AVDC National Service Dog Oral Healthcare Exam 2014
Owner/Agent email (optional) ______Phone (optional) ______Registration#______Dog Name: ______
Age______Breed______Sex______Body Weight (lbs) ______
Years dog in service______Dog in training (not yet certified) ______
Type of Work Dog Performs______(Police, drug detection, guide dog, etc.)
Certifying Organization______
(Guide Dog, National Assn. Detection Dogs, etc)
How did you hear about the AVDC SDOHE______
What food and items does your dog chew?______
Primary Care Veterinarian ______
Oral Exam / Abnormal FindingsHead and Face / Normal
Dentition / Normal / Missing, SN, RD:
Occlusion / Normal / MAL1 MAL2 MAL3 Other
Plaque and Calculus / None
Gingivitis / None
Periodontitis* / None
Fractured teeth / None / UCF/UCRF (Tooth #)
CCF/CCRF
Abrasion / None / Tooth #:
Caries / None / Tooth #:
Resorption / None / Tooth #:
Oral (non-gingival) soft tissue / Normal
Other abnormalities or observations
* Gingival recession, furcation exposure, odor, or anything that is suspect of subgingival attachment loss that will require probing and radiographs under anesthesia to confirm.
Prompt Treatment is indicated: £ Yes £ No
Treatment Recommendations: ______
______
Prevention Recommendations: ______
______
INSTRUCTIONS
To provide consistency with data entry, when recording pathology, please use the Triadan tooth numbering system and the AVDC approved abbreviations for dental pathology.
Examples:
A fracture of the crown of the left maxillary fourth premolar, with pulp exposure, would be recorded in the table beside CCF/CCRF as tooth #208, because it is a complicated crown fracture of premolar 208.
An uncomplicated crown/root fracture of the right mandibular canine would be recorded beside UCF as tooth #404.
If there are no abnormal findings, circle normal or none in the second column.
110 / 109 / 108 / 107 / 106 / 105 / 104 / 103 / 102 / 101 / 201 / 202 / 203 / 204 / 205 / 206 / 207 / 208 / 209 / 210411 / 410 / 409 / 408 / 407 / 406 / 405 / 404 / 403 / 402 / 401 / 301 / 302 / 303 / 304 / 305 / 306 / 307 / 308 / 309 / 310 / 311
The dental chart may be used to record data prior to completing the exam form. Data will not be retrieved from the dental chart.
Upload the exam data onto the DMS exam form prior to the deadline. A copy may be printed for the service dog owner/handler.
Thank you for your participation in the National Service Dog Oral Healthcare Exam