Animal Dentistry & Oral Surgery165 Fort Evans Rd. NE, #106Leesburg, VA 20176P: 571-209-1146F: 703-662-6186animaldentalspecialist.com
Tooth
Triadan
Recession
Furcation
Calculus
Plaque
Gingivitis
M1 P4 P3 P2 C I3 I2 I1 I1 I2 I3 C P2 P3 P4 M1
109 108 107 106 104 103 102 101 201 202 203 204 206 207 208 209
RIGHT LEFT
Tooth
Triadan
Recession
Furcation
Calculus
Plaque
Gingivitis
M1 P4 P3 C I3 I2 I1 I1 I2 I3 C P3 P4 M1
409 408 407 404 403 402 401 301 302 303 304 307 308 309
Date
N A - Extraoral/facial
N A – Lymphnodes
N A – Buccal mucosa
N A – Tongue
N A – Palate
N A – Tonsils
N A – Pharynx
Plaque Index 0 1 2 3
Calculus Index 0 1 2 3
Gingival Index 0 1 2 3
Owner: Pet's name:
Ref. veterinarian: Pet's breed:
Ref. hospital: Pet's age: Pet's sex: F/S M/N
DENTAL RECORD
Maxilla
Mandible
R L
DIAGNOSIS
MAL/2 MAL/3 MAL/WRY Malocclusion/base narrow mand. canines Mal/anterior, posterior crossbite Supernumerary tooth Deciduous tooth Retained deciduous tooth No perio dx (maybe calculus) Gingivitis (no bone loss) Mild periodontitis (< 25% attach loss)Mod periodontitis (< 50% attach loss) Severe periodontitis (> 50% attach loss) Gingival hyperplasia/Enlargement Gingival recession (mm) Stomatitis/MucositisStomatitis/Mucositis - Contact ulcerOral mass: OM/EPA OM/EPF OM/EPOOM//MM OM/FS OM/SCC OM/OS OM/AD OM/LS OM/PAPDentigerous cyst Missing teethPeriapical lucencyPerio pocket (mm)
MAL/1MAL/BN
MAL/ABX, PBXSNDTRD
PD0PD1PD2PD3PD4
GHGR
STMSTM/CU
OM
DTCO
PALPP
Attrition/abrasionEnamel/defect, hypoplasiaCariesTooth resorp./Internal Tooth resorp./External replace Tooth resorp./Cervical root surfaceTooth resorp./External in�am. Retained tooth rootTooth/avulsed, impacted, luxatedTooth fracture( EI, EF, UCF, CCF, UCRF, CCRF, RF )Tooth/non-vital, vitalGranuloma/buccal, sublingualEosinophilic gran./lip, palate, tongueForeign bodyOsteomyelitisLaceration/buccal, lip, tongueJaw fracturesSymphyseal separationCleft palate, Cleft lipOronasal �stulaOrally exposed resorptive lesionTMJ/dysplasia, fracture, luxation
AT/ABE/D, H
CATR/I
TR/ERTR/CRTR/EI
RTRT/A, I, LUX
T/FX
T/NV, VG/B, L
G/E/L, P, TFB
OSTLAC/B, L, T
MN/FX MX/FXSYM/S
CFP CFLONF
RLTMJ/D, FX, LUX
Nerve Block 0.5% Marcaine Right LeftInfraorbital ml mlInferior Alveolar ml mlMental ml mlMaxillary ml mlLocal In�ltration ml ml
Rads (dental, CDR, CT scan, plain �lm)Photos (digital, 35 mm)Biopsy – incisional/excisionalCulture/sensitivity
Periodontal prophylaxisSubgingival curettageBone curettageClosed root planingOpen root planingGingivoplastyAlveoloplastyApical repositioning �apCoronal repositioning �apLateral sliding periodontal �apCrown lengtheningBone graftGuided tissue regenerationSplint/acrylic, composite, wire reinforced
Root canal therapySurgical root canal therapyRoot resection (crown intact)Tooth partial resection (hemisection)Crown reductionVital pulp therapyDirect/indirect pulp cappingCrown amputationApexi�cationApexogenesis
Restoration/composite, GI, amalgamDentinal bonding
Flap mucogingivalExtr. – closed, no sectioningExtr. – closed, w/sectioningExtr. – open, surgicalIntercept ortho (perm/dec)Oronasal �stula repairCleft palate repairCleft lip repairPalate surgeryMandibulectomyMaxillectomyFrenoplastySymphyseal separation/wiringJaw fracture repair (j. fx. rp.)Pin j. fx. rp.Plate j. fx. rp.Screw j. fx. rpWire j. fx. rp.Cerclage wire j. fx. rp.Interdental wire j. fx. rpOsseous wire j. fx. rpSuture lacerationOral surgery/mass removal
Core build upCrown preparationCrown metalImpressions/modelsInclined plane/acrylic, composite, metalOrtho appliance – installOrtho appliance – adjustOrtho appliance – removeOrtho app./bracket, button, elastic, wire
RADY
B/I B/ECS
PROSC
BCTRPCRPO
GVAVP
F/ARF/CR
F/LCRLBG
GTRSPL/AC, C, WIR
RCRC/SRRXTRXCRR
VPPC/D PC/I
CRAAPXAPG
R/C, I, ADB
FX
XSXSS
IO/P IO/DONF/RCFP/RCFL/R
S/PS/MS/XFRE
SYM/WIRFX/R
FX/R/PFX/R/PL
FX/R/SFX/R/WIR
FX/R/WIR/CFX/R/WIR/ID
FX/R/WIR/OSLAC/R
OS/MR
CBUCR/P
CR/MIM
IP/AC, C, MOAI
OAAOAR
OA/BKT, BU, EC, WIR
Pet's name:
TREATMENT
Maxilla
Mandible
R L
DIAGNOSIS:
TREATMENT:
INSTRUCTIONS AND MEDICATIONS:
FOLLOW-UP:
Thomas P. Chamberlain, MS, DVM, DAVDC Curtis A. Stiles, DVM, DAVDC