Friday, July 14, 2017

Modified Triadan-Simplified Tooth Identification in Veterinary Dentistry

www.AnimalDentistrySolutions.blogspot.com
Donald H DeForge, VMD
Fellow of the Academy of Veterinary Dentistry
14July2017--- No. 24

Modified Triadan-Simplified Tooth Identification in Veterinary Dentistry




CANINE SPECIES




Image result for Modified Triadan Numbering System in the cat
FELINE SPECIES

All of veterinary dentistry centers on communication.  Comprehensive oral care involves excellent Problem Oriented Oral Medical Records; detailed oral exams; precise oral radiology; and thorough identification of all pathology.

The Modified Triadan Numbering System is the key that unlocks a unique nomenclature that allows for an exchange of medical information from............... practitioner to client and....... in referral cases....... to the animal dentist.  We live in an age of telemedicine.  To communicate in medicine standards must be utilized that are universally accepted.

Over a quarter of a century ago, Michael R. Floyd, DVM, FAVD wrote a paper in The Journal of Veterinary Dentistry: "The Modified Triadan System: Nomenclature for Veterinary Dentistry" [JVetDent 8[4]1991].  With Dr. Floyd's permission his paper became an important Appendix to An Atlas of Veterinary Dental Radiology-Edited by Donald H DeForge, VMD-Fellow of the Academy of Veterinary Dentistry and Ben H Colmery III, DVM-Diplomate of the American Veterinary Dental College.

The rest is history.  In the MTS, all canine teeth end in "4" and all first molars end in "9"-[the Rule of 4 and 9].  This system applies equally well to all domestic species.  As Dr. Floyd wrote: "The Modified Triadan System has a distinct advantage of anatomical notation in that it is equally easy to write, type, speak, print, store, and retrieve.  It leaves no room for confusion about left and right; upper and lower; or comparative evaluations between species even when one species has a reduced dentition."

It is the responsibility of every veterinarian and technician to understand and utilize this system in their veterinary hospital or clinic. It is impossible to communicate without a consistent vocabulary.  Veterinary dentistry continues to grow. Technology and products change on a weekly basis.  To grow, we must never forget the words complete and accurate.

This author thanks Dr. Michael Floyd for his contribution to veterinary dentistry in the arena of nomenclature and exchange of oral information.  Comprehensive Oral Diagnostics and Treatment [CODAT] is based on the Modified Triadan System [MTS].  Once you review this simple system of nomenclature, you will see how simple it is to incorporate it into your computer Problem Oriented Oral Medical Records.

Comments:
Contact Dr. DeForge at:
DoctorDeForge@yahoo.com


Thursday, July 13, 2017

CODAT

Donald H DeForge, VMD
Fellow of the Academy of Veterinary Dentistry
The New England and New York Animal Dental Health Services
Web Blog #23  13July2017


Comprehensive Oral Diagnostics and Treatment
CODAT

The Teeth Cleaning
Periodontal Prophylaxis



The Components:

1] The Oral Structure Exam-
The teeth; ventral tongue; surrounding soft tissue structures; oral mucosa –gingiva; lips and cheeks; soft palate; tonsils; glossopalatine folds; frenula; incisive papilla and duct openings; lingual frenulum; commissures; and vestibules are examined by Dr. DeForge.

2] Crown Scaling-Supragingival-the visible crown is cleaned

3] Root Planing-Subgingival with curettes and/or Piezoelectric ultrasonic power instrumentation is completed.  Most periodontal pathology is subgingival and hidden from the eye on clinical exam.  Thorough subgingival root planing and oral radiology allows Dr. DeForge to see and treat areas which are not visible on clinical exam.

4] Cup Polishing and/or air polishing.  This removes micro-particulate  material that can accelerate plaque and calculus reformation.

5] Sulcar Lavage-flushing the gingival crevice and/or pathologic pockets with saline and/or Chlorhexidine 0.12% removes foreign material that can cause pathology to be readily introduced

6] Dr. DeForge records Periodontal Indices:
·        Plaque Index-0-3
·        Gingival Index-0-3
·        Furcation Index-0-3
·        Tooth Mobility Index-0-3
·        Calculus Index-0-3
·        Attachment Loss-0-3
·        Bleeding on probing-0-3
·        Oral Pain Index-0-3

The Oral Exam Continues
Comprehensive Oral Diagnostics and Treatment with Oral Radiology
CODAT

The periodontium is composed of the gingiva, alveolar mucosa, cementum, periodontal ligament, and alveolar bone . These components serve to support the teeth in their alveolar bone [i.e. tooth socket] The tissues typically seen on clinical inspection are only those of the oral mucosa.  Radiology and probing allows the other areas of the periodontium to be evaluated.  Oral Radiology is essential in the treatment of all patients with advanced periodontal disease.

Examining and recording data on the state of the periodontium MUST is an intregral part of each teeth cleaning and periodontal exam by Dr. DeForge.


The following examination parameters have been completed:
Site Specific Periapical dental x-rays
A count of missing teeth
Occlusion problems noted
Tooth mobility has been recorded

Special Points of Care:
Please report any co-mobidities to Dr. DeForge-liver, kidney, heart, pancreas,
adrenal, Diabetes, thyroid, or other important health problems.
In 
medicine, a comorbidity is the presence of one or more additional diseases or disorders co-occurring with (that is, concomitant or concurrent with) a primary disease or disorder.  Overweight patients suffer commonly from advanced periodontal disease.  Toy breeds and small breeds have a genetic linkage to periodontal disease.

Bleeding on probing is considered a sign of inflammation; Dr. DeForge’s goal with professional care and homecare is to reduce and/or eliminate bleeding on probing.

Dr. DeForge records pocket probing depths around specific teeth in advanced periodontitis.  Four readings are taken; mesial, distal, lingual/palatal, labial/buccal.  Pocket depths of 1-3mm are considered normal.

Clinical attachment level [CAL] is measured by adding pocket probing depth to the amount of gingival recession in each area of the tooth.

In Periodontitis: oral malodor; bleeding on probing; probing levels of 4mm or greater with pocket formation; indistinct periodontal ligaments; and interrupted lamina dura [seen on oral radiology exam] are classic signs of ADVANCED inflammatory gum disease and oral infection.

If deeper probing depths are noted periodontal surgery and/or extraction is always recommended by Dr. DeForge

The keep to all animal oral health is to stabilize periodontal end points of Peridontitis and return the patient to normal oral health. 

This is done with professional care under general inhalation anesthesia and different homecare programs.  Advanced forms of periodontal disease is only treated, by Dr. DeForge, with rechecks under anesthesia every 6-12 months.

Comprehensive Oral Diagnostics and Treatment must be coupled with Supportive Periodontal Therapy.  The more aggressive the pathology the more frequent the appointments for periodontal therapy.

Always consult with Dr. DeForge.  E-Reports are recommended daily for the first 14 days after any periodontal or oral surgery appointment.  Send E-Photos from your Smart Phone of the healing process to Dr. DeForge very 2 weeks for 4 times after the completion of any advanced periodontal care or oral surgery appointment.  The failure to communicate and to complete your re-check appointments will lead to a progression of pathology and the unnecessary need for further oral surgery.

Contact Dr. DeForge at:
or 1-800-838-3368