How to perform a thorough dental exam

How to perform a thorough dental exam

Make sure you collect—and record—all the important information during this exam, so the veterinarian can make the correct diagnosis and provide the best therapy.

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Technicians are likely to perform preliminary dental examinations to provide initial observations. A thorough evaluation should include performing conscious and anesthetized examinations and charting disease processes, pathology, and anomalies. When performing an examination, be sure to record all findings and bring abnormalities to the veterinarian's attention.

Conscious examination

An oral examination on a conscious patient is important, but you are often limited to a visual inspection and digital palpation. This initial examination involves more than just the oral cavity. Be sure to palpate the facial bones and zygomatic arch, temporomandibular joint, salivary glands, and lymph nodes. Also be sure to evaluate the dental occlusion, which can be done by gently retracting the lips to look at the soft tissue, the occlusion (bite), and the buccal aspects of the teeth.

Anesthetized examination

1. A mouth demonstrating mild (A), moderate (B), and heavy (C) calculus.
Anesthesia is required for both routine dental cleaning and treatment of dental abnormalities or diseases of the oral cavity. Once a patient is anesthetized, you can complete a thorough oral examination. Examine all the structures of the oral cavity, including the oropharynx, lips and cheeks, mucous membranes, hard palate, floor of the mouth, tongue, and teeth. Evaluate the periodontium (gingiva, periodontal ligament, cementum, and alveolar bone) of each tooth.

If patients have large amounts of calculus on their teeth, you may need to remove these deposits to accurately access the periodontium. Calculus (tartar) is mineralized plaque. Using calculus removal forceps is recommended to remove supragingival calculus, but take care to ensure that the gingiva and tooth crown are not damaged.

Record the amount of calculus and plaque observed on the teeth for future reference before cleaning. The amount of calculus and plaque can be recorded as mild, moderate, or heavy (Figure 1). 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 can only be removed by hand scaling or using a power scaler.

When evaluating the periodontium, you will need a periodontal probe, a dental explorer, and a dental mirror. Evaluate the following seven indices for each tooth in each patient.

1—Gingival index

The gingival index is a measurement of gingival health. To assess a patient's gingival health, gently place a periodontal probe into the gingival sulcus (the area between the tooth and free gingiva), and guide the probe around the tooth. Score the assessments of gingival changes by using the following criteria:

  • 0 = normal healthy gingiva
  • 1 = mild inflammation or redness, no bleeding on probing, possible edema or contour changes
  • 2 = moderate inflammation, moderate to severe redness, edema, bleeding on probing
  • 3 = severe inflammation or redness, edema, ulceration, spontaneous bleeding