Anesthetic, Specific Tooth

BenzocaineBenzocaine/ Dyclonine hydrocholoride / Ethocaine / Lidocaine solution / Lidocaine ointment / Lidocaine spray / Oraqix / Procaine / Topicaine anesthetic gel / Topex anesthetic gel / Topex anesthetic spray / Xylocaine was placed on the palatepalate/ facial / buccal / lingual, adjacent to tooth 11/ 2 / 3 / 4 / etc. A total of 00/ 2 / 3 / 4 / etc. .00.00/ .10 / .20 / .30 / etc.  carpules of Articaine, 4% with Epinephrine 1:100,000Articaine, 4% with Epinephrine 1:100,000Articaine, 4% with Epinephrine 1:200,000 / Bupivacaine, 0.5% with Epinephrine 1:200,000 / Carbocaine, 3% plain / Citanest Forte, 4% with Epinephrine 1:200,000 / Citanest Plain, 4% without Vasoconstrictior / Duranest, 1.5% with Epinephrine 1:200,000 / Lidocaine, 2% with Epinephrine 1:100,000 / Lidocaine HCL, 2% with Epinephrine 1:100,000 / Lidocaine HCL, 2% with Epinephrine 1:50,000 / Mepivacaine, 2% with Levonordefrin 1:20,000 / Mepivacaine, 3% plain / Prilocaine, 4% plain / Prilocaine, 4% with Epinephrine 1:200,000 / Septocaine, 4% with Epinephrine 1:100,000 / Xylocaine, 2% with Epinephrine 1:50,000 / Xylocaine, 2% with Epinephrine 1:100,000 was injected into the palatepalate/ facial / buccal / lingual using a longlong/ short, 2525/ 27 / 30-gauge needle. A suck-back safety syringe was used to avoid inter-vesicular injection. The patient tolerated the injection and had no adverse reactions to the anesthetic.

Local Anesthetic, Brief

The patient was given 00/ 2 / 3 / 4 / etc. .00.00/ .10 / .20 / .30 / etc.  total carpules of Articaine, 4% with Epinephrine 1:100,000Articaine, 4% with Epinephrine 1:100,000Articaine, 4% with Epinephrine 1:200,000 / Bupivacaine, 0.5% with Epinephrine 1:200,000 / Carbocaine, 3% plain / Citanest Forte, 4% with Epinephrine 1:200,000 / Citanest Plain, 4% without Vasoconstrictior / Duranest, 1.5% with Epinephrine 1:200,000 / Lidocaine, 2% with Epinephrine 1:100,000 / Lidocaine HCL, 2% with Epinephrine 1:100,000 / Lidocaine HCL, 2% with Epinephrine 1:50,000 / Mepivacaine, 2% with Levonordefrin 1:20,000 / Mepivacaine, 3% plain / Prilocaine, 4% plain / Prilocaine, 4% with Epinephrine 1:200,000 / Septocaine, 4% with Epinephrine 1:100,000 / Xylocaine, 2% with Epinephrine 1:50,000 / Xylocaine, 2% with Epinephrine 1:100,000   to achieve satisfactory local anesthesia results.

No Injection Given to Patient

No injection was given to the patient. The procedure was minimally invasiveThe procedure was minimally invasive/ The patient requested no anesthesia for the dental treatment.

Cosmetic Aberration

The patient has skeletal aberrationskeletal aberration/ soft tissue aberration, treatable by Dentisttreatable by Dentist/ treatable by Physician / not treatable. (Cosmetic Aberration Notes)

Cosmetic Issue

The patient has abnormal tooth morphologyabnormal tooth morphology/ diastema / fractured teeth / malalignment / missing teeth / stains / unacceptable restorations in the maxillary, anteriormaxillary, anterior/ maxillary, posterior / mandibular, anterior / mandibular, posterior area.

