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#):

CI0

No calculus

CI1

On crown and slightly subgingival

CI2

Moderate amount above and below the gingival margin

CI3

Abundant above and below the gingival margin

Gingivitis is reversible inflammation that can be graded using the Gingival Index (GI#) score.

GI0

Normal gingival

GI1

Mild inflammation, slight color change, mild swelling

GI2

Moderate inflammation and swelling with bleeding

GI3

Severe inflammation

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.

Periodontal Index
(PI#)

Stage

Attachment loss

RAD analysis

Probing Depth
mm Dog

Probing Depth
mm Cat

Normal
Healthy

0

0%

Normal

<3

<0.5

Gingivitis

1

0%

Normal

<3

<0.5

Early

2

<25%

Crestal bone loss

<5

<1

Moderate

3

<50%

< 50% bone loss

<7

<2

Severe

4

>50%

> 50% bone loss

>7

>2

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.

References

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.

Speaker Information
(click the speaker's name to view other papers and abstracts submitted by this speaker)

Mary Hernandez, DVM
University of Florida, College of Veterinary Medicine
Florida, USA


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