INDICATIONS
- “Every mouth, every time”: a complete oral examination should be performed whenever possible to detect lesions as early as possible.
- Make it a part of puppy and kitten exams to start a lifetime of oral care (Fig. 1-1).
- Deciduous occlusion
- Broken or damaged teeth
- Proper eruption sequence
- Brushing/home care instruction
- Deciduous occlusion
- Continue with oral examinations at each visit, making oral care a cornerstone of a wellness program.
- An alert oral exam can give a quick overview of oral conditions in most patients.
- A complete oral examination can only be performed under general anesthesia and will include physical examination of the oral and dental structures, periodontal probing, transillumination, and intraoral radiography.
EQUIPMENT
Alert Exam
- Adequate but gentle restraint
- Good lighting
- Charts
Complete Exam
- General anesthetic components, including monitoring
- Good lighting
- Mouth gags for accessibility (use particular caution with spring-loaded mouth gags)—they can damage teeth or strain the temporomandibular joint unnecessarily
- Magnification (usually needed)
- Periodontal probe/explorer
- Mirror (Fig. 1-2)
- Transilluminator
- Charts
PROCEDURE
Alert Examination
- Use great caution with anxious, aggressive, or painful animals; examination may have to be accomplished under sedation (carefully) or when the patient is anesthetized.
- With the patient gently restrained on the table, first observe the external structures of the head for any irregularities—symmetry, swelling (Fig. 1-3), discoloration, discharge; note any malodor (halitosis).
- Gently hold the muzzle closed with your nondominant hand, and lift up the lips to observe the buccal/labial surfaces of the teeth. Note and record the following:
- Accumulations of plaque and/or calculus (Fig. 1-4)
- Missing teeth (circle on chart)
- Worn (AT for attrition), chipped, broken (FX for fractured), or discolored teeth
- Gingival inflammation/overgrowth
- Red or bleeding gingiva
- Gingival hyperplasia
- Possible presence of tooth resorption (TR)—feline and canine
- Red or bleeding gingiva
- Position of teeth (occlusion)
- Incisors should be in “scissor bite” (Fig. 1-5)
- Lower canine should be spaced equally between upper third incisor and upper canine
- Premolars should interdigitate in a “pinking shear” configuration
- Individual teeth in proper position
- Incisors should be in “scissor bite” (Fig. 1-5)
- Oral soft tissues
- Note if any unusual masses are present; press up in the intermandibular space to lift tongue to view sublingual area (Fig. 1-6)
- Accumulations of plaque and/or calculus (Fig. 1-4)
Figure 1-3 Before looking inside the mouth, examine the entire head for abnormalities, such as the generalized swelling of the muzzle of this dog.
Figure 1-4 During the alert exam, many patients will let you examine the buccal surfaces of the teeth, and the extent of calculus and plaque can be estimated (significant accumulations in this patient).
Figure 1-5 This patient shows a variation from a correct “scissors” bite, with the left maxillary first incisor positioned behind the mandibular incisors (crossbite).
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