Exam Type

Exam Type: InitialInitial/ Recare / Emergency / Other

Functional Evaluation, TMJ

A Functional Evaluation of the patient's TMJ shows the following:

Motion/Deviation: NoneNone/ Mild / Moderate / Severe

Subluxation/Crepitus: NoneNone/ Mild / Moderate / Severe

Symptoms Reported: NoneNone/ (Notes)

Diagnosis: TMJ Issues Not PresentTMJ Issues Not Present/ TMJ Treatable by Dentist / TMJ Treatable by Specialist / TMJ is not Treatable

Myofunctional Analysis

A Functional Evaluation, Myofunctional Analysis shows the following:

Tongue Habits: NormalNormal/ (Notes)

Lip Habits: NormalNormal/ (Notes)

Speech: NormalNormal/ (Notes)

Occlusion

A Functional Evaluation of the patient's Occlusion shows the following.

Occlusion Classification: Class IClass I/ Class II / Class III

Left Lateral: NormalNormal/ (Notes)

Right Lateral: NormalNormal/ (Notes)

Space for Appliances: NormalNormal/ (Notes)

Overall Spacing: No issuesNo issues/ Mild / Moderate / Severe

Crowding:  NoneNone/ Mild / Moderate / Severe

Crossbite:  NoneNone/ Anterior / Posterior

Arch Length:  No issuesNo issues/ Mild / Moderate / Severe

Overbite (mm): 22/ (Notes)

Overjet (mm):  22/ (Notes)

Patient's perceived level of function: NoneNone/ Good / Fair / Poor

Dentist's perceived level of function: NoneNone/ Good / Fair / Poor

Patient's perceived level of aesthetics: NoneNone/ Good / Fair / Poor

Dentist's perceived level of aesthetics: NoneNone/ Good / Fair / Poor

Oral Hygiene

The patient's overall Oral Hygiene is NormalNormal/ Excellent / Poor. Today's exam shows the following.

Plaque: NormalNormal/ (Notes)

Calculus: NormalNormal/ (Notes)

Stain: NormalNormal/ (Notes)

Food Impaction Areas: NormalNormal/ (Notes)

Oral Pathology

The patient has nono/ mild / moderate / severe evidentevident/ developmental / systemic / surface / deep oral pathology. No treatmentNo treatment/ A biopsy / Other treatment / Patient referral to a specialist is recommended. The prognosis is goodgood/ fair / poor / unknown. There is no evident tooth-related oral pathologyThere is no evident tooth-related oral pathology/ Oral pathology is tooth related / Oral pathology is not tooth related.

Patient Habits

An evaluation of the patient's habits pertaining to their oral health shows the following.

Cigar/Cigarette Smoking: NoneNone/ Potential / Manifested

Pipe Smoking: NoneNone/ Potential / Manifested

Nail Biting: NoneNone/ Potential / Manifested

Smokeless Tobacco Use: NoneNone/ Potential / Manifested

Thumb/Finger Sucking: NoneNone/ Potential / Manifested

Toothpick/Stimulator Use: NoneNone/ Potential / Manifested

Gum Chewing: NoneNone/ Potential / Manifested

Teeth Grinding/Clenching: NoneNone/ Potential / Manifested

Cheek Biting: NoneNone/ Potential / Manifested

Tongue Thrusting: NoneNone/ Potential / Manifested

Mouth Breathing: NoneNone/ Potential / Manifested

Bulemia/Anorexia: NoneNone/ Potential / Manifested

Substance Abuse: NoneNone/ Potential / Manifested

Other Habits: NoneNone/ (Notes)

Patient Health

Patient health conditions: (select all that apply)(select all that apply)/ AIDS / Allergies / Anemia / Arthritis / Artificial Joints / Asthma / Blood Disease / Cancer / Diabetes / Dizziness / Epilepsy / Excessive Bleeding / Fainting / Glaucoma / Growths / Hay Fever / Head Injuries / Heart Disease / Heart Murmur / Hepatitis / HIV Positive / Hypertension / Jaundice / Kidney Disease / Liver Disease / Mental Disorders / Nervous Disorders / Pacemaker / Pregnancy / Radiation Treatment / Respiratory Problems / Rheumatic Fever / Rheumatism / Sinus Problems / Stomach Problems / Stroke / Tuberculosis / Tumors / Ulcers / Venereal Disease / Codeine Allergy / Penicillin Allergy

Restorative Issues

The patient exhibits nono/ minimal / moderate / extensive existing decay.

