Some information from a doggie dentist
Overall Veterinary Dentistry
Dental Charting Abbreviations
Identification of Oral Pathology and Dental Charting
World Small Animal Veterinary Association World Congress Proceedings, 2007
Mary Hernandez, DVM
Riverview, FL, USA
The practice of good medicine includes evaluating the mouth. Examination of the oral cavity should be part of every physical exam. The oral examination then continues once the patient is under general anesthesia. All detected abnormalities should be recorded on a dental chart which is part of the patient's medical record. To be as efficient as possible, one person should evaluate while a second person records the findings. This has been termed "four handed dentistry."
The physical exam should include assessment of skull type and head symmetry, TMJ palpation and lymph node palpation. Skull types include: brachycephaly, mesocephaly and doliocephaly. Brachycephaly has a short, broad facial profile like that of the Bulldog and Boxer. Mesocephalic patients have a well balanced facial profile like that of the German Shepard and Beagle. Dolicocephalic breeds include the long narrow profiles of the Collie and Greyhound. Next move on to the incisors relationship were the maxillary incisors should overlap the mandibular incisors in the scissor bite. A level bite has the incisors meeting edge to edge. The diastema between the maxillary lateral incisor and the maxillary canine should allow the mandibular canine to rest in place without impinging on the palate. If the diastema is too narrow or the mandibular canine will be displaced. Rostral deviation of the maxillary canine is also referred to as "lance canine." Base narrow canines impinge on the palate. The alignment of the premolars should be in a pinking shear fashion. The maxillary 4th premolar should be buccal to the mandibular 1st molar. Look for individual tooth malpositioning also.
Normal occlusion (Class 0) is a scissor bite (i.e., Schnauzer, Chihuahua) or a breed accepted variant of normal (i.e., Corgi or Labrador Retriever with a level bite). Class I malocclusions have a normal mesiodistal relationship but have a facial lingual disturbance. These include: anterior crossbite, posterior crossbite, base narrow canines, crowded/rotated teeth, or a level bite. Distoclusions are classified as Class II and have some or all mandibular teeth distal to the maxillary counterpart. This mandibular brachygnathism is sometimes called an undershot jaw. Class III mesioclusions have some or all mandibular teeth mesial to their maxillary counterpart. The long mandible is known as mandibular prognathism or an overshot jaw. Wry mouths are Class IV malocclusions where by one of the 4 quadrants are in a mesial relationship to its counterpart and the other side is in distal relationship.
The oral examination continues when the animal is under general anesthesia. Some practitioners chose to probe prior to scaling the teeth while others wait until the calculus is removed. Dental calculus should be evaluated and graded using a standardized system like the Ramfjord Calculus Index (CI#):
The evaluator uses a periodontal probe to gently check periodontal depth and record the measurements. Be sure to assess any gingival attachment loss. Periodontal disease (PD#) is diagnosed by probing and radiographic evaluation.
Crowded (CRD) or rotated (ROT) teeth can lead to periodontal disease. Gingival recession (GR) and subsequent furcation (F#) exposure is commonly seen.
F1 Furcation exposed
F2 Furcation undermined
F3 Furcation open through to the other side
Mobility (M) occurs when the bone of the alveolar socket is lost, as in periodontal disease or neoplasia or if the socket is fractured. Sometimes tooth mobility will occur because of root fracture, malformation of the root or resorption.
M1 Slight mobility
M2 Moderate mobility, about 1mm in any lateral direction
M3 Severe mobility >1mm or depressible; movement in a 3 rooted tooth
Enamel and dentinal pathology should be evaluated and recorded. A small pit or malformation in the enamel termed enamel defect (ED).
Enamel hypoplasia/hypocalcification (EH) is when the enamel layer is thin, soft or poorly mineralized. Abrasion (AB) is caused by wear from an external source such as a tennis ball. Attrition, on the other hand is tooth wear from contact from another tooth. Teeth staining can be either extrinsic (SE) on the outside of the tooth (i.e.,; metallic stains from chewing on a metal crate) while intrinsic staining (SI) lies within the tooth (i.e.,; tetracycline, blood). Fractured teeth (FX) should be evaluated to see if the pulp chamber has been exposed (PE). Carious lesions are a condition in which the tooth decays. This is a rare condition in dogs. Feline odontoclastic resorptive lesions (ORL) are an idiopathic external root resorption where the hard tissues of the root surfaces are destroyed. The process starts in the cementum and spreads to the dentin. Diagnosis is made with visual inspection, tactile examination with an explorer and radiography. Full mouth radiographic examination is advocated for all feline patients.
