Name | Description | Options |
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Anesthetic Area | The area for the anesthetic | Select one: palate facial buccal lingual
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Anesthetic for Tooth | The tooth that the anesthetic was injected adjacent to | Select one: |
Anesthetic, Local | The local anesthetic that was injected | Select one: Articaine, 4% with Epinephrine 1:100,000 Articaine, 4% with Epinephrine 1:200,000 Bupivacaine, 0.5% with Epinephrine 1:200,000 Carbocaine, 3% plain Citanest Forte, 4% with Epinephrine 1:200,000 Citanest Plain, 4% without Vasoconstrictior Duranest, 1.5% with Epinephrine 1:200,000 Lidocaine, 2% with Epinephrine 1:100,000 Lidocaine HCL, 2% with Epinephrine 1:100,000 Lidocaine HCL, 2% with Epinephrine 1:50,000 Mepivacaine, 2% with Levonordefrin 1:20,000 Mepivacaine, 3% plain Prilocaine, 4% plain Prilocaine, 4% with Epinephrine 1:200,000 Septocaine, 4% with Epinephrine 1:100,000 Xylocaine, 2% with Epinephrine 1:50,000 Xylocaine, 2% with Epinephrine 1:100,000
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Anesthetic, Needle Gauge | The gauge of the needle that was used | Select one: |
Anesthetic, Needle Length | The length of the needle that was used | Select one: |
Anesthetic, None Given | The reason that no anesthesia was given | Select one: |
Anesthetic, Topical | The topical anesthetic that was used | Select one: Benzocaine Dyclonine hydrocholoride Ethocaine Lidocaine solution Lidocaine ointment Lidocaine spray Oraqix Procaine Topicaine anesthetic gel Topex anesthetic gel Topex anesthetic spray Xylocaine
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Bonding Agent | The bonding agent that was used | Select one: Adper Scotchbond Clearfil Excite Fuji Bond OptiBond.
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Carpules, Fraction | The fraction of the whole carpules that were injected | Select one: |
Carpules, Qty | The whole number of carpules that were injected | Select one: |
Cement, Permanent | The cement that was used | Select one: Durelon Glasionomer Panavia RelyX Variolink II Zinc Phosphate
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Cement, Temporary | The temporary filling that was used | Select one: Cavit IRM Provolink Tempbond Temrex ZOE Zone
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Cosmetic Aberration | The cosmetic abberation that the patient has | Select one: skeletal aberration soft tissue aberration
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Cosmetic Aberration Notes | Notes regarding the cosmetic abberation, such as the location | Type text |
Cosmetic Aberration Treatable | Whether or not the cosmetic abberation is treatable | Select one: treatable by Dentist treatable by Physician not treatable
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Cosmetic Area | The area of the cosmetic issue | Select one: maxillary, anterior maxillary, posterior mandibular, anterior mandibular, posterior
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Cosmetic Issue | The cosmetic issue that the patient has | Select one: |
Cosmetic Level | The severity of the cosmetic issue | Select one: no a mild level of a moderate level of a severe level of
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Crown Replacement Reason | The reason for the crown replacement | Select one: decay fractured porcelain other
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Crown Type | The type of crown | Select one: resin-based composite resin with high noble metal resin with predominantly base metal resin with noble metal porcelain ceramic substrate porcelain fused to high noble metal porcelain fused to predominantly base metal porcelain fused to noble metal full cast high noble metal full cast predominantly base metal full cast noble metal titanium provisional previous
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Decay Detection Method | The method that the decay was detected by | Select all that apply: x-ray explorer laser fluorescence other
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Decay Level | The level of existing decay that the patient has | Select one: no minimal moderate extensive
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Denture Arch | The denture arch | Select one: |
Exam Type | The clinical exam type | Select one: Initial Recare Emergency Other
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Eval MA, Lip Habits | Notes regarding the myofunctional analysis that was made of the lip habits | Type text |
Eval MA, Speech | Notes regarding the myofunctional analysis that was made of the speech habits | Type text |
Eval MA, Tongue Habits | Notes regarding the myofunctional analysis that was made of the tongue habits | Type text |
Eval TMJ Diagnosis | The TMJ diagnosis | Select one: |
Eval TMJ, Motion/Deviation | The level of TMJ motion or deviation | Select one: |
Eval TMJ, Subluxation/Crepitus | The level of TMJ subluxation or crepitus | Select one: |
Eval TMJ, Symptoms Report | Notes regarding the TMJ symptoms that the patient reported. | Type text |
Habits, Bulemia/Anorexia | The result of the evaluation of signs of bulemia or anorexia | Select one: |
