● Tooth formation abnormalities : pets may have extra teeth or missing teeth. Any missing tooth warrants radiographic investigation to rule out subgingival pathology (Bellows, 2020): ○ Retained deciduous tooth: a deciduous tooth that has not fallen out, while the adult tooth has already erupted (deciduous tooth and adult tooth occupying the same position) ■ This causes accumulation of food and debris. While many veterinarians will wait to remove the Tooth resorption Another important phenomenon that is commonly diagnosed in practice is tooth resorption. This condition typically requires radiographs for diagnosis. Tooth resorption is most commonly seen in cats, where it is known as feline odontoclastic resorptive lesions (FORL). However, it can occur in other species as well. Over 75% of cats over five years old in America have at least one tooth effected by FORL, in which the dentin resorbs. This can affect the root, the crown, or both, and its cause is often unpredictable (Carozza, 2020). Tooth resorption is divided in five stages: 1. Stage I : mild loss of enamel or enamel and cementum 2. Stage II : moderate loss of hard tissues of the tooth without involving the pulp chamber 3. Stage III : loss of hard tissue of the tooth that does involve the pulp chamber, but the tooth mostly retains integrity 4. Stage IV : severe loss of hard tissue of the tooth that does involve the pulp chamber with loss of most structural integrity of the tooth 5. Stage V: radiolucent remnants of where the tooth can be seen on radiographs, with the gums completely healed over the site Periodontal disease Periodontal disease refers to inflammation and infection of the periodontal tissues. Like tooth resorption, periodontal disease can also be divided into stages: ● Normal : gingival or periodontal inflammation is not clinically relevant. ○ The periodontal ligament, which appears on radiographs as a thin black line that goes around the roots, should be seen along normal teeth ● Stage I : presence of gingivitis, but all structural tissues are normal
deciduous tooth at the time of spay or neuter, the deciduous tooth should be removed as soon as possible (Bellows, 2020). ○ Supernumerary teeth: extra teeth ○ Hypodontia; congenitally missing teeth ○ Unerupted tooth: tooth that has not popped through the gums ○ Dentigerous cyst/follicular cyst: cyst that has formed around a partially erupted or unerupted tooth
Figure 4: Five Stages of Tooth Resorption
Note . From American Veterinary Dental College AVDC.org.
● Stage II : 25% or less of attachment loss, seen as radiolucency around the tooth root on radiographs (loss of alveolar bone surrounding the tooth) ● Stage III : 25-50% loss of alveolar bone attachment ● Stage IV : greater than 50% loss of alveolar bone around the tooth Keep in mind you can have normal teeth and teeth with stage IV periodontitis in the same mouth at the same time. It is important to evaluate each tooth individually.
PREPARE FOR DENTAL CHARTING
Remember that your dental is a medical record and, therefore, a legal document. If it is not written down, it did not happen. In other words, if an abnormality is not written down, even if you saw it, legally it is as good as you missing it. Incomplete or improper charts also make follow-ups and referrals more challenging. There is some debate as to when to chart. Some veterinarians begin by charting, then perform dental radiographs and procedures, with scaling and polishing occurring at the end of the procedure. This can save time, because the technician will not scale and polish teeth that will get removed. Unfortunately, heavy dental calculus can prevent a thorough exam. Structural calculus may be so dense and rigid that it holds mobile teeth in place, leading loose teeth to be missed in charting if charting is performed prior to scaling.
Now that you can properly label teeth and identify dental lesions, you are ready to perform a dental examination and chart your findings in the records for everyone to understand. It is often helpful to use a preprinted dental chart, allowing you to fill in your findings as you perform your dental exam. There are numerous dental charts available. Most dental charts have small boxes that correspond with the Triadan number for each tooth. Abnormalities should be filled in for each tooth when applicable, noting missing teeth, mobility, fractures, and so on. A good source of examples is the American Veterinary Dental College website, AVDC.org. Go to Primary Care Practice Resources and click “Examples of Dental Charts” for downloadable sample charts.
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Book Code: VFL1526
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