Patient present for Hygiene and/or <<Exam>>

Patient signed consent for, temp taken at the start of the appointment, found to be
WNL
Consent for the treatment obtained: Yes

Medical History Update: <<Health History Updated>>

IO/EO: <<Intraoral/Extraoral Check>>
CC: <<Chief Complaint>>

Oral Hygiene:<<Oral Hygiene>>

Home Care: <<Home Care>>

<<Plaque>>
<<Calculus>>
<<Bleeding>>
<<Stain>>
Scaling: <<Debridement>>
Prophy: <<Prophy>>
Fluoride: <<Flouride>>
Gingival Condition: <<Condition of Gingival Tissue>>

Periodontal Status: <<Periodontal Status>>

Gingivitis (Gen) : <<Gingivitis Generalized>>
Gingivitis (Loc): <<Gingivitis Localized>>
Periodontitis (Gen): <<Periodontitis Generalized>>
Periodontitis (Loc): <<Periodontitis Localized>>

OHI:
Checked patient's brushing and flossing technique and advised changes.
Educated client on the importance of flossing and advised to include flossing in
daily OSC.
Gave instructions on Mod [ Bass / Stillman ] brushing technique to the patient.
Gave instructions on c shaped string flossing technique.
Educated on Perio process.
Instructed to include mouth rinse in daily oral self-care.
Educated client on the use of Waterpik to improve oral health
Educated client on the use of electric brushing to improve oral health
Instructed on benefits of using Night Guard
Educated client on the importance of orthodontically sound dentition and how it
improves overall dental health.

FMP: Gen [ ]mm pockets with Loc [ ]mm pockets. disc findings with client / To be
done at next appt.

Stage: <<Staging of periodontitis>>

Grade: <<Grading of periodontitis>>

Risk/Contributing factors:
Oral hygiene non-compliance/ineffectiveness - Fair 10-50% surfaces are plaque
covered
Oral hygiene non-compliance/ineffectiveness - Poor > 50% surfaces are plaque
covered
Impaired healing of systemic conditions - controlled
Impaired healing of systemic conditions - uncontrolled
Hx of Perio Disease - stable
Hx of Perio Disease - unstable
Smoking/Tobacco use
Local Contributing Factors - retain plaque but are maintained
Local Contributing Factors - retain plaque and are not maintained/maintainable
Medications with some effect on oral health
Medications with extreme effect on oral health
Bruxism controlled with NG
Bruxism uncontrolled
Diet containing starches, acidic drinks

Hygiene Frequency/Rationale: [ 3 / 4 / 6 ] mo Hygiene / [ 6 / 9 / 12 ] mo Recall

Note for next visit:

Treatment planned for next visit:

Steri:

Patient Dismissed in healthy Condition

AG RDH 5322