Habits, Cheek Biting | The result of the evaluation of signs of cheek biting | Select one: |
Habits, Chewing Tobacco | The result of the evaluation of signs of smokeless tobacco use | Select one: |
Habits, Cig Smoking | The result of the evaluation of signs of cigarette and/or cigar smoking | Select one: |
Habits, Gum Chewing | The result of the evaluation of signs of gum chewing | Select one: |
Habits, Mouth Breathing | The result of the evaluation of signs of mouth breathing | Select one: |
Habits, Nail Biting | The result of the evaluation of signs of nail biting | Select one: |
Habits, Other | Notes regarding any other habits that the patient exhibits signs of | Type text |
Habits, Pipe Smoking | The result of the evaluation of signs of pipe smoking | Select one: |
Habits, Substance Abuse | The result of the evaluation of signs of substance abuse | Select one: |
Habits, Teeth Grind/Clench | The result of the evaluation of signs of teeth grinding and/or clenching | Select one: |
Habits, Thumb Sucking | The result of the evaluation of signs of thumb and/or finger sucking | Select one: |
Habits, Tongue Thrusting | The result of the evaluation of signs of tongue thrusting | Select one: |
Habits, Toothpick Use | The result of the evaluation of signs of toothpick or stimulator use | Select one: |
Health Issues | The health issues that apply to the patient | Select all that apply: AIDS Allergies Anemia Arthritis Artificial Joints Asthma Blood Disease Cancer Codeine Allergy Diabetes Dizziness Epilepsy Excessive Bleeding Fainting Glaucoma Growths Hay Fever Head Injuries Heart Disease Heart Murmur Hepatitis HIV Positive
| Hypertension Jaundice Kidney Disease Liver Disease Mental Disorders Nervous Disorders Pacemaker Penicillin Allergy Pregnancy Radiation Treatment Respiratory Problems Rheumatic Fever Rheumatism Sinus Problems Stomach Problems Stroke Tuberculosis Tumors Ulcers Venereal Disease
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Occlusion, Aesthetic, Dr. | The perception of the doctor regarding the aesthetics of the occlusion | Select one: |
Occlusion, Aesthetic, Patient | The perception of the patient regarding the aesthetics of the occlusion | Select one: |
Occlusion, Appliance Space | Notes regarding the space that is available for appliances | Type text |
Occlusion, Arch Length | The result of the examination of the arch length | Select one: No issues Mild Moderate Severe
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Occlusion, Classification | The classification of the occlusion | Select one: |
Occlusion, Crossbite | The result of the examination for crossbite | Select one: |
Occlusion, Crowding | The result of the examination for crowding | Select one: |
Occlusion, Function, Dr. | The perception of the doctor regarding the functionality of the occlusion | Select one: |
Occlusion, Function, Patient | The perception of the doctor regarding the functionality of the occlusion | Select one: |
Occlusion, Left Lateral | Notes regarding the left lateral side of the occlusion | Type text |
Occlusion, Overall Spacing | The result of an examination of the overall spacing | Select one: No issues Mild Moderate Severe
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Occlusion, Overbite (mm) | The length of the overbite in millimeters | Type text |
Occlusion, Overjet (mm) | The length of the overjet in millimeters | Type text |
Occlusion, Right Lateral | Notes regarding the right lateral side of the occlusion | Type text |
Oral Hygiene, Calculus | Notes regarding the examination of calculus | Type text |
Oral Hygiene, Food Impaction | Notes regarding the examination of food impaction | Type text |
Oral Hygiene, Overall | The assessment of the overall oral hygiene | Select one: |
Oral Hygiene, Plaque | Notes regarding the examination of plaque | Type text |
Oral Hygiene, Stain | Notes regarding the examination of stains on the teeth | Type text |
Oral Pathology Level | The severity level of the oral pathology | Select one: |
Oral Pathology Prognosis | The prognosis of the oral pathology | Select one: |
Oral Pathology Treatment | The recommended treament option for the oral pathology | Select one: |
Oral Pathology Type | The type of oral pathology present | Select one: evident developmental systemic surface deep
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Oral Pathology, Tooth Related | The determination of the oral pathology being tooth related | Select one: There is no evident tooth-related oral pathology Oral pathology is tooth related Oral pathology is not tooth related
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Oral Rinse | The oral rinse that was used | Select one: ACCLEAN Oris CHX Peridex PerioGard Peroxyl Rincinol Viadent
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Ortho Issue | The reason for the orthodontic referral | Select all that apply: |
Pain Area | The area of the pain | Select one: facial buccal palatal lingual
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Pain Level | The pain level tha was reported by the patient | Select one: low acute low chronic high acute high chronic
