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 AND RESOURCES (see Chapter 9)
Alert Examination
Adequate but gentle restraint
Good lighting
Charts
Gloves
Complete Examination
General anesthetic components, including monitoring
Good lighting
Soft mouth blocks (gauze, spiral perm rollers): do not use spring‐loaded mouth gags, which can damage teeth or strain the temporomandibular joint unnecessarily, and can cause blindness in cats when they compress the maxillary artery
Magnification (usually needed): loupes
Periodontal probe/explorer
Mirror (Figure 1.1)
Transilluminator
Charts
Figure 1.1 A dental mirror allows you to examine the distal aspects of molars during therapy.
Figure 1.2 Before looking inside the mouth, examine the entire head for abnormalities, such as the generalized swelling of the face of this dog (oral mass).
PROCEDURE
Alert Examination
Use great caution with anxious or aggressive animals or those in pain; examination may have to be accomplished under sedation (carefully) or when the patient is anesthetized.
With the patient gently restrained on the table or floor, first observe the external structures of the head for any irregularities: symmetry, swelling (Figure 1.2), 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:Accumulations of plaque and/or calculus (Figure 1.3).Missing teeth (circle on chart).Supernumerary teeth.Worn (AT for attrition), chipped, broken (FX for fractured) or discolored teeth.Gingival inflammation, overgrowth or recession.Red or bleeding gingiva: draining tract (parulis), purulent discharge.Gingival enlargement.Possible presence of tooth resorption (TR) – feline and canine.Position of teeth (occlusion).Incisors should be in “scissor bite” (Figure 1.4).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.Oral soft tissues.Any fistula or defects.Note if any unusual masses are present; press up in the intermandibular space to lift tongue to view sublingual area (Figure 1.5).
If the patient is not in pain, and will allow it, briefly open the mouth:Assess palate.Look at tongue, and even raise the tongue pushing with your finger in the intermandibular space.Caudal mouth: assess inflammation in any possible stomatitis case.
With discolored teeth, occasionally a patient will allow you to transilluminate the tooth during the initial exam.
Figure 1.3 During the alert exam in anxious patients, caution may be needed to carefully lift the lips with gentle restraint (use a tongue depressor to preserve your fingers), so the extent of calculus and plaque can be estimated (significant accumulations in this patient).
Figure 1.4 This patient shows a variation from a correct “scissors” bite, with the left maxillary first incisor positioned behind the mandibular incisors (rostral crossbite).
Figure 1.5 With a cooperative patient, the tongue can be elevated by pushing up with a finger in the intermandibular space.
Complete Examination Under General Anesthesia
Reevaluate occlusion before intubation.
Initial identification of significant lesions to help treatment planning and inform owner of unexpected problems (“red flag check”).
Continue more extensive evaluation of above indices (Table 1.1):Plaque index.Calculus index (Figure 1.6).Gingival index.TABLE 1.1 Periodontal indices.Plaque index (PI) PI 0No observable plaquePI 1Plaque covers less than one‐third of buccal surfacePI 2Plaque covers between one‐ and two‐thirds of buccal surfacePI 3Plaque covers greater than two‐thirds of buccal tooth surfaceCalculus index (CI) CI 0No observable calculusCI 1Calculus covering less than one‐third of the buccal tooth surfaceCI 2Calculus covering between one‐ and two‐thirds of the buccal surface with minimal subgingival extensionCI 3Calculus covering greater than two‐thirds of the buccal surface and extending subgingivallyGingival index (GI) GI 0Normal healthy gingiva with sharp, noninflamed edgesGI 1Marginal gingivitis; minimal inflammation at the free margin; no bleeding on probingGI 2Moderate gingivitis; wider band of inflammation; bleeding on probingGI 3Advanced gingivitis; inflammation clinically reaching mucogingival junction; spontaneous bleeding sometimes presentFigure 1.6 A more accurate assessment of the extent of plaque and calculus accumulation can be determined under anesthesia. This patient shows moderate calculus accumulation (CI 2) and plaque accumulation (PI 2, covering the calculus).
Missing teeth: radiograph for embedded or unerupted teeth (see