عنوان مقاله [English]
نویسنده [English]چکیده [English]
Dental disease is the number one clinical problem in small animal practices,
And thus oral pathology is exceedingly common in small animal patients. In addition, there is a very wide variety of pathologies that are encountered within the oral cavity. These conditions often cause significant pain and/or localised, regional and systemic infection. Since oral health is critical for all other body systems including the other vital assessments (nutrition, pain, etc) it should be evaluated during in every patient every time.  
 Lund EM, Armstrong PJ, Kirk CA, Kolar LM, Cleanser JS. Health status and population characteristics of dogs and cats examined at private veterinary practices in the United States. J Am Vet Med Assoc. 1999 May 1;214(9):1336-41.
 Niemiec BA Oral pathology. Top Companion Anim Med. 2008 May;23(2):59-71.
DeBowes LJ, Mosier D, Logan E, et al: Association of periodontal disease and histologic lesions in multiple organs from 45 dogs. J Vet Dent 13(2):57–60, 1996.
Pavlica Z, Petelin M, Juntes P, et al: Periodontal disease burden and pathological changes in organs of dogs. J Vet Dent 25(2):97–105, 2008.
Boutoille F, et al: Echocardiographic alterations and periodontal disease in dogs: A clinical study [abstract]. Proc ECVD:63–65, 2006.
Oral health impacts general health!
Pets with poor oral health often have other health problems. Oral disease can result in general health problems. Dental professionals have long suspected: Infections in the mouth can lead to problems elsewhere in the body. For a long time it was thought that bacteria was the primary factor that linked periodontal disease to other infections in the body. Heart, liver, kidney and other diseases have been associated with bacteria from periodontal disease. More recent research demonstrates that inflammation is significant and may link periodontal disease to other chronic conditions. Experts agree that there is an association between periodontal diseases and other chronic inflammatory conditions, such as diabetes and heart disease. Therefore, treating inflammation as well as bacteria may not only help manage periodontal diseases, but may also help with the management of other chronic inflammatory conditions.
The oral cavity plays a key role in getting the nutrients to the remainder of the GI track. Pets with painful teeth/mouth may experience partial to complete anorexia.Pets with painful teeth/mouth or without teeth may not chew properly which is known to decrease proper digestion and assimilation of nutrients regardless of a proper diet.Oral disease has numerous local/regional and systemic ramifications. The local ones include: abscesses, mandibular pathologic fracture, ocular damage/eye loss, increased incidence of oral cancer, oronasal fistulas (which may further decrease eating). Systemic diseases which may have the oral pathology background are: renal liver and heart disease, Increased incidence of certain cancers, Increased incidence and worsened complications of diabetes mellitus, Risk of early mortality, general lethargy.
All of the above factors prove that oral/dental health is critical to not only the overall patient health, but also quality of life.
Importance of oral examination
The only way to reveal oral pathology is a thorough examination. An oral examination should always begin in a conscious patient.  (Fig.) If the patient (due to aggression or impatience) does not allow a thorough visible inspection, the next step is sedation. The position of evaluator should be comfortable. Appropriate lighting, close access to the head, and ideally an assistant who records the findings will improve the quality of the examination. In addition, an assistant is a significant asset in the photographic evaluation. In this part of examination particular attention is paid at the occlusion (head symmetry, number of the teeth, and their relationship). Dentition and dental deposits are carefully measured and recorded. Finally, regional lymph nodes palpated
Anesthesia allows comfortable access, but the relationship between the maxilla and mandible is not the same as when natural tension of the masticatory muscles is present so it is less reliable for e.g. orthodontic purposes. Only in anesthetized animal one can perform detailed oral/periodontal assesment, intraoral radiography and other diagnostic procedures like biopsy or impression.
After sedation and induction, the patient should undergo all necessary preparations to provide safe anaesthesia. After safe anesthesia is assured, the entire oral cavity must be systematically evaluated using both visual and tactile senses. Careful visual examination should be performed along with the periodontal evaluation. Salient findings include (but are not limited to): fractured, mobile, or intrinsically stained teeth, foreign bodies, tooth defects such are caries or tooth resorption, and oral
masses. The authors recommend that the patient be placed in dorsal recumbency for this step, as it will improve visualization.