The patient is missing the following teeth: 11/ 2 / 3 / 4 / etc

The patient has the following additional restorative issues: NoneNone/ (Notes)

Soft Tissue Exam

A Soft Tissue Exam shows the following:

Extraoral Head/Neck: NormalNormal/ (Notes)

Lymph Chain: NormalNormal/ (Notes)

Lips: NormalNormal/ (Notes)

Labial/Buccal Mucosa: NormalNormal/ (Notes)

Tongue: NormalNormal/ (Notes)

Floor of Mouth: NormalNormal/ (Notes)

Palate, Hard/Soft: NormalNormal/ (Notes)

Pharynx: NormalNormal/ (Notes)

Attempted Root Canal, Closed

Attempted root canal treatment on tooth 11/ 2 / 3 / 4 / etc. Examination of the X-ray revealed that the canal has closed off. The patient has been informed that the tooth can either be extracted and crowned or have a post and core and be crowned. A treatment plan is being determined.

High Pulp Test Reading

A pulp test was administered on tooth 11/ 2 / 3 / 4 / etc. The pulpal reading was 0.00.0/ 0.5 / 1.0 / 1.5 / 2.0 / etc. The high test result indicates that the nerve is dead and the tooth is abscessed. The patient has agreed to an amalgam surface restorationamalgam surface restoration/ a composite surface restoration / an extraction / an apicoectomy / a root canal / a post and core / a crown / a bridge / a partial denture / a full denture / an implant / a referral to a specialist.

Low Pulp Test Reading

A pulp test was administered on tooth 11/ 2 / 3 / 4 / etc. The pulpal reading was 0.00.0/ 0.5 / 1.0 / 1.5 / 2.0 / etc. The low result represents a normal reading for the tooth.

Crown Replaced Large Amalagam

The amalgam restoration covering the11/ 2 / 3 / 4 / etcsurface(s) of tooth 11/ 2 / 3 / 4 / etc has been replaced with a crown.

Crown to be Replaced

The resin-based compositeresin-based composite/ resin with high noble metal / resin with predominantly base metal / resin with noble metal / porcelain ceramic substrate / porcelain fused to high noble metal / porcelain fused to predominantly base metal / porcelain fused to noble metal / full cast high noble metal / full cast predominantly base metal / full cast noble metal / titanium / provisional / previous crown on tooth 11/ 2 / 3 / 4 / etc  needs to be replaced due to decaydecay/ fractured porcelain / other.

Pre-Op Impression

An impression has been taken using alginate hydrocolloid in order to fabricate a temporary bridgebridge/ crown.

Ready for Crown

Tooth11/ 2 / 3 / 4 / etc is in need of a crown. The tooth has already had a root canalroot canal/ root canal and post and core placed.

Shade Guide Selected

Patient has selected BioblendBioblend/ Bioform / Chromascop / Portrait / SR Vivodent PE / Trublend / Trubyte / Vita / Custom Shade Guide AA/ B / C / D / etc. 11/ 2 / 3 / 4 / etc as the Shade Guide for use on the bridgebridge/ crown  for tooth 11/ 2 / 3 / 4 / etc.

Stumpshade Selected

A stumpshade was selected to be used in conjunction with the Shade Guide for the (Tx Plan, Bridge/Crown) on tooth 11/ 2 / 3 / 4 / etc. BioblendBioblend/ Bioform / Chromascop / Portrait / SR Vivodent PE / Trublend / Trubyte / Vita / Custom Shade Guide AA/ B / C / D / etc. 11/ 2 / 3 / 4 / etc  will be used as the shade on the mesialmesial/ incisal / occlusal / distal / lingual / facial / buccal / mesiobuccal / mesiolingual / distobuccal / distolingual surface of the bridgebridge/ crown.

