How to Document a Dental Examination and Procedure Using a Dental Chart

RESPIRATORY/DENTISTRY

Stephen S. Galloway, DVM

1. Introduction and oral anatomical locations, pathologies, diag- A dental chart is a permanent record of a patient’s noses, treatments, procedures, and dental materi- dental care, and completion of a dental chart is the als. Terminology and abbreviations specific to minimum standard of care for documenting any pro- equine dentistry have also been accepted by the fessional dental procedure. Dental charting is the Academy of Veterinary Dentistry (AVD). An exten- process of recording the state of health or disease of sive glossary of veterinary dental terminology can be the teeth and oral cavity, and it is an integral part of found in veterinary dental texts.2,3 Extensive lists the examination, diagnosis, treatment planning, of the abbreviations accepted by the AVDC and the and monitoring of dental cases.1 The dental chart AVD are available online within the application provides legal documentation of the procedure per- packets for these organizations. Diagnostic and formed and facilitates communication with colleagues. treatment abbreviations commonly used by the au- The scope of this paper is limited to documenting thor are listed in Appendix A. routine equine dental care (occlusal adjustment, Although various systems for describing and num- floating, periodontal therapy, and simple extrac- bering teeth are recognized, the Modified Triadan tions). Although the purpose of this paper is not to Tooth Numbering System is the tooth-identification describe how to perform a dental examination, a system of choice in veterinary dentistry.4 This sys- thorough oral examination is prerequisite to com- tem is applicable to most domestic animal species pleting an accurate dental chart. Additionally, to and provides accurate tooth identification in both properly document any dental procedure and com- written and oral communication. Each tooth is as- municate with colleagues, practitioners must have a signed a unique three-digit number. The first digit working knowledge of dental terminology. designates the tooth’s quadrant and dentition, and the second and third digits designate the specific Standardized Terminology and Abbreviations tooth. Teeth in each quadrant are numbered se- To facilitate communication between colleagues, the quentially from the first (central) incisor (X01) dis- Nomenclature Committee of the American Veteri- tally to the third molar (X11), assuming a complete nary Dental College (AVDC) reviews, clarifies, and phenotypic equine dentition ([I 3/3 C 1/1 P 4/4 M 3/3] recommends standardized terminology for dental ϫ 2 ϭ 44).

NOTES

AAEP PROCEEDINGS ր Vol. 56 ր 2010 429 RESPIRATORY/DENTISTRY 101–111: Maxillary right quadrant, permanent 8. Treatment plan, implementation, drugs ad- dentition. ministered, and procedures performed 201–211: Maxillary left quadrant, permanent 9. Prognosis dentition. 10. Patient progress 301–311: Mandibular left quadrant, permanent 11. Client communication dentition. 401–411: Mandibular right quadrant, perma- 2. Materials and Methods nent dentition. The following outline describes the steps in docu- 501–508, 601–608, 701–708, and 801–808: de- menting a dental procedure using the author’s com- ciduous 100, 200, 300, 400 dentition, respec- bined format (examination and treatment) equine tively. dental chart (Appendix B):