RL1 Cementum only
RL2 Cementum and dentin
RL3 Into the pulp chamber
RL4 Extensive root and crown damage
RL5 Lack of a clinical crown, but root fragments remain on radiographs
Missing teeth (O) are documented by circling the tooth on the dental chart. Radiographic evaluation will allow missing teeth to be assessed. Retained roots (RR) may be present or perhaps a dentigerous cyst (DTC) has developed.
Extra teeth are referred to as supernumerary teeth (SN) while retained deciduous teeth (RD) are charted by drawing them in.
Oral masses (OM) should be biopsied and the histopathology results recorded. Oronasal fistulas (ONF) and oroantral fistulas (OAF) are found by probing. Kissing lesions, or contact ulcers (CU) can be found on the buccal surface of the lip where the tooth contacts the mucosa. Stomatitis (STM) can be recorded until histologically evaluation of biopsied tissue is received.
The use of a dental chart and abbreviations makes recording of the pathology easier and more detailed. Accurate medical records are part of practicing good medicine.
1. Gorrel C. Veterinary Dentistry for the General Practitioner. Edinburgh:Saunders, 2004.
2. Wiggs RB, Lobprise HB, eds. Veterinary Dentistry: Principles & Practice. Philadelphia:Lippincott-Raven, 1997.
3. Holmstrom SE, et al. AAHA Dental Care Guidelines for Dogs and Cats. J AAHA September, 2005.
4. Bellows J. Smile Book IV. New York:Pfizer Animal Health, 2004.
Mary Hernandez, DVM
University of Florida, College of Veterinary Medicine
From Jan Bellows
The dental chart is a permanent record of a patient's dental care including dental history, tooth abnormalities, radiographic findings, periodontal examination, proposed, actual, declined, and future treatment plans as well as home care instructions.
Recording the condition of all teeth, as well as soft and hard tissues, is necessary to provide quality care. The charting of existing conditions provides basic information for an accurate, comprehensive treatment plan.
A thorough clinical examination must be conducted to complete the chart. Helpful hand instruments include a periodontal probe, explorer, and dental mirror. Excellent lighting and magnification are also necessary to clinically evaluate the oral cavity.
The dental chart includes:
- Dental history- Has the patient had professional oral treatment in the past? What is the patient's diet? What is the client doing for home dental care?
- Skull type (brachycephalic-flat faced, mesaticephalic-medium faced, dolichocephalic-long nosed)
- Occlusion abnormalities
- The amount of plaque and calculus present
- Tooth abnormalities
- Radiographic findings
- Periodontal abnormalities including inflammation, gingival edema, periodontal pocket depths, attachment loss, gingival recession or hyperplasia, furcation involvement, and mobility
- Proposed/ declined treatment
- Actual treatment
- Future treatment plans
- Home care instructions including proposed re exam appointments
Before anesthesia the animal is given a general head examination with attention to structures around the mouth (facial swellings, painful areas, lymph nodes). The mouth is opened and shut to check for pain, crepitus, decreased range of motion, and occlusion.
Anesthesia is essential for thorough examination and charting. To evaluate each tooth individually, complete immobilization is necessary. Generally, the mouth is charted before cleaning and can be recharted if a significant amount of calculus has been removed.
Two person (“four handed”) charting is a fast and efficient way to record dental disease. One person examines the mouth while the other records information on the chart. Under anesthesia, charting begins with evaluation of the mouth for presence of plaque and calculus on the teeth. Next, the mouth is examined for missing teeth. A circle is placed on the chart around missing teeth. Enamel and dentin fractures are then noted, including pulpal exposure if present. A periodontal probe with millimeter gradations is inserted at the interface between the free gingiva and tooth surface. The probe is gently advanced to the bottom of the sulcus or periodontal pocket and “walked” around the tooth. Abnormal measurements at the four corners of each tooth are recorded. The attachment loss and probe depths are noted on the chart. Finally, other lesions are observed and noted.
1. Examine rostral and distal occlusion before intubation, record abnormalities.
2. After intubation, examine the mouth and circle all visibly missing teeth on the dental chart.
3. Record any fractured teeth.
4. Check for tooth mobility using an instrument handle pressed against the tooth. Record abnormal mobility (M1, M2, M3).
5. Record amounts of plaque and/or calculus accumulation.
6. Record abnormal probing depths and/or attachment levels around each tooth.
7. Expose and process dental radiographs where indicated.
8. Clean the teeth.
9. Reprobe, if a significant amount of calculus is removed.
10. Formulate a treatment plan through tooth by tooth evaluation-draw a diagonal line though teeth which need to be extracted, record a “PCT” (perioceutical) next to teeth which can be helped with local antibiotic application.
11. Calculate fees for the treatment plan and contact the owner for approval while the technician is completing the teeth cleaning process.
12. Once the owner approves, complete the initial treatment and record all care on the dental chart.