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<!DOCTYPE html>
<html>
<head>
<title>PERIODONTAL RECARE EXAMINATION</title>
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<h1>PERIODONTAL RECARE EXAMINATION</h1>
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<pre>
PERIODIC PERIO EXAM (recare/transfer):
HISTORY OF PAST PERIO THERAPY:
PRIOR CLINICAL FINDINGS: Date, copy "Current Clinical Findings" from last eval
PRIOR DIAGNOSIS: copy from last eval
TREATMENT RENDERED: list tx since last eval
CURRENT CLINICAL FINDINGS:
Probing Depths (1-3mm): #
Pockets:
-4 mm #
-5-? mm #
Recession: 1-? mm #
Attachment Loss: loc slight/moderate/severe # ; gen slight/moderate/severe
MG (Lack of KG): #
BOP: #
Gingiva:
-Color: Normal / Pink / Pigmented / Redness / Red / Magenta
-Size: Normal / Enlarged
-Shape : Normal / Knife-edged / Rolled
-Consistency: Normal / Firm / Spongy
-Texture: Normal / Stippled / Smooth
Gingival Inflammation: loc/gen slight/moderate/severe
Plaque free score: %
Plaque: loc/gen slight/moderate/heavy
Calculus: loc/gen
Gingival Sensitivity: wnl / slight / severe loc # / gen
Mobility: minor # , mod # , severe #
Furcas: (I) # , (II) # , (III) #
Attrition
Crowding: #
SEE CURRENT PERIO CHART FOR THIS DATE:
RADIOGRAPHIC FINDINGS: Tentative, need supplemental radiographs (as listed in 'recommendations') to verify findings.
Bone Loss: loc slight/moderate/severe # , gen slight/moderate/severe
Angular Bone Loss: #
Other:
PERIODONTAL SUMMARY:
Chief complaint: " ___ "
Bacterial Component: plaque
Functional Component: bruxism / malocclusion / reduced functional occlusion
ETIOLOGY:
Plaque/Bacteria
CURRENT DIAGNOSIS:
Clinical Health
Clinical Health on a Reduced Periodontium
Localized Slight/Mod/Sev Plaque Induced Gingivitis #
Generalized Slight/Mod/Sev Plaque Induced Gingivitis
Localized Slight/Mod/Sev Plaque Induced Gingivitis on a Reduced Periodontium #
Generalized Slight/Mod/Sev Plaque Induced Gingivitis on a Reduced Periodontium
Puberty/Menstrual Cycle/Pregnancy/Diabetes Mellitus/Blood Dyscrasia Associated Gingivitis
Drug-Influenced Gingival Enlargements/Gingivitis #
Localized Slight/Mod/Sev Chronic Periodontitis #
Generalized Slight/Mod/Sev Chronic Periodontitis
Localized / Generalized Aggressive Periodontitis #
Periodontitis as a Manifestation of Systemic Disease (associated w/ __ )
Necrotizing Ulcerative Gingivitis # / Necrotizing Ulcerative Periodontitis #
Abcess (Gingival # / Periodontal # / Pericoronal # )
Periodontic-Endodontic Lesion (combined) #
Mucogingival Deformities/Conditions (around teeth):
----Recession #
----Lack of Keratinized Gingiva #
----Decreased Vestibular Depth #
----Aberrant Frenum/Muscle #
----Pseudopocket #
----Excessive Gingival Display #
Mucogingival Deformities/Conditions (on edentulous ridges):
----Ridge Deficiency (Vertical and/or Horizontal) #
----Lack of Keratinized Gingiva #
----Decreased Vestibular Depth #
----Aberrant Frenum/Muscle #
Occlusal Trauma (Primary # / Secondary # )
PROGNOSIS (Good/Fair/Poor/Hopeless):
Overall:
Individual Teeth: Fair # ; Poor # ; Hopeless #
ADA CLASSIFICATION:
Type I/II/III/IV
PROGRESS (significant/some/slight/none): ___ especially in terms of ___ . Problems remain as noted in Findings and are addressed in Recommendations of _ today's date_ .
RECOMMENDATIONS:
-Diagnostic PA radiographs (for all teeth / for # ), BW's #
-Modification of findings/diagnosis/recommendations based on new radiographs
Phase I Therapy: (delete if not indicated)
-OHI
-Adult Prophylaxis
-SCRP UR,UL,LL,LR
-Interdiciplinary Consult
-Caries Control / Temp
-Eval Phase I Therapy
-Ging/Perio Case Complete?
Phase II Therapy: (delete if "Case Complete")
-Perio Surg:
-Eval Phase II Therapy
-Ging/Perio Case Complete
Phase III Therapy:
-Final Prosth:
-Final Restorative:
Phase IV Therapy:
-Occlusal Guard
-Recare Therapy Q 3/4/6 mos
-Periodic Perio Eval
The patient needs a PC referral to PG Perio for the above in conjunction w/ this student. The patient is not to be seen in PG Perio w/o a written PC referral. The UG Student wishes to work with PG Perio Resident Dr. ___ .
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