Download - Dental examination template
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Dental Examination Template
and Treatment Planning
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Patient Details• Name
• Sex
• Age
• Marital Status
• Occupation
• Date
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HISTORY
• PRESENTING COMPLAINT
• HISTORY OF PATIENT’S PRESENTING COMPLAINT(S)
• MEDICAL HISTORY
• DENTAL HISTORY
• SOCIAL HISTORY
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Oral Hygiene Habit
• Toothbrushing
• Interdental Aids
• Mouthwash
• Tongue Cleaning
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Personal History
• Smoking
• Drinking
• Contact Sports
• Other Habits
• PARAFUNCTION
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DIET
• CHARTS
• ANALYSIS
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CLINICAL EXAMINATION
• EXTRA-ORAL
• ASYMMETRY
• MOUTH OPENING
• INTRA-ORAL
• BPE
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OCCLUSION• CLASS I / II / III
• OVERJET / OVERBITE
• ARCH SHAPE
• CO:CR
• RIGHT LATERAL
• LEFT LATERAL
• PROTRUSIVE
• FREEWAY SPACE
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DENTITION• TEETH PRESENT
• CARIES
• RESTORATION
• HARD TISSUE PATHOLOGY
• RESTORATION FAILURES
• IMPACTED TEETH
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TOOTH SURFACE LOSS
• ATTRITION
• EROSION
• ABRASION
• ABFRACTION
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SPECIAL TESTS• RADIOGRAPHS
• DIAGNOSTIC CASTS
• PULP TESTS
• PHOTOGRAPHS
• CBCT
• SALIVA TESTS
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DIAGNOSIS
• DESCRIPTION ALONG WITH THE PROBABLE CAUSE
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TREATMENT OBJECTIVES
• AIMS AND OBJECTIVES OF TREATMENT
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TREATMENT PLAN
• BASED ON ALL THE FINDINGS
• CUSTOMIZED INFORMED CONSENT SIGNED
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KEY STAGES IN TREATMENT PROGRESS
• ALONG WITH DIFFICULTIES AND CHALLENGES ENCOUNTERED
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POST-TREATMENT PHOTOGRAPHS: EXTRA-ORAL
AND INTRA-ORAL
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TREATMENT APPRAISAL
• MAY REQUIRE A CHANGE OF PLAN
• PLAN FOR FUTURE MANAGEMENT
• PROGNOSIS REVISITED
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CUSTOMIZED
• TREATMENT PLAN BASED ON FINDINGS
• INFORMED CONSENT
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LONG-TERM TREATMENT PLAN AND FUTURE
CONSIDERATIONS
• MAINTENANCE AND FURTHER
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DISCUSSION AND REFLECTION
• REFLECTIVE SUMMARY
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REFERENCES
• EVIDENCE BASED DENTISTRY