The Dental Chart

Why Chart?

Abnormal clinical and radiographic findings are noted on the dental chart as a permanent part of the patientís record. Recording the condition of all teeth, as well as soft and hard tissues, is necessary for a number of reasons:

Quality care - charting of existing conditions provide basic information for an accurate, comprehensive treatment plan
Communication with other veterinarians
Legal documentation of care delivered or declined

The dental chart is a permanent record of the whats, whys, whens, and what nexts in a patientís dental care. It should include:

Dental history
Skull type (brachycephalic-flat faced, mesiocephalic-medium faced, dolichocephalic-long nosed)
Oral hygiene - is plaque and calculus present?
Tooth abnormalities
Radiographic findings
Periodontal examination including inflammation, gingival edema, sulcular probe depths, recession, hyperplasia, and mobility
Proposed treatment
Actual treatment
Future treatment plans
Home care instructions including proposed re exam appointments

Four handed charting

Anesthesia is essential for complete examination and charting. To evaluate each tooth individually on its own merit, complete immobilization is necessary.

Two person charting is the fastest and most efficient. One person examines the mouth and the other records information on the chart. The examiner begins by saying "one hundred series" and then says "101" which is the maxillary right central incisor, notes any abnormalities then moves distally until the right maxillary quadrant is completed. The right mandibular quadrant (four hundred series) follows, then the animalís head is rotated for the two and three hundred series. Each tooth must be charted completely including periodontal probe depths before the next tooth is examined.

Charting steps (using Dentalabels)

  1. Charting begins with general evaluation of the gingiva for presence of calculus on the buccal and labial areas of the teeth. Grading is 1=slight, 2=moderate, 3=heavy calculus
  2. Next, examine the mouth for missing teeth. A circle is placed on the chart around missing teeth
  3. Enamel/ dentin+enamel/ pulpal fractures are observed and noted
  4. A periodontal probe with millimeter gradations is inserted at the interface between the free gingiva and tooth surface. The probe is gently pressed down to the bottom of the sulcus, "walked" around the tooth and measurements are noted at the four corners of each tooth. The attachment loss probe depths from the cemento- enamel junction (if gingival recession exists) or from the free gingival margin, are noted on the chart.
  5. Other lesions are observed and noted

Dental chart examples

A dental chart must be "user friendly." When choosing one to be used in your dental practice, look for ease of noting general oral problems (halitosis, rubbing of the face, drooling, bleeding, problems with opening or closing the mouth), as well as oral pathology including ailments listed above, and below the gumline.

There are several dental charts commercially available. An example produced by the Dentalabel Company. Charting shorthand-letters are placed over a tooth to indicate type of pathology noted. Some examples:

A - adontia - absence of a tooth or multiple teeth - also called hypodontia or oligodontia

AB - abrasion - a pathologic wearing away of dental tooth surface by friction of a foreign material. Examples: tennis balls (dirt gets trapped in the fiber, the dog chews or spins the ball in its mouth, and wears down the tooth surface), haircoat, metal furniture

ACB - anterior cross bite - malocclusion where the one or more of the maxillary incisors lie distal to maxillary incisors. Anterior cross bite only affects the incisor teeth

AK - ankylosis - fusion of cementum with alveolar bone

ARF - apical repositioned flap - surgical procedure used to replace gingiva apically to eliminate periodontal pocket

AT - attrition - a pathological wearing away of the tooth caused by an opposing tooth

AV - avulsion - the separation of a tooth from its alveolus

BNC - base narrow canine - mandibular canines penetrating maxilla

CA - carious lesion - crater-like lesion also called a cavity. Occurs mainly in the molar pits of large dogs

CR - crowding

C/SL - calculus slight

C/MOD - calculus moderate

C/H - calculus heavy

D - dehisence - absence of bone support around root

E - enamel defect

EH - enamel hypoplasia - a condition where is enamel is thin or absent. Appears as areas of shinny enamel surrounded by opaque areas of dentin. In time, the opaque regions become stained a brownish color. In dogs, enamel hypoplasia is usually caused by a febrile disease, occurring before the animal is six months old as the enamel is forming

EP - epulis - a periodontal growth classified as either fibromatous, ossifying, or acanthomatous

ER - external resorption

F - furcation exposure

F1 - Class I (incipient) furcation exposure exists when the tip of a probe can just 1-mm) enter the furcation area. Bone fills most of the area where the roots meet

F2 - Class II (definite) furcation exposure exists when the probe tip extends more than one millimeter horizontally into the area where the roots converge