The typical domestic male horse is missing his man- I. Documentation of all veterinary cases be- dibular wolf teeth, and many domestic mares are gins with recording the owner information, additionally missing all canine teeth; therefore, the patient’s signalment, and primary com- dental formulae for male and female equids are ([I plaint for the visit. 3/3 C 1/1 P 4/3 M 3/3] ϫ 2 ϭ 42) and ([I 3/3 C 0/0 P II. The patient’s history is taken with particu- 4/4 M 3/3] ϫ 2 ϭ 38), respectively. In the Modified lar emphasis on the horse’s use, bit and bri- Triadan System, “The Rule of Four and Nine” is dle, diet, and masticatory and performance used to simplify annotation among various species problems. and variations within a species. Tooth X04 is al- III. A thorough physical examination is per- ways the canine tooth (104, 204, 304, 404), and tooth formed and documented. The clinician X09 is always the first molar (109, 209, 309, 409). must first rule out sources of systemic dis- Applying this rule, the first molarized cheek tooth ease before any elective dental procedure is (the second premolar) in domestic horses is tooth performed. Because sedative restraint is X06 (106, 206, 306, 406). required for a thorough dental examination, emphasis during the physical examination The Dental Chart should be placed on the horse’s body condi- The dental chart is a record of the condition of the tion and cardiovascular system. patient’s dentition and oral cavity. It should in- IV. After diseases of other body systems are clude a dental history, oral-examination findings, ruled out, the horse’s head is examined, and proposed and completed dental procedures, pro- abnormalities are recorded. posed future dental care, and home-care instruc- V. On completion of the external examination, tions.5 Although many small animal and human the horse is sedated for oral examina- dentists prefer a two-chart system (one chart for tion. Sedative and other medications are recording examination findings, diagnoses, and pro- recorded on the dental chart as they are posed treatment planning and a second chart for given during the procedure. recording the treatment performed), most equine VI. Oral examination includes the examination dental practitioners use a combined report for both of all tissues in the mouth. The soft-tissue the examination and treatments. The most com- findings are documented in the appropriate monly accepted chart format is an anatomical dental fill-in-the-blank section of the chart (e.g., a diagram supplemented by brief descriptions to clar- cheek laceration caused by a hard enamel ify the examination findings, diagnoses, and proce- point on the maxillary right first molar is dure performed. Most dental charts are designed abbreviated LAC/B 110). with a fill-in-the-blank and check-off format to en- VII. Dental abnormalities are documented on the sure consistent documentation. The dental chart dental diagram and explained in the exam- should include a legend for non-standardized sym- findings section of the chart using the appro- bols and abbreviations; however, the use of approved priate diagnostic abbreviation followed by AVDC/AVD abbreviations should minimize this re- the affected tooth’s Triadan number and the quirement. To meet the legal requirements of med- aspect of the tooth, when appropriate. The ical documentation, most state veterinary-practice tooth aspects are apical, coronal, occlusal, acts require that the following information be in- mesial (M), distal (D), palatal (P), lingual cluded in the medical record6: (L), and vestibular (V)7. A forward slash (/) or a space is often used between abbrevia- 1. Date tions for clarity. For example, a hook on 2. Primary complaint the maxillary right first cheek tooth is ab- 3. History breviated HK 106. 4. Physical examination findings A. Clinically missing teeth are circled on 5. Preliminary diagnosis with rule-outs the diagram and annotated by the tooth 6. Tests performed and results number and abbreviation O (e.g., an ab- 7. Diagnosis sent maxillary left second incisor is ab-

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Fig. 1. Dental diagram charting a diagonal bite 4 (DGL/4). Fig. 2. Dental diagram charting hook malocclusions on the maxillary third incisors (HK 103/203).

breviated 0/202). During the mixed dentition period, unerupted molars are by describing the affected aspect of the recorded by circling the adult molar on tooth (e.g., cribbing attrition on the ves- the dental diagram. tibular aspect of the maxillary first inci- B. The presence of deciduous dentition is sors is abbreviated AT 101V/201V). annotated on the dental diagram by plac- F. Crown fractures of the incisors should be ing a single line through the adult tooth drawn on the dental chart and described number and writing in the appropriate (e.g., a crown fracture of the maxillary deciduous tooth number (e.g., 508). right third incisor is abbreviated T/FX C. Supernumerary teeth and retained de- 403CR). The extent of the fracture can ciduous teeth are drawn on the diagram be further described using the tooth-frac- and appropriately annotated (e.g., SN ture abbreviations (T/FX/) in Appendix 111, not 112, and RD 503). A. D. An unerupted or partially erupted tooth G. Iatrogenic pulp damage secondary to is usually impacted; therefore, a blind overreduction of the incisors with power maxillary right wolf tooth is abbreviated instrumentation is a common find- TI 105. ing. Exposed pulp is differentiated E. Dental malocclusions, fractures, cavities, based on its vitality and recorded (e.g., a and periodontal pockets are drawn on living, bleeding pulp in the mandibular the chart to approximate the outline of right third incisor is abbreviated T/PE/V actual finding and annotated in the ex- 203, whereas a necrotic, non-vital pulp in am-findings section. the same tooth is abbreviated T/PE/NV VIII. Malocclusions and other abnormal dental 203). findings commonly effecting the incisors in- H. Cavities (CA) should be staged according clude the following: to severity. A. Diagonal bites are defined with respect 1. Stage 1: cavities in the cementum to the mandibular incisors. DGL/3 is a only (CA1). diagonal bite in which the mandibular 2. Stage 2: cavities through the cemen- left incisors are longer than the mandib- tum and into the enamel (CA2). ular right incisors (Fig. 1). DGL/4 is a 3. Stage 3: cavities involving the ce- diagonal bite in which mandibular right mentum, enamel, and dentin (CA3). incisors are longer. 4. Stage 4: cavities exposing pulp B. Ventral curvature (CV) and dorsal cur- (CA4). vature bites (CD) are the dental terms I. Tooth resorption (TR; equine odontoclas- for a smile and frown bite, respectively. tic tooth resorption and hypercementosis C. Although overbites and underbites usu- [EOTRH]) should be classified using the ally affect the entire dentition of a pa- AVDC classification (see TR in Appendix tient, these malocclusions are typically A). recorded in the incisor part of the exam- IX. Dental findings commonly affecting the ca- findings section as MAL2 or MAL3, re- nine teeth include: spectively. A. Tartar (calculus [CAL]) that may be as- D. Hooks on the maxillary third incisors are sociated with periodontal disease (dis- a common finding (HK 103/203) (Fig. 2). cussed below). E. Abnormal wear patterns or attrition B. Blind canines in young males and mares such as that seen in cribbers is recorded (TI).

