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Dental Practitioner
5-10 minutes

Pediatric Dental Examination Template

The s10.ai Child Dental Check-up template is expertly crafted for dental professionals performing routine pediatric dental exams. This comprehensive template includes fields for documenting the dentist and nurse's names, appointment specifics, and the child's complete medical and dental history. It systematically guides clinicians through the examination process, encompassing oral hygiene evaluation, caries risk assessment, periodontal disease evaluation, and tooth surface loss analysis. Additionally, it facilitates treatment discussions, consent acquisition, and orthodontic evaluations. Perfect for pediatric and general dentists specializing in child dental care, this template ensures thorough and precise documentation of every visit, enhancing clinical efficiency and patient care.

1,514 uses
4.1/5.0
A
Aisha Patel
Template Structure

Organized sections for comprehensive clinical documentation

Dentist: [Clinician Name] (mention the dentist's name)
Nurse: [nurse name] (mention the nurse's name)
Pt attended at: [time of appointment] (mention the exact time) / with: [person accompanying patient] (mention who brought the patient)
EXAM
C/O: [primary complaints] (mention primary complaint or state "nil/checkup" if no complaints)
MH: Checked, [medical history/medications] (mention any relevant medical history or "no changes"), signed by [parent/guardian name] (mention the parent who confirmed medical status)
DH:
- Brushing: [0, 1, or 2] (mention brushing frequency)
Adv always brush x2 a day - morning before breakfast & evening
- Diet: [HIGH/MOD/LOW] (mention sugar intake and types of sugary foods) Sugar & [HIGH/MOD/LOW] (mention acid/fizzy drink intake) Acid
E/O: [nad] (mention if normal, otherwise state findings)
I/O: [nad] (mention if normal, otherwise state findings)
Teeth charted
OH: [GOOD/POOR/FAIR] (mention overall oral hygiene status)
Compliance: [good/poor] (mention patient’s compliance)
Risk Assessment:
- Caries risk: [HIGH/MOD/LOW] (mention risk level based on caries)
- Perio risk: [HIGH/MOD/LOW] (mention risk based on gum disease or gingivitis)
- TSL risk: [HIGH/MOD/LOW] (mention risk of tooth surface loss based on wear)
DISCUSSED:
[discussion points] (mention any treatment discussions, risks, benefits, or instructions provided to patient/parents)
TX PLAN:
1. OHI, diet advice, [fluoride toothpaste/mouthwash/antibiotics] (mention any prescribed items)
2. Topical Fluoride application
3. [fillings/extractions] (mention any planned restorative procedures)
Treatment and options explained, parent understands.
Parent consented to tx plan Band [1/2/3] (mention the NHS banding of treatment provided)
Verbal consent gained [FP17DC signed by] [mum/dad] (mention who signed the consent form)
ORTHO ASSESSMENT:
[ortho assessment details] (mention any orthodontic assessment if performed, or state "Pt too young for ortho assessment" if applicable)
Radiographs (Consent Gained from) - Taken By: [Clinician's Name] [mention "none indicated" if no radiographs taken]
LEFT BITEWING:
Justification: assess caries and bone levels
REPORT: [mention findings from the left bitewing, e.g., bone levels, decay, infection, missing teeth]
RIGHT BITEWING:
Justification: assess caries and bone levels
REPORT: [mention findings from the right bitewing, e.g., bone levels, decay, infection, missing teeth]
Treatment:
1. OHI - advised brushing x2/day for 2 mins with F- toothpaste [spit don't rinse] (mention 'spit don't rinse' if pt ≥ 5 years old)
2. Diet advice - Low sugar advised & low acid
- Advised sugary snacks/drinks with meals, not between meals. Cut down fizzy drinks, use straw if needed.
[3. Topical fluoride application] (mention if fluoride applied to all teeth)
NV: [next visit plan] (mention plan for next visit or "TC" if treatment complete)
[TC if treatment completed] (mention "Treatment complete" if applicable)
[Clinician's Name]
[Clinician's Title]
Sample Clinical Note

Example of completed documentation using this template

Dentist: s10.ai  
Nurse: Sarah Johnson
Pt attended at: 10:00 AM / with: Mother
EXAM  
C/O: nil/checkup
MH: Reviewed, no changes, signed by Mrs. Lisa Brown
DH:  
- Brushing: 2  
  Recommend always brushing twice daily - morning before breakfast & evening  
- Diet: MOD Sugar & LOW Acid
E/O: nad  
I/O: nad
Teeth charted  
OH: GOOD  
Compliance: good
Risk Assessment:  
- Caries risk: LOW  
- Perio risk: LOW  
- TSL risk: LOW
DISCUSSED:  
Emphasized the importance of maintaining good oral hygiene and regular dental visits. Advised on reducing sugar consumption.
TX PLAN:  
1. OHI, dietary advice, fluoride toothpaste  
2. Topical Fluoride application  
3. None
Treatment and options explained, parent understands.  
Parent consented to tx plan Band 1  
Verbal consent obtained FP17DC signed by mum
ORTHO ASSESSMENT:  
Pt too young for ortho assessment
Radiographs (Consent Gained from) - Taken By: s10.ai  
LEFT BITEWING:  
Justification: assess caries and bone levels  
REPORT: No decay, bone levels normal
RIGHT BITEWING:  
Justification: assess caries and bone levels  
REPORT: No decay, bone levels normal
Treatment:  
1. OHI - advised brushing twice daily for 2 mins with fluoride toothpaste, spit don't rinse  
2. Diet advice - Low sugar advised & low acid  
   - Advised sugary snacks/drinks with meals, not between meals. Reduce fizzy drinks, use straw if needed.  
3. Topical fluoride application
NV: 6-month recall for routine check-up
Dr. s10.ai  
Dentist
Clinical Benefits

Key advantages of using this template in clinical practice

  • This comprehensive dental clinical template is designed to streamline patient documentation and enhance the quality of care provided by dental professionals. It includes detailed sections for recording patient complaints, medical and dental history, oral hygiene practices, and risk assessments for caries, periodontal disease, and tooth surface loss. The template also facilitates thorough examination documentation, including extraoral and intraoral findings, and provides a structured approach to treatment planning and patient education. With sections dedicated to orthodontic assessments and radiographic evaluations, this template ensures all aspects of dental care are meticulously documented. Clinicians can easily customize the template with specific patient details, ensuring accurate and personalized care. By adopting this template, dental practitioners can improve workflow efficiency, enhance patient communication, and ensure compliance with clinical standards, ultimately leading to better patient outcomes and satisfaction.
Frequently Asked Questions

Common questions about this template and its usage

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Pediatric Dental Examination | Medical Chart Template