Full-mouth radiographic series
The importance of full-mouth radiography can't be overstated for our veterinary patients. Normal-appearing teeth and gingiva
don't necessarily mean that all is well. Considerable pathology can be uncovered in apparently normal patients when a full-mouth
radiographic series is used.
To facilitate a full-mouth series effectively, keep these tips in mind:
First, start at the back of the mouth and move forward. We traditionally start with the right maxilla, moving to the left
maxilla. The patient is rotated to dorsal recumbency, and the left-to-the-right mandible is taken in a similar manner.
The template in your digital software system should be set up and numbered so that all images are positioned correctly as
soon as they appear on the screen. Numbering starts at the upper left of the template and progresses clockwise to the lower
left, depending on the number of images desired (Photo 9).
Photo 9: An example of sensor software template demonstrating numbering for a full-mouth dental radiographic series for a
cat or small dog.
If done correctly, all images will appear as if you were looking at the patient. Maxillary crowns will point down, and the
mandibular crowns will point up. The images on the left of the template are the patient's right. The images on the right of
the template are the patient's left.
Secondly, don't think that you need to get every tooth in its entirety on one image. This is a common thought that significantly
adds to procedure time. For example, start with the right caudal maxilla. Depending on the size of the patient, you may get
only the second and first molar and the distal root of the fourth premolar in your first image. If so, place the sensor to
include the mesial roots of the fourth premolar so that these appear on the far left of the image. You will then likely include
the third and second premolar in this image. Proceed in this manner for the entire series.
Some dogs' size makes it difficult to get an entire large tooth on a Size 2 sensor. The same principle should apply. Perhaps
the crown and half of the root are exposed in the first view. Proceed to include the apex in the subsequent view, but avoid
trying to include the whole tooth.
Small things can make a big difference in the ease and efficiency in veterinary dental radiography. Using these techniques
and tricks may help to minimize patient anesthetic time and increase operator satisfaction.
Brett Beckman, DVM, FAVD, Dipl. AVDC, practices referral dentistry at Affiliated Veterinary Specialists, Orlando, Fla.; Noah's
Animal Hospitals in Indianapolis; and at Florida Veterinary Dentistry and Oral Surgery in Punta Gorda, Fla. He is president-elect
of the American Veterinary Dental Society and diplomate of the American Academy of Pain Management.