AAEP PROCEEDINGS ր Vol. 56 ր 2010 431 RESPIRATORY/DENTISTRY the occlusal chart margin and in the exam- findings section of the dental chart. A. Occlusal fractures often fit into one of the following categories: 1. Chip: fracture involving only the occlusal margin (T/FX/CHIP). 2. Wedge: fracture outside the infun- dibulae, involving one or more pulp horns (T/FX/WDG). 3. Sagittal: fracture through the infundibulum; classically, through both in- fundibulae (T/FX/SAG) (Fig. 4). Fig. 3. Dental diagram charting a typical cheek-tooth malocclu- 4. The AVDC has further divided tooth sion pattern (HK 206/311, WV 308–9, ATR 210/311). fractures into seven classifications (See T/FX/ in Appendix A). B. Infundibular cavities (INF/CA) should be C. Vestigial canines commonly seen in staged according to severity: mares. No dental abbreviation is recog- 1. Stage 1: cavities in the infundibular nized for this finding; therefore, the au- cementum only (INF/CA1). thor uses a check-the-box format in the 2. Stage 2: cavities involving the infun- exam-findings section of the dental chart dibular cementum and infundibular to record this finding. enamel ring (INF/CA2). D. Cavities and tooth resorption are anno- 3. Stage 3: cavities involving the infun- tated as described for incisors. dibular cementum, enamel, and den- X. Dental findings commonly involving the wolf tin (INF/CA3). teeth include missing (0) and blind teeth 4. Stage 4: cavities through the infun- (TI). dibulae resulting in tooth fracture XI. Dental malocclusions and findings com- (INF/CA4). This staging is rarely monly affecting the cheek teeth include used, because the pathology is usually hooks (HK), ramps (RMP), waves (WV), documented as a sagittal fracture (T/ steps (STP), abnormal transverse ridges FX/SAG). (ATR), hard enamel points (PTS), cupped XIII. Periodontal disease should be noted on the teeth (CUPD), and expired teeth (EXP). dental diagram and described in the exami- These findings are documented on the dental diagram by drawing the lateral profile nation findings. of the cheek-tooth arcade onto the dia- A. Periodontal pockets should be probed, gram. The individual tooth malocclusions and their depths should be recorded (e.g., are clarified in the exam-findings section of a 15-mm deep periodontal pocket on the the dental chart (Fig. 3). distopalatal interproximal aspect of the XII. Dental abnormalities affecting the occlusal maxillary left fourth premolar is abbre- aspect of the cheek teeth, such as fractures viated PP15 208IPD/P (Fig. 5). and infundibular cavities, are best docu- B. Teeth affected by periodontal disease mented on an occlusal diagram such as the should be checked for mobility, and the DuToit Equine Endodontic Numbering Sys- index should be recorded: tem Chart (Appendix C). The lesion is 1. M1: less than 1 mm movement in drawn onto the chart and described both in any direction.

Fig. 4. Dental diagram charting a sagittal fracture of tooth 109 with a missing (vestibular) buccal slab, a grade 2 infundibular cavity in the mesial infundibulum of tooth 110, and cupping in tooth 111 (T/FX/SAG 109, 0 109/V, INF/CA2 110, CUPD 111).