Oral Hygiene Instructions

Proper technique of brushing demonstrated. Flossing with fingers and a floss holder demonstrated. Patient given a soft toothbrush and floss.

Oral Rinse

Patient rinsed with ACCLEANACCLEAN/ Oris CHX / Peridex / PerioGard / Peroxyl / Rincinol / Viadent after treatment.

Prophylaxis

Performed generalgeneral/ light scaling with hand instruments. Flossed all contacts.

Antibiotic Pre-Med Confirmed

The patient confirmed that they pre-medicated with Amoxicillin 500 mgAmoxicillin 500 mg/ Celcor 500 mg / Hydrocondone 5 mg / Keflex 500 mg / Tylenol #3 / Valium 5 mg / Zpak one hour prior to today's appointment, as instructed. The patient's dental chart indicates that they must be pre-medicated prior to any dental treatment. The patient was instructed to pre-medicate with two grams of the antibiotic (4 pills) one hour prior to today's appointment.

Antibiotic Pre-Med Negative

The patient was asked if they pre-medicated with antibiotics one hour prior to today's appointment. The patient's dental chart indicates that they must be pre-medicated prior to any dental treatment. The patient stated that they DID NOT pre-medicate prior to today's appointment. The patient was re-appointed.

Health History Updated

Before dental treatment, the patient was asked about changes to their medical history such as a recent surgery or changes in medication. Patient confirmed verbally that there have been changes in their medical history. These changes have been recorded and updated in the patient's chart.

Health History, No Change

Before dental treatment, the patient was asked about changes to their medical history such as a recent surgery or changes in medication. Patient confirmed verbally that there have been NO changes in their medical history.

Health History, None

The patient has stated that they are not currently taking any medications, do not have any health issues, and have no need to be under a doctor's care at this time.

Orthodontic Extraction

The following teeth were extracted for orthodontic purposes:11/ 2 / 3 / 4 / etc. A letter from the orthodontist instructed that the teeth be extracted.

Orthodontic Referral

Patient has been given an orthodontic referral to discuss options with, and seek treatment from an orthodontist for correction of a crossbitea crossbite/ an overbite / an overjet / tooth crowding / a diastema / tooth spacing issues / multiple orthodontic issues.

Pain, Hard Tissue

The patient has pain in the following teeth:11/ 2 / 3 / 4 / etc  

Pain, No Swelling

Patient experiences pain but has no swelling in the Upper RightUpper Right/ Upper Left / Lower Right / Lower Left quadrant. The pain seems to be associated with tooth 11/ 2 / 3 / 4 / etc.

Pain, Swelling

Patient complains of pain and swelling in the Upper RightUpper Right/ Upper Left / Lower Right / Lower Left quadrant. The swelling is located near the mesialmesial/ incisal / occlusal / distal / lingual / facial / buccal / mesiobuccal / mesiolingual / distobuccal / distolingual  surface of tooth11/ 2 / 3 / 4 / etc.

Pain, Soft Tissue

There is evidence of bleedingbleeding/ suppuration / swelling / ulceration on the facialfacialbuccal / palatal / lingual adjacent to tooth 11/ 2 / 3 / 4 / etc  . From the patient's description it is determined that the pain level is low acutelow acutelow chronic / high acute / high chronic.

TMJ Joint Problem

Patient complained of pain in the following joint(s): Right TMJRight TMJ/ Left TMJ.