F3 - Class III (through and through) - alveolar bone has eroded to a point that the explorer probe passes through the defect unobstructed

FEN - fenestration - a round or oval defect or opening in the alveolar cortical plate of bone over the root surface

FGG - free gingival graft - transplanting attached gingiva from one area of the mouth to another

FU - fusion - union of two teeth buds. The root canals may be separate or joined. Clinically there is one less tooth in the arch. Radiographically there will be two roots with one crown

FWS - freeway space - the space between the maxillary and mandibular premolar opposing teeth cusp tips when the mouth is closed

FX - fractured tooth

GE - gemination - the division of a single tooth at the time of development resulting in incomplete formation of two teeth. On radiographs, there will be one root with a split crown. Clinically there will be an extra tooth in the arch

GV - gingivectomy

GR - gingival recession - areas where the gingival margin exists apical to the cemento enamel junction (CEJ)

H - gingival hyperplasia - proliferation of attached gingiva coronal to the cemento enamel junction (CEJ)

I - impacted tooth - a tooth that cannot erupt or complete its eruption due to its contact with an obstruction

LB - level bite - where the maxillary and mandibular incisors meet at the incisal edges

M - mobile tooth - an important diagnostic sign that results from a decrease in root attachment or changes in the periodontal ligament. Mobility is noted as M1, M2, M3, based on severity

N - neck lesion (feline oral resorptive lesion)

Class I - enamel loss only
Class II - enamel and dentin exposure
Class III - pulpal exposure
Class IV - partial crown loss
Class V - full crown loss

NE - near exposure - fractured tooth with near pulpal exposure

O - missing tooth

Adult dogs normally have 42 teeth, cats 30. Missing teeth occur from various reasons:

Congenital absence
Impaction of an unerupted tooth
Previous trauma causing exfoliation or fracture
Previous dental care

To evaluate the cause of missing teeth, radiography will show if there is an impacted tooth, retained, or fractured root, or no root

OB - open bite - an area of open space when the jaw is closed, which normally should be occupied by occluding teeth

OD - odontoplasty - area of reshaped tooth by dental bur.

OM - oral mass

ONF - oronasal fistula - an abnormal communication between the mouth and nasal cavity

PCB - posterior cross bite - a malocclusion where one or more of the mandibular premolar teeth occlude bucally with the maxillary teeth

PE - pulpal exposure - opening of the pulp organ made of blood vessels, nerves, and cellular elements to the outside environment usually caused by trauma

PP - periodontal pocket

PU - pulpitis - inflammation of the pulp results in discoloration of the tooth

R - rotated tooth - usually secondary to tooth crowding, most commonly affected teeth are the maxillary second and third premolars

RD - retained deciduous teeth - teeth that have not been shed when secondary (permanent) teeth erupt

RR - retained root - areas where crown is no longer apparent but root(s) remain

RCT - root canal therapy

R/A - restoration amalgam

R/C - restoration composite

R/M - restoration metallic crown

R/I - restoration glass ionomer

RPC - root planing closed

RPO - root planing open

S - supernumerary tooth - extra adult tooth in the arch. Most commonly located in the incisor and premolar areas. Supernumery teeth may cause overcrowding causing periodontal disease or traumatic occlusion

SD - repairative or sclerotic dentin - shiny, transparent, dentin formed as a defense mechanism to chronic irritation

SE - supereruption - condition where a tooth has the cementoenamel junction erupted more coronal than normal. Most common in the canines of older cats

V - vital pulpotomy - surgical amputation of the dental pulp coronal to the cementoenamel junction, and restoration of the reduced crown

W - worn tooth - usually secondary to abrasion from grinding or wearing away of tooth substance by mastication

WF - wear facet - a flattened highly polished area on the toothís surface from chronic wear

WB - wry bite or wry mouth - a skeletal defect where the midline of the maxilla does not line up with the midline of the mandible

X - extracted tooth

Summary

Only a thorough and exacting examination of the teeth, periodontium, soft tissue, and occlusion provides adequate information to base a diagnosis. After abnormalities of the structures are radiographed, diagnosed, and recorded, the treatment planning process begins. A treatment plan and subsequent therapy are only as effective as the quality of information obtained during the examination.

 



This page last updated on October 31, 2000
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Jan Bellows, DVM
All Pets Dental Clinic
17100 Royal Palm Blvd.
Weston, FL 33326
(954) 349-5800
dentalvet@aol.com