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Patient Assessment

History and Physical Examination
The history must include prior home dental hygiene delivered by the client; diet; access to treats and chews; chewing habits; current and previous dental care and procedures; prior and current diseases, including any behavioral issues and allergies; and medications or supplements currently administered. Perform a physical examination of all body systems based on the species, age, health status, and temperament of the animal. If the patient is presented for a complaint not related to dentistry, give due consideration to the primary complaint, performing the diagnostic tests and treatments indicated. Establish priorities if multiple procedures are indicated.

Assessment by Life Stage

Focus on age-related dental conditions and common abnormalities in the dog and cat. From birth to 9 mo of age, evaluate the patient for problems related to the deciduous teeth, missing or extra teeth, swellings, juvenile diseases (such as feline juvenile onset periodontitis), occlusion, and oral development. From 5 mo to 2 yr of age, evaluate the patient for problems related to developmental anomalies, permanent dentition, and the accumulation of plaque and calculus. Periodontal diseases may begin during that time period, especially in cats and small-breed dogs. The onset andseverity of periodontal diseases varies widely depending on breed, diet, and home dental care. In a small-breed dog without home dental care, periodontal diseases can start as early as 9 mo of age. In a large-breed dog, periodontal diseases may not start until later. Many small-breed dogs have periodontal diseases by 3 yr of age.9–12 Beyond 2 yr of age, evaluate the progression of periodontal diseases, damage to tooth structures, occurrence of oral masses, and the existence and adequacy of preventive home dental care. As the animal ages, continue to evaluate the patient for progressive periodontal diseases, oral tumors, and other aspects of dental pathology.13

TABLE 1: Definitions that Pertain to Dental Guidelines*

 
Term Definition
Dental chart A written and graphical representation of the mouth, with adequate space to indicate pathology and procedures (see Table 5 for included items)
Dental prophylaxis A procedure performed on a healthy mouth that includes oral hygiene care, a complete oral examination, and techniques to prevent disease and to remove plaque and calculus from the teeth above and beneath the gum line before periodontitis has developed
Dentistry The evaluation, diagnosis, prevention, and/or treatment of abnormalities in the oral cavity, maxillofacial area, and/or associated structures. Nonsurgical, surgical, or related procedures may be included.
Endodontics The treatment and therapy of diseases of the pulp canal system
Exodontia (extraction) A surgical procedure performed to remove a tooth
Gingivitis Inflammation of the gingiva without loss of the supporting structure(s) shown with X-ray
Oral surgery The surgical invasion and manipulation of hard and soft tissue to improve/restore oral health and comfort
Orthodontics The evaluation and treatment of malpositioned teeth for the purposes of improving occlusion and patient comfort and enhancing the quality of life
Periodontal disease A disease process that begins with gingivitis and progresses to periodontitis when left untreated
Periodontitis A destructive process involving the loss of supportive structures of the teeth, including the periodontium, gingiva, periodontal ligament, cementum, and/or alveolar bone
Periodontal surgery The surgical treatment of periodontal disease. This is indicated for patients with pockets . 5 mm, class II or III furcation exposure, or inaccessible areas.
Periodontal therapy Treatment of tooth-supporting structures where periodontal disease exists. This involves the nonsurgical removal of plaque, calculus, and debris in pockets; and the local application of antimicrobials.
Periodontium The supporting structures of the teeth, including the periodontal ligament, gingiva, cementum, and alveolar and supporting bone
Pocket A pathologic space between supporting structures and the tooth, extending apically from the normal site of the gingival epithelial attachment
*Some of these definitions were derived from descriptions in Holmstrom et al. (2004).3

Oral/Dental Examination in the Conscious Patient

Record all findings in the medical record (Table 5, Page 10). Evaluate the head and oral cavity both visually and by palpation. Changes in body weight, eating habits, or other behaviors can indicate dental disease. Specific abnormal signs to look for may include pain; halitosis; drooling; dysphagia; asymmetry; tooth resorption; discolored, fractured, mobile, missing, or extra teeth; inflammation and bleeding; loss of gingiva and bone; and changes in the range of motion or pain in the temporomandibular joint. In addition, the practitioner should assess the patient’s occlusion to ensure it is normal, or at least atraumatic. Evaluate the patient’s eyes, lymph nodes, nose, lips, teeth, mucous membranes, gingiva, vestibule (i.e., the area between the gum tissue and cheeks), palatal and lingual surfaces of the mouth, dorsal and ventral aspects of the tongue, tonsils, and salivary glands and ducts. Note all abnormalities such as oral tumors, ulcers, or wounds. A diagnostic test strip for the measurement of dissolved thiol levels can be used as an exam room indicator of gingival health and periodontal status.14

The oral examination performed on a conscious patient allows the practitioner to design a preliminary diagnostic plan. Take into consideration potential patient pain. Do not offend the patient by probing unnecessarily when such manipulations can be better achieved under anesthesia. Also, realize in many instances that the examiner will underestimate the conditions present because it is impossible to visualize all oral structures when the patient is awake. It is only when the patient has been anesthetized that a complete and thorough oral evaluation can be accomplished successfully. The complete examination includes a tooth-by-tooth visual examination, probing, and radiographic examination. Only then can a precise treatment plan and fees for proposed services be tabulated and discussed with the pet owner(s).

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