Scribd Logo
Upload

Welcome to Scribd!

  • 31 views

    Individual Dental Health Record. Back

    Uploaded by

    ESPOS JEMS MYKEL
    This document appears to be a dental examination form containing fields to record a patient's dental information including: date of examination, age, and presence of various dental issues like caries, gingivitis, periodontal pockets, debris, and deposits. It also includes fields to record the number of teeth present, teeth indicated for filling or extraction, missing teeth, filled/restored teeth, and total DMF teeth. Additional fields include occlusion type, fluoride application, examining dentist information, treatment details, and certification by the university dentist.

    Copyright:

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

    Individual Dental Health Record. Back

    Uploaded by

    ESPOS JEMS MYKEL
    31 views1 page
    This document appears to be a dental examination form containing fields to record a patient's dental information including: date of examination, age, and presence of various dental issues like caries, gingivitis, periodontal pockets, debris, and deposits. It also includes fields to record the number of teeth present, teeth indicated for filling or extraction, missing teeth, filled/restored teeth, and total DMF teeth. Additional fields include occlusion type, fluoride application, examining dentist information, treatment details, and certification by the university dentist.

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document appears to be a dental examination form containing fields to record a patient's dental information including: date of examination, age, and presence of various dental issues like caries, gingivitis, periodontal pockets, debris, and deposits. It also includes fields to record the number of teeth present, teeth indicated for filling or extraction, missing teeth, filled/restored teeth, and total DMF teeth. Additional fields include occlusion type, fluoride application, examining dentist information, treatment details, and certification by the university dentist.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    31 views1 page

    Individual Dental Health Record. Back

    Uploaded by

    ESPOS JEMS MYKEL
    This document appears to be a dental examination form containing fields to record a patient's dental information including: date of examination, age, and presence of various dental issues like caries, gingivitis, periodontal pockets, debris, and deposits. It also includes fields to record the number of teeth present, teeth indicated for filling or extraction, missing teeth, filled/restored teeth, and total DMF teeth. Additional fields include occlusion type, fluoride application, examining dentist information, treatment details, and certification by the university dentist.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    DATE OF EXAMINATION

    y y y y
    AGE AT LAST BIRTHDAY /o /o /o /o
    PRESENCE OF DENTAL CARIES Y N Y N Y N Y N
    PRESENCE OF GINGIVITIS Y N Y N Y N Y N
    PRESENCE OF PERIODONTAL POCKET Y N Y N Y N Y N
    PRESENCE OF ORAL DEBRIS Y N Y N Y N Y N
    PRESENCE OF CALCULAR DEPOSIT Y N Y N Y N Y N
    PRESENCE OF NEOPLASM Y N Y N Y N Y N
    PRESENCE OF DENTO-FACIAL ANOMALY Y N Y N Y N Y N
    T P T P T P T P
    T D
    NUMBER OF TEETH PRESENT E
    O
    O CARIES INDICATED FOR FILLING C
    A
    T CARIES INDICATED FOR EXTRACTIO Y
    H E
    ROOT FRAGMENT D

    C MISSING DUE TO CARIES M


    O
    U
    FILLED OR RESTORED F
    N
    T TOTAL OF THE DMF TEEETH
    OCCLUSION TYPE
    FLOURIDE APPLICATION
    EXAMINER

    III – TREATMENTS:

    DATE TREATMENT TOOTH No. DENTIST REMARKS

    FOR BICOL UNIVERSITY HEALTH SERVICE DENTIST’S VALIDATION ONLY

    The above findings are certified correct and are based on the dental examination, diagnostic results available, and the
    disclosure of the student’s/parent’s pertinent dental history at the time and date of examination.

    _______________________________________________ __________________ ____ __________ ________________


    Signature over Printed Name of University Dentist License Number PTR Number Date of Examination

    Doc. No. BU-F-UHS-21


    Effectivity: February 8, 2020
    Revision: 2 Page 2 of 2

    You might also like