In today’s VETgirl online veterinary continuing education blog, Mary L. Berg, BS, LATG, RVT, VTS (Dentistry) reviews oral examination and charting in veterinary medicine.

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, the procedure performed, therapeutic plan, prognosis and photographs. These can be in either 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.

Important Terms:

Occlusion – the way teeth fit together
Furcation – are where roots join
Recession – loss of gingival tissue
Inflammation – swelling, redness, infection
Pocket – the pathological area between gingiva and tooth surface
Hyperplasia – excessive gingival tissue
Supernumerary – too many teeth
Mobility – tooth moves

Oral Examination
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, the floor of the mouth and tongue as well as the teeth. The periodontium (gingiva, 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 access the periodontium accurately. 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 gingiva 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, furcation 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 with each tooth given the most severe score.

0: normal healthy gingiva
1: moderate inflammation, moderate redness, not bleeding on probing, edema
2: moderate inflammation, moderate to severe redness, edema, bleeding upon probing
3: severe inflammation, severe redness, edema, ulceration, spontaneous bleeding

Probe Depth (PD): Probe depth (PD) is a measure of the depth the periodontal pockets often found in periodontal disease. The probe depth is measured at multiple sites of the tooth. A periodontal probe with millimeter markings is gently placed between the free gingiva and the tooth surface and carefully advanced until soft tissue resistance is felt. The tip of the probe should be parallel to the long axis of the tooth. The pocket depth is recorded as the distance in mm from the free gingival margin to the bottom of the pocket. The probe may be glided or walked along the tooth to measure the varying pocket depths. A normal gingival sulcus depth is 1-3 mm in dogs and 0.5 to 1mm in cats. Measurements in excess of these values should be recorded in the appropriate location on the dental chart.

Gingival Recession (GR): Gingival recession is also measured with the periodontal probe. It is the distance from the cementoenamel junction to the margin of the free gingiva. At sites with gingival recession, the probe depth may be normal despite the loss of alveolar bone.

Furcation Index (FI): The furcation index (FI) measures the loss of bone support in multi-rooted teeth. A periodontal probe is placed perpendicular to the long axis of the tooth and slid along the free marginal groove to the furcation site. The following criteria are used to assign a numerical score.

0: no loss of bone support
1: horizontal loss of supporting tissues not exceeding one-third of the width of the tooth
2: horizontal loss of supporting tissues exceeding one-third of the width of the tooth but no encompassing the total width of the furcation area.
3: horizontal through and through loss of supporting tissue.

Mobility Index (MI): The mobility index (MI) measures the loss of bone support by indicating the amount of movement of the tooth. The length of the periodontal probe is placed on the buccal surface of the crown of the tooth and gentle pressure is applied to the tooth. The following criteria are used to assign a numerical score.

0: no mobility
1: perceptible mobility but less than 1 mm buccolingually
2: definite mobility between 1-2 mm
3: gross mobility exceeding 2 mm buccolingually and/or vertical mobility

Periodontal Attachment Level (PAL): In the PAL, the pocket depth is measured from the base of the pocket to the cementoenamel junction. This is a more accurate assessment of bone loss in periodontitis. PAL can be directly measured, or it can be calculated as the sum of PD plus GR.

Furcation Exposure: In multi-rooted teeth, the area where the roots meet is referred to as the furcation. The bone loss caused by the periodontal disease often affects this area early in the disease process. The presence of furcation involvement should be evaluated and recorded as Grade 0 – 3 depending upon the amount of involvement.

Stage of Periodontal Disease: The stages of periodontal disease can be used to help price your periodontal therapies but also need to be recorded so that the progression of the disease can be determined. These stages are determined by either measuring clinical attachment level or radiographically.

• Stage 1 -Gingivitis only with attachment loss.
• Stage 2 – Less than 25% attachment loss. Grade 1 furcations present.
• Stage 3 – 25 to 50% attachment loss. Grade 2 furcations present
• Stage 4 – Over 50 % attachment loss. Grade 3 furcations present.

Oral masses need to be drawn onto the chart and noted. This includes epuli and gingival hyperplasia. This is important to note these in order to have a record of the mass and be able to note changes in future examinations as well as gingivectomies or the removal of excess gingival tissues.

References available upon request.

  3. Tayla Moore says:

    very helpful to have each index broken down to keep in mind the recording of periodontics.

Only VETgirl members can leave comments. Sign In or Join VETgirl now!