Three steps for veterinarians to effective periodontal disease diagnosis - DVM
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Three steps for veterinarians to effective periodontal disease diagnosis
Visual examination, anesthetized probing and intraoral radiography can help veterinarians assess each patient's level of disease.


DVM360 MAGAZINE


Step 3: Intraoral radiography


Photo 9: An intraoral radiograph of a mandibular first molar showing Stage 2 periodontal disease.
To walk the talk of veterinary dentistry, intraoral radiography is essential. Exam room diagnostics, as well as probing and mobility examinations, are important, but intraoral radiography provides the most information. Yet, to date, it hasn't become routine in most practices.


Photo 10: An intraoral radiograph showing Stage 3 periodontal disease (less than 50 percent bone loss); the white arrow is pointing to calculus.
Three of the four structures composing the periodontium (cementum, periodontal ligament and alveolar bone) are located below the gum line out of visual view. Radiography is the best way to determine what lies beneath the fourth component, the gingiva.


Photo 11: An intraoral radiograph showing Stages 2, 3 and 4 periodontal disease in a patient’s left mandibular cheek teeth.
Severe periodontal disease appears radiographically as loss of bone support around one or more roots. Bone loss may be horizontal (a decrease in bone height around one or more teeth), vertical (infrabony defect) or oblique (a combination of both) (Photo 9). When more than 50 percent of the bone and tooth support remains (Photo 10), periodontal procedures—together with a healthy patient and stringent home care—often will result in a saved tooth. A guarded prognosis is given when bone loss is greater than that. If the loss more than 75 percent, support is lost, and the prognosis for saving the tooth is poor (Photo 11).

Client communication: Before and after

Your clients are important partners in periodontal diagnostics, treatment and prevention. It's up to them to approve the initial plan of examination under anesthesia with intraoral radiographs and to understand that periodontal disease or other oral problems may be uncovered that should be addressed while the animal is still anesthetized. Set a time (usually two to three hours after the initial inspection in the exam room) for the owner to call to ask what was found after the tooth-by-tooth examination under anesthesia and for the staff to gain client compliance for additional care if needed.

From the beginning, fees should be discussed, but there's no way of knowing what stage of disease exists without at least an in-person examination. Review known fees (e.g., examination, required preanesthetic testing, intravenous fluids, anesthesia, dental radiographs, dental scaling), with the knowledge that there most probably will be additional fees, which may be significant, required to correct issues uncovered once the thorough examination is conducted. Thanks to third-party payment plans, needed treatment often can be paid over time.

Conclusion

Periodontal disease affects most of our patients. With exam room diagnostics, anesthetized probing and intraoral radiography, its diagnosis is within grasp of every practitioner.

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:
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Source: DVM360 MAGAZINE,
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