ppt/care plan

Dental Hygiene Assessment/Diagnosis

In congruence with dental treatment plan as evidenced by:

(circle those that apply)

Explanation

(provide details of diagnosis)

Goal(s)

(circle goal and letters that apply)

Evaluation Method(s)

(circle letters that apply and method(s) for measuring

goal attainment)

Education &/or Counseling

(specify which appt. education will be provided)

Oral Hygiene Instruction

Plaque removal technique or product to be introduced

(if applicable) (specify which appt. OHI will be provided)

Wholesome Facial Image

*expresses dissatisfaction with appearance of (provide exact teeth numbers if applicable:

a) teeth

b) gingiva

c) facial profile

d) breath

e) other

a)

b)

c)

d)

e)

Improve satisfaction with appearance of:

a), b), c), d), e)

by:______________

a), b), c), d), e)

pt. report

chief complaint

health hx/vitals

I/E exam

odontogram

periodontal exam

progress note

other:

a)

b)

c)

d)

e)

a)

b)

c)

d)

e)

Freedom From Anxiety/Stress

*reports or displays:

a) anxiety about

proximity of the clinician

or confidentiality

b) oral habits

c) substance abuse

*concern about:

d) infection control

e) fluoride therapy

f) fluoridation

g) mercury toxicity

h) DH care planned

i)previous dental experience

j) other

a)

b)

c)

d)

e)

f)

g)

h)

i)

j)

Reduce/eliminate anxiety/stress with

a), b), c)

by:______________

Reduce/eliminate concern with

d), e), f), g), h)

i), j)

by:______________

a), b), c), d), e), f), g), h), i), j)

pt. report

chief complaint

progress note

other:

a)

b)

c)

d)

e)

f)

g)

h)

i)

j)

a)

b)

c)

d)

e)

f)

g)

h)

i)

j)

Dental Hygiene Assessment/Diagnosis

In congruence with dental treatment plan as evidenced by:

(circle those that apply)

Explanation

(provide details of diagnosis)

Goal(s)

(circle goal and letters that apply)

Evaluation Method(s)

(circle letters that apply and method(s) for measuring

goal attainment)

Education & Counseling

(specify which appt. education will be provided)

Oral Hygiene Instruction

(plaque removal technique or product to be introduced

if applicable) (specify which appt. OHI will be provided)

Skin & Mucus Membrane Integrity Of Head & Neck

*provide complete lesion desc.

a) extra/intra oral lesion/finding (*lesions/findings of concern)

b) intraoral swelling

*note exact tooth numbers and surfaces if applicable for :

c) gingival inflammation

d) bleeding on probing

e) pockets> 4mm

f) attachment loss (bone loss, recession, etc.) > 4mm

g) xerostomia

h) other

a)

b)

c)

d)

e)

f)

g)

h)

Maintain/reduce/

eliminate

a), b), c), d), e), f)

g), h)

by:______________

a), b), c), d), e), f), g), h),

pt. report

chief complaint

health hx/vitals

I/E exam

periodontal exam

progress note

other:

a)

b)

c)

d)

e)

f)

g)

h)

a)

b)

c)

d)

e)

f)

g)

h)

Protection From Health Risks (note all health history risks as well as medications impacting oral health status)

a) BP outside of normal limits

b)Need for prophylactic antibiotics

c) potential for injury

d) other

a)

b)

c)

d)

Maintain/achieve health/ reduce

a), b), c), d)

by:______________

a), b), c), d)

pt. report

health hx/vitals

progress note

other:

a)

b)

c)

d)

a)

b)

c)

d)

Dental Hygiene Assessment/Diagnosis

In congruence with dental treatment plan as evidenced by:

(circle those that apply)

Explanation

(provide details of diagnosis)

Goal(s)

(circle goal and letters that apply)

Evaluation Method(s)

(circle letters that apply and method(s) for measuring

goal attainment)

Education & Counseling

(specify which appt. education will be provided)

Oral Hygiene Instruction

(plaque removal technique or product to be introduced

if applicable) (specify which appt. OHI will be provided)

Freedom From Head & Neck Pain

a) extra/intra oral pain

b) extra/intra oral sensitivity

c) other

a)

b)

c)

Reduce/eliminate

a), b), c)

by:______________

a), b), c)

observation of patient

pt. report

chief complaint

progress note

other:

a)

b)

c)

a)

b)

c)

Biologically Sound Or Functional Dentition

a) difficulty in chewing

*presents with

(note exact tooth numbers and surfaces)

b) defective restorations;

c) teeth with signs of disease;

d) missing teeth

e) ill fitting dentures

f) ill fitting appliances

g) abrasion

h) attrition

i) erosion

j) rampant caries

k) other

a)

b)

c)

d)

e)

f)

g)

h)

i)

j)

k)

Restore/eliminate/

maintain

a), b), c), d), e)

f), g), h), i), j)

k)

by:______________

a), b), c), d), e)

f), g), h), i), j)

k)

pt. report

health hx/vitals

chief complaint

I/E exam

odontogram

progress note

other:

a)

b)

c)

d)

e)

f)

g)

h)

i)

j)

k)

a)

b)

c)

d)

e)

f)

g)

h)

i)

j)

k)

Dental Hygiene Assessment/Diagnosis

In congruence with dental treatment plan as evidenced by:

(circle those that apply)

Explanation

(provide details of diagnosis)

Goal(s)

(circle goal and letters that apply)

Evaluation Method(s)

(circle letters that apply and method(s) for measuring

goal attainment)

Education & Counseling

(specify which appt. education will be provided)

Oral Hygiene Instruction

(plaque removal technique or product to be introduced

if applicable) (specify which appt. OHI will be provided)

Conceptualization & Understanding

a) has questions or misconceptions associated with DH care

b) does not understand factors associated with dysfunction, disease or rationale for Rx

c) other

a)

b)

c)

Improve understanding of:

a), b), c)

by:______________

a), b), c)

pt. report

progress note

other:

a)

b)

c)

a)

b)

c)

Responsibility For Oral Health

*provide PI AND location

a) inadequate plaque control (plaque and/or calculus present & is associated with disease)

b) inadequate compliance with professional oral health maintenance care

c) no dental exam within last 2 years

d) other

a)

b)

c)

d)

Improve plaque control/compliance with

a), b), c), d)

by:______________

a), b), c), d)

pt. report

PI

periodontal exam

progress note

other:

a)

b)

c)

d)

a)

b)

c)

d)