Ulcers in Mouth

The patient complained of pain in the oral cavity. An examination revealed the presence of an ulcerated, white, circular lesion of less than 5 mmless than 5 mm/ 5 mm to 10 mm / greater than 1 cm in diameter, on the mucosa in the (Quadrant-With Pain) quadrant, on the mesialmesial/ incisal / occlusal / distal / lingual / facial / buccal / mesiobuccal / mesiolingual / distobuccal / distolingual  surface adjacent to tooth 11/ 2 / 3 / 4 / etc.

Topical Anesthesia, Extraction

Topical anesthetic was used to numb the gum tissue surrounding tooth 1 1/ 2 / 3 / 4 / etc  prior to the extraction of the tooth.

Severe Pulpal Exposure

Examination revealed that tooth 11/ 2 / 3 / 4 / etc  had a severe pulpal exposure. Options were discussed, and the patient's family chose to have the tooth extracted.

Deep Root Scaling, Quadrant(s)

Deep root scaling was used to remove deep calculus from the teeth in the Upper RightUpper Right/ Upper Left / Lower Right / Lower Left  quadrant(s) of the mouth. Patient rinsed with ACCLEANACCLEAN/ Oris CHX / Peridex / PerioGard / Peroxyl / Rincinol / Viadent  after treatment.

Deep Root Scaling, Teeth

Deep root scaling was used to remove deep calculus from the following teeth: 11/ 2 / 3 / 4 / etc. Patient rinsed with ACCLEANACCLEAN/ Oris CHX / Peridex / PerioGard / Peroxyl / Rincinol / Viadent  after treatment.

Periodontal Exam Notes

A periodontal exam indicates the following for quadrant(s):Upper RightUpper Right/ Upper Left / Lower Right / Lower Left .

Classification: SkippedSkipped
Normal
I-Gingival Diseases, dental plaque-induced
I-Gingival Diseases, non-plaque-induced lesions
II-Chronic Periodontitis, localized, slight severity 
II-Chronic Periodontitis, localized, moderate severity 
II-Chronic Periodontitis, localized, severe 
II-Chronic Periodontitis, generalized, slight severity 
II-Chronic Periodontitis, generalized, moderate severity 
II-Chronic Periodontitis, generalized, severe 
III-Aggressive Periodontitis, localized, slight severity 
III-Aggressive  Periodontitis, localized, moderate severity  
III-Aggressive  Periodontitis, localized, severe 
III-Aggressive Periodontitis, generalized, slight severity 
III-Aggressive  Periodontitis, generalized, moderate severity 
III-Aggressive Periodontitis, generalized, severe 
IV-Periodontitis as a Manifestation of Systemic Diseases
V-Necrotizing Periodontal Diseases, ulcerative gingivitis
V-Necrotizing Periodontal Diseases, ulcerative periodontitis
VI-Abscesses of the Periodontium, gingival
VI-Abscesses of the Periodontium, pericoronal
VII-Periodontitis Associated With Endodontic Lesions
VIII-Developmental or Acquired Deformities and Conditions

Gingiva Color:  SkippedSkippedNormal / Pale White / Whitish Pink / Coral Pink / Pink / Red / Magenta / Pink with Magenta areas / Bluish Red / Deep Red

Gingival Inflammation: SkippedSkipped/ None / Mild / Moderate / Severe

Free Gingival Margins: SkippedSkipped/ Normal (Knife Edged) / Rolled / Recessions / Rounded / Clefts / Pseudoclefts / Cuffing

Interdental Papillae: SkippedSkipped/ Normal / Pyramidal or pointed / Bulbous / Blunted / Absent / Cratered / Scalloped / Enlarged

Gingiva Consistency: SkippedSkipped/ Firm and resilient / Edematous / Fibrotic / Retractable

Gingiva Surface Texture: SkippedSkipped/ Normal / Stippling / Shiny and smooth / Rough

