SlideShare a Scribd company logo
DENTAL TREATMENT PLAN                                                           1.    CONSULTATION DESIRED                    YES           NO
            For use of this form, see TB MED 250; proponent agency is Office of TSG.                                    (If yes, complete Section III, on reverse side)
                           SECTION I - PLANNED TREATMENT AND SEQUENCE OF ACCOMPLISHMENT
           Check items in Column c to indicate treatment planned. If sequence of treatment is other than that printed in column b,
           use numbers (1 thru 10) in column c to show desired order.
L    C                                                                                                                            CHART
     O                                                 PLANNED
I                                                                      ACCOM-                      Chart ONLY missing teeth and TREATMENT TO BE ACCOMPLISHED.
     D               TYPE TREATMENT                       SE-
N                                                                      PLISHED
     E                                                 QUENCE                                      Do NOT chart existing Pathology or Restorations.
E    a                         b                           c               d                                                         e

2    A    URGENT



3    B    PERIODONTAL                                   3c,4,6

4    C    PROPHYLAXIS               SnF2 PASTE

          TOPICAL    SnF2
5    D
          REPEAT AFTER              MONTHS

6    E    COUNSELING IN SELF CARE                       3a,3c
                                                                                              1    2    3     4    5       6    7    8    9    10   11 12 13         14   15   16



                                                                                      RIGHT




                                                                                                                                                                                    LEFT
7    F    OCCLUSION                                     4f, 5                                 32   31    30   29       28 27 26 25 24 23 22 21                 20   19    18   17


8    G    SURGERY



9    H    RESTORATIONS                                  5b,c

10   I    PROSTHESES
                                                        4f
                                                        5b,c,e
          OTHER (specify)
11   J

                                                                          12. REMARKS OR INSTRUCTIONS
                    Use this space for additional clarification of recommended treatment or for describing treatment which does not lend itself to charting.
                    Indicate nature of treatment and teeth or other tissues involved. Identify entry by code letter (Column a, above).
1. Urgent: None
2. Systemic: Uncontrolled Stage 1 Hypertension (medical referral); smoking cessation (referral to cessation clinic)
3. Preparatory:
     a. Comprehensive Exam, Dx waxup, Tx plan presentation
     b. Anderson Medical Model - RMGI Restorations #‘s 3,4,5,6,7,8,9,10,14,21,28,31; Sealants, 0.12% CHX rinse; Fl varnish
     c. Initial non surgical periodontal therapy; OHI; NaF rinse (home); Xylitol gum
4. Decision Point: Perio re-eval (≥85% plaque free surfaces) - (open flap debridement for PDs >5mm) & Bacteriologic testing
     e. Endo Retreatment #9; Amal rest #‘s 3,4,5,14,21,28,31
     f. Fixed Ortho Appliances Mx/Md arch (Correct OB/OJ, Intrude #14, Close Md diastemas) for 12-18 months
        i. 1 stage implant - Md arch opposing tooth #14 - ortho anchorage (if required) & RDP Locator abutment
     g. Clinical Crown Lengthening (#’s 6-11,14, 21, 28)
5. Corrective:
   a. Cast Post/Core #9
   b. PFM #’s 3,6,7,8,9,10; Surveyed PFMs #’s 21/28
   c. PFM FDP #’s 11-14; #‘s 22&27 incisal composite
   d. Locator Abutment placement on Md implant + final impression for Md RDP
   e. Implant supported Mandibular Kennedy Class III RDP
   f. Nocturnal Bruxism appliance
6. Maintenance: Perio - 3 mos for 1 yr., 6 mos thereafter; Prostho - 6 mos, then yearly; Endo - yearly
13. DATE                      14. TREATMENT FACILITY                                                          15. SIGNATURE OF DENTIST RECORDING TREATMENT
                                                                                                               PLAN



