WSAVA Nov 2021 Proceedings - Flipbook - Page 20
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evaluated with a periodontal probe.
Mobility: the grade of mobility has to be determined
Examination Step-by-Step (Niemiec et al., 2020):
Total Mouth Periodontal Score (TMPS): this method allows for a very
accurate determination of the patient’s periodontal health.
Inspect the oropharynx: it is advisable to make a quick inspection of the
oropharynx and tonsils in the fauces before endotracheal intubation and
placing a throat pack.
Take preoperative photographs: preoperative photographs should be taken
before any procedure. It is recommended to take one of each side and one
from the rostral aspect. The photographs serve as proof of pre-operative
dental condition as well as provide visual evidence to the owner.
Decrease the bacterial load: rinse the oral cavity with 0.12% chlorhexidine
oral rinse.
Assess and identify the dentition: primary, permanent, or mixed.
Assess the soft tissue: the entire oral cavity and vestibular tissues should
be examined, including oral mucous membranes (for colour, moistness,
swelling), lips and cheeks, palate, tongue and sublingual tissue for abnormalities and oral masses.
Initial scaling of the teeth: for better visibility of the tooth surfaces and
gingiva an initial cleaning with a dental scaler is recommended.
Intraoperative photograph: it is advised to take a photograph of any
pathology revealed by the scaling
Dental examination with dental explorer:
Single tooth: each tooth must be examined with a dental explorer, beginning with the first incisor of each quadrant and progressing caudally tooth
by tooth to cover the entire arch. A normal tooth surface is smooth; any
roughness is an indication of pathology. The entire surface of each tooth
should be explored, especially the area just below the gingival margin to
detect resorptive lesions. The examination should note:
Presence (or absence) of the teeth: the absence of a tooth can mean hypodontia (congenitally missing tooth), an unerupted (or impacted) tooth,
a retained tooth root, or a previously extracted or exfoliated tooth. Dental
radiographs are always indicated for every instance of a “missing” tooth.
Supernumerary teeth may be present.
Tooth surface: any irregularity is suspicious for a pathologic process.
Differentials for a roughened tooth surface include tooth fracture, enamel
defect, caries, attrition/abrasion or tooth resorption.
Colour: Intrinsic staining (a purple, yellow, pink or gray tooth) indicates
pulpitis (i. e. a nonvital tooth) or the use of certain antibiotics during
tooth development. Teeth suspected to have pulpitis or pulp necrosis
require root canal therapy or extraction. Extrinsic staining may be due to
wear, metal chewing. These teeth generally require no therapy, but dental
radiographs are indicated.
Periodontal examination:
Periodontal probing depth (PPD): the periodontal probing depth has to be
measured with a graduated periodontal probe. The sulcus/pocket must
be measure circumferentially around the whole tooth and recording of 4-6
places can be done. (Some charts only record the deepest pocket as it is
the most significant). The normal PPD in dogs is 0-3 mm, and in cats in
cats 0-1 mm.
Gingival enlargement: enlargement of the gingiva can lead to pseudo
pockets
Gingival recession: is an indication of periodontal disease although the
PPD does not necessarily increase
Furcation involvement: furcation involvement indicates bone loss between
the roots of multi rooted teeth
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WSAVA GLOBAL COMMUNITY CONGRESS
Expose dental radiographs: dental radiographs are a very important part of
the dental examination and should be taken whenever possible.
Staging of periodontal disease: staging can be performed by combining
the clinical findings and the dental radiographs (AVDC Nomenclature
Committee 2021)
Definitive cleaning and polishing
Additional therapy: Based on all available information (visual, tactile, and
radiographic) determine and execute the final treatment plan.
Postoperative radiographs and photographs
Recording
Manual Scoring
The clinical findings can be recorded manually. Dental charts for several
species are available for free download at the website of the British
Veterinary Dental Association (www.bvda.co.uk/bvda-articles/808-dental-charts) . The results can either be hand drawn into a dental chart or
marked in an attached multiple-choice spreadsheet. The most common
signs for dental recording are a circle for a missing tooth (O), a hash mark
for a fractured tooth (#) and a cross for an extracted tooth (X). For more
detailed instructions see the periodontal therapy section.
Electronic Scoring
The results can also be recorded digitally. A free online dental charting software (electronic Veterinary Dental Scoring) is available for all
veterinarians and technicians in ten screen (English, English (US), French,
German, Spanish, Portuguese, Dutch, Russian, Czech, Chinese) and eleven
print languages (plus Italian). It is a simple tool to support the practitioner
in their daily work. The basic clinical findings can be scored with a simple
mouse click onto the dental charts.
Tier 2 & 3 are recommended to use a more detailed commercial program. There are several options available (in alphabetical order, without
claiming completeness: www.animaldentalchart.com, www.chartific.com;
www.e-vds.vet ; www.vetdentalcharts.com).
Key Points:
The conscious examination is important but is of very limited value, as a
complete examination is only possible under general anaesthesia.
A thorough oral examination MUST be part of every dental procedure.
The Modified Triadan Systems and anatomical names can be used for
recording dental examination and treatment.
The examination of the oral cavity must be performed in a systematic and
repeatable fashion.
Dental radiographs are an essential part of the examination.
Proper recording of clinical findings and treatments is crucial.
References:
American Veterinary Dental College Nomenclature (https://avdc.org/
avdc-nomenclature) accessed 12th September 2021
Floyd M. R. (1991). “The Modified Triadan System: Nomenclature for Veterinary Dentistry”. J Vet Dent, 18-19. DOI:10.1177/089875649100800402
Niemiec B. A., Gawor J., Nemec A., Clarke D., Tutt C., Gioso M., Steagall P.,