Attached Gingiva: SkippedSkipped/ Normal / Recession / Enlarged Tissue

Gingival Sulcus: SkippedSkipped/ None / Blood / Exudates

Gingival Bleeding: SkippedSkipped/ None / Mild / Moderate / Severe

Suppuration: SkippedSkipped/ None / Mild / Moderate / Severe

Pattern of Bone Loss: SkippedSkipped/ None / Horizontal / Vertical

Severity of Bone Loss: SkippedSkipped/ None / Mild / Moderate / Severe

Plaque: SkippedSkipped/ None / Light / Moderate / Heavy

Calculus: SkippedSkipped/ None / Light / Moderate / Heavy

Dentinal Hypersensitivity: SkippedSkipped/ None / Mild / Moderate / Severe

Tooth Stain: SkippedSkipped/ None / Exogenous / Endogenous

Tooth Stain Pigment: SkippedSkipped/ Intrinsic, brownish red, blush black / Intrinsic, grayish brown / Intrinsic, whitish brown, localized / Intrinsic, whitish brown, generalized / Intrinsic, yellowish brown / Extrinsic, brown / Extrinsic, black-line / Extrinsic, green

Other: (Notes)

Referral to Periodontist

Patient has been referred to a periodontist for further treatment.

No Medication or Antibiotic

Neither pain medication nor antibiotics were given to the patient. The patient understood that their procedure was minor and did not require the use of either pain medication or antibiotics.

Prescription

The patient has been given the following prescription:

Amoxicillin 500 mgAmoxicillin 500 mg/ Celcor 500 mg / Hydrocondone 5 mg / Keflex 500 mg / Pen VK 500 mg / Tylenol #3 / Valium 5 mg / Zpak, 8 tabs8 tabs/ 14 tabs / 16 tabs / 20 tabs / 30 tabs / dispense one pack; Take 2 now, 1 Q 6 H until goneTake 2 now, 1 Q 6 H until gone/ 1 Q4-6H pm pain. There are 11/ 2 / 3 / 4 / etc refills on the prescription. Prescription instructions have been given to the patient and the patient has confirmed that they understand the instructions.

Prescription to Pharmacy

The patient's prescription was phoned in to a pharmacy technicianphoned in to a pharmacy technicianphoned in to the pharmacy. A message was left on the pharmacy's answering machine / sent to the pharmacy by fax / sent to the pharmacy by e-mail.

Patient Referred

The patient has been referred to an endodontistan endodontist/ an orthodontist / an oral surgeon / a pedodontist / a periodontist / a prosthodontist / their primary care physician for a second opinionsecond opinion/ further treatment.

Patient, Consider Tx Options

The patient has been presented with several treatment options and understands that they need to schedule an appointment and return to the office for treatment when they have decided upon a treatment plan.

Treatment Importance

The importance of making and keeping treatment appointments has been discussed. A printout of costs associated with treatment has been given to the patient. The patient understands that if they do not seek immediate dental treatment the costs of restoring their dentition could increase significantly and may or may not include additional procedures such as root canals and crowns.

Occlusal Bite Guard Delivered

An Occlusal Bite Guard was delivered to the patient. The patient has been instructed to wear the bite guard at night. The patient has also been encouraged to wear the guard any time they are biting or grinding their teeth.

Patient Instructions

The patient has been given their removable appliance and has been instructed to return to the office if they experience any discomfort related to the appliance or if the appliance requires any adjustments.

Chip in Tooth, Large

The mesialmesial/ incisal / occlusal / distal / lingual / facial / buccal / mesiobuccal / mesiolingual / distobuccal / distolingual  surface of tooth 11/ 2 / 3 / 4 / etc  has been chipped. The patient has been advised that since the chip is large the tooth will need an amalgam surface restorationan amalgam surface restoration/ a composite surface restoration / an extraction / an apicoectomy / a root canal / a post and core / a crown / a bridge / a partial denture / a full denture / an implant / a referral to a specialist. Patient will make an appointment for treatment.

Chip in Tooth, Small

The mesialmesial/ incisal / occlusal / distal / lingual / facial / buccal / mesiobuccal / mesiolingual / distobuccal / distolingual  surface of tooth 11/ 2 / 3 / 4 / etc  has been chipped. The patient has been advised that since the chip is relatively small the best treatment option is sanding, smoothing and polishing.

