Dentist Template

Child Check-up (Dental)

A professional Dentist template for healthcare professionals.

About this template

This Child Check-up (Dental) template is designed for dentists conducting routine dental examinations for children. It includes sections for recording the dentist and nurse's names, appointment details, and the child's medical and dental history. The template guides the dentist through the examination process, including oral hygiene assessment, risk assessment for caries, periodontal disease, and tooth surface loss. It also covers treatment discussions, consent, and orthodontic assessments. This template is ideal for paediatric dentists and general dentists focusing on child dental care, ensuring comprehensive documentation of each visit.

Preview template

Dentist: Faathima Karim Nurse: Sarah Johnson Pt attended at: 10:00 AM / with: Mother EXAM C/O: nil/checkup MH: Checked, no changes, signed by Mrs. Lisa Brown DH: - Brushing: 2 Adv always brush x2 a day - morning before breakfast & evening - Diet: MOD Sugar & LOW Acid E/O: nad I/O: nad Teeth charted OH: GOOD Compliance: good Risk Assessment: - Caries risk: LOW - Perio risk: LOW - TSL risk: LOW DISCUSSED: Discussed importance of maintaining good oral hygiene and regular dental check-ups. Advised on reducing sugar intake. TX PLAN: 1. OHI, diet advice, fluoride toothpaste 2. Topical Fluoride application 3. None Treatment and options explained, parent understands. Parent consented to tx plan Band 1 Verbal consent gained FP17DC signed by mum ORTHO ASSESSMENT: Pt too young for ortho assessment Radiographs (Consent Gained from) - Taken By: Faathima Karim LEFT BITEWING: Justification: assess caries and bone levels REPORT: No decay, bone levels normal RIGHT BITEWING: Justification: assess caries and bone levels REPORT: No decay, bone levels normal Treatment: 1. OHI - advised brushing x2/day for 2 mins with F- toothpaste spit don't rinse 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 NV: 6-month recall for routine check-up Dr. Faathima Karim Dentist

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]

Browse more templates

Use this template