Dental Charting Checklist: Exam Findings & Treatment Needs

Ensure accurate patient records and optimal treatment planning with our Dental Charting Checklist. Streamline exam findings, track treatment needs, and boost your dental practice's efficiency - all in one place!

This Template was installed 2 times.

Patient Demographics & Medical History

1 of 9

Verify patient information, review medical history updates, and note any pertinent allergies or medications.

Patient Full Name

Date of Birth

Patient Age

Patient Phone Number

Medical History (Please describe)

Allergies

Primary Insurance

Current Medications (List all medications and dosages)

Extraoral Examination

2 of 9

Document observations of the face, lymph nodes, temporomandibular joints (TMJs), and occlusal relationships.

Patient Name

Facial Symmetry Observations

TMJ Crepitus (0-3)

TMJ Opening (Normal/Restricted/Painful)

Lymph Node Palpation (Bilateral/Unilateral/Absent)

Lymph Node Description (if palpable)

Occlusion at Rest (Class I/Class II/Class III)

Intraoral Soft Tissue Examination

3 of 9

Record findings regarding the lips, tongue, cheeks, palate, floor of the mouth, and oropharynx. Note any lesions, inflammation, or abnormalities.

Lips: Description of Color, Texture, and Presence of Lesions

Tongue: Description of Color, Texture, Size, and Presence of Ulcerations or Swelling

Buccal Mucosa (Cheeks): Description of Color, Texture, and Presence of Lesions

Palate (Hard & Soft): Description of Color, Texture, and Presence of Exostoses or Lesions

Floor of Mouth: Description of Color, Texture, and Presence of Swelling or Lesions

Oropharynx: Description of Tonsils, Uvula, and Posterior Pharyngeal Wall

Saliva Production

Hard Tissue Examination (Teeth)

4 of 9

Assess each tooth for caries, restorations, fractures, mobility, and periodontal condition. Document existing restorations and their condition.

Caries Risk Assessment (0-5)

Tooth #18 - Condition

Tooth #30 - Condition

Tooth #11 - Probing Depth (mm)

Tooth #31 - Probing Depth (mm)

Existing Restorations (Check all that apply)

Notes on Tooth #19

Periodontal Assessment

5 of 9

Record probing depths, recession, bleeding on probing, furcation involvement, and plaque/calculus indices.

Probing Depth (Tooth #1)

Recession (Tooth #1)

Bleeding on Probing (BOP)

Furcation Involvement (Tooth #3)

Gingival Index Score

Plaque Index Score

Additional Periodontal Notes

Radiographic Findings

6 of 9

Document observations from radiographs (bitewings, periapicals, panoramic). Note any pathology or areas of concern.

Radiographic Interpretation Summary

Bitewing Index (Carson Index or similar)

Presence of Pathology (check all that apply)

Specific Findings (e.g., calculus amount, bone loss)

Panoramic Radiograph Interpretation (if applicable)

Attach Radiographic Image (optional)

Occlusion & Bite Analysis

7 of 9

Assess the relationship of the upper and lower teeth. Note any discrepancies or issues with the bite.

Occlusal Intercuspal Position (ICP)

TMJ Status (Right)

TMJ Status (Left)

Overbite (mm)

Overjet (mm)

Detailed Occlusal Notes

Treatment Plan Recommendations

8 of 9

Outline proposed treatment options for identified dental needs. Prioritize treatment based on urgency and patient goals.

Detailed Treatment Plan Description

Prioritization Level

Estimated Treatment Cost

Proposed Treatment Start Date

Treatment Provider

Patient Financial Arrangement Notes

Patient Communication & Consent

9 of 9

Record discussion with the patient regarding findings and treatment plan. Document patient understanding and consent for proposed treatment.

Summary of Findings Discussed

Explanation of Proposed Treatment Plan

Estimated Treatment Cost

Patient Understanding of Risks & Benefits?

Consent for Specific Procedures?

Date of Next Appointment (if scheduled)

Patient Signature

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