Dental Exam Record
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1Dental Exam Record
Patient Name:
Date:
Account No.
DOB:
Medications:
Allergies:
Findings
BP:
Pulse:
¨ Plaque
Med Changes:
¨ Stains
¨ Abrasions
¨ PA #
¨ Gingivitis
¨ Impressions
¨ Cavities (early)
¨ Anesthetic:
¨ Cavities
¨ Laser
¨ Tooth Infection
¨ Lab Slip
¨ Cracked Tooth
¨ Broken Tooth
Conditions
¨ Soft Tissue
General
¨ Bruxism
Renovations
¨ TMD
Mouth Floor
¨ Calculus
Palate
¨ Occlusion
Cheeks
¨ Wisdom Teeth Impacted
Lips
¨ Dry Mouth
Tongue
¨
Throat/Neck
¨
Frenum
¨
Ridges
¨
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8
9
10
11
12
13
14
15
16
L
R
L
R
L
R
L
R
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17
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Parent category: Legal