Clinical Treatment Planning Treating Clinician:

Patient Name: Gender: Date of Birth: Age: Marital Status: Race: Date of Initial Examination: Occupation: Personality Type: Treatment Planning Case Presentation. Introduction and Background.

Introduction-Background Chief Dental Complaint: Reason for Initial Visit: Oral Image and Expectation:

Medical History ASA: Medications: Allergies: Smoker: Systemic Diseases:

Dental History Previous Dental Treatment History: What does the patient desire?

Diagnostic Findings Head and Neck Nodes: TMJ/Mandibular: Range of Motion: Functional: Joint sounds: Tenderness to musculature palpation: Myofacial pain: Headaches:

Extra-Oral - Face/Profile/Symmetry

Extra-Oral : Lips/Smiles

Extra-Oral - Buccal Corridors

Combination Dental-Perio. Chart

Periodontal Chart GI – PI –

Intra-oral Images: (Soft tissue) L R

Intra-oral, Anterior – (Soft Tissue) L R

Intra-oral - Occlusal Views L R

Radiographs L R

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Images - Intra oral, Including casts L R

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Occlusal Notes Class occlusion: Class: Incisal guidance and Canine Guidance No non-working interferences. CO/CR/MIP - relationship: Slide

Occlusal Images L R

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Problem list

Diagnosis and Prognosis AAP Type: AAP Hopeless: #’s Guarded: #’s See risk factors. Good: The rest, assuming homecare improvement, and patient pursues prescribed treatment.

Comprehensive Care Caries EndodonticsPeriodontics Restorative Dentistry Predictability Function and Esthetics.

Treatment Planning Work Sheet. Additional consultations requested: Disease control, aka. Initial Therapy, Phase 1 Therapy, Restorative: Periodontal: Endodontic: Oral Surgical: Other: Reconstructive Dentistry Periodontal: Orthodontic: Oral Surgical: Restorative: Prosthodontic: Esthetic enhancement: Functional: Other: Maintenance Professional: Patient:

Treatment Plan Break out time - 30 min Group A Ideal, costs are not a factor Group B Ideal, costs are a factor Group C The best you can do, costs and time are major factors. Outline Goals/Objectives of Treatment