USE OF THIS TEMPLATE FOR EACH AND EVERY PATIENT CARE WILL HELP US IN GIVING OUR PATIENTS THE BEST DENTAL CARE POSSIBLE. THIS IS MADE IN A CONCISE FORMAT AND THEREFORE TOPICS LIKE MEDICAL HISTORY MUST BE ELABORATED.

1. Dental Examination
Template
and
Treatment Planning

2. Patient Details
•
Name
•
Sex
•
Age
•
Marital Status
•
Occupation
•
Date

3. HISTORY
•
PRESENTING COMPLAINT
•
HISTORY OF PATIENT’S PRESENTING
COMPLAINT(S)
•
MEDICAL HISTORY
•
DENTAL HISTORY
•
SOCIAL HISTORY

4. Oral Hygiene Habit
•
Toothbrushing
•
Interdental Aids
•
Mouthwash
•
Tongue Cleaning

5. Personal History
•
Smoking
•
Drinking
•
Contact Sports
•
Other Habits
•
PARAFUNCTION

6. DIET
•
CHARTS
•
ANALYSIS

7. CLINICAL EXAMINATION
•
EXTRA-ORAL
•
ASYMMETRY
•
MOUTH OPENING
•
INTRA-ORAL
•
BPE

8. OCCLUSION
•
CLASS I / II / III
•
OVERJET / OVERBITE
•
ARCH SHAPE
•
CO:CR
•
RIGHT LATERAL
•
LEFT LATERAL
•
PROTRUSIVE

9. DENTITION
•
TEETH PRESENT
•
CARIES
•
RESTORATION
•
HARD TISSUE PATHOLOGY
•
RESTORATION FAILURES
•
IMPACTED TEETH

10. TOOTH SURFACE LOSS
•
ATTRITION
•
EROSION
•
ABRASION
•
ABFRACTION

11. SPECIAL TESTS
•
RADIOGRAPHS
•
DIAGNOSTIC CASTS
•
PULP TESTS
•
PHOTOGRAPHS
•
CBCT
•
SALIVA TESTS

12. DIAGNOSIS
•
DESCRIPTION ALONG WITH THE PROBABLE
CAUSE

13. TREATMENT OBJECTIVES
•
AIMS AND OBJECTIVES OF TREATMENT

14. TREATMENT PLAN
•
BASED ON ALL THE FINDINGS
•
CUSTOMIZED INFORMED CONSENT SIGNED

15. KEY STAGES IN
TREATMENT PROGRESS
•
ALONG WITH DIFFICULTIES AND
CHALLENGES ENCOUNTERED

16. POST-TREATMENT PHOTOGRAPHS:
EXTRA-ORAL AND INTRA-ORAL

17. TREATMENT APPRAISAL
•
MAY REQUIRE A CHANGE OF PLAN
•
PLAN FOR FUTURE MANAGEMENT
•
PROGNOSIS REVISITED

18. CUSTOMIZED
•
TREATMENT PLAN BASED ON FINDINGS
•
INFORMED CONSENT

19. LONG-TERM TREATMENT PLAN
AND FUTURE CONSIDERATIONS
•
MAINTENANCE AND FURTHER

20. DISCUSSION AND
REFLECTION
•
REFLECTIVE SUMMARY

21. REFERENCES
•
EVIDENCE BASED DENTISTRY