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Pain Manifestation | What there is evidence of regarding the pain | Select one: bleeding suppuration swelling ulceration
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Patient Dismissal Reason | The reason that the patient was dismissed | Select one: |
Patient Referred, Reason | The reason for the referral | Select one: second opinion further treatment
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Patient Referred, Specialty | The specialty of the doctor who the patient was referred to | Select one: |
Patient Response, Sensitivity | Whether or not the patient experiences sensitivity | Select one: affirmative negative undecided
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Perio, Attached Gingiva | The result of the examination of the ginigival attachment | Select one: Skipped Normal Recession Enlarged Tissue
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Perio, Bleeding | The level of gingival bleeding | Select one: Skipped None Mild Moderate Severe
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Perio, Bone Loss Pattern | The bone loss pattern | Select one: Skipped None Horizontal Vertical
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Perio, Bone Loss Severity | The severity of the bone loss | Select one: Skipped None Mild Moderate Severe
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Perio, Calculus | The level of calculus | Select one: Skipped None Light Moderate Heavy
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Perio, Classification | The periodontal classification | Select one: Skipped Normal I-Gingival Diseases, dental plaque-induced I-Gingival Diseases, non-plaque-induced lesions II-Chronic Periodontitis, localized, slight severity II-Chronic Periodontitis, localized, moderate severity II-Chronic Periodontitis, localized, severe; II-Chronic Periodontitis, generalized, slight severity II-Chronic Periodontitis, generalized, moderate severity II-Chronic Periodontitis, generalized, severe III-Aggressive Periodontitis, localized, slight severity III-Aggressive Periodontitis, localized, moderate severity III-Aggressive Periodontitis, localized, severe III-Aggressive Periodontitis, generalized, slight severity III-Aggressive Periodontitis, generalized, moderate severity III-Aggressive Periodontitis, generalized, severe IV-Periodontitis as a Manifestation of Systemic Diseases V-Necrotizing Periodontal Diseases, ulcerative gingivitis V-Necrotizing Periodontal Diseases, ulcerative periodontitis VI-Abscesses of the Periodontium, gingival VI-Abscesses of the Periodontium, pericoronal VII-Periodontitis Associated With Endodontic Lesions VIII-Developmental or Acquired Deformities and Conditions
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Perio, Color | The color of the gingiva | Select one: Skipped Normal Pale White Whitish Pink Coral Pink Pink Red Magenta Pink with Magenta areas Bluish Red Deep Red
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Perio, Consistency | The consistency of the gingiva | Select one: Skipped Firm and resilient Edematous Fibrotic Retractable
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Perio, Hypersensitivity | The level of dentinal hypersensitivity | Select one: Skipped None Mild Moderate Severe
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Perio, Inflammation | The level of gingival inflammation | Select one: Skipped None Mild Moderate Severe
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Perio, Margins | The result of the examination of the free gingival margins | Select one: Skipped Normal (Knife Edged) Rolled Recessions Rounded Clefts Pseudoclefts Cuffing
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Perio, Miscellaneous | Additional notes regarding the periodontal examination | Type text |
Perio, Papillae | The result of the examination of the interdental papillae | Select one: Skipped Normal Pyramidal or pointed Bulbous Blunted Absent Cratered Scalloped Enlarged
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Perio, Plaque | The level of plaque | Select one: Skipped None Light Moderate Heavy
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Perio, Stain | Whether or not stain is present | Select one: Skipped None Exogenous Endogenous
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Perio, Stain Pigment | The description of the pigment of the stain | Select one: Skipped Intrinsic, brownish red, blush black Intrinsic, grayish brown Intrinsic, whitish brown, localized Intrinsic, whitish brown, generalized Intrinsic, yellowish brown Extrinsic, brown Extrinsic, black-line Extrinsic, green
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Perio, Sulcus | The result of the examination of the gingival sulcus | Select one: |
Perio, Suppuration | The level of suppuration | Select one: Skipped None Mild Moderate Severe
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Perio, Texture | The texture of the gingiva surface | Select one: Skipped Normal Stippling Shiny and smooth Rough
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Phosphoric Acid Etchant % | The phosphoric acid etchant percent | Select one: 10% 25% 34% 35% 36% 37% 38% 40% 50%