Crown Cemented

The resin-based compositeresin-based composite/ resin with high noble metal / resin with predominantly base metal / resin with noble metal / porcelain ceramic substrate / porcelain fused to high noble metal / porcelain fused to predominantly base metal / porcelain fused to noble metal / full cast high noble metal / full cast predominantly base metal / full cast noble metal / titanium / provisional / previous crown on tooth 11/ 2 / 3 / 4 / etc  was cemented using DurelonDurelon/ Glasionomer / Panavia / RelyX / Variolink II / Zinc Phosphate, phosphoric acid etchant 10%10%/ 25% / 34% / 35% / 36% / 37% / 38% / 40% / 50%, and
Adper ScotchbondAdper Scotchbond/ Clearfil / Excite / Fuji Bond / OptiBond. One digital X-ray was taken to verify fit and ensure removal of excess cement. The patient received computer generatedcomputer generated/ verbal / written post-op instructions.

Crown Off, Structure Sound

The crown came off tooth 11/ 2 / 3 / 4 / etc. Examination revealed both the tooth and the crown to be in good structural condition. Crown cleaned and re-cemented to tooth using DurelonDurelon/ Glasionomer / Panavia / RelyX / Variolink II / Zinc Phosphate. Patient advised that should this happen again the crown will need to be replaced.

Crown Off, Structure Unsound

The crown came off tooth 11/ 2 / 3 / 4 / etc. Examination revealed part of the tooth structure to have broken off with the crown. Patient has been advised that re-cementing the crown is not an option because of the broken tooth. Several treatment options were presented, including a root canal with a post and core and a new crown. Patient has agreed to an amalgam surface restorationan amalgam surface restoration/ a composite surface restoration / an extraction / an apicoectomy / a root canal / a post and core / a crown / a bridge / a partial denture / a full denture / an implant / a referral to a specialist to repair the tooth.

Fractured Crown

The mesialmesial/ incisal / occlusal / distal / lingual / facial / buccal / mesiobuccal / mesiolingual / distobuccal / distolingual  surface of the crown on tooth11/ 2 / 3 / 4 / etc is fractured. Patient has agreed to an amalgam surface restorationan amalgam surface restoration/ a composite surface restoration / an extraction / an apicoectomy / a root canal / a post and core / a crown / a bridge / a partial denture / a full denture / an implant / a referral to a specialist to repair the tooth.

Crown Restoration Post-Op

Patient has been given all instructions and information concerning the   resin-based compositeresin-based composite/ resin with high noble metal / resin with predominantly base metal / resin with noble metal / porcelain ceramic substrate / porcelain fused to high noble metal / porcelain fused to predominantly base metal / porcelain fused to noble metal / full cast high noble metal / full cast predominantly base metal / full cast noble metal / titanium / provisional / previous crown placed today. They have been advised regarding the duration of numbness, expected sensitivity, and amount of time until they can chew. The patient has also been advised to contact the office if they experience swelling of the jaw or severe pain related to temperature changes in the mouth.

Post-Op Instructions

For today's treatment, computer generatedcomputer generated/ verbal / written  post-op instructions were given to the patientpatient/ patient's parent / patient's guardian / patient's spouse / other.

Pat. Confirms Pregnancy, X-ray

The patient responded affirmatively when asked whether she was pregnant. X-rays will not be taken because of her condition.

Used FMX Instead of X-ray

No X-ray was taken of the patient. The most recent FMX was used instead.

X-ray, Patient NO Permission

A thorough explanation of the benefits and risks associated with the taking of digital x-rays was verbally discussed with the patient, including the necessity of taking an x-ray on tooth11/ 2 / 3 / 4 / etc. Despite my recommendations to have x-rays taken, the patient refused to give permission to take x-rays and the patient understands the possible consequences of this action.