Periodontist Template
Periodontal Exam Note (IH)
A professional Periodontist template for healthcare professionals.
About this template
The Periodontal Exam Note template is designed for periodontists to document comprehensive periodontal evaluations. This template includes sections for medical and dental history, extraoral and intraoral examinations, clinical and radiographic findings, diagnoses, prognosis, and treatment recommendations. It is ideal for capturing detailed information about a patient's periodontal health, including gum conditions, oral hygiene practices, and any previous treatments. This template ensures thorough documentation, aiding in the development of effective treatment plans and facilitating communication with referring dentists. Perfect for periodontists seeking a structured approach to periodontal assessments.
Preview template
REFERRING DENTIST: Dr. Emily Johnson
MEDICAL HISTORY:
Medical Conditions: Hypertension, Type 2 Diabetes
Medications: Metformin, Lisinopril
Allergies: Penicillin
Family History: Father had periodontal disease
Social History: Smokes 10 cigarettes per day
Blood Pressure: 140/90 mmHg, Pulse: 78 bpm. Patient advised on lifestyle changes to manage blood pressure.
CHIEF COMPLAINT:
- Bleeding gums for the past 3 months
- Gums bleed during brushing and have become swollen. No cosmetic concerns reported.
DENTAL HISTORY:
Past periodontal treatment: Scaling and root planing in 2022 by Dr. Sarah Lee
Past orthodontic treatment: None
Previous hygiene interval: Every 6 months
Last dental hygiene visit: 15 July 2024
Oral Hygiene: Brushes twice daily, flosses occasionally
Parafunctional Habits: Clenching at night, does not use a nightguard
EXTRAORAL EXAMINATION:
Head/Neck/Lymph Nodes: NSF
TMJ: NSF
Range of motion: Normal
Lips: NSF
Thyroid: NSF
INTRAORAL EXAMINATION:
Oral Mucosa: WNL
Tongue: NSF
Floor of the mouth: NSF
Salivary Glands: NSF
Oropharynx/Palate: NSF
CLINICAL FINDINGS:
Missing teeth: None
Implants: None
Occlusion: Class I occlusion
Overjet: 2 mm. Overbite: 20%.
Dental midlines: Coincident
Caries or defective restorations: None
Wear: None
Compensatory eruption: None
NCCLs: None
Gingival phenotype: Thin
Limited Keratinized Tissue (2mm or less): Present in lower anterior region
Oral hygiene: Fair, advised to improve flossing
Supragingival biofilm/calculus: Moderate, especially in lower anterior region
Subgingival plaque/calculus: Moderate, noted in posterior molars
RADIOGRAPHIC FINDINGS:
- Bitewings and selected periapicals obtained on 1 November 2024
- Radiographs show moderate bone loss around molars
DIAGNOSES:
- Chronic periodontitis
PROGNOSIS:
- Overall prognosis is fair with treatment
- Specific prognosis for lower molars is guarded
TREATMENT RECOMMENDATIONS:
- Discussed the need for deep cleaning and potential surgical intervention if condition does not improve
- Recommended scaling and root planing
- Advised on smoking cessation and improved oral hygiene practices
- Follow-up in 3 months for reassessment
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