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Post-Op Given | Who the post-op instructions were given to | Select one: |
Post-Op Instructions | How the post-op instructions were given | Select all that apply: computer generated verbal written
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Prophy Scaling | The degree of scaling | Select one: |
Pulp Test | The reading of the pulp test | Select one: 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0
| 5.5 6.0 6.5 7.0 7.5 8.0 8.5 9.0 9.5 10.0
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Quadrant-Select Multiple | The quadrants | Select all that apply: Upper Right Upper Left Lower Right Lower Left
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Quadrant-Select One | The quadrant | Select one: Upper Right Upper Left Lower Right Lower Left
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Quadrant-With Pain | The quadrant where the pain is present | Select one: Upper Right Upper Left Lower Right Lower Left
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Restoration Material | The restoration material | Select one: |
Restorative Issues | Notes regarding any additional restorative issues | Type text |
Return Appointment | Select whether or not a return appointment was scheduled | Select one: |
Rx Drug Name | The drug name | Select one: Amoxicillin 500 mg Celcor 500 mg Hydrocondone 5 mg Keflex 500 mg Tylenol #3 Valium 5 mg Zpak
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Rx Quantity | The quantity to dispense | Select one: 8 tabs 20 tabs 30 tabs dispense one pack
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Rx Refills | The number of refills that are allowed | Select one: |
Rx Sig - Instructions | The dosing instructions | Select one: Take 2 now 1 Q 6 H until gone 1 Q4-6H pm pain
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Rx to Pharmacy | The method that the prescription was given to the pharmacy | Select one: phoned in to a pharmacy technician phoned in to the pharmacy A message was left on the pharmacy's answering machine sent to the pharmacy by fax sent to the pharmacy by e-mail
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Shade # | Type the shade number for the specified shade letter and shade guide | Type text |
Shade Guide | The shade guide that was used | Select one: Bioblend Bioform Chromascop Portrait SR Vivodent PE Trublend Trubyte Vita Custom Shade Guide
|
Shade Letter | The shade letter | Select one: |
Size of Ulcer | The size of the ulcer | Select one: less than 5 mm 5 mm to 10 mm greater than 1 cm
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| Notes regarding the soft-tissue examination of the head and neck | Type text |
STE Floor of Mouth | Notes regarding the soft-tissue examination of the floor of the mouth | Type text |
STE Labial/Buccal Mucosa | Notes regarding the soft-tissue examination of the labial or buccal mucosa | Type text |
STE Lips | Notes regarding the soft-tissue examination of the lips | Type text |
STE Lymph Chain | Notes regarding the soft-tissue examination of the lymph chain | Type text |
STE Palate, Hard/Soft | Notes regarding the soft-tissue examination of the hard or soft palate | Type text |
STE Pharynx | Notes regarding the soft-tissue examination of the pharynx | Type text |
STE Tongue | Notes regarding the soft-tissue examination of the tongue | Type text |
Surface-Select | The surfaces | Select all that apply: mesial incisal occlusal distal lingual lingual, class five facial facial, class five buccal buccal, class five
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Surface-Select Text | The surface | Select one: mesial incisal occlusal distal lingual facial buccal mesiobuccal mesiolingual distobuccal distolingual
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Surfaces Covered-Old | The surfaces that were covered by the old restoration | Select all that apply: mesial incisal occlusal distal lingual lingual, class five facial facial, class five buccal buccal, class five
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Temperature | What the patient has sensitivity to | Select one: |
TMJ Joints | The TMJ | Select one: |
Tooth-Missing | The tooth that is missing | Select one: |
Tooth-Receiving Treatment | The tooth that is receiving treatment | Select one: |
Tooth-Select Multiple | The teeth | Select all that apply: |
Tooth-Select One | The tooth | Select one: |
Tooth-With Pain | The tooth that is causing the patient pain | Select one: |
Tx Plan | The recommended treatment option | Select one: amalgam surface restoration a composite surface restoration an extraction an apicoectomy a root canal a post and core a crown a bridge a partial denture a full denture an implant a referral to a specialist
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Tx Plan, Bridge/Crown | Whether the recommended treatment is for a bridge or a crown | Select one: |
Tx Plan, Ready for Crown | The treatment that was performed to make the tooth ready for a crown | Select one: |
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