BACK TO BASICS: DENTISTRY FUNDAMENTALS


worlds is a bariatric laparoscope with a variable angle.a


Medical endoscopes need to be coupled with a camera and light source. These can range from dedicated endoscopy systems, as would be used for laparoscopy or arthroscopy, to customized systems using compact cameras, smartphones and USB lap- top cameras, and light sources. The choice of sys- tem is largely personal, with the two main essentials being a remote screen of sufficient size and lack of time-lag in the viewed image, something that can be an issue on some wireless systems.


3. Oral Endoscopy for Examination


The most obvious use for an oral endoscope is in oral examination. The use of sedation for this proce- dure is mandatory and deeper levels tend to be re- quired as the combination of movement and magnification will render the image and equipment unusable. Use of an alpha2 agonist (romifidine or detomidine) alongside butorphanol is usually suffi- cient but additional sedation with acepromazine, di- azepam and/or applications of topical lidocaine may be necessary to reduce movement, particularly if the tongue is very active. A relaxed mouth and tongue is the aim to allow accurate placement of the endo- scope and a clear view in the absence of movement. Full-mouth speculae are always used to hold the


mouth open to allow effective examination and pre- vent damage to the scope. Care should be taken to open the speculum the smallest amount to enable effective use of the endoscope, as stretching the cheeks taut can restrict examination of the buccal vestibule, risking damage to the endoscope and al- lowing significant pathology to be missed. The head should preferably be supported using a stand or sling at a comfortable height for the horse and endoscope operator, which usually means the head just above the operator’s waist height. Operators and handlers should be aware of the risks of a horse moving backward on a stand and trapping the endoscope.


Examination should follow a systematic ap- proach.2 Each quadrant of the mouth should be evaluated separately starting with a slow, steady examination of the occlusal surface of each tooth in turn. The scope should be positioned, if possible, so the entire tooth can be seen, and this is something to be considered when choosing which system to buy. A narrow field of view or a cropped image on the viewer (to create an initially spectacular magnified view) can limit the operator’s ability to assess the whole tooth and it becomes easy to lose track of what has been assessed and what hasn’t. Examination in this manner of the buccal and lingual/palatal aspects should be undertaken for each tooth. Close-up examination may require refocusing of


the endoscope or camera, but this is necessary to evaluate lesions first noted on the initial wider ex- amination. For this reason, fixed-focus systems are less user friendly. The endoscopy can be combined


426 2019  Vol. 65  AAEP PROCEEDINGS


with use of periodontal probes or explorers to fur- ther assess the significance of the identified lesions, although coordinating this requires practice. The key features of using endoscopy for oral ex- amination are familiarity with normal anatomy and abnormal pathology, and the limitations of the two- dimensional view. For detailed assessments of subtle pathology of the endodontium and/or perio- dontium oral endoscopy can excel,3–5 but for evalu- ation of overgrowths and malocclusions, visual and manual palpation is often superior. Recording findings for clinical notes during an examination can be challenging, especially in cases where there are a large number of different pathol- ogies present. A technician familiar with oral ex- amination and terminology, who is able to write notes, is beneficial; or use of a phone or embedded endoscopy system voice recorder can all be helpful in addressing the issue. Recording video of the proce- dure as opposed to still images is also preferred. Once oral endoscopy is complete, detailed clinical


notes or charts should be written to record the sig- nificant findings as well as any treatment plans that may arise.


4. Endoscopic-Guided Procedures


The use of endoscopes during dental procedures to aid better visualization has grown.6 While outside the specific title of this talk, the use of endoscopes during procedures will influence the choice of endo- scope systems, so it is an important consideration for those seeking to purchase equipment and maximize its use. Use in this manner tends to fall in to two categories. The first involves intermittent use of the endo-


scope to assess placement of instruments, progress of a procedure, or as a postoperative documentation process. This certainly improves documentation of cases; however, it doesn’t allow visualization while the procedure is being undertaken. For quick in- traprocedural examination or checking, one can ar- gue that a dental mirror, with its ease of use and ability to assess from different angles, is likely to be just as good and, in some situations, may be supe- rior, although documentation of cases with a mirror and camera can be very frustrating. True endoscopic-guided procedures, where the en- doscope remains inside the oral cavity during a sur- gery, is clearly the most useful approach. However, the operator learning curve when switching to this technique is steep, and where more than one person is involved, for example an assistant holding the scope and veterinary dental surgeon undertaking the procedure, this can be very difficult. It is clear that all parties need to be experienced, understand their roles and what is being undertaken, as well as being able to work in the confined area of the oral cavity together without putting the horse, person- nel, and equipment at risk. More recently the speaker has used a scope-stabilizing system, which


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