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The equine oral examination
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Summary
The equine oral examination is an important first step in any dental appointment from a routine maintenance visit to an advanced consultation. Performing the examination in a repeatable, methodical and clinical way following a routine will ensure nothing is missed. The goals of an oral examination are:
- Identification of dental and oral pathology
- Observation of occlusion and functional anatomy
- To enable selection of further diagnostic procedures if required
- To formulate a treatment plan
Summary of procedure for equine oral examination
- Record signalment, history, previous dental care
- General physical and brief clinical examination; cardiac auscultation
- Observe mastication if considered necessary e.g. referral case, dysmatication reported
- External head examination, including smell from nostrils
- Incisor examination including lateral mandibular excursion assessment
- Buccal retraction and ‘line of sight’ to assess cheek tooth occlusion
- Administer sedation
- Soft tissue manual palpation of interdental space, lips, bars of mouth
- Place speculum, rinse mouth (3-4 large volume syringe flushes, collect mouthwash in bucket)
- Intra-oral visual inspection and manual palpation – consider
- Soft tissues
- Dentition – number of teeth, overgrowths and malocclusions, fractures, endodontic status, periodontic status, infundibular assessment
- Oroscopic examination
- Record findings – video, dental chart
Overview
Oral and dental diseases are common in horses as evidenced by results of various incidence studies[1-4]. Signs of dental disease are often not apparent to the owner until the disease is well advanced. Horses are expert at concealing signs of dental pain and can adjust mastication patterns to avoid painful regions of the mouth or teeth. The minimal dental examination process must be thorough enough to detect abnormalities in early stages of development, to allow informed decisions to be made about potential treatments. The examination process must be performed in a routine fashion to ensure efficiency and quality. A complete oral examination includes observing and palpating both oral hard and soft tissues for pathology. The hard tissues consist of teeth and osseous structures. The soft tissues consist of the lips, cheeks, tongue, palate, gingiva, oral mucosa, and salivary glands. Variations and/or abnormalities detected at the time of the initial examination must be documented. If no notation is made in the record, it can be assumed there were no abnormalities at the time of examination. A standard dental record form can be a valuable aid in the development of good examination habits. Computerized dental records make information more available for retrieval and case follow-up.
The examination
A suitable location should be chosen for the intra-oral examination, preferably indoors to avoid the
poor contrast provided by working outside in bright sunlight. Sedation should be considered mandatory for a complete oral and dental clinical examination. An a-2 agonist and opioid combination is very suitable for oral examinations and procedures. Before sedation is administered, it can be useful to observe the horse eating a variety of feedstuffs including biting a carrot to assess the incisors e.g. many horses with EOTRH will be unable to bite hard on a carrot. The equine oral examination should start by recording the clinical history and signalment on a dental chart. This is followed by an external examination of the head noting symmetry, soft tissue swelling, bony masses or depressions perhaps suggesting previous sinus surgery. Manual palpation of the interdental space and the bars of the mouth may also be performed at this stage.
Examination of the incisor teeth is commonly overlooked but should always be performed before placing the speculum for intra-oral examination. In addition to assessing the presence or absence of teeth, approximate age of the horse and any pathology, the lateral excursion to molar contact test (LMC) may be used to assess for masticatory symmetry and suspected oral or dental pain.
Direct intra-oral examination using a bright head torch, speculum, mouthwash and manual retraction of the tongue will yield useful information regarding pathology in many cases e.g. food material may be seen protruding from interproximal spaces, suggesting a diastema. However, because of the limited opening of the equine mouth, and the rostral arrangement of the lip commissures, much of the oral cavity, especially the buccal and lingual aspects of the dental arcades are not visible directly from a rostral position. The only way to visually inspect the otherwise inaccessible areas of the mouth is by using a dental mirror or a dental endoscope. All areas of the mouth and teeth should be visualised noting any initial observations, such as increased food staining on one side or other, digitally palpated, noting any smell from any area, followed by a systematic examination using a dental mirror noting soft tissue tissue and then dental pathology inclusing a general, periodontal, endotontic and infundibular assessment of every tooth and interproximal space.
Dental endoscopes can provide very detailed and highly magnified images of the oral cavity, and are especially useful for small defects in the occlusal surfaces. Any aspect of the mouth or teeth can be imaged using an endoscope, with the magnified image enabling more sensitive detection of dental pathology such as dentinal fissures, pulp defects, periodontal disease, caries lesions and any soft tissue lesions. Most endoscopes using a chip to grab the image will display the image on a screen that is a great advantage when explaining and demonstrating pathology to clients.
Dental charting
Recording of findings from the oral examination is important for good clinical practice and for owners to keep a record, and to help owners understand the pathology present[5]. For this reason, the author prefers dental charts with the outline of a head and teeth that are easily recognisable. Whatever style of chart is chosen, it is imperative that there are anatomically accurate and detailed occlusal surface images for recording occlusal pathology using a common pulp numbering system[6].
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[1] Brigham E.j., D.G.R. (2000) An equine postmortem dental study: 50 cases. Equine Veterinary Education 12, 59-62.
[2] Simhofer, H., Griss, R. and Zetner, K. (2008) The use of oral endoscopy for detection of cheek teeth abnormalities in 300 horses. Vet J 178, 396-404.
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