Child Recare Exam & Hygiene Notes

Dentist: [SELECT/INSERT: Dentists]
Assistant: [SELECT/INSERT: RDA]
Hygienist: [SELECT/INSERT: Hygienist]

Informed verbal consent given by [AUTO: Patient First Name] [AUTO: Patient Last Name] for treatment today.
Class 5 indicator strip checked: [SELECT/INSERT: Cl5 Indicator Strip Checked]
Miele Sterilization codes scanned:

Patient presents for a pedo recall exam and cleaning

Patients chief concern: [SELECT/INSERT: Chief concern]

Medical history: [SELECT/INSERT: MedHx/DentalHx]
Premedication required: [SELECT/INSERT: PREMED]

Radiographs: [SELECT/INSERT: Radiographs]
Intraoral photos: [SELECT/INSERT: Intraoral]

Exam:
Extraoral- WNL
Intraoral- WNL
Oral habits- N/A

TMJ- WNL

Molar occlusion/Molar Classification:
Skeletal Classification:

Overjet-  mm
Overbite-   %

Doctor Comments-

Caries Detected : YES/NO

• Disclosed - YES/NO

• Plaque Index-

• Calculus- NO/YES  (If yes where- )

• Intraoral Images- YES/NO

• OHI Reviewed
Flossing Technique:
Brushing Technique:

Scaling? Yes or No   #__ units

Polish? Yes or No

Fluoride :  Yes or No

• Relayed info to parent or legal guardian: YES/NO

• Goal for next visit:

RDH/RDA Comments:

Recall Interval: [SELECT/INSERT: REC RECALL INTERVAL]
Hygiene Interval : [SELECT/INSERT: REC HYGIENE INTERVAL]

NEXT VISIT: [SELECT/INSERT: NEXT VISIT]
BOOKED: [AUTO: Next Appointment Date]