Split Adult Hygiene — Part 2

Hygiene Area of Concern:

Plaque:  [SELECT/INSERT: PLAQUE]
Stain:  [SELECT/INSERT: STAIN]
Calculus: [SELECT/INSERT: CALCULUS]
Bleeding: [SELECT/INSERT: BLEEDING]


Recession:
FMP Done: [SELECT/INSERT: FMP DONE]

Health/Gingivitis: [SELECT/INSERT: HEALTH]

Periodontitis Stage:            [SELECT/INSERT: PERIODONTITIS: STAGING]
Periodontitis Grade: [SELECT/INSERT: PERIODONTITIS: GRADING]

Oral hygiene compliance: [SELECT/INSERT: OHI COMPLIANCE]
Home care instruction: STRESSED THE IMPORTANCE OF HOMECARE- IDEALLY FLOSSING AT LEAST 1XDAY AND BRUSHING MINIMUM 2XDAY
OH Aids Reviewed/Recommended: [SELECT/INSERT: OHI AIDS REVIEWED/RECOMMENDED]

REVIEWED DISEASE PROCESS WITH PATIENT TODAY

Patient is currently: [SELECT/INSERT: FLOSSING x/day] [SELECT/INSERT: BRUSHING x/day]


Hygiene goal:


Treatment recommended:
1) HYGIENE MAINTENANCE


Treatment completed today: [SELECT/INSERT: RDH: Treatment]

Anesthetic:  [SELECT/INSERT: HYGIENE ANESTHETIC]

Desensitizer: [SELECT/INSERT: DESENSITIZER]

Additional Notes:
-ALL PROPER PPE WAS WORN DURING APPT AS PER AHS AND ACDH GUIDELINES
-PRE-PROCEDURAL RINSE OF OPTIRINSE 0.05% FL WITH CITROX PROVIDED TO PT. NO ADVERSE REACTIONS.
-HVE WAS USED AT ALL TIMES DURING AEROSOL GENERATING PROCEDURES.
Does patient have a NightGuard?
Do they use NightGuard?

Have they had orthodontics?
Do they wear Retainers? Fixed or removable?


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

Next visit: [SELECT/INSERT: NEXT VISIT]
Date Booked: