Oral cavity exam Flashcards
What does an oral exam include?
Oral Investigation
- History
- Conscious exam
- Pre operative testing (blood test, urinalysis, viral test)
- Exam under GA
Discuss conscious oral investigation?
- History
- Examination
- Pre operative testing
- 1 st oral over-view
- Occlusion
- ‘Ticket to GA exam’
If you look at a mouth and spot one thing it is likely if you anaesthetise you’ll find many more. For every conscious lesion found he was finding 5 more under GA. So manage owner expectations let them know that you will often find more.
Oral investigation under GA?
DIAGNOSTICS REQUIRE GA!!
- Because lots of fluid and irritants will be about so need to protect the trachea
- 2nd oral over-view (check tongue, arytenoids as great opportunity to look at these structures more detailed)
- Test occlusion when under GA just before you place the tube
- induction
- intubation
- chlorhexidine prep (0.12% solution dribble around ST and teeth as you go as we do this we are making are field cleaner and observing what we are dribbling it on to)
- Debulk calculus (in some cases you may have so much that need to remove it before we do anything, use a hand scaler)
- Once stabilising under GA get a chance to look at the STs
Discuss oral investigation steps?
Oral Investigation steps
- Soft tissue examination
- Probe and chart
- Radiography
- Biopsy?
Discuss oral examination equipment?
- Periodontal Probe
- Explorer
Lines on probes help us measure in mm to measure ginigival margin
DOG: On healthy ginigiva allow up to 3mm. Sulcal depth anything up to 3mm is normal on canine it is 4 normal 5 gingivitis
Cat: Healthy so small you can hardly measure it 0-.05mm canine may measure 1mm
Discuss measuring teeth?
Measure from our central incisor and work out way down that arcade of teeth till last molar.
The explorer has a sharp needle tip this is used only when necessary as can scratch, can be used to identify FORLs or hairline #
What is the dental chart?
Chart
- dentition map
- permanent record
- General note in reference to calculus is fine as we will be removing it anyhow
Charting abnormality examples?
- Periodontal disease
- Missing & extra teeth
- Damaged teeth
- Abscess & tracts
- Resorptive lesions
- Caries
- Oral masses
- Pre & Post Tx eg extraction
- Only cross out the tooth number on the chart when you have got every bit out
Discuss ginigitivitis scoring on dental chart?
Gingivitis severity scored on tendency to bleed (0-3)
G0= clincal health
G1= startting to get signs no bleeding
G2= cardinal signs and delayed bleededing
G3= bleeds straight away on touch
Clinical signs: signs of inlammation erythema, oedema and sensitivity
Periodontitis (left unchecked ginigivitis will progress to periodontitis) Attachment loss progression:
- Periodontal pocket
- Gingival recession
- Furcation involvement
- Mobility
Discuss gingivitis?
Gingivitis can be reversed by brushing teeth/removing plaque
4 periodontal tissues: Gingiva, alveolar bone, cementum and peridontal ligament
Periodontitis is irreversible
Sulcus gets bigger as bone disappears the gingiva recedes and the root starts to be exposed
Furcation: start to be able to place a probe between tooth roots
How is furcation exposure graded?
Grade 1= shallow cave under the tooth root but less than a 1/3 of its width
Grade 2= “” more than 1/3 rd width of tooth
Grade 3= probe goes all the way through like a tunnel
How is mobility graded?
Discuss intra-oral radiography?
- View the ‘hidden’ 60-70% !!
- Remove guesswork and surprises!
- Accurate diagnosis & Tx plan
- Monitoring
- Advanced techniques
- Tooth is like an iceberg the crown is what we can see if we want to see pathology we need to see root and that is where x-ray comes in. Most of the pathology we get will effect the bone and root.
What is the best radiography modality?
Intra-oral:
non-screen film, detail & accuracy
What is this?
Can see that this FORL has not root left so does not need to be surgically extracted
Indications for intra-oral radiography?
- Oral masses
- Damaged teeth-Tx options
- Periodontitis
- Abscess
- Resorptive lesions
- Caries
- During Tx egRCT
- Pre & Post Tx eg extraction
Discuss this radiograph?
If you see this can see the pulp is infected
Discuss parallel and bisecting angle techniques?
Discuss creating a bisecting angle?
Estimating BA: tooth angle & curvature
Beam too steep: short, thick image
Beam too shallow: long, narrow image
Discuss bisecting angle further?
- Accurate representation of size and shape
- BUT 2D image of 3D object
- Several views often required (esp re multi-rooted dentition)
Look at this bisecting angle technique?
Look at this for more help with bisecting angle?
Discuss biopsy of the oral cavity?
Biopsy
- All masses & abnormal lesions!!!
- Wedge (containing normal and effected tissue)
- Sufficient size
- Adequate depth
- Avoid ulcerated / inflamed areas
- Label / orientate on dental chart
- Twin with radiography
- Oral pathologist…..
Summarise oral investigation?
Oral Investigation
- Probe & chart = 30-40% of tooth
- 60-70% = subgingival ie hidden
- RADIOGRAPHY ESSENTIAL!!!
- File all records (chart and radiographs) Medico-legal document which can be passed on to –Colleagues, referral
- Assessment, Tx planning, monitoring
Discuss the use of antibiotics in oral disease?
- Antibiotics
- Grossly over used
- Alteration of commensal flora
- Resistance potential (cross species)
- Do not address underlying problem
Justify usage-specific indications:
- Ulcerative oral disease is a time to use ABs
- Osteomyelitis needs long course of ABs
- Cardiac/renal issues: may use a prophylactic dose to protect vulnerable from bacteraemia from seeding from mouth. Amoxicillin at time of induction to avoid complication in healthy animal immune system is usually capable of dealing with this within 20 mins
- May use for infected abscess we can’t lance on the day as it may cause some pressure relief.
- If suspect a systemic infection as a result of dental infection and be using it IV as well
Discuss antibiotic treatment for prophylactic/preventative and therapeutic benefit?
PROPHYLACTIC/ PREVENTIVE
- Operator
- Patient
THERAPEUTIC
- Specific infections
Prophylactic antibiotic use in patient indications?
Prophylactic Antibiotic Use
PATIENT
- Bacteraemia
- Immunocompromise
- Local compromise
- Aid wound healing
- Pre, peri, post operative usage
Discuss therapeutic antibiotic use?
Therapeutic Use
- Compromised patient
- Severe infection
- Eg abscess + osteomyelitis
- Pain reduction
- Reduce inflammation
- Pre and post op
- Eg gingivostomatitis, tissue trauma
Discuss analgesics and oral disease?
Analgesics
ARE OFTEN UNDER USED!!!
Painful procedures
- Welfare
- Recovery
- Wound healing
Discuss when to give analgesia?
Analgesics
Pre-operative; ‘pre- emptive’ multi-modal analgesia
Avoid pain
Prevent wind-up
In pre-med
- NSAIDS
- Opiates (methadone)
- partial opiates
- Dogs paracetomol
- Local analgesia
Discuss oral surgery principles?
- No sharp/ rough bone
- No tension
- Gentle tissue handling
- Preserve blood supply
- Supported sutures