                                                                SECTION II - PATIENT IDENTIFICATION
16. SEX       17. RACE        18. GRADE               19. ORGANIZATION




20. PATIENT'S LAST NAME - FIRST NAME - MIDDLE INITIAL                                                         21. DATE OF BIRTH               22. IDENTIFICATION NUMBER




DA FORM 3984, DEC 72                              REPLACES DA FORM 8-276, 1 AUG 62 WHICH WILL BE USED.                                                                    USAPA V1.01

More Related Content

What's hot

Anterior metal ceramic crown pfm
Anterior metal ceramic crown pfmAnterior metal ceramic crown pfm
Anterior metal ceramic crown pfm
Muaiyed Mahmoud Buzayan
 
MTA Apexification
MTA ApexificationMTA Apexification
MTA Apexification
Dr. Roshni Maurya
 
Endodontic emergencies and mid term flare ups
Endodontic emergencies and mid term flare upsEndodontic emergencies and mid term flare ups
Endodontic emergencies and mid term flare ups
DR POOJA
 
Conservative Dentistry case sheet / endodontics courses online
Conservative Dentistry case sheet / endodontics courses online Conservative Dentistry case sheet / endodontics courses online
Conservative Dentistry case sheet / endodontics courses online
Indian dental academy
 
Root canal obturating materials in primary teeth
Root canal obturating materials in primary teethRoot canal obturating materials in primary teeth
Root canal obturating materials in primary teeth
aravindhanarumugam1
 
Atraumatic restorative treatment
Atraumatic restorative treatmentAtraumatic restorative treatment
Atraumatic restorative treatment
Parveen Ash Ash
 
Instrument seperation and its management
Instrument seperation and its managementInstrument seperation and its management
Instrument seperation and its management
Nivedha Tina
 
Dental water line system WDS
Dental water line system WDSDental water line system WDS
Dental water line system WDS
sukaram
 
Post retained endodontic restorations
Post retained endodontic restorationsPost retained endodontic restorations
Post retained endodontic restorations
IAU Dent
 
Access Cavity Prepration
Access Cavity PreprationAccess Cavity Prepration
Access Cavity Prepration
Cing Sian Dal
 
INTRACANAL MEDICAMENTS IN ENDODONTICS
INTRACANAL MEDICAMENTS IN ENDODONTICSINTRACANAL MEDICAMENTS IN ENDODONTICS
INTRACANAL MEDICAMENTS IN ENDODONTICS
Sk Aziz Ikbal
 
Impression techniques for rpd / dental crown & bridge courses
Impression techniques for rpd  / dental crown & bridge coursesImpression techniques for rpd  / dental crown & bridge courses
Impression techniques for rpd / dental crown & bridge courses
Indian dental academy
 
Intra canal medicaments
Intra canal medicamentsIntra canal medicaments
Intra canal medicamentsParth Thakkar
 
Child abuse
Child abuseChild abuse
Dental Case Sheet
Dental Case Sheet Dental Case Sheet
Dental Case Sheet
Mahmoud Shaheen
 
“ Laminate veneer ,,
“ Laminate veneer ,, “ Laminate veneer ,,
“ Laminate veneer ,, TOC2014
 
Endo crown
Endo crownEndo crown
Endo crown
abdokorany
 
Post dr. hicham nuaimi
Post dr. hicham nuaimiPost dr. hicham nuaimi
Post dr. hicham nuaimi
Husham Al-noaimi
 
Mangement of endodontic pain
Mangement of endodontic painMangement of endodontic pain
Mangement of endodontic pain
alka shukla
 

What's hot (20)

Anterior metal ceramic crown pfm
Anterior metal ceramic crown pfmAnterior metal ceramic crown pfm
Anterior metal ceramic crown pfm
 
MTA Apexification
MTA ApexificationMTA Apexification
MTA Apexification
 
Endodontic emergencies and mid term flare ups
Endodontic emergencies and mid term flare upsEndodontic emergencies and mid term flare ups
Endodontic emergencies and mid term flare ups
 
