Clinical attachment level
Normally, the gingival margin is less than 1 mm coronal to the cementoenamel junction. With gingival recession, the gingival
margin lies apical to the cementoenamel junction. In these cases, the loss of attachment will be greater than the pocket depth.
The clinical attachment level offers greater diagnostic significance compared with the probing depth. Attachment loss, or
clinical attachment level, is determined by measuring the distance from the cementoenamel junction to the pocket base. Alternatively,
this measurement is determined by adding the probing depth to the gingival recession measurement (distance between the cementoenamel
junction to the gingival margin) (Photos 5A and 5B).
Bleeding on probing
While examining the gingiva with the periodontal probe, blood is occasionally observed. Bleeding on probing is not considered
normal. Typically a 1- to 2-mm epithelial-lined sulcus exists between the attached gingiva and tooth surface. Disruption of
the periodontal support apparatus by disease often results in bleeding on probing and should alert you to look further (Photo
Photo 6: Bleeding on probing.
A dental explorer has a sharp point or tip used to examine the tooth for surface irregularities, calculus, resorption, necrotic
cementum and mobility. The explorer can also be used to look for pulp exposure. Exposure is suspected if the explorer tip
sticks into the pulp or porous dentin (Photo 7). The explorer is not used to remove calculus.
Photo 7: An explorer penetrating into the pulp cavity indicating the need for root canal therapy or extraction.
Examples of explorers useful in feline dental pathology assessment include the Orban No. 17 explorer, which has a fine 2-mm
tip that extends at a right angle from the shank (Photo 8), and the 11/12 Old Dominion University explorer, which is patterned
after the Gracey 11/12 curette. Its thin tip is especially useful for examining areas of tooth resorption. A shepherd's hook
explorer, although thicker, can also be used (Photo 9).
Normally you'll encounter a smooth path when inserting and withdrawing the explorer from the sulcus or pocket. When a ledge
of subgingival calculus is present, the explorer moves over the tooth surface, encounters the ledge, moves laterally over
it and returns to the tooth surface. If fine deposits of subgingival calculus are present, there will be a gritty sensation
as the explorer passes over the fine calculus. In cases of tooth resorption and other structural defects, the probe enters
the area of dental hard tissue loss (Photos 10 and 11).
Photo 10: Exploring a cat’s cementoenamel root resorption.
Photo 11: Exploring furcation involvement in a cat with stage 2 periodontal disease.
- Baxter CJK. Oral and dental diagnostics. In: Tutt C, Deeprose J, Crossley DA, eds. BSAVA manual of canine and feline dentistry. 3rd ed. Gloucester, U.K.: BSAVA, 2007; 22-40.
- Harvey CE, Emily PP. Oral examination and diagnostic techniques. In: Small animal dentistry. St. Louis, Mo: Mosby, 1993; 19-41.
- Holmstrom SE, Frost Fitch P, Eisner ER. Dental records. In: Veterinary dental techniques for the small animal practitioner. 3rd ed. Philadelphia, Pa: Saunders, 2004; 1-38.
- Lobprise HB. Treatment planning based on examination results. Clin Tech Small Anim Pract 2000; 15 (4): 211-220.
Dr. Bellows owns ALL PETS DENTAL in Weston, Fla. He is a diplomate of the American Veterinary Dental College and the American Board of
Veterinary Practitioners. He can be reached
at (954) 349-5800; e-mail: firstname.lastname@example.org