2021 Adult Hygiene Interactive

Patient and Visit Context

Patient ID

Note started

Last recall date

Visit Team

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Dentist

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RDH

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RDA

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Consent, Medical History, and Sterilization

Class 5 indicators checked

Miele sterilization codes

Consent given by

Select every applicable source.

PatientParentLegal guardian

Medical history reviewed

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Premedication

Patient Concerns and Hygiene Findings

Patient chief concern

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List each concern on a separate line in the note

Hygiene area of concern

Plaque

Choose options in each applicable section.

Other plaque

Stain

Choose options in each applicable section.

Other stain

Calculus

Choose options in each applicable section.

Other calculus

Bleeding

Choose options in each applicable section.

Other bleeding

Periodontal Assessment

PSR/Pocketing

Enter the six sextants in clockwise order. Blank sextants remain visibly unfilled when another sextant is documented.

Sextant 1

Sextant 2

Sextant 3

Sextant 6

Sextant 5

Sextant 4

Recession

FMP done

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Health/Gingivitis

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Periodontitis stage

Periodontitis stage comments

Periodontitis grade

Periodontitis grade comments

Oral Hygiene and Education

Oral hygiene compliance

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Oral hygiene compliance comment

Flossing frequency

Brushing frequency

Standard home-care instruction reviewed

OH aids reviewed/recommended

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Disease process reviewed with patient today

Additional OHE topics reviewed

OHE notes

Hygiene goal

Treatment

Treatment recommendedHygiene maintenance

Other treatment recommended

Treatment completed today

Treatment types can be remembered. Select one or more standard Tooth/area choices, or add custom text for this note only.

No treatment completed today added.

Anesthetic

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Desensitizer

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Appliances and Relevant History

Has a night guard

Orthodontic history

Retainers

Additional notes

Intervals and Next Visit

Standard PPE statement applies

Recommended recall interval

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Recommended recall interval comments

Recommended hygiene interval

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Recommended hygiene interval comments

Next visit

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Date booked