WSAVA Nov 2021 Proceedings - Flipbook - Page 19
this position, the temporomandibular joints will be superimposed on each
other - the nose is elevated approximately 30o to separate the joints. The
joint closest to the beam will appear forward to the farthest from the film
when produced in the image.
Orientation
Once the images are produced, they are evaluated for technical quality
and correctly oriented for proper interpretation. Firstly, evaluate the
images produced for the quality of exposure or the presence of any processing errors. Secondly, assess for positioning errors. Confirm the area
of interest has been captured. A sound knowledge of the oral anatomy of
the species is required in order to assess that all dentition and surrounding structures have been imaged. Further assess the image for any
foreshortening, elongation, blurriness due to movement (of the generator
or patient), distortions, opacities or cone-cutting (appears as a white
crescent). Other factors to consider are the summation effect, tangential
effect and the need for the ‘tube shift’ technique to locate the position of
overlapping structures.
Dental radiographs are oriented using a ‘labial/buccal mounting’ technique. The images are rotated into the following position: the roots of the
maxillary teeth should be pointing upward and the roots of the mandibular
teeth downward. The occlusal views are then placed centremost with the
first incisors oriented at midline and the molar teeth to the periphery. This
orientation now reflects the patient facing you – where what appears to
you on the right, is the left side of the patient and what appears to you on
the left being the right side of the patient.
In order to efficiently produce diagnostic dental radiography, it is vital
to not only have a sound knowledge of the oral anatomy (including the
subgingival structures), but the ability to utilise multiple radiographic
techniques to suit the variations seen in the anatomy of the small animal
general practice patient.
Sources:
• Lobprise, H., & Dodd, J. (2019). Wiggs’s Veterinary Dentistry Principles
and Practice, 2nd Edition. Hoboken, NJ: John Wiley & Sons Inc.
• Bellows, J., Berg, M., Dennis, S., Harvey, R., Lobprise, H., Snyder, C., . . .
Van de Wetering, A. (2019). 2019 AAHA Dental Care Guidelines for Dogs
and Cats. Retrieved from American Animal Hospital Association: JAAHA.
org
• Niemiec, B., Gawor, J., Nemec, A., Clarke, D., McLeod, K., Tutt, C., . .
. Jouppi, R. (2020). World Small Animal Veterinary Association Global
Dental Guidelines. Journal Small Animal Practice, Vol 61.
• Dupont, G., & DeBowes, L. (2009). Atlas of Dental Radiography in Dogs
and Cats. St. Louis, Missouri: Saunders Elsevier.
0004
ORAL EXAM AND CHARTING
G. Morgenegg
OBFELDEN/Switzerland
Qualifications:
GOTTFRIED MORGENEGG
DVM
G.MORGENEGG@TIERARZT-MORGENEGG.CH
ORAL EXAMINATION AND CHARTING
Gottfried Morgenegg
An accurate oral diagnosis is based on the results of the case history,
clinical examination and recording, dental radiographs and laboratory
tests if indicated. The examination must be performed in a systematic
way to avoid missing important details. All findings should be recorded in
the medical record (Niemiec et al., 2020).
It is of great importance to follow a prescribed protocol during the examination to avoid overlooking details. Experience has shown that many
inexperienced examiners forget to note the missing teeth.
A complete examination contains:
Recording of the situation with photographs
Visual inspection of head and oral cavity
Tactile examination of dental crowns (dental explorer) and the periodontium (periodontal probe)
Dental radiographs
Recording of the results manually or digitally
Oral/Dental Examination
Examination on conscious patient
Some parts of the examination can be performed on a conscious patient.
The clinical investigation begins with inspection of the head, by assessing
the eyes, symmetry of the head, swellings, lymph nodes, nose and lips.
Then, the occlusion and the functionality of the temporomandibular joint
(TMJ) should be evaluated. The dental examination includes noting the
stage of dentition (primary/permanent), as well as any missing, fractured,
or discoloured teeth. The examination of the soft tissues of the oral
cavity includes oral mucosa, gingiva, palate, dorsal and ventral aspect
of the tongue, tonsils, salivary glands and ducts. The examiner should
evaluate the oral soft tissues for masses, swelling, ulcerations, bleeding
and inflammation. The conscious periodontal examination should focus
on gingival inflammation, calculus deposits and gingival recession. The
identification of individual teeth should be performed according to the
modified Triadan System (Floyd, 1991).
Examination under general anaesthesia
A thorough examination can only be performed under general anaesthesia. After induction of anaesthesia, placement of the ET tube, inflation of
the cuff and fixation of the ET tube, and stabilisation the patient, the examination should be performed in a detailed and systematic manner with
the charting performed simultaneously. After the visual inspection of the
entire oral cavity, the tactile examination is carried out in two steps using
the appropriate instruments. First, the dental crowns examined for defects
such as tooth wear, resorption, caries, pulp exposure, and enamel disease
with a dental explorer. Then, sulcus/pocket and furcation exposure are
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