Periodontal Disease: Examination & Documentation
The veterinary technician should “lift the lip” for a quick inspection of the patient’s teeth. The veterinarian should focus on the patient’s overall health status and oral examination findings. Cardiac, renal, hepatic, or other diseases can affect the anesthetic procedure or the patient’s immune system and recovery. Appropriate preanesthetic screening includes CBC, blood chemistry, urinalysis, and ECG. Consider chest radiographs or an echocardiogram if evidence of cardiac disease is present.
On oral examination, evaluate for an abnormal bite that may be traumatizing other structures. Facial swelling or thickening of the bone covering the roots may indicate endodontic disease. The presence of gingival recession or the amount of plaque and tartar accumulation or mucogingival inflammation can indicate periodontal disease, while mobile teeth or exposure of root surfaces indicate significant bone recession. Identify persistent deciduous teeth or missing teeth. Diagnostic test strips help reveal pathogenic bacteria, several of which produce thiols that will change the strip’s color after it is swiped along the gingival margin.
The goal of a comprehensive cleaning is the removal of all plaque and tartar from the teeth and subgingival areas. A chlorhexidine solution is sprayed or lavaged through the oral cavity to reduce potential aerosolization of bacteria. Plaque and calculus are removed supragingivally with an ultrasonic scaler and hand instruments and subgingivally with a hand scaler or ultrasonic instruments. Appropriate training and correct instrumentation are necessary for this procedure.
Polish teeth with a dental paste to remove any remaining plaque and smooth the tooth surface to slow the adhesion of plaque microbes. Thoroughly lavage the gingival sulcus to clear debris, and apply a dental sealant if desired.
The goal of a comprehensive cleaning is the removal of all plaque and tartar from the teeth and subgingival areas.
Gently probe the gingival sulcus in multiple sites around each tooth to measure the depth and identify any periodontal pockets. Measure any gingival recession and identify furcation exposure.
Carefully examine the crown of each tooth for attrition or fractures and identify sites of pulp exposure. In cats, examine teeth for evidence of tooth resorption (eg, inflamed painful granulomatous lesions) along the neck of the tooth. Cats also develop mucogingival stomatitis with diffuse painful inflammation and mouth ulceration that may initially occur in the caudal oral cavity but can involve the whole mouth. Record each abnormality in the patient’s medical file.
Radiographs are used to evaluate the root structures, examine alveolar bone and tissue for bone recession, and determine the presence of periapical lesions. In cats, radiographs help determine if intact roots need to be extracted or the roots have undergone ankylosing resorption. Resorption requires crown amputation with marginal bone contour and a gingival flap to cover the extraction location.
Fractured teeth with pulp exposure should be extracted or treated with root canal therapy. Periodontal pockets may require root planing, and a perioceutic may be applied or a guided tissue regeneration with bone augmentation performed to regenerate boney tissues and enhance healing.
Most veterinarians recommend full-mouth extractions for cats with stomatitis; however, some cats respond to caudal mouth extractions if no disease is present in or around the canines and incisors. Orthodontic movement of maloccluded teeth or selected extractions may be required.