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Fig. 5. Dental diagram charting a diastema and periodontal Fig. 7. Dental diagram charting the correction of the HK103/203 pocketing between the maxillary left third and fourth cheek teeth presented in Figure 2 (OD 103/203). (DIA/PP15 208IPD).

the treatment section of the chart. The 2. M2: less than 2 mm movement in appropriate dental term for the adjust- any direction. ment of the contour of a tooth crown is 3. M3: movement of 3 mm or more in odontoplasty (OD). any direction. B. Floating (FLT), the reduction of sharp C. After radiographic evaluation, the peri- enamel points (PTS), is recorded in the odontal index stage can be classified: treatment section but is not usually 1. PD1: gingivitis only, and no bony at- drawn on the dental diagram. tachment loss. C. Simple extractions of retained deciduous 2. PD2: less than 25% attachment loss. and wolf teeth are common procedures 3. PD3: 25–50% attachment loss. and are recorded by drawing an X 4. PD4: greater than 50% attachment through the extracted tooth on the den- loss. tal diagram and annotating the proce- XIV. Many dental and oral pathologies can only dure in the treatment section (e.g., be diagnosed with radiography. Radio- simple extraction of the maxillary right graphic findings should be recorded on the wolf tooth is abbreviated X105, and sim- dental chart (preferably) or on a separate ple extraction of the mandibular left sec- radiology report. ond cheek-tooth cap is abbreviated X707) XV. After a complete oral examination and an- (Fig. 9). cillary diagnostics have been completed, a D. Many commonly used nerve blocks have tentative treatment plan and fee estimate recognized abbreviations. Practitioners are formulated. On approval, treatment who perform infiltration nerve blocks be- procedures are performed and annotated on fore extracting wolf teeth can abbreviate the dental chart (Figs. 6–8). the procedure as BUC/LIP/X 105/205 to A. Occlusal adjustment reductions are re- indicate that a buccal local infiltration corded on the dental diagram by shading anesthesia, local infiltration anesthesia in the portion of each tooth that has been of the palate, and simple extraction of removed and describing the procedure in

Fig. 8. Dental diagram charting the correction of the cheek- Fig. 6. Dental diagram charting the correction of the DGL/4 tooth malocclusion pattern presented in Figure 3 (OD 206/210/ presented in Figure 1 (I/OD). 308/309/311).

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Fig. 9. Combined examination/treatment dental diagram charting a 2.5-yr-old horse. Examination: O 104/111/204/211/304/305/311/ 404/405/411, HK 310/410, RD 501/506/601/606/706/806. Treatment: X 105/205/501/506/601/606/706/806, OD/FLT.

both maxillary wolf teeth were per- 3. Results formed. Documentation of a dental examination and dental E. Periodontal treatments should be re- procedures using a dental chart. corded in the treatment section of the chart. 1. Supragingival calculus scaling, closed 1. facilitates providing consistent quality dental care to patients by developing good ex- root planning (RPC), and subgingival 8 curettage (SC) are procedures appli- amination habits cable to equine incisors and canine 2. facilitates accurate treatment planning and teeth. No standardized abbreviation fee estimation for supragingival calculus scaling ex- 3. accurately reﬂects the patients past and ists, because dental professionals as- present care as well as establishes a future sume that this procedure will be treatment plan performed; therefore, the author has a 4. provides legal documentation of the proce- check-the-block format in the treat- dure performed ment section to record this procedure. 5. facilitates communication with colleagues. 2. Although the bradydontic periodontal treatment terminology (e.g., RPC and 4. Discussion SC) is often used to describe periodon- Until recently, the horse industry and some equine tal pocket debridement involving practitioners have considered equine dental proce- equine cheek teeth, clinicians must dures to be non-professional services; therefore, the understand that current instrumen- documentation of dental services has been inconsis- tation limits our ability to perform tent and non-standardized. The recognition of den- these procedures correctly, and the tistry as a professional veterinary discipline dictates use of these terms may be inappro- that practitioners document these services, and the priate. The author elects to describe dental chart provides equine practitioners with a the actual treatment performed. concise, legally recognized format for reporting 3. The application of perioceutic medica- these services. During the initial period when a ment (PCT), such as doxycycline gela practitioner is learning how to use the dental chart, and bone-grafting materials (BG), terminology, and abbreviations, charting can be such as synthetic, bioactive ceramicb cumbersome; however, after dental charting be- should be annotated in the treatment comes a routine event, a case can be documented in section of the dental chart. a few minutes. F. Endodontic, orthodontic, oral surgery, The dental chart can be either hand written or and restorative procedures can be docu- computerized, but accompanying digital photogra- mented on a dental chart; however, indi- phy always helps to clarify the recorded document. vidualized case reports may be more Several dental supply companies and printers sell appropriate for advanced dental pro- equine dental charts, or a practitioner can person- cedures with preoperative diagnostic alize a dental chart to his/her practice; some practi- work-ups, prolonged sedative/anesthetic tioners prefer to use a duplicate chart format so that protocols, repeated intraoperative radi- the client receives a copy at the completion of the ography, ancillary treatments, and ex- dental procedure. Although practitioners can de- tended aftercare requirements. bate about which chart format and abbreviations are XVI. The visit is completed by prescribing neces- best, the format of the report is a matter of personal sary medications and aftercare, recording preference as long as information is completely doc- any special instructions, and scheduling the umented in a legible manner that other colleagues next examination, treatment, or follow-up can understand. Whichever format a clinician procedure. chooses, dental charting will always improve the

