Animals hide their oral problems as much as possible, so most of them go undetected.

Animal Dental Clinic: oral-diagnostics-home
Normal dental radiograph showing the mandibular incisors, canine tooth, and first two premolars of a dog. Dental radiographs allow visualization of the tooth roots, root canals, and periodontal tissues.

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.


Awake oral examination

Animal Dental Clinic: farcas-oral-exam
Dr. Farcas performs an oral exam on a patient. He examines the visible portion of the mouth for tooth fractures, periodontitis, tumors, and other problems. This serves only as the first step to planning treatment.

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

Animal Dental Clinic: farcas-oral-exam-1
Dr. Farcas performs a complete oral examination on an anesthetized patient while a staff member takes photographs for documentation in the patient’s medical record. All surfaces of all the teeth, the palate, tonsils, and pharynx are evaluated. It’s not uncommon to find new problems at this stage that were not detectable on the previous awake 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.

Dental radiography

Animal Dental Clinic: cristine-dental-rads
Dr. Mincheff obtains dental radiographs while the patient is monitored by another highly-trained staff member. The dog is wrapped in a towel and a patient warming system that continuously provides warm air for heat support. Keeping anesthetized patients at a normal body temperature helps to maintain normal blood pressure and allows a smoother recovery.

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

Animal Dental Clinic: probing
A periodontal probe is gently inserted into the gingival sulcus of an anesthetized patient to determine the depth of periodontal pockets.

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

Animal Dental Clinic: mincheff-microscope
Dr. Mincheff examines a stained tissue sample under the microscope. While all of our biopsy samples are evaluated by board-certified veterinary pathologists, our veterinarians can also learn from these tissue samples.

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.

Advanced imaging

Animal Dental Clinic: CT
Evaluation of the extent and severity of a tumor with computed tomography (CT) scan. This dog has a mandibular tumor causing lysis (destruction) of the bone of the mandible as well as significant soft tissue involvement surrounding the bony lesion.

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.