Conservative Dentistry case sheet / endodontics courses online
Conservative Dentistry case sheet / endodontics courses online Conservative Dentistry case sheet / endodontics courses online
Conservative Dentistry case sheet / endodontics courses online
 
Access opening of molar teeth
Access opening of molar teethAccess opening of molar teeth
Access opening of molar teeth
 
Root canal obturating materials in primary teeth
Root canal obturating materials in primary teethRoot canal obturating materials in primary teeth
Root canal obturating materials in primary teeth
 
Atraumatic restorative treatment
Atraumatic restorative treatmentAtraumatic restorative treatment
Atraumatic restorative treatment
 
Instrument seperation and its management
Instrument seperation and its managementInstrument seperation and its management
Instrument seperation and its management
 
Dental water line system WDS
Dental water line system WDSDental water line system WDS
Dental water line system WDS
 
Post retained endodontic restorations
Post retained endodontic restorationsPost retained endodontic restorations
Post retained endodontic restorations
 
Access Cavity Prepration
Access Cavity PreprationAccess Cavity Prepration
Access Cavity Prepration
 
INTRACANAL MEDICAMENTS IN ENDODONTICS
INTRACANAL MEDICAMENTS IN ENDODONTICSINTRACANAL MEDICAMENTS IN ENDODONTICS
INTRACANAL MEDICAMENTS IN ENDODONTICS
 
Impression techniques for rpd / dental crown & bridge courses
Impression techniques for rpd  / dental crown & bridge coursesImpression techniques for rpd  / dental crown & bridge courses
Impression techniques for rpd / dental crown & bridge courses
 
Intra canal medicaments
Intra canal medicamentsIntra canal medicaments
Intra canal medicaments
 
Child abuse
Child abuseChild abuse
Child abuse
 
Dental Case Sheet
Dental Case Sheet Dental Case Sheet
Dental Case Sheet
 
“ Laminate veneer ,,
“ Laminate veneer ,, “ Laminate veneer ,,
“ Laminate veneer ,,
 
Endo crown
Endo crownEndo crown
Endo crown
 
Post dr. hicham nuaimi
Post dr. hicham nuaimiPost dr. hicham nuaimi
Post dr. hicham nuaimi
 
Mangement of endodontic pain
Mangement of endodontic painMangement of endodontic pain
Mangement of endodontic pain
 

Viewers also liked

Orthodontic treatment planning
Orthodontic treatment planningOrthodontic treatment planning
Orthodontic treatment planning
IAU Dent
 
Treatment plan for Implants in funtional zone
Treatment plan for Implants in funtional zoneTreatment plan for Implants in funtional zone
Treatment plan for Implants in funtional zone
Vinay Kadavakolanu
 
Orthodontic treatment coordinator performance appraisal
Orthodontic treatment coordinator performance appraisalOrthodontic treatment coordinator performance appraisal
Orthodontic treatment coordinator performance appraisal
jennymarion69
 
Juan Olivier Wax up
Juan Olivier Wax upJuan Olivier Wax up
Juan Olivier Wax upThad Hegwood
 
Drawing: Proportions of a face
Drawing: Proportions of a faceDrawing: Proportions of a face
Drawing: Proportions of a face
CEStein
 
Dentofacial esthetics / cosmetic dentistry course
Dentofacial esthetics / cosmetic dentistry courseDentofacial esthetics / cosmetic dentistry course
Dentofacial esthetics / cosmetic dentistry course
Indian dental academy
 
Proportion and the human face
Proportion and the human faceProportion and the human face
Proportion and the human faceCandice McPherson
 
Recent advances in atrumatic extraction techniques
Recent advances in atrumatic extraction techniquesRecent advances in atrumatic extraction techniques
Recent advances in atrumatic extraction techniquesManthru Naik Ramavath
 
