DENTAL CHARTING CHECKLIST: EXAM FINDINGS & TREATMENT NEEDS

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--- PATIENT DEMOGRAPHICS & MEDICAL HISTORY ---
[ ] Patient Full Name
[ ] Date of Birth
[ ] Patient Age
[ ] Patient Phone Number
[ ] Medical History (Please describe)
[ ] Allergies (Medications, Latex, Other)
[ ] Primary Insurance (Yes, No)
[ ] Current Medications (List all medications and dosages)

--- EXTRAORAL EXAMINATION ---
[ ] Patient Name
[ ] Facial Symmetry Observations
[ ] TMJ Crepitus (0-3)
[ ] TMJ Opening (Normal/Restricted/Painful) (Normal, Restricted, Painful)
[ ] Lymph Node Palpation (Bilateral/Unilateral/Absent) (Bilateral, Unilateral, Absent)
[ ] Lymph Node Description (if palpable)
[ ] Occlusion at Rest (Class I/Class II/Class III) (Class I, Class II, Class III)

--- INTRAORAL SOFT TISSUE EXAMINATION ---
[ ] Lips: Description of Color, Texture, and Presence of Lesions
[ ] Tongue: Description of Color, Texture, Size, and Presence of Ulcerations or Swelling
[ ] Buccal Mucosa (Cheeks): Description of Color, Texture, and Presence of Lesions
[ ] Palate (Hard & Soft): Description of Color, Texture, and Presence of Exostoses or Lesions
[ ] Floor of Mouth: Description of Color, Texture, and Presence of Swelling or Lesions
[ ] Oropharynx: Description of Tonsils, Uvula, and Posterior Pharyngeal Wall
[ ] Saliva Production (Normal, Increased, Decreased)

--- HARD TISSUE EXAMINATION (TEETH) ---
[ ] Caries Risk Assessment (0-5)
[ ] Tooth #18 - Condition (Sound, Small Caries, Large Caries, Existing Restoration, Crown, Missing)
[ ] Tooth #30 - Condition (Sound, Small Caries, Large Caries, Existing Restoration, Crown, Missing)
[ ] Tooth #11 - Probing Depth (mm)
[ ] Tooth #31 - Probing Depth (mm)
[ ] Existing Restorations (Check all that apply) (Amalgam, Composite, Gold, Ceramic, None)
[ ] Notes on Tooth #19

--- PERIODONTAL ASSESSMENT ---
[ ] Probing Depth (Tooth #1)
[ ] Recession (Tooth #1)
[ ] Bleeding on Probing (BOP) (Yes, No)
[ ] Furcation Involvement (Tooth #3) (None, Class I, Class II, Class III)
[ ] Gingival Index Score
[ ] Plaque Index Score
[ ] Additional Periodontal Notes

--- RADIOGRAPHIC FINDINGS ---
[ ] Radiographic Interpretation Summary
[ ] Bitewing Index (Carson Index or similar)
[ ] Presence of Pathology (check all that apply) (Caries, Periapical Lesion, Root Resorption, Dilaceration, Ankylosis, None Observed)
[ ] Specific Findings (e.g., calculus amount, bone loss)
[ ] Panoramic Radiograph Interpretation (if applicable) (Normal, Slight Abnormalities, Moderate Abnormalities, Significant Abnormalities)
[ ] Attach Radiographic Image (optional)

--- OCCLUSION & BITE ANALYSIS ---
[ ] Occlusal Intercuspal Position (ICP) (Class I, Class II, Class III, Crossbite, Open Bite)
[ ] TMJ Status (Right) (Normal, Clicking, Popping, Pain, Limited ROM, Crepitus)
[ ] TMJ Status (Left) (Normal, Clicking, Popping, Pain, Limited ROM, Crepitus)
[ ] Overbite (mm)
[ ] Overjet (mm)
[ ] Detailed Occlusal Notes

--- TREATMENT PLAN RECOMMENDATIONS ---
[ ] Detailed Treatment Plan Description
[ ] Prioritization Level (Emergency, High Priority, Medium Priority, Low Priority)
[ ] Estimated Treatment Cost
[ ] Proposed Treatment Start Date
[ ] Treatment Provider (Dr. [Dentist's Name], Hygienist, Specialist)
[ ] Patient Financial Arrangement Notes

--- PATIENT COMMUNICATION & CONSENT ---
[ ] Summary of Findings Discussed
[ ] Explanation of Proposed Treatment Plan
[ ] Estimated Treatment Cost
[ ] Patient Understanding of Risks & Benefits? (Fully Understands, Partially Understands, Does Not Understand)
[ ] Consent for Specific Procedures? (Radiographs, Local Anesthesia, Fluoride Treatment, Restorative Treatment)
[ ] Date of Next Appointment (if scheduled)
[ ] Patient Signature

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