Taking a systematic approach to assessing patients reveals the severity and extent of their oral disease. With this information, a treatment plan can be tailored to their needs.
ORAL DIAGNOSTICS OVERVIEW
Awake oral examination
Valuable, but just a small part of the story.
Even before an animal enters the veterinary hospital, the veterinarian has some clues about their oral health status. The signalment, or species, breed, sex, and age of the patient is key, as there are predispositions to oral disease based on these factors. Larger dogs are predisposed to endodontic disease, for example, while smaller dogs are predisposed to periodontal disease. Age is crucial because oral disease progresses with time, particularly without routine oral hygiene and other oral health care.
In compliant pets, the awake oral examination provides further clues about oral health status. Indications of oral disease that can be noted on physical examination are tooth fractures, tumors, mucosal lesions, abrasion and/or attrition, gingival recession, oral odor, and significant dental plaque and calculus.
As helpful as it is to have this information, it is still only a partial description of the patient’s oral disease status. Prescribing or performing treatment based on these easily visible findings alone is likely to be similarly incomplete and can cause more harm than benefit.
Anesthetized oral examination
Now, the oral cavity can be completely evaluated.
With the patient anesthetized, the veterinarian can proceed with a thorough evaluation of all of the tooth surfaces, tonsils, pharynx (back of the mouth), and the base of the tongue. Finding previously-unseen abnormalities at this stage is fairly common.
Assessing oral health below the surface.
The next step in oral diagnostics is dental radiography (x-ray). Dental radiography provides images of the inner structures of teeth, their roots, the surrounding bone and periodontal tissues. Dental radiographs direct treatment decisions for both individual teeth and the patient as a whole.
Probing, exploration, and charting
The next step.
For periodontal probing, a fine blunt probe is used to measure depth of the gingival sulcus surrounding each tooth. Periodontal pockets are found when the probe easily passes beyond a normal probing depth. While it’s common to find periodontal pockets associated with obviously-diseased teeth, it’s also surprising how often they are found around otherwise-normal-appearing teeth. Interpretation of both periodontal probing depth and dental radiographic bone loss determines the treatment plan for affected teeth.
An explorer is a very fine, sharp instrument used to evaluate enamel surfaces of teeth. Caries lesions, tooth resorptive lesions, and enamel defects are found and assessed using both exploration and dental radiographs.
Charting is medical record keeping. Oral examination findings, periodontal probing depths, and exploration findings are recorded. The dental chart is an important part of the patient’s medical record, and allows the veterinarian to build a complete picture that organizes results of several detailed examinations.
Biopsy and culture
Further investigation of abnormal tissue.
Biopsy is the process of surgically obtaining a sample of a mass or abnormal tissue. The sample is then sent to a veterinary pathologist for interpretation. The process of preparing the sample for the pathologist takes days to weeks. The pathologist’s evaluation allows determination of what types of cells are present in the sample, and whether they are normal, inflamed, infected, or neoplastic (cancerous). When neoplastic cells are found, the pathologist also provides evidence-based predictions about their expected behavior, such as whether to expect local tissue expansion or metastasis (invasion of distant tissues). .
Sometimes, microorganisms that are different than usual oral flora cause problems in the oral cavity. In these patients, obtaining a sample for culture can be helpful. A culture sample is sent to a diagnostic laboratory, where microorganisms are grown under specific conditions, identified, and can be tested to determine the appropriate treatment.
When knowing the 3-dimensional structure of a problem is important, advanced imaging, particularly computed tomography (CT or CAT scan) can be an important part of the plan.
Computed tomography is a form of imaging that generates 3-dimensional x-ray images. These image can be reconstructed in many different ways to create a more detailed picture to guide a treatment plan.