NEW PATIENT EXAMINATION

MEDICAL HISTORY-

C/O-

REASON FOR ATTENDANCE-

ANY CONCERNS/FEARS-

LDV-

LAST RADS-

SOCIAL HISTORY-

EXPECTATIONS FROM TREATMENT-

EO—SWELLING

TMJ

NODES

IO—SOFT TISSUE

TOOTH CHARTING

Current Oral Hygiene Regime

BPE

RADIOGRAPHS-

JUSTIFICATION

OTHER SPECIAL TESTS

RADIOGRAPH REPORT

Quality Assessment

HARD TISSUE- FRACTURES

WEAR

CARIES

Caries Risk

Perio Risk

DIAGNOSIS-

DISCUSSIONS-

Written Treatment Plan Agreed with Patient

RECALL PERIOD (Nice Guidelines)

Justification

ADULT RECALL EXAMINATION

MEDICAL HISTORY-

C/O

EO— SWELLING

TMJ

NODES

IO—SOFT TISSUE

TOOTH CHARTING

CURRENT ORAL HYGIENE REGIME/DIET

BPE

RADIOGRAPHS

JUSTIFICATION

OTHER SPECIAL TESTS

RADIOGRAPH REPORT

Quality Assessment

HARD TISSUE- FRACTURES

WEAR

CARIES

Caries Risk –

Perio Risk –

DIAGNOSIS

DISCUSSIONS

Written Treatment Plan Agreed with the patient

RECALL INTERVAL AGREED WITH PT (in accordance with Nice Guidelines) –

Justification –

CROWN/BRIDGE FIT

MED HIST

REPORT ON TEMPORARY PHASE:-

LA—TYPE

BATCH NO.

AMOUNT

SITE

PROCEDURE:-

OCCLUSION:-

PT HAPPY AND SHOWN BEFORE FIT:-

CEMENTATION:-

OCCLUSION:-

COMMENTS/WARNINGS

CROWN/BRIDGE PREPARATION

MED HIST

PA(S) AVAILABLE:-

LA—TYPE

BATCH NO.

AMOUNT

SITE

PRELIMINARY IMPRESSIONS:-

PREPARATION DETAILS:-

IMPRESSION MATERIALS:-

BITE REGISTRATION;-

TEMPORISATION:-

OCCLUSION:-

SHADE DETAILS:-

LABORATORY:-

COMMENTS/WARNINGS

EMERGENCY PAIN APPT

MEDICAL HISTORY

C/O:

WHEN DID IT START?

HAS IT HAPPENED BEFORE?

IS IT CONSTANT?

HAS IT STOPPED—-EATING?

SLEEPING?

HAVE YOU USED PAINKILLERS?

ARE THEY EFFECTIVE?

IS IT SENSITIVE TO HOT?

COLD?

PRESSURE?

IS IT RELIEVED BY ANYTHING?

O/E—

RADIOGRAPHS

JUSTIFICATION

OTHER SPECIAL TESTS

RADIOGRAPH REPORT

DIAGNOSIS

DISCUSSIONS

TREATMENT AGREED

CROWN PREPARATION

reviewed risks w pt-

informed consent

articaine 4% with Adr 1:100000

ID block

bu infiltration

Amount

Advised caution in this region whilst still numb, especially with Hot food or drinks.

remove old cr

prep for PBC

impression-putty/wash-retraction cord

opposing alginate

temp cr made quicktemp/cemented temp bond

shade

lab

return

POIG re temp cr/la/post op sens etc

CROWN FIT

articaine 4% with Adr 1:100000

ID block

bu infiltration

Amount

Advised caution in this region whilst still numb, especially with Hot food or drinks.

remove temp crown

try in crown-check + adjust contacts/ margins checked/bite checked -adjusted+polished

fit and shade good

prepare fit surface emax-porcelain etch/rinsed/phosphoric etch/rinsed/silane applied

cemented- fuji plus rely x

warned may fail

POIG re LA/post op sens/OHI

COMPOSITE FILLING

informed consent-

articaine 4% with Adr 1:100000

lidocaine 2% with adr 1;80000

ID block-

bu infiltration-

Advised caution in this region whilst still numb, especially with Hot food or drinks.

