Dental Charting Checklist Template
Ensure accurate and consistent patient records with our Dental Charting Checklist Template! Streamline your charting process, improve communication between dental professionals, and minimize errors - all while optimizing patient care and compliance. Download now and elevate your dental practice's charting standards.
Patient Demographics Verification
Confirm accuracy of patient information before charting begins.
Patient First Name
Patient Last Name
Date of Birth
Patient Phone Number
Insurance Provider
Gender
Chief Complaint & History
Record patient's primary concern and relevant medical/dental history.
Chief Complaint (Patient's Words)
Detailed History of Presenting Complaint
Duration of Complaint (Days/Weeks)
Relevant Medical History
Medications (List and Dosage)
Date of Last Dental Visit
Reason for Visit
Extraoral Examination
Document observations of the face, lymph nodes, temporomandibular joints (TMJs), and occlusal forces.
Patient Name
Chief Complaint (Extraoral Perspective)
TMJ Assessment (Left)
TMJ Assessment (Right)
Neck Circumference (cm)
Observations - Skin/Lymph Nodes
Intraoral Examination - Soft Tissues
Assess and record findings related to the lips, cheeks, tongue, floor of the mouth, palate, and pharynx.
Lip Condition (Color, Texture, Lesions)
Cheek Condition (Color, Texture, Lesions)
Tongue Condition (Color, Papillae, Ulcerations)
Floor of Mouth Condition (Color, Masses, Lesions)
Palate Condition (Color, Texture, Lesions)
Presence of Ulcerations?
Saliva Characteristics (Quantity, Consistency, Color)
Intraoral Examination - Hard Tissues
Evaluate and document the condition of the teeth, gums, and alveolar bone.
Tooth #
Enamel Condition
Dentin Condition
Crown/Restoration Condition (if applicable)
Notes on Tooth Condition
Existing Caries Depth (mm)
Periodontal Assessment
Record probing depths, recession, bleeding on probing, and mobility.
Probing Depth (Anterior)
Probing Depth (Posterior)
Recession (mm)
Bleeding on Probing (BOP)
Mobility (mm)
Furcation Involvement
Additional Periodontal Notes
Caries Assessment (Tooth Surfaces)
Document the presence and severity of existing and potential caries.
Tooth Surface D1 (Occlusal):
Tooth Surface D2 (Mesial-Occlusal):
Tooth Surface D3 (Distal-Occlusal):
D1 Caries Depth (mm):
D2 Caries Depth (mm):
D3 Caries Depth (mm):
Existing Restoration on Surface D1:
Restorations & Existing Dental Work
List all existing restorations, crowns, bridges, implants, and other dental work, noting material, size, and condition.
Tooth Number
Restoration Type
Size/Width (mm)
Condition
Notes/Comments
Placement Date
Lab/Manufacturer
Occlusion & Bite Analysis
Evaluate and document the patient’s bite and occlusal relationships.
Occlusal Class
Overbite (mm)
Overjet (mm)
Occlusal Interferences/Premature Contacts
TMJ Status
Deviations/Comments (e.g. Crossbite, Open Bite)
Radiographic Assessment
Record type and findings of radiographs taken (e.g., BW, Pano, CBCT).
Radiograph Type(s) Taken
Radiographic Findings (Detailed)
Radiograph Date (MM/DD/YYYY)
Attach Radiograph Image(s)
Radiographic Assessment Quality
Treatment Plan Recommendations
Outline proposed treatment modalities, sequencing, and priorities.
Prioritized Treatment Categories
Estimated Treatment Cost
Proposed Treatment Start Date
Patient Communication Notes (e.g., financial arrangements, treatment explanation)
Financial Arrangement Type
Treatment Sequencing Priority
Additional Notes / Considerations
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