1. Inland Empire Perio Study Club - presentation date- - Name of Study Club Member - - Patient ID -

2. Facial Photo + Patients Background

3. Medical History Item 1 Item 2 Item 3 Item 4 Item 5 Item 6 Item 7

4. Chief Complaint Complaint 1 Complaint 2 Complaint 3

5. Dental History DentHx1 DentHx2 DentHx3 DentHx4 DentHx5 DentHx6 DentHx7

6. Family History FamilyHX1 FamilyHX2 FamilyHX3 FamilyHX4

7. Dental Findings DentalFinding1 DentalFinding2 DentalFinding3 DentalFinding4 DentalFinding5 DentalFinding6 DentalFinding7 DentalFinding8

8. Dental Findings, 2 nd slide if needed DentalFinding1 DentalFinding2 DentalFinding3 DentalFinding4 DentalFinding5 DentalFinding6 DentalFinding7 DentalFinding8

9. Periodontal Findings PerioFinding

10. Radiographic Findings XrayFinding

11. Facial Photo /Frontal intraoral photo (full arch, occluding)

12. Facial Photo (normal smile) /Facial Photo (exaggerated smile)

13. Facial Photo (lips relaxed) /Profile Photo

14. Maxillary Arch, occlusal photo /Mandibular Arch, occlusal photo

15. R Posterior photo, in occlusion /L Posterior photo, in occlusion

16. Probings, maxillary /Probings, mandibular

17. X-rays, right half /X-rays, left half

18. UR Posterior, buccal photo /UR Posterior, lingual photo

19. Probings, UR Posterior /X-rays, UR Posterior

20. Probings, U Anterior /X-rays, U Anterior

21. UL Posterior, lingual photo /UL Posterior, buccal photo

22. Probings, UL Posterior /X-rays, UL Posterior

23. LL Posterior, lingual photo /LL Posterior, buccal photo

24. L Anterior, facial photo /L Anterior, lingual photo

25. Probings, Lower Anterior /X-rays, Lower Anterior

26. Probings, upper /Probings, lower

27. X-rays, right /X-rays, left

28. Diagnoses Diagnosis1 diagnosis2 diagnosis3 diagnosis4 diagnosis5 diagnosis6 diagnosis7

29. Diagnoses, 2 nd slide if needed Diagnosis1 diagnosis2 diagnosis3 diagnosis4 diagnosis5 diagnosis6 diagnosis7

30. Problem List Problem 1 Problem 2 Problem 3 Problem 4 Problem 5 Problem 6 Problem 7

31. Problem List, 2 nd slide if needed Problem 1 Problem 2 Problem 3 Problem 4 Problem 5 Problem 6 Problem 7

32. Etiology and Contributing Factors Item 1 Item 2 Item 3 Item 4 Item 5 Item 6 Item 7 Item 8

33. Etiology and Contributing Factors 2 nd slide if needed Item 1 Item 2 Item 3 Item 4 Item 5 Item 6 Item 7 Item 8

34. Prognosis, Short Term Excellent: Good: Fair: Poor:

35. Prognosis, Long Term Excellent: Good: Fair: Poor:

36. PAUSE HERE for Discussion

37. Treatment Options Proposed to patient Item 1 Item 2 Item 3 Item 4 Item 5 Item 6 Item 7 Item 8

38. Treatment Options Proposed to patient, slide 2 Item 9 Item 10 Item 11 Item 12 Item 13 Item 14 Item 15 Item 16

39. Treatment Options accepted by patient Item 1 Item 2 Item 3 Item 4 Item 5 Item 6 Item 7 Item 8

40. Treatment Options accepted by patient Item 9 Item 10 Item 11 Item 12 Item 13 Item 14 Item 15 Item 16

41. Post-Treatment Photos (if available)

55. THE END