course organised by Henry Tremaine and held at the University of Bristol. The course concluded on the third day with an international equine dentistry research forum, at which Sam presented some current research.

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Who is the course for?

This new course combines aspects of BEVA's advanced dentistry and advanced dental techniques wetlab courses, and is aimed at delegates with a good level of dental knowledge who have previously undertaken a two-day dentistry course and are experienced with routine equine dental care. The research forum that followed was for veterinarians, postgraduate students and residents with an interest in equine dental research or clinical dentistry.

How is it structured?

The advanced course comprised morning lectures on advanced equine dental techniques delivered by experts. After lunch, delegates were given wetlab-based demonstrations, using cadaver specimens, and the opportunity to apply some of these procedures to clinical cases.

The research forum on the third day involved invited speakers involved in equine dental research or clinical practice. Research or case series results were presented for discussion with a panel of experts and the attending audience.

When did you do it?

July 11 to 13 this year.

Why did you do it?

The high tutor to delegate ratio on the BEVA practical dental courses allows maximum delegate participation. You also have the opportunity to see and trial the latest equine dental techniques and equipment. This year Manfred Stoll, from Germany, was speaking and demonstrating his novel technique – ‘minimally invasive transbuccal extraction’ (MTE).

What did it entail?

Lectures kicked off with an update on equine developmental dental disorders by Paddy Dixon, followed by the management of disorders of wear by Jack Easley, and the management of equine diastemata and periodontal disease by Mr Tremaine. After a coffee break, Travis Henry spoke on restorative techniques and endodontics. The morning programme concluded with Dr Stoll speaking on exodontia (different techniques and applications, including his MTE technique).

The afternoon practical sessions on both days involved rotating through four wetlab stations and two clinical stations. Advanced dental techniques were demonstrated to small groups by the tutors and delegates were then encouraged to have a go themselves. The two clinical stations allowed delegates to diagnose and treat conditions in live horses, with emphasis on chronic diastemata and periodontal disease.

The second day opened with Mr Tremaine speaking on nerve blocks in equine dentistry and his view that the use of dental nerve blocks is key and always time well spent. Professor Dixon followed with an update on acquired disorders. Dr Easley gave a review of orthodontic techniques and Dr Henry discussed advances in imaging for equine dentistry, including intraoral radiography and CT.

The take home messages for radiography was preparation, the use of metallic markers to aid diagnosis and that radiographs are vital in any advanced dental assessment. Professor Dixon concluded the lectures with a review of sinusitis and a discussion on the challenging nature of oronasal fistula management. All lectures were informative, with great use of high-quality photographs and video. Questions were taken at the end of the session and discussed freely.

The dentistry research forum was divided into four sessions, each chaired by a world-renowned expert; Professor Dixon, Mr Tremaine, Dr Henry and Dr Easley. The presentations were wide and varied, and stimulated much debate and discussion. Equine veterinary dentistry, including surgical and advanced dentistry, has progressed significantly over recent years and could now be considered to be a field in its own right and a standalone specialism. However, at present, there is a weak evidence base, despite significant work from an Edinburgh university research group, producing ever-increasing numbers of publications on dental anatomy, pathology, surgery and imaging. There is a lack of case-control studies on advanced dental techniques, although much anecdotal success is reported. Correcting this lack of research and case-control studies was the driving force behind the forum, with the hope of developing and validating equine dentistry further, as a science and a specialism.

Was it worth it?

In short, ‘yes’. The small group size meant that there was great access to the tutor's expertise and a change of tutor at each practical station allowed all delegates to be exposed to the opinions and techniques of each expert. Constant discussion between delegates and tutors regarding technique, and the sharing of ‘tips’, was, as always, a very beneficial part of a practical course.

Summary

Personally I got a great deal from the practical nature of this course, and having both time and expert guidance to master techniques on cadaver heads gave me renewed confidence and assurance of my own skills. The course was immensely valuable in showing equine vets in practice the advances in equine veterinary dentistry and the level of specialist care that we can attain within horses' mouths.

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