Oral Examination and Charting for the Veterinary Technician

Transcription

1 Oral Examination and Charting for the Veterinary Technician Brenda L. Mulherin, DVM, Diplomate AVDC Associate Clinical Professor Iowa State University College of Veterinary Medicine Overview Dentition Eruption Tooth root numbers Occlusion/malocclusion Skull types and indications Plaque, calculus, gingival indices Oral examination Tooth pathology Periodontal disease Oral examination charting and abbreviations Feline dentition Deciduous Dental formula x 2 arcades I3, C1, PM3 I3, C1, PM2 Total 26 teeth Permanent Dental formula x 2 arcades I3, C1, PM3, M1 I3, C1, PM2, M1 Total 30 teeth 1

2 Feline Triadan Numbering System Veterinary Dentistry Principles & Practice, Wiggs and Lobprise Canine dentition Deciduous Deciduous dentition x 2 Incisors 3/3 Canines 1/1 Premolars 3/3 Molars 0/0 Total 28 teeth Permanent Permanent dentition x 2 Incisors 3/3 Canines 1/1 Premolars 4/4 Molars 2/3 Total 42 teeth Canine Triadan Numbering System 2

3 Eruption times for cats Cats Deciduous Teeth Permanent Teeth Incisors 3-4 weeks 3-4 months Canines 3-4 weeks 3-5 months Premolars 5-6 weeks 4-5 months Molars 5-6 months Eruption times for dogs Permanent tooth roots in the cat Incisors- 1 root Canine-1 root MX 2 nd PM-1-2 roots (usually fused) MX 3 rd PM-usually 2 roots MX 4 th PM- 3 roots MX 1 st M- 1-3 roots (usually fused) MN 3 rd and 4 th PM- 2 roots MN 1 st M- 2 roots kull_and_teeth_drawing.jpg 3

4 Permanent tooth roots in the dog Incisors-1 root Canine-1 root MX 1 st PM-1 root MX 2 nd -3 rd PM-2 roots MX 4 th PM, 1 st, 2 nd M-3 roots MN 1 st PM-1 root MN 2 nd, 3 rd, 4 th PM and 1 st, 2 nd M-2 roots MN 3 rd M-1 root Occlusion and malocclusion Occlusion checklist 5 points of occlusion Midline match Incisor overlap Canine interlock Premolar interdigitation Carnassial overlap 4

5 Malocclusion: Class 1 Maxilla and mandible of appropriate length 1-2 teeth malpositioned(out of place) Malocclusion: Class 2 Maxilla longer than mandible Maxillary prognathism Malocclusion: Class 3 Mandible longer than maxilla Mandibular prognathism 5

6 Malocclusion: Class 4 Maxillary-mandibular asymmetry Skeletal malocclusions Rostro-caudal Side-to side(loss of midline alignment) Dorso-ventral direction Complications of malocclusion Crowding and rotation Attrition and abrasion Uncomplicated crown fractures Complicated crown fractures Periodontal disease Disruption selfcleansing mechanism Feline Dentistry; Oral Assessment, Treatment, and Preventative Care, Bellows, Skull type in relation to disease 6

7 Brachycephalic Dental crowding Tooth rotation Partial eruption Non-erupted Mesaticephalic Nice intermediate between brachycephalic and dolichocephalic breeds Increased incidence of missing premolars 1 st and 4 th Dolichocephalic Elongated jaws Normal scissor bite Abnormally large interdental spacing 7

8 Oral examination Complete examinations need HEAVY sedation or general anesthesia Should include Oral examination Plaque index, calculus index, gingivitis index Tongue, tonsils, hard palate soft palate, buccal mucosa Plaque index PI-0: No plaque PI-1: Minimal gray-tan plaque deposits Thin film of plaque along gingival margin PI-2: Moderately dense gray-tan plaque deposits Moderate accumulation, plaque in sulcus PI-3: Heavy plaque deposition exudes from gingival sulcus Large amount of plaque in sulcus Modified Ramfjord Calculus Index CI-0: No calculus CI-1: Minimal supragingival calculus deposition CI-2: Moderate subgingival and supragingival calculus deposition CI-3: Heavy calculus deposits on crown and subgingivally 8

9 Gingival index GI-0: Normal gingival shape and color GI-1: Mild gingival inflammation, swelling, slight red color GI-2: Moderate gingival inflammation, swelling, red, with bleeding GI-3: Severe gingival inflammation, swelling, bright red with bleeding crvetcenter.com Normal structures? Lingual molar salivary gland Evaluate on both sides What other structure is commonly biopsied, even though it is a normal anatomical structure? Incisive papilla Oral abnormalities 9

