A thorough, systematic approach to oral exams in the consult means you are more likely to discover abnormalities that require further investigation.
In Part 1, we outlined the all-important questions to ask your client in gathering an accurate history of their pet’s dental habits. These questions focused not only on how the animal uses its mouth, but also on gaining insight into your client’s willingness to perform home care. (Stay with us, as the need for these answers will become apparent in a future post.)
Information about your patient’s everyday habits, and more specifically, changes in those normal habits, can often lead us to discover the incidence of oral pain. Oral pain tends to manifest itself through changes in the patient’s behaviour relating to eating or play habits, and how the animal interacts with its usual surroundings, rather than choosing to stop eating altogether.
Take your time and use a systematic approach.
In this post, we’re focusing on the initial Oral Examination, and the first tip is time! Take your time when performing this examination because it takes time to do it well. A rushed oral examination is more likely to be inaccurate, potentially leading to an inaccurate estimate. An inaccurate estimate can lead to a disgruntled client when their expectations are not met. Changing the price mid-procedure and catching the owner unawares is a sure-fire way not to meet those clients’ expectations.
The more thorough your examinations are, the more accurate your estimate of the required treatment and associated costs will be. Using a thorough, systematic approach also means you are more likely to discover abnormalities that require further investigation under general anaesthesia. At this point, your examination is also somewhat subjective, so at best, your goal is to give some direction to your client as to where the treatment for the patient could lead.
The Oral Examination – simple steps to follow.
Let’s look at a simple, easy-to-follow systematic approach to the oral examination on the conscious patient:
1. Skull assessment
The patient’s skull type can predispose them to certain conditions. You are probably acutely aware that patients bred to have malocclusions or crowded and rotated teeth are more likely to have a faster progression of periodontal disease, or that active mesiocephalic patients are more likely to experience traumatic injury or tooth wear. The skull type/shape can give you some clues as to what to expect to see.
2. Asymmetry
In nature, not all things are equal, especially when there are conditions of the oral cavity. Look for any facial swellings, wounds or discharges and asymmetry of the face.
3. Bite Assessment
Malocclusions that cause trauma can often be difficult to assess. Assessing for malocclusions involves an examination of both sides of the mouth (closed) and a frontal view also. Look for any tooth-on-tooth contact or tooth-on-soft tissue contact.
4. Oral Mucosa
Assess the oral mucosa for inflammation, lacerations, oral masses, and discolouration. Assessment of oral masses can be complex, requiring biopsy, surgical intervention, histopathology and discussions on treatment options. Look beyond gingivitis, as many oral conditions can involve the oral mucosa.
5. The Dentition
Look for missing teeth, extra teeth, deciduous teeth, discoloured or fractured teeth. Assess the crowns as best you can, looking for any of these variations that require further (radiographic) examination.
6. Smell
Finally, smell the halitosis and assess whether it matches what you see. Keep in mind that some dental care products are aimed at masking malodor.
The importance of client communication.
Clear communication with your client is key. During the examination, it’s important to guide your client through each step, explaining what you’re doing, what you’re observing, and what it means for the patient. This not only ensures that your client understands the diagnosis and treatment plan but also encourages a sense of trust and connection with you as their veterinary professional.
Your client’s perspective on their pet’s oral health may be based solely on their experiences going to the dentist, and if they have never experienced oral pain or had any dental procedures performed on them, they may not be able to easily relate to what is going on with their pet.
Avoid using industry jargon.
Find simple and straightforward ways to explain the oral conditions seen in your patients. Use diagrams, point out key findings, and speak in a language that your clients can easily understand. This approach makes you more approachable and relatable, enhancing the client’s understanding and trust in your expertise.
Undertaking a thorough oral examination and communicating your findings simply and clearly to your client ensures they will walk away with not only a better understanding of their pet’s oral condition but also with greater trust in your ability to properly treat and care for their pet.
Missed Part 1? Read it here: Periodontal Disease Doesn’t Wait — Top Tips on Improving Your Veterinary Client Compliance Part 1