Esthetics / orthodontics courses in india
Esthetics  / orthodontics courses in indiaEsthetics  / orthodontics courses in india
Esthetics / orthodontics courses in india
Indian dental academy
 
Socket Management in the Esthetic Zone
Socket Management in the Esthetic ZoneSocket Management in the Esthetic Zone
Socket Management in the Esthetic Zone
theaacd
 
Restorative and Esthetic Dentistry
Restorative and Esthetic DentistryRestorative and Esthetic Dentistry
Restorative and Esthetic DentistryMedicineAndFamily
 
Anterior Direct Restorations
Anterior Direct RestorationsAnterior Direct Restorations
Anterior Direct Restorations
theaacd
 
Anterior dental esthetics /academy of cosmetic dentistry
Anterior dental esthetics /academy of cosmetic dentistryAnterior dental esthetics /academy of cosmetic dentistry
Anterior dental esthetics /academy of cosmetic dentistry
Indian dental academy
 
Symphysis & Angle MANDIBULAR FRACTURES
Symphysis & Angle MANDIBULAR FRACTURES Symphysis & Angle MANDIBULAR FRACTURES
Symphysis & Angle MANDIBULAR FRACTURES Dr-Faisal Al-Qahtani
 
Phase I Orthodontic treatment
Phase I Orthodontic treatmentPhase I Orthodontic treatment
Phase I Orthodontic treatment
Dr Victoria J Lynskey, Orthodontist
 
Orthodontic diagnosis
Orthodontic diagnosisOrthodontic diagnosis
Orthodontic diagnosis
Manish Kumar
 

Viewers also liked (20)

Orthodontic treatment planning
Orthodontic treatment planningOrthodontic treatment planning
Orthodontic treatment planning
 
Treatment plan for Implants in funtional zone
Treatment plan for Implants in funtional zoneTreatment plan for Implants in funtional zone
Treatment plan for Implants in funtional zone
 
Orthodontic treatment coordinator performance appraisal
Orthodontic treatment coordinator performance appraisalOrthodontic treatment coordinator performance appraisal
Orthodontic treatment coordinator performance appraisal
 
Aacd dr-kirtley-monograph08a
Aacd dr-kirtley-monograph08aAacd dr-kirtley-monograph08a
Aacd dr-kirtley-monograph08a
 
Juan Olivier Wax up
Juan Olivier Wax upJuan Olivier Wax up
Juan Olivier Wax up
 
Drawing: Proportions of a face
Drawing: Proportions of a faceDrawing: Proportions of a face
Drawing: Proportions of a face
 
Dentofacial esthetics / cosmetic dentistry course
Dentofacial esthetics / cosmetic dentistry courseDentofacial esthetics / cosmetic dentistry course
Dentofacial esthetics / cosmetic dentistry course
 
Proportion and the human face
Proportion and the human faceProportion and the human face
Proportion and the human face
 
Recent advances in atrumatic extraction techniques
Recent advances in atrumatic extraction techniquesRecent advances in atrumatic extraction techniques
Recent advances in atrumatic extraction techniques
 
Esthetics / orthodontics courses in india
Esthetics  / orthodontics courses in indiaEsthetics  / orthodontics courses in india
Esthetics / orthodontics courses in india
 
Socket Preservation _NIDM January 2011
Socket Preservation _NIDM January 2011Socket Preservation _NIDM January 2011
Socket Preservation _NIDM January 2011
 
Socket Management in the Esthetic Zone
Socket Management in the Esthetic ZoneSocket Management in the Esthetic Zone
Socket Management in the Esthetic Zone
 
Restorative and Esthetic Dentistry
Restorative and Esthetic DentistryRestorative and Esthetic Dentistry
Restorative and Esthetic Dentistry
 
Anterior Direct Restorations
Anterior Direct RestorationsAnterior Direct Restorations
Anterior Direct Restorations
 
