Dental Dental Case Presentation Checklist: Diagnostic Records & Treatment Options
Ace your dental case presentations with confidence! This checklist ensures you cover every diagnostic detail, explore treatment options thoroughly, and impress colleagues & patients alike. Perfect for dentists, hygienists, and dental students.
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Diagnostic Records Review
Ensuring all relevant records are accessible and reviewed before case presentation.
Date of Initial Exam
Patient's Age
Chief Complaint
Summary of Patient History
Previous Records (if applicable)
Medical Allergies
Radiographic Findings
Verification of all radiographic images are present and findings are clearly documented and understood.
Bitewing Exposure Factor
PA Exposure Factor
Radiographic Technique Quality
Description of any pathology/abnormalities observed
Presence of Third Molars?
Upload Radiographic Images (if needed for reference)
Clinical Examination Findings
Documentation and review of all clinical examination findings – periodontal, caries, occlusion, soft tissues etc.
Bleeding on Probing (BOP) - Maxillary
Bleeding on Probing (BOP) - Mandibular
Occlusal Status
Detailed Notes on Soft Tissue Evaluation
Periodontal Pocket Depths (Average)
Existing Restorations - Condition
Additional Clinical Observations
Treatment Options Presented
Clearly outlining all viable treatment options, benefits, risks, and costs associated with each.
Detailed Description of Treatment Option 1
Estimated Cost of Treatment Option 1
Treatment Option 1: Direct Access?
Potential Risks and Complications of Treatment Option 1
Insurance Coverage for Treatment Option 1 (Estimated)
Patient Questions/Concerns Regarding Treatment Option 1
Patient Understanding & Consent
Confirmation that the patient understands the proposed treatment plan and has provided informed consent.
Summary of Treatment Plan Explained
Patient Acknowledges Risks and Benefits?
Alternative Treatments Discussed?
Estimated Treatment Cost
Date of Consent
Patient Signature
Witness Signature (if applicable)
Financial Considerations & Payment Plan
Discussion and documentation of estimated costs, insurance coverage, and payment plan options.
Estimated Total Treatment Cost
Patient's Estimated Insurance Coverage
Patient’s Financial Responsibility
Payment Options Offered
Financing Option Selected (if applicable)
Specify Other Financing Option (if selected above)
Date Payment Plan Agreed Upon
Patient Signature - Acknowledgment of Payment Plan
Documentation of Presentation
Verification that all key points of the presentation are accurately documented in the patient's record.
Summary of Patient's Understanding
Treatment Plan Accepted?
Date of Presentation
Time of Presentation
Doctor Signature
Patient Signature (if applicable)
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