Step 3: Intraoral radiography
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 9: An intraoral radiograph of a mandibular first molar showing Stage 2 periodontal disease.
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 10: An intraoral radiograph showing Stage 3 periodontal disease (less than 50 percent bone loss); the white arrow is
pointing to calculus.
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).
Photo 11: An intraoral radiograph showing Stages 2, 3 and 4 periodontal disease in a patient’s left mandibular cheek teeth.
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.
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: email@example.com