The oral structures must be visually assessed, palpated and examined with the use of dental explorer (dedicated to hard tissues) and periodontal probe (used for soft tissues) and with the help of the mirror and retractor. The oral mucosa present at cheeks, lips, palate, pharynx, tongue, and sublingual area is evaluated for its integrity and color. One has to take into account that some anesthetic drugs (e.g. medetomidine) influence vascularity of mucosa and reduce inflammatory signalment (redness).
The periodontal evaluation should begin with determining the plaque, calculus, and gingivitis index. These key pieces of information are best noted prior to the dental cleaning. Following this, the periodontal status is measured. The only accurate method for detecting and measuring periodontal pockets is with a periodontal probe, as pockets are not always diagnosed by radiographs. 
Radiographic evaluation of oral structures is mandatory and complementary part of oral examination. The value of radiographic evaluation in veterinary patients was proven in studies which found 27.8 % of clinically important lesions in dogs and 41.7% in cats would be missed without full mouth radiography.
Questions & Answers
Why we should know more about oral diseases? BECAUSE IT IS THE NUMBER ONE PROBLEMS IN COMPANION ANIMALS.
Why we deal with oral problems? BECAUSE THEY AFFECT THE GENERAL HEALTH BY LOCAL, REGIONAL AND SYSTEMIC COMPLICATIONS AND DECREASE LIFE COMFORT
How we deal with oral problems: WE MUST DIAGNOSE THEM AND ESTABLISH SAFE AND REASONABLE TREATMENT PLAN.
How we diagnose Oral problems? WE NEVER NEGLECT THE SIGNALMENTS AND ALWAYS PROVIDE A THOROUGH EXAMINATION.
How not to miss dental pathology: EVERY PATIENT, EVERY VISIT SHOULD RECEIVE A DENTAL EXAMINATION. RADIOGRAPHY IS A MANDATORY PART OF THE EXAMINATION.
What is the major purpose of dental treatment: PAIN MANAGEMENT AND INFECTION CONTROL.
 Gorrel C, Oral examination and recording in Small Animal Dentistry Saunders 13-21
 Wiggs RB, Lobprise HB. Oral Examination and Diagnosis in Veterinary Dentistry Principles and Practice Lippincott Raven 1997, 87-103
 Jan Bellows Orthodontic equipment, materials and techniques in Small Animal dental equipment, materials and techniques A primer. Blackwell 2004 263-296
 Gawor J. The Orthodontic exam and normal occlusion in Veterinary Orthodontics Ed Niemiec B. Practical Veterinary Publishing, San Diego 2013 1-7
 Huffman LJ: Oral examination. In: Small Animal dental, oral and maxillofacial disease, A color handbook (Niemiec BA ed.). London, Manson, 2010, pp39-61.
 Murrell, J.C. (2007). Premedication and sedation. In: BSAVA Manual of Canine and Feline Anaesthesia and Analgesia. 120-132. Seymour, C.and Duke-Novakovski, T. (Eds.). 2nd ed. Gloucester UK: British Small Animal Veterinary Association.
 Tetradis S, Carranza FA, Fazio RC, Takei HH: Radiographic aids in the diagnosis of periodontal disease, in Carranza’s Clinical Periodontology. St. Louis, Mo, WB Saunders, 2006, pp 561-578
 Niemiec BA: Veterinary dental radiology. In: Small Animal dental, oral and maxillofacial disease, A color handbook (Niemiec BA ed.). London, Manson, 2010, pp 63-87.
 Verstraete FJ, Kass PH, Terpak CH. Diagnostic value of full-mouth radiography in dogs. Am J Vet Res. 1998 Jun;59(6):686-91.
 Verstraete FJ, Kass PH, Terpak CH. Diagnostic value of full-mouth radiography in cats. Am J Vet Res. 1998 Jun;59(6):692-5.