Anterior dental esthetics /academy of cosmetic dentistry
Anterior dental esthetics /academy of cosmetic dentistryAnterior dental esthetics /academy of cosmetic dentistry
Anterior dental esthetics /academy of cosmetic dentistry
 
Symphysis & Angle MANDIBULAR FRACTURES
Symphysis & Angle MANDIBULAR FRACTURES Symphysis & Angle MANDIBULAR FRACTURES
Symphysis & Angle MANDIBULAR FRACTURES
 
Treatment plan
Treatment planTreatment plan
Treatment plan
 
Orthodontic case presentation
Orthodontic case presentationOrthodontic case presentation
Orthodontic case presentation
 
Phase I Orthodontic treatment
Phase I Orthodontic treatmentPhase I Orthodontic treatment
Phase I Orthodontic treatment
 
Orthodontic diagnosis
Orthodontic diagnosisOrthodontic diagnosis
Orthodontic diagnosis
 

More from Ashley Mark

Antibiotics
AntibioticsAntibiotics
Antibiotics
Ashley Mark
 
The effect of finishing and polishing on the decision to replace existing ama...
The effect of finishing and polishing on the decision to replace existing ama...The effect of finishing and polishing on the decision to replace existing ama...
The effect of finishing and polishing on the decision to replace existing ama...Ashley Mark
 
Arteriovenous malformation Lit Abstract
Arteriovenous malformation Lit AbstractArteriovenous malformation Lit Abstract
Arteriovenous malformation Lit Abstract
Ashley Mark
 
Endo file separation discussion
Endo file separation discussionEndo file separation discussion
Endo file separation discussionAshley Mark
 
Dental Treatment Table - Patient SM
Dental Treatment Table - Patient SMDental Treatment Table - Patient SM
Dental Treatment Table - Patient SMAshley Mark
 
Dental Treatment Problem List - Patient SM
Dental Treatment Problem List - Patient SMDental Treatment Problem List - Patient SM
Dental Treatment Problem List - Patient SMAshley Mark
 
SOAP Notes - Dentistry - Example
SOAP Notes - Dentistry - ExampleSOAP Notes - Dentistry - Example
SOAP Notes - Dentistry - ExampleAshley Mark
 

More from Ashley Mark (7)

Antibiotics
AntibioticsAntibiotics
Antibiotics
 
The effect of finishing and polishing on the decision to replace existing ama...
The effect of finishing and polishing on the decision to replace existing ama...The effect of finishing and polishing on the decision to replace existing ama...
The effect of finishing and polishing on the decision to replace existing ama...
 
Arteriovenous malformation Lit Abstract
Arteriovenous malformation Lit AbstractArteriovenous malformation Lit Abstract
Arteriovenous malformation Lit Abstract
 
Endo file separation discussion
Endo file separation discussionEndo file separation discussion
Endo file separation discussion
 
Dental Treatment Table - Patient SM
Dental Treatment Table - Patient SMDental Treatment Table - Patient SM
Dental Treatment Table - Patient SM
 
Dental Treatment Problem List - Patient SM
Dental Treatment Problem List - Patient SMDental Treatment Problem List - Patient SM
Dental Treatment Problem List - Patient SM
 
SOAP Notes - Dentistry - Example
SOAP Notes - Dentistry - ExampleSOAP Notes - Dentistry - Example
SOAP Notes - Dentistry - Example
 

Recently uploaded

Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptxPharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
Dr. Rabia Inam Gandapore
 
Ophthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE examOphthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE exam
KafrELShiekh University
 
KDIGO 2024 guidelines for diabetologists
KDIGO 2024 guidelines for diabetologistsKDIGO 2024 guidelines for diabetologists
KDIGO 2024 guidelines for diabetologists
د.محمود نجيب
 
New Drug Discovery and Development .....
New Drug Discovery and Development .....New Drug Discovery and Development .....
New Drug Discovery and Development .....
NEHA GUPTA
 
