Dental Examination Template

and Treatment Planning

Patient Details• Name

• Sex

• Age

• Marital Status

• Occupation

• Date

HISTORY

• PRESENTING COMPLAINT

• HISTORY OF PATIENT’S PRESENTING COMPLAINT(S)

• MEDICAL HISTORY

• DENTAL HISTORY

• SOCIAL HISTORY

Oral Hygiene Habit

• Toothbrushing

• Interdental Aids

• Mouthwash

• Tongue Cleaning

Personal History

• Smoking

• Drinking

• Contact Sports

• Other Habits

• PARAFUNCTION

DIET

• CHARTS

• ANALYSIS

CLINICAL EXAMINATION

• EXTRA-ORAL

• ASYMMETRY

• MOUTH OPENING

• INTRA-ORAL

• BPE

OCCLUSION• CLASS I / II / III

• OVERJET / OVERBITE

• ARCH SHAPE

• CO:CR

• RIGHT LATERAL

• LEFT LATERAL

• PROTRUSIVE

• FREEWAY SPACE

DENTITION• TEETH PRESENT

• CARIES

• RESTORATION

• HARD TISSUE PATHOLOGY

• RESTORATION FAILURES

• IMPACTED TEETH

TOOTH SURFACE LOSS

• ATTRITION

• EROSION

• ABRASION

• ABFRACTION

SPECIAL TESTS• RADIOGRAPHS

• DIAGNOSTIC CASTS

• PULP TESTS

• PHOTOGRAPHS

• CBCT

• SALIVA TESTS

DIAGNOSIS

• DESCRIPTION ALONG WITH THE PROBABLE CAUSE

TREATMENT OBJECTIVES

• AIMS AND OBJECTIVES OF TREATMENT

TREATMENT PLAN

• BASED ON ALL THE FINDINGS

• CUSTOMIZED INFORMED CONSENT SIGNED

KEY STAGES IN TREATMENT PROGRESS

• ALONG WITH DIFFICULTIES AND CHALLENGES ENCOUNTERED

POST-TREATMENT PHOTOGRAPHS: EXTRA-ORAL

AND INTRA-ORAL

TREATMENT APPRAISAL

• MAY REQUIRE A CHANGE OF PLAN

• PLAN FOR FUTURE MANAGEMENT

• PROGNOSIS REVISITED

CUSTOMIZED

• TREATMENT PLAN BASED ON FINDINGS

• INFORMED CONSENT

LONG-TERM TREATMENT PLAN AND FUTURE

CONSIDERATIONS

• MAINTENANCE AND FURTHER

DISCUSSION AND REFLECTION

• REFLECTIVE SUMMARY

REFERENCES

• EVIDENCE BASED DENTISTRY