rubber dam

remove old flg

exc caries

etch

bond-P&B

SDR

esthetic x A

bite checked + adjusted

polished

contact checked-

POIG

Warnings

-deep flg/risk future rct/crown needed-

-risk of cracks/risk future cr +/- rct-

warned may fail

NIGHTGUARD

Nightguard options to help protect teeth and restorations from further wear cracks and fractures;

-michigan/tanner splint-hard plastic £475 – upper or lower jaw

-NTI splint-covers front teeth only £375- upper or lower jaw

-soft plastic- £150 – upper or lower jaw

-thin hard plastic essix retainers if you think wearing the more bulky guards would be difficult £150 per set upper + lower-these may however wear through more quickly

CRACKED TOOTH

discussed with patient re need for crown/onlay

-ideally root filled molar teeth should be crowned as risk #/splitting

-tooth weakened + risk fracture/loss

-explained risk long term tooth may also need root filling

-patient to consider

PERIODONTAL ADVICES

discussed OHI re caries/perio/tsl prevention/ging recession etc

-pt shown plaque/calc/bop

-adv needs improved OH/limit sugar intake/use F t/p etc

-future r-g needed to review areas early decay-may need future flg if worsen

-floss/brush use exp’d -soft t/b + technique re t/b abrasion + ging recession prevention

– dietary acid re erosion discussed-to try to limit intake acidic foods/drinks

-sensodyne/pronamel etc suggested re any sensitivity

Discussed and explained periodontal disease with patient

-smoking cessation adv re perio/oral cancer given

-explained perio disease/ shown pocketing/bone loss on r-g /risk of tooth loss if left untreated

-stressed patients responsibility for improved OH on daily basis for perio disease prevention- brushing/technique and interdental cleaning with floss/tepe exp’d and demostrated

-stressed needs regular hygiene and exams to monitor and treat

-perio referal to

Dr Harper advised OR may be needed in future -patient agreed/declines

CRACKED TOOTH

This tooth has a crack in it and will need a crown to help splint the tooth together and try to prevent the crack from spreading. However if the crack has spread into the nerve it may also require a root filling as well. If when doing the root filling we find the cracks have already spread into the roots it may need extraction. Sometimes a specialist referal may be needed to assess the crack and decide on the most appropriate treatment

To assess if the tooth requires a root filling we may either cement a metal band around it for 3-4 months or cement the final crown on for 3-4 months with temporary cement. I f you still get symptoms during this time it usually means a root filling is required.

Even after root filling and crowning there is a small risk the crack can still spread into the roots in the future and it may need extraction.

Your only other option for this tooth other than root filling and crowning is to extract it and consider replacment with either an implant/denture or bridge.

Provisional cementation of metal orthontic band to monitor symptoms £125

Root fillings for molars approx £650 or from £750 with a specialist

crown £750

extraction from £275-500 depending on difficulty/cracks or if surgical extraction required

EXAM NEW PT

C/O-

PDH;

PMH;

updated-

med-

allergies-

other-

PSH;

-smoking-

EO—

IO–

PERIO;

TOOTH CHARTING/HARD TISSUES;

OCCLUSION;

RADIOGRAPHS;

Taken-

Justification-

OTHER SPECIAL TESTS-

RADIOGRAPH REPORT;

Quality Assessment-

Caries-

Bone Levels-

DISCUSSIONS

TREATMENT AGREED

NEW PATIENT EXAMINATION

C/O-

REASON FOR ATTENDANCE-

ANY CONCERNS/FEARS-

LDV-

LAST RADS-

EXPECTATIONS FROM TREATMENT-

PMH;

checked-

med-

allergies-

other-

SOCIAL HISTORY

smoking-

alcohol-

EO—

SWELLING-

TMJ-

NODES-

IO—

SOFT TISSUE

PERIO;

Current Oral Hygiene Regime-

BPE-see chart

Deposits-

OH-

Mobility-

Other-

TOOTH CHARTING;

HARD TISSUES;

-Caries-

-Fractures-

-Wear-

OCCLUSION;

RADIOGRAPHS;

TAKEN-

JUSTIFICATION-

OTHER SPECIAL TESTS-

RADIOGRAPH REPORT

Quality Assessment-

Caries-

Bone Levels-

RISK ASSESSMENT;

Caries Risk –

Perio Risk-

Oral Cancer-

DIAGNOSIS-

DISCUSSIONS-TREATMENT PLAN;