Colonic and anorectal physiology with surgical implications
Colonic and anorectal physiology with surgical implicationsColonic and anorectal physiology with surgical implications
Colonic and anorectal physiology with surgical implications
Dr Maria Tamanna
 
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Novas diretrizes da OMS para os cuidados perinatais de mais qualidadeNovas diretrizes da OMS para os cuidados perinatais de mais qualidade
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Prof. Marcus Renato de Carvalho
 
Pictures of Superficial & Deep Fascia.ppt.pdf
Pictures of Superficial & Deep Fascia.ppt.pdfPictures of Superficial & Deep Fascia.ppt.pdf
Pictures of Superficial & Deep Fascia.ppt.pdf
Dr. Rabia Inam Gandapore
 
Pharma Pcd Franchise in Jharkhand - Yodley Lifesciences
Pharma Pcd Franchise in Jharkhand - Yodley LifesciencesPharma Pcd Franchise in Jharkhand - Yodley Lifesciences
Pharma Pcd Franchise in Jharkhand - Yodley Lifesciences
Yodley Lifesciences
 
263778731218 Abortion Clinic /Pills In Harare ,
263778731218 Abortion Clinic /Pills In Harare ,263778731218 Abortion Clinic /Pills In Harare ,
263778731218 Abortion Clinic /Pills In Harare ,
sisternakatoto
 
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptxMaxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Dr. Rabia Inam Gandapore
 
Best Ayurvedic medicine for Gas and Indigestion
Best Ayurvedic medicine for Gas and IndigestionBest Ayurvedic medicine for Gas and Indigestion
Best Ayurvedic medicine for Gas and Indigestion
SwastikAyurveda
 
micro teaching on communication m.sc nursing.pdf
micro teaching on communication m.sc nursing.pdfmicro teaching on communication m.sc nursing.pdf
micro teaching on communication m.sc nursing.pdf
Anurag Sharma
 
Top-Vitamin-Supplement-Brands-in-India.pptx
Top-Vitamin-Supplement-Brands-in-India.pptxTop-Vitamin-Supplement-Brands-in-India.pptx
Top-Vitamin-Supplement-Brands-in-India.pptx
SwisschemDerma
 
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists  Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Saeid Safari
 
Flu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore KarnatakaFlu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore Karnataka
addon Scans
 
Cardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdfCardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdf
shivalingatalekar1
 
Sex determination from mandible pelvis and skull
Sex determination from mandible pelvis and skullSex determination from mandible pelvis and skull
Sex determination from mandible pelvis and skull
ShashankRoodkee
 
Superficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptxSuperficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptx
Dr. Rabia Inam Gandapore
 
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptxANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
Swetaba Besh
 
Light House Retreats: Plant Medicine Retreat Europe
Light House Retreats: Plant Medicine Retreat EuropeLight House Retreats: Plant Medicine Retreat Europe
Light House Retreats: Plant Medicine Retreat Europe
Lighthouse Retreat
 

Recently uploaded (20)

Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptxPharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
 
Ophthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE examOphthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE exam
 
KDIGO 2024 guidelines for diabetologists
KDIGO 2024 guidelines for diabetologistsKDIGO 2024 guidelines for diabetologists
KDIGO 2024 guidelines for diabetologists
 
New Drug Discovery and Development .....
New Drug Discovery and Development .....New Drug Discovery and Development .....
New Drug Discovery and Development .....
 