434 2010 ր Vol. 56 ր AAEP PROCEEDINGS RESPIRATORY/DENTISTRY quality of care that the practitioner provides to the 2. Baker GJ, Easley J, eds. A glossary of equine dental ter- equine patient. minology. In: Equine dentistry, 2nd ed. Edinburgh, Scot- land: Elsevier Saunders, 2005;329–346. Sample dental charts are available online at 3. Wiggs RB, Lobprise HB. Glossary of terms. In: Veteri- www.aaep.org nary dentistry principles and practice. Philadelphia, PA: Lippincott-Raven Publishers, 1997;628–676. Suggested Reading 4. Bellows JE, et al. Clarification of veterinary dental nomenclature. J Vet Dent 2005;22:276. Holmstrom SE, Frost P, Eisner ER. Dental 5. Bellows JE. Smile book IV, small animal dental anatomy, records. In: Veterinary dental techniques for the pathology, and charting. New York, NY: Pfizer Animal small animal practitioner, 2nd ed. Philadelphia, Health, 2004;4. PA: W.B. Saunders Company, 1998;1–30. 6. Scoggins GA. Legal considerations concerning patient medical records, in Proceedings. 51st Annual American Associ- Wiggs RB, Lobprise HB. Abbreviations, dental ations of Equine Practitioners Convention 2005;516. and oral indices. In: Veterinary dentistry princi- 7. Bellows JE, et al. Vestibular is preferred to buccal or labial. ples and practice. Philadelphia, PA: Lippincott- Clarification of veterinary dental nomenclature. J Vet Dent Raven Publishers, 1997;677–690. 2005;22:272. 8. Easley J. Dental and oral examination. In: Baker GJ, Easley J, eds. Equine dentistry, 2nd ed. Edinburgh, Scot- References and Footnotes land: Elsevier Saunders, 2005;151. 1. Wiggs RB, Lobprise HB. Oral examination and diagnosis. In: Veterinary dentistry principles and practice. Philadel- aDoxyrobe Gel, Pfizer Animal Health, Exton, PA 19341. phia, PA: Lippincott-Raven Publishers, 1997;96. bConsil, Nutramax Laboratories, Edgewood, MD 21040.

AAEP PROCEEDINGS ր Vol. 56 ր 2010 435 RESPIRATORY/DENTISTRY Appendix A: Equine Dental Abbreviations

Diagnostic Abbreviations Abbreviations in RED are recognized by the American Veterinary Dental College (AVDC). Abbreviations in BLUE are recognized by the Academy of Veterinary Dentistry (AVD).

Tooth Aspects: V Vestibular (AVDC Preferred) B Buccal L Lingual P Palatal IPM or D Interproximal: Between teeth. Mesial or distal.

AB Abrasion (Tooth or soft tissue). Pathological wear. AT Attrition. Physiologic wear. ATR Abnormal Transverse Ridge. CA Caries INF/CA Infundibular Cavity CAL Calculus. CV Ventral Curvature: Maxillary central incisors extend beyond the level of the maxillary intermediate and corner incisors, “smile”. CD Dorsal Curvature: Mandibular central incisors extend beyond the level of the mandibular intermediate and corner incisors, “frown”. CUPD Cupped: Crown worn past infundibulum. Still has crown above gingival margin. CWD Crowded Tooth. DGL Diagonal: Mandibular incisors longer on either the left side or right side. Defined with respect to mandibular incisors longer on arcade number 300 or 400. DGL/4 400 arcade longer DGL/3 300 arcade longer DIA Diastema between proximal incisor or proximal cheek teeth. E Enamel. E/D Enamel Defect. EXP Expired: Attrition to gingival margin with crown connecting all roots. EXT Extrution. FB Foreign Body. FX Fracture. Tooth or Bone, Also see Tooth Fracture ( T/FX). HK Hook: Excess crown longer than wide. GH Gingival Hyperplasia/Hypertropy. GR Gingival Recession. LAC Laceration. LAC/B Laceration Cheek (Buccal) LAC/L Laceration Lip. LAC/T Laceration Tongue. M Mobile Tooth. M1 Mobile Tooth Index Stage 1. First distinguishable sign of movement. M2 Mobile Tooth Index Satge 2. <3 mm of movement in any direction. M3 Mobile Tooth Index Satge 3. >3 mm of movement in any direction. MAL2 Class II malocclusion, overbite, brachygnathism, mandibular brachygnathism: Extension of maxillary teeth vertically beyond mandibular teeth.1 Defined by the term "distoclusion", where some or all of the mandibular teeth are distal in relationship to their maxillary counterparts. MAL3 Class III malocclusion, underbite, prognathism, mandibular prognathism: Defined by the term "mesioclusion", where some or all of the mandibular teeth are mesial in their relationship to their maxillary counterparts. MN Mandible. MX Maxilla. O Missing/Absent. OAF Oroantral Fistula. ONF Oronasal Fistula.