10 Oral examination Dental examination Crowns of teeth Periodontal examination Periodontal probing Oral charting Documentation Periodontal probing Explorer Tactile assessment Evaluate Cementum Dentin Enamel Probe Periodontium assessment Evaluate Pocket depth 6 different areas Irregularities of tooth and gingiva Clinical anatomy 10

11 Normal probing depth Dog 1-3 mm Cat mm nixaanimalhospital.com Furcation exposure cliniciansbrief.com FE-1: Furcation exposure; probe extends less than half-way under the crown in any direction of a multi-rooted tooth with attachment loss FE-2: Moderate furcation exposure; probe extends more than halfway under the crown of a multi-rooted tooth with attachment loss, but not all the way through FE-3: Extensive furcation exposure; probe passes from one side all the way through (through and through exposure) Mobility index M0: Normal physiologic movement M1: Slight tooth mobility in any direction Tooth moves a distance < 1 mm M2: Moderate tooth mobility in any direction Tooth moves a distance about 1 mm M3: Severe tooth mobility in any direction Tooth moves distance > 1 mm and/or may be depressed into alveolus 11

12 Tooth pathology Intrinsic staining Discoloration of teeth Purple, pink, grey All shades Can be the entire tooth Focal areas of tooth surface 92.2% of these teeth are non-vital Extrinsic staining Stain present on the external surface Accumulation in grooves and pits On exposed dentin/cementum 12

13 Persistent deciduous teeth May need to differentiate between permanent and deciduous No 2 teeth should occupy the same space at the same time Supernumerary teeth Too many teeth Draw them into the dental chart Potentially no need for treatment Careful not to confuse with persistent deciduous tooth Attrition and abrasion Abrasion Tooth on inanimate object wear Cage chewers/tennis ball Attrition Tooth on tooth contact and wear Malocclusion 13

14 Tooth fractures Complicated crown fractures Uncomplicated crown fractures Evaluate whether attrition/abrasion or uncomplicated crown fracture Evaluate whether extends below the gum line Missing teeth Never developed Previously extracted Exfoliated on own Impacted Confirm missing No treatment if missing Confirm presence Dentigerous cyst Extraction (if present) Count the teeth! Periodontal disease 14

15 Tooth anatomy Dentin Enamel Pulp Gingival Sulcus Gingiva Periodontal Ligament Cementum Alveolar Bone Periodontal disease Bacterial plaque accumulating on the tooth surface Mineralizes into tartar (calculus) within 24 hours Causes inflammation potentially to the periodontium. What is the periodontium? 4 structures that attach the teeth into the jaw Gingiva Gingiva Alveolar bone Periodontal ligament Cementum Periodontal Ligament Cementum Alveolar Bone 15

16 Periodontal disease Evidence of periodontal disease Increased periodontal probing depth Gingivitis Gingival recession Periodontal attachment loss Furcation involvement Stages of periodontal disease Stage 0 Clinically normal No gingivitis or inflammation Normal periodontal probing Stage 1 Gingivitis present Inflammation tissues Only stage that is reversible No attachment loss Normal periodontal probing Stages of periodontal disease Stage 2 Gingivitis/periodontal inflammation <25% attachment loss Stage 3 Gingivitis/periodontal inflammation 25-50% attachment loss Stage 4 Gingivitis/periodontal inflammation >50% attachment loss 16

17 Periodontal disease Stage 1 Reversible Stage 2,3,4 Non-reversible Periodontal disease cannot be assessed based on radiographic bone loss alone! A clinical diagnosis based on attachment loss and probing is needed. Examination charting Record Skull type Occlusion abnormalities Calculus index Gingivitis index Gingival, tooth, oral cavity abnormalities After oral charting, recording information and taking dental radiographs, assess a periodontal disease score Oral Chart 17

18 Oral Examination Abbreviations Oral Examination Abbreviations 18

19 Conclusion Remember the number of teeth in the normal oral cavity Know when the teeth should erupt Know the normal number of roots for each tooth Know the normal points of occlusion to identify a malocclusion Know common abnormalities associated with different skull types Have consistent plaque, calculus and gingivitis scores Perform consistent oral examinations of all structures within the oral cavity Conclusion cont Identify what the normal tooth should look like to identify pathology Be able to assess a periodontal disease score Record all oral examination findings in a dental chart Have consistent abbreviations within your clinic Send or have an abbreviation list attached to your dental chart if referring to another doctor 19

20 For more dental education Questions??? 20