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Intraoral Examination: Dental Record Chart

This dental record chart documents an intraoral examination for a patient, including their name, age, gender, and date. It provides a legend for documenting the condition of each tooth as well as restorations, prosthetics, surgery, and periodontal screening. Spaces are included to record information about occlusion, appliances, and temporomandibular joint (TMD) issues.

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Gina
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2K views1 page

Intraoral Examination: Dental Record Chart

This dental record chart documents an intraoral examination for a patient, including their name, age, gender, and date. It provides a legend for documenting the condition of each tooth as well as restorations, prosthetics, surgery, and periodontal screening. Spaces are included to record information about occlusion, appliances, and temporomandibular joint (TMD) issues.

Uploaded by

Gina
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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DENTAL RECORD CHART

INTRAORAL EXAMINATION
Name:

Age: Gender: M / F Date:

Legend:
Condition Restorations & Prosthetics Surgery
D - Decayed (Caries Indicated for Filling) J- Jacket Crown X- Extraction due to Caries
M - Missing due to Caries A -Amalgam Filling XO - Extraction due to Other Causes
F - Filled AB - Abutment 0 - Present Teeth
I - Caries Indicated for Extraction p - Pontic Cm - Congenitally Missing
RF - Root Fragment In - Inlay Sp- Supernumerary
MO - Missing due to Other Causes Fx - Fixed cure Composite
Im - Impacted Tooth S - Sealants
Rm - Removable Denture

Periodontal Screening: Occlusion Appliances: TMD:


_____ Gingivitis _____ Class (Molar) _____ Orthodontic _____ Clenching
_____ Early Periodontitis _____ Overjet _____ Stayplate _____ Clicking
_____ Moderate Periodontitis _____ Overbite _______ Others _____ _____ Trismus
_____Advanced Periodontitis _____ Midline Deviation ___________________ _____ Muscle Spasm
_____ Crossbite ___________________

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