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    Consultation Worksheet

    Uploaded by

    Toni Maddox
    This document is a patient consultation worksheet used by dentists. It contains fields to record a patient's medical history, reason for attendance, dental examination findings, options for treatment, and obtain signed consent. Treatment may involve options like fillings, bridges, dentures, or dental implants.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd

    Consultation Worksheet

    Uploaded by

    Toni Maddox
    144 views4 pages
    This document is a patient consultation worksheet used by dentists. It contains fields to record a patient's medical history, reason for attendance, dental examination findings, options for treatment, and obtain signed consent. Treatment may involve options like fillings, bridges, dentures, or dental implants.

    Original Description:

    discussion manual

    Original Title

    consultation Worksheet

    Copyright

    © © All Rights Reserved

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    DOC, PDF, TXT or read online from Scribd

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    This document is a patient consultation worksheet used by dentists. It contains fields to record a patient's medical history, reason for attendance, dental examination findings, options for treatment, and obtain signed consent. Treatment may involve options like fillings, bridges, dentures, or dental implants.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    144 views4 pages

    Consultation Worksheet

    Uploaded by

    Toni Maddox
    This document is a patient consultation worksheet used by dentists. It contains fields to record a patient's medical history, reason for attendance, dental examination findings, options for treatment, and obtain signed consent. Treatment may involve options like fillings, bridges, dentures, or dental implants.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 4

    Patient Consultation Worksheet

    Dentist Name: __________________

    Supervisor: _________________________

    Patient Name: _________________________________________________________

    Extra Oral

    Date of consultation:___________________
    Item
    Check medical history:
    relevant points

    Date of birth: __________________

    Diagnosis/ Details

    Reviewed

    Name of current dentist


    (Check patient notes to see if
    already recorded)
    Reason for patient attendance

    History of current clinical


    situation

    What does the patient want to


    achieve?
    Is the patient happy with
    current function / appearance?
    (give details)
    Is the patient wearing a
    denture?
    Are they happy with it?
    Is there a flange on the
    denture?
    Smile

    Wide
    High lip line
    Lip support

    TMJs

    Guarded
    Clicks / pops
    Limited opening
    Pain
    No problems

    Dentale

    (DT.006 updated April 2011)

    Intra Oral

    Full dental chart taken?

    Yes
    No

    Problems, caries?
    Check for pockets over 3mm/
    mobility
    Need for full pocket chart?
    Reduced lower face height
    Restorative volume, overerupted teeth ,space closure?

    Teeth:

    Tissue type

    Thin
    Average/medium

    Bone loss

    Vertical

    Thick
    Upper
    Lower

    Horizontal Upper
    Occlusion class:

    Lower
    Class 1
    Class 2 div1

    Other

    Class 2 div 2
    Interferences

    Class 3
    Teeth:

    Over Eruption

    Teeth:

    Further tests required? (PA,


    OPG, CT scan, Ridge map)
    Tooth type (for CT scanner)

    Square
    Parallel
    Triangular

    Jaw shape (for CT scanner)

    V
    U

    OtherExtr

    Square
    Options given for missing teeth

    Gap
    Denture
    Bridge
    Implant

    Explain to patient how


    implants work including
    failure, smoking, perio, time
    scales, number of visits

    Patient Consent to Treatment


    (DT.008) to be completed and
    signed

    Dentale

    (DT.006 updated April 2011)

    Risks of procedures including


    failure, infection, surgical
    procedure
    Temporisation
    (denture need to leave out 1
    week after surgery)
    Extractions needed:
    As an IR or GDP to do 6/52
    prior to placement

    Patient Consent to Treatment


    (DT.008) to be completed and
    signed
    Gap
    Denture
    Mary land
    Teeth:
    Details:

    Grafting required
    Type: Osteon, Bio-gide,
    Easy Graft
    Nature of biomaterials
    Osteon man made
    Bio-gide - pig collagen
    Easy Graft synthetic

    Yes
    No
    Yes
    No

    Other treatment needed first


    and explained why?
    Sinus lift, occlusion, perio
    Lab work?
    Spare denture, wax up, drill
    guide, split model
    Any other information
    - Black triangles missing
    papilla
    -Need to leave denture out for
    1 week after surgery
    -Summers lift - not to fly for 1
    week after
    -Appearance compromise?
    (long shaped teeth)
    -Restricted appointment dates
    set by Dentale (refer to Patient
    Terms and Conditions)
    -Likely post op pain
    -Need for time off work
    Category

    Easy
    Difficult

    Dentale

    (DT.006 updated April 2011)

    Treatment Plan / options

    1
    2
    3
    4
    5
    6
    7
    8

    Potential pitfalls

    1
    2
    3

    Implant Sizes and positions

    Healing abutments /
    closure screws?

    Consent
    Estimate given
    Photos taken

    Dentale

    Legal requirement Patient Consent to


    Treatment (DT.008) must be completed and
    signed
    Must print two copies patient to sign both, one
    for patient and one for Dentale records
    Must have pictures of all stages see Standard
    Photo Template (DT.026)

    (DT.006 updated April 2011)

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