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PERIODONTAL CHART PATIENT NAME Pre-treatment FILE NO. Re-evaluation DATE Recall maintenance Diagnosis CAL BOP PD PI Calc CEJ-GM FACIAL Mobility LINGUAL GM- Gingival Margin. CAL- Clinical Attachment Loss. CEJ- Cementoenamel Junction* PD- Probing Depth Pl- Plaque if presents put. Calc- Calculus if presents put. BOP- Bleeding on probing if presents put red Plaque Index Bleeding Index Periodontal Diagnosis Supervisor s Signature. CEJ- Cementoenamel Junction* PD- Probing Depth Pl- Plaque if...
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How to fill out perio chart template form
How to fill out Periodontal Chart
01
Gather necessary tools: periodontal probe, mouth mirror, and patient information.
02
Start by explaining the procedure to the patient and ensuring their comfort.
03
Begin examining the patient’s mouth, focusing on one quadrant at a time.
04
Use the periodontal probe to measure the depth of the sulcus or pocket around each tooth.
05
Record the measurements in millimeters on the chart for each tooth.
06
Note any signs of gum disease, such as bleeding or swelling, next to the corresponding tooth on the chart.
07
Check for mobility of teeth and record any abnormal findings.
08
Assess the presence of calculus or plaque and document these observations.
09
Summarize the findings and determine the periodontal health status of the patient.
10
Review the completed chart with the patient and discuss any necessary treatment.
Who needs Periodontal Chart?
01
Patients with periodontal disease or risk factors for gum disease.
02
Dental professionals conducting routine check-ups or cleanings.
03
Orthodontic patients who may be at increased risk for periodontal issues.
04
Individuals experiencing symptoms such as bleeding gums, tooth mobility, or bad breath.
05
Anyone undergoing periodontal treatment needs regular monitoring.
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What is Periodontal Chart?
A Periodontal Chart is a graphical representation of the health of an individual's gums and supporting structures of the teeth. It records information about periodontal conditions, such as pocket depths, gum recession, and mobility of teeth.
Who is required to file Periodontal Chart?
Dental professionals, such as dentists and dental hygienists, are required to file a Periodontal Chart for patients undergoing periodontal assessment or treatment.
How to fill out Periodontal Chart?
To fill out a Periodontal Chart, a dental professional examines the patient's mouth, measures the depth of the gum pockets around each tooth using a periodontal probe, notes any signs of gum disease or other conditions, and records this information in the chart.
What is the purpose of Periodontal Chart?
The purpose of a Periodontal Chart is to assess and document the periodontal health of a patient, enabling dental professionals to diagnose conditions, plan treatment, and monitor changes over time.
What information must be reported on Periodontal Chart?
The information that must be reported on a Periodontal Chart includes pocket depths, attachment levels, gum bleeding, tooth mobility, furcation involvement, gum recession, and any other significant findings related to the periodontal health of the patient.
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