Oral pathology & dental charting: part I (Proceedings)
It is important to be able to identify oral pathology and anomalies. It is equally important to correctly record the pathology on dental charts. A thorough dental examination includes both conscious and anesthetized examinations as well as charting disease processes, pathology and anomalies, and treatment plans.
Why is dental charting important? A dental chart is a diagrammatic representation of the dentition where information can be entered in a pictorial and/or notation format. It allows you to keep a record of the patient's oral health, track changes in oral health and record treatment. A dental chart is also a legal document.
In order to ensure efficient record keeping the chart should include: a chart with a key, brief descriptions to clarify disease and treatments, procedure preformed, therapeutic plan, prognosis and photographs. These can be in either a fill in or check off format. The chart needs to have basic vital information that is similar to the items needed in all veterinary records. There are commercially available dental charts available but you can develop your own.Being aware of dental formulas, oral anatomy as well as terminology is crucial to proper charting. Head type of the animal as well as malocclusions need to be noted.
In human dentistry, there is one universal tooth identification system, however in the veterinary world there are many identification systems currently being used. The anatomical system uses the first letter of each tooth type along with a number to identify each tooth. The advantage of the anatomical system is that it is easy to remember and many teeth can be identified at one time. The disadvantages are that is can be more time consuming to identify individual teeth and some computer systems may not be alpha numeric friendly.
The Triadan numbering system gives each tooth a three digit number. The first digit represents the quadrant of the mouth and the other two numbers represent the tooth identification. The rule of 4 & 9 helps to identify the teeth. The number 04 is always given to the canine tooth and the number 09 is always given to the first molar. The advantages of the Triadan system is that it is quicker to say and can be used with most computers. The disadvantages are that it is not intuitive and that you must know the code. This system is gaining in popularity.
It is imperative that individuals performing dentistry know the number of roots for each tooth. The root systems for both canine and feline are illustrated in the following figures.
An oral examination on a conscious patient is important but often limited to a visual inspection and digital palpation. The examination involves more than just the oral cavity. Palpation of the facial bones and zygomatic arch, temporomandibular joint, salivary glands and lymph nodes are also important. Dental occlusion should also be evaluated. This can be done by gently retracting the lips to look at the soft tissue, the bite and the buccal aspects of the teeth.
Once the animal is anesthetized, a thorough oral examination can be completed. All the structures of the oral cavity must be evaluated to include the oropharynx, lips and cheeks, mucous membranes, hard palate, floor of the mouth and tongue as well as the teeth. The periodontium (gingival, periodontal ligament, cementum and alveolar bone) of each tooth needs to be evaluated. In animals with large amounts of calculus on the teeth, it may be necessary to remove these deposits to accurately access the periodontium. The use of a calculus removal forceps is a recommended method to remove supragingival calculus. Use care when using this instrument to ensure that the gingivia and tooth crown are not damaged.
When evaluating the periodontium a periodontal probe, a dental explorer and a dental mirror are used. The following indices should be evaluated for each tooth; gingivitis, periodontal probe depth, gingival recession, furacation involvement, mobility and periodontal attachment levels.
The amount of plaque observed on the teeth prior to cleaning should be recorded. Because plaque is the soft, gelatinous matrix of bacteria and bacterial by-products that lead to gingival irritation and gingivitis it may be necessary to use a disclosing agent to visualize.
Calculus (tartar) is calcified plaque. The amount of calculus should be recorded as light, moderate or heavy. Calculus can only be removed by either hand scaling or power scalers.
Gingivitis Index (GI)
The gingival index (GI) is a measurement of gingival health. The assessments of gingival changes are scored using the following criteria.
0 - normal healthy gingiva
Each tooth is given the most severe score.