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 animal’s 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)
- 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
- Next, examine the mouth for missing teeth. A circle is placed on the chart around missing teeth
- Enamel/ dentin+enamel/ pulpal fractures are observed and noted
- 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.
- 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:
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 tooth’s 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.