Discussions-see above

Written Treatment Plan Agreed with Patient

RECALL PERIOD (Nice Guidelines)-

Justification-

INVISALIGN

–approximate cost of invisalign is from £3500-4500 depending on difficulty and time treatment takes

–after completion of active treatment phase you need to hold the teeth in position to prevent them moving back-retention phase

–retention options are

1. fixed retainers-a this wire is bonded to the back of your front teeth-approx £300

2 standard invisalign essix removable retainers- approx £250

3. thicker invisalign Vivera removable retainers- approx £350

SPLINT

Michigan Splint Impressions

upper putty wash

lower alginate

beauty wax bite in RCP

facebow recorded

lab-

return-

tca fit

Fit Michigan Splint

fit good

adj bite in RCP/lateral + protrusive excursions

pt comfortable

pt instructions on use + OH measures given

POIG-pt advised may need further bite adjustment-refinement- and to call if needed or if problems

TEETH WHITENING CONSULTATION

TW consult

-pt worried tooth going darker/yellow and enq re tooth whitening

PMH

PSH

ORAL EXAM

ST

PERIO

-deposits

-OH

TEETH

-anterior fillings/crowns

-stainings etc

-shade

Tooth whitening options discussed;

1. home kit-may take 2-4 weeks daily TW / if sensitivty may only be able to do everty second day/can be done in conjunction with in surgery TW to speed up process

2 in surgery TW-less predictable-best done in conjunction with home kit -more predictable + have home kit to top up/maintain in future

3 combination of home kit + in surgery

Discussed risks/benefits/options re TW

-risk of variable results + time taken due to enamel thickness,density etc

-specifically showed pt areas of flurosis, advised these areas are likely to turn “chalky” white and will therefore standsout initially. These areas normally blend back in with time, but cant guarentee.

-exp’d risks re tooth/gum sensitivity(reversible), risk relapse with time/diet etc + no guarentee re result + need for future maintainance/top up

Pt Opted for Option-

Pt understands and is happy to proceed

WHITENING HOMEKIT

fit Tw home kit-supply 6% wyten gel 6% poladay 16% polanight

pre shade

pre photos taken

tray fit-

adv re loading gel + use/adv avoid overloading trays to avoid gum irritation

adv re tooth sens + expectations-no guarentte re result

trays loaded with gel to start treatment in surgery

pt to cont at home-1-2 x/day 30min advised 2-3 weeks for best results dependent on tooth porosity/thickness etc

tca if more gel needed or if problems

IN SURGERY LASER WHITENING

In Surgery Tooth Whitening-Wyten TW system used

-reviewed consent form with pt-signed + in notes

-reviewed options re in surg vs home kit vs combo-pt wants to proceed with in surg + to review use of home kit after to maintain as TW may relapse with time + diet

-adv ideally to be used in conjunction with home kit to get best results due to variability of one off in surgery TW results

-reviewed risks re tooth/gum sensitivity but advised only temporay

-pre op neurofen advised

-reviewed expectations-pt aware no guarentee how white teeth will go or how long will last- dependent on tooth density/porosity/thickness/diet/home kit use etc

pre op photos + shade

in surg proceedure carried out as per britesmile Wyten instructions

post op photos + shade

pt treatment record in notes re proceeedure

pt happy with result

POIG V+W re sensitivity/diet/relapse/use home kit to maintain

REFERRAL LETTER

Oral medicine

Eastman Dental Hospital

256 Gray’s Inn Road

London, WC1X 8LD

re;

Mr Kemal Ahson

4 Belmont Court

Pembroke Mews

REFERRAL

London W86ES

DOB-24/02/1966

Phone-Home-020 7937 0919

-Mobile-079 5094 3051

Dear Doctor,

Thank you for seeing Mr Kemal Ahson

I would be grateful if you could assess the diffuse white area affecting the whole of his hard palate. Mr Ahson is a non smoker, but says he does have a habit of drinking very hot drinks. He was unaware of the white area and is not getting any symptoms from it.

Medically Mr Ahson is not on any medications and suffers from hay fever.

Many Thanks

Kind Regards

Peter Wilkie

Associate

Oasis Dental Care Kensington High Street

21 Kensington High Street

London W8 5 NP

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