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OM Oral Mass. PDI Periodontal Disease Index PD1 PD Stage 1: Gingivitis only. PD2 PD Stage 2: < 25% attachment loss. PD3 PD Stage 3: 25%- 50% attachment loss. PD4 PD Stage 4: >50% attachment loss. PE Pulp Exposure PP Periodontal Pocket PTS Sharp Enamel Points: Buccal cusps on maxillary cheek teeth and lingual cusps on mandibular cheek teeth sharpened from wear (attrition). RAD Radiograph RD Retained Deciduous Tooth RMP Ramp: Excess tooth wider than long. RRT Retained Root Tip: Portion of root or tip retained. RTR Retained Tooth Root. STP Step: One tooth only with excess crown. T Tooth T/A Avulsed Tooth. T/FX Tooth Fracture T/FX/EI Enamel Infraction. T/FX/EF Enamel Fracture. T/FX/UCF Uncomplicated Crown Fracture. T/FX/CCF Complicated Crown Fracture. T/FX/UCRF Uncomplicated Crown-Root Fracture. T/FX/CCRF Complicated Crown-Root Fracture. T/FX/RF Root Fracture.

T/FX/SAG Sagittal: Below gum line (subgingival) through infundibulum. T/FX/WDG Wedge: Outside infundibulum. T/FX/CHIP Chip: Occlusal margin only. Not fractured down to gingiva. T/I "Tooth impacted”, "Blind": Not completely erupted. Partially or fully covered by bone or soft tissue. Commonly seen with wolf teeth. T/NE Near Pulp Exposure T/NV Non-vital Tooth T/PE Pulp Exposure T/V Vital Tooth TR Tooth Resorption TR1 TR Stage 1: Mild. Cementum +/- enamel. TR2 TR Stage 2: Moderate. Lesion extends into dentin, but not into pulp cavity. TR3 TR Stage 3: Deep. Lesion extends through dentin into pulp cavity. TR4 TR Stage 4: Extensive. Compromised integrity. TR4a Crown and Root Equally affected. TR4b Crown more severely affected than Root. TR4c Root more severely affected than Crown. TR5 Tooth remnants radiographically. Gingival covering complete. TO Tooth Overlong. WV Wave: More than one tooth with excess crown.

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Treatment Abbreviations B Biopsy B/E Biopsy Excisional. B/I Biopsy Incisional. BG Bone Graft. DB Dentin Bonding FLT Float: Reduction of lingual and buccal enamel points. GV Gingivectomy/ Gingivoplasty. OC Orthodontic Consultation. OD Odontoplasty: Reduction of excessive crown of occlusal surface. PCT Perioceutic Therapy R Restoration R/C Restoration with Composite R/I Restoration with Glass Ionomer.

SC Subgingival Curettage TP Treatment Planning VP Vital Pulpotomy X Extraction, simple XS Extraction, Tooth sectioned XSS Surgical extraction

Nerve Blocks: IFA Inferior Alveolar NB (Mandibular Nerve). IFO Infraorbital NB. MAX Maxillary NB. MEN Mental NB.

BUC Buccal Local Nerve Block LIP Local Infiltration of Palate

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Appendix B: A Completed Dental Chart

AAEP PROCEEDINGS ր Vol. 56 ր 2010 439 RESPIRATORY/DENTISTRY Appendix C: DuToit Endodontic Numbering System

ANIMAL CARE HOSPITAL, 8565 Hwy 64, Somerville, TN 38068, (901) 466-9224 Date: Owner: Patient:

DuToit Endodontic Numbering System

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