HOW-TO SESSION: DENTISTRY


endoscope. A bright halogen or LED endoscopic light source is essential for optimal image quality. There are several equine oral endoscopic systems available commercially. Alternately, the compo- nents for the endoscopic system can be purchased separately and assembled by the practitioner.10 An effective oral examination of the equine pa-


tient begins with a well-sedated horse in a quiet environment.11 The head should be supported in a comfortable position by an equine dental halter or head stand. A full-mouth speculum is placed and all feed and foreign material is flushed from the mouth with an oral-flushing syringe or equine water pick. A bright light source is essential for the oral examination. For a mirror examination, a high- quality halogen or LED headlight or speculum light should be used. As mentioned, equine oral endo- scopic systems should incorporate a bright light source coupled to the endoscope. Excessive motion of the tongue or a chewing motion can inhibit the ability to use an oral mirror or endoscope effectively. This type of movement can be minimized by intra- venous boluses of detomidine HClb and butorphanol tartratec.2 Fogging of the mirror or lens of the en- doscope can be problematic, particularly in cold cli- mates. This can be managed by rinsing the mirror head or tip of the endoscope with hot water or by using an antifogging glass spray or chlorhexidine solution.1,2,8 The tip of the endoscope should not be submerged in water unless the scope is barometri- cally sealed. Medical endoscopes are preferred over cheaper borescopes because they are specifi- cally designed for medical applications and thus have stronger barriers in place against fluids enter- ing the scope. In addition, many models of rigid medical endoscopes are designed to withstand ster- ilization via autoclave. Rigid endoscopes are pre- ferred for oral endoscopy over flexible endoscopes, as sharp enamel points can damage the outer surface of flexible scopes and cause them to leak. The oral examination is performed systematically


to evaluate all surfaces of the teeth as well as the surrounding soft tissues. The mirror or endoscope is first placed between the right maxillary and man- dibular arcades so that the occlusal surface of 106 is in the field of view. The mirror or endoscope is then carefully advanced caudally to visualize the occlusal surface of each tooth in the arcade. When the dis- tal aspect of 111 is reached, the mirror or endoscope is tipped to visualize the palatal aspect of 111 and then withdrawn in a rostral direction to examine the palatal mucosa and interdental spaces. When the rostral aspect of tooth 106 is reached, the mirror or endoscope is again advanced to the distal aspect of 111, tipped to visualize the vestibular (buccal) as- pect of 111, and withdrawn in a rostral direction to examine the vestibular interdental spaces and buc- cal mucosa. When examining the vestibular aspect of the maxillary cheek teeth, it may help to loosen the straps of the speculum to enable sufficient cheek retraction. The mirror or endoscope is then reposi-


26 2018  Vol. 64  AAEP PROCEEDINGS


Fig. 1. Measurement of periodontal pocket depth via oral endoscope.


tioned over the 200 arcade, and the same systematic examination process is repeated. Upon completing the examination of the 200 arcade, the mirror or endoscope is rotated and the 300 and 400 arcades are examined in a similar fashion, taking care to visualize the occlusal, lingual, and vestibular as- pects of the teeth as well as the surrounding soft tissues. When examining the lingual aspect of the mandibular arcades, gentle retraction of the tongue by an assistant, the gloved opposite hand of the operator, or by use of a long thin retractor is helpful to improve visualization.2,8,12


3. Results


Examination using an oral mirror or endoscope can help identify pathology of dental hard and soft tis- sues. The mirror or endoscope can be used in com- bination with a fine dental explorer to assess endodontic pathology, including cemental or enamel fissures, fractured teeth, or exposure of pulp horns. When viewed through the endoscope, exposed pulp horns will appear lighter in color and will lack light reflection when compared with normal healthy pulp horns. Oral endoscopy is also a very useful way to visualize and assess signs of periodontal disease, including diastemas, periodontal pockets, and gingi- val recession. The oral mirror or endoscope can be used in combination with an equine periodontal probe to determine the extent of attachment loss of affected teeth (Fig. 1). Infundibular caries and pe- ripheral cemental abnormalities can also be identi- fied and monitored using these modalities. Other findings that may be observed during mirror or en- doscopic exam include oral tumors, lingual or buccal


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