Child Check-up (Dental)

Dentist: [Clinician Name] (mention the dentist's name) Nurse: [nurse name] (mention the nurse's name) Pt attended at: [time of appointment] (mention the exact time) / with: [person accompanying patient] (mention who brought the patient) EXAM C/O: [primary complaints] (mention primary complaint or state "nil/checkup" if no complaints) MH: Checked, [medical history/medications] (mention any relevant medical history or "no changes"), signed by [parent/guardian name] (mention the parent who confirmed medical status) DH: - Brushing: [0, 1, or 2] (mention brushing frequency) Adv always brush x2 a day - morning before breakfast & evening - Diet: [HIGH/MOD/LOW] (mention sugar intake and types of sugary foods) Sugar & [HIGH/MOD/LOW] (mention acid/fizzy drink intake) Acid E/O: [nad] (mention if normal, otherwise state findings) I/O: [nad] (mention if normal, otherwise state findings) Teeth charted OH: [GOOD/POOR/FAIR] (mention overall oral hygiene status) Compliance: [good/poor] (mention patient’s compliance) Risk Assessment: - Caries risk: [HIGH/MOD/LOW] (mention risk level based on caries) - Perio risk: [HIGH/MOD/LOW] (mention risk based on gum disease or gingivitis) - TSL risk: [HIGH/MOD/LOW] (mention risk of tooth surface loss based on wear) DISCUSSED: [discussion points] (mention any treatment discussions, risks, benefits, or instructions provided to patient/parents) TX PLAN: 1. OHI, diet advice, [fluoride toothpaste/mouthwash/antibiotics] (mention any prescribed items) 2. Topical Fluoride application 3. [fillings/extractions] (mention any planned restorative procedures) Treatment and options explained, parent understands. Parent consented to tx plan Band [1/2/3] (mention the NHS banding of treatment provided) Verbal consent gained [FP17DC signed by] [mum/dad] (mention who signed the consent form) ORTHO ASSESSMENT: [ortho assessment details] (mention any orthodontic assessment if performed, or state "Pt too young for ortho assessment" if applicable) Radiographs (Consent Gained from) - Taken By: [Clinician's Name] [mention "none indicated" if no radiographs taken] LEFT BITEWING: Justification: assess caries and bone levels REPORT: [mention findings from the left bitewing, e.g., bone levels, decay, infection, missing teeth] RIGHT BITEWING: Justification: assess caries and bone levels REPORT: [mention findings from the right bitewing, e.g., bone levels, decay, infection, missing teeth] Treatment: 1. OHI - advised brushing x2/day for 2 mins with F- toothpaste [spit don't rinse] (mention 'spit don't rinse' if pt ≥ 5 years old) 2. Diet advice - Low sugar advised & low acid - Advised sugary snacks/drinks with meals, not between meals. Cut down fizzy drinks, use straw if needed. [3. Topical fluoride application] (mention if fluoride applied to all teeth) NV: [next visit plan] (mention plan for next visit or "TC" if treatment complete) [TC if treatment completed] (mention "Treatment complete" if applicable) [Clinician's Name] [Clinician's Title]