Colonic and anorectal physiology with surgical implications
Colonic and anorectal physiology with surgical implicationsColonic and anorectal physiology with surgical implications
Colonic and anorectal physiology with surgical implications
 
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Novas diretrizes da OMS para os cuidados perinatais de mais qualidadeNovas diretrizes da OMS para os cuidados perinatais de mais qualidade
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
 
Pictures of Superficial & Deep Fascia.ppt.pdf
Pictures of Superficial & Deep Fascia.ppt.pdfPictures of Superficial & Deep Fascia.ppt.pdf
Pictures of Superficial & Deep Fascia.ppt.pdf
 
Pharma Pcd Franchise in Jharkhand - Yodley Lifesciences
Pharma Pcd Franchise in Jharkhand - Yodley LifesciencesPharma Pcd Franchise in Jharkhand - Yodley Lifesciences
Pharma Pcd Franchise in Jharkhand - Yodley Lifesciences
 
263778731218 Abortion Clinic /Pills In Harare ,
263778731218 Abortion Clinic /Pills In Harare ,263778731218 Abortion Clinic /Pills In Harare ,
263778731218 Abortion Clinic /Pills In Harare ,
 
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptxMaxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
 
Best Ayurvedic medicine for Gas and Indigestion
Best Ayurvedic medicine for Gas and IndigestionBest Ayurvedic medicine for Gas and Indigestion
Best Ayurvedic medicine for Gas and Indigestion
 
micro teaching on communication m.sc nursing.pdf
micro teaching on communication m.sc nursing.pdfmicro teaching on communication m.sc nursing.pdf
micro teaching on communication m.sc nursing.pdf
 
Top-Vitamin-Supplement-Brands-in-India.pptx
Top-Vitamin-Supplement-Brands-in-India.pptxTop-Vitamin-Supplement-Brands-in-India.pptx
Top-Vitamin-Supplement-Brands-in-India.pptx
 
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists  Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
 
Flu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore KarnatakaFlu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore Karnataka
 
Cardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdfCardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdf
 
Sex determination from mandible pelvis and skull
Sex determination from mandible pelvis and skullSex determination from mandible pelvis and skull
Sex determination from mandible pelvis and skull
 
Superficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptxSuperficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptx
 
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptxANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
 
Light House Retreats: Plant Medicine Retreat Europe
Light House Retreats: Plant Medicine Retreat EuropeLight House Retreats: Plant Medicine Retreat Europe
Light House Retreats: Plant Medicine Retreat Europe
 

Treatment Plan

  • 1. DENTAL TREATMENT PLAN 1. CONSULTATION DESIRED YES NO For use of this form, see TB MED 250; proponent agency is Office of TSG. (If yes, complete Section III, on reverse side) SECTION I - PLANNED TREATMENT AND SEQUENCE OF ACCOMPLISHMENT Check items in Column c to indicate treatment planned. If sequence of treatment is other than that printed in column b, use numbers (1 thru 10) in column c to show desired order. L C CHART O PLANNED I ACCOM- Chart ONLY missing teeth and TREATMENT TO BE ACCOMPLISHED. D TYPE TREATMENT SE- N PLISHED E QUENCE Do NOT chart existing Pathology or Restorations. E a b c d e 2 A URGENT 3 B PERIODONTAL 3c,4,6 4 C PROPHYLAXIS SnF2 PASTE TOPICAL SnF2 5 D REPEAT AFTER MONTHS 6 E COUNSELING IN SELF CARE 3a,3c 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 RIGHT LEFT 7 F OCCLUSION 4f, 5 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 8 G SURGERY 9 H RESTORATIONS 5b,c 10 I PROSTHESES 4f 5b,c,e OTHER (specify) 11 J 12. REMARKS OR INSTRUCTIONS Use this space for additional clarification of recommended treatment or for describing treatment which does not lend itself to charting. Indicate nature of treatment and teeth or other tissues involved. Identify entry by code letter (Column a, above). 1. Urgent: None 2. Systemic: Uncontrolled Stage 1 Hypertension (medical referral); smoking cessation (referral to cessation clinic) 3. Preparatory: a. Comprehensive Exam, Dx waxup, Tx plan presentation b. Anderson Medical Model - RMGI Restorations #‘s 3,4,5,6,7,8,9,10,14,21,28,31; Sealants, 0.12% CHX rinse; Fl varnish c. Initial non surgical periodontal therapy; OHI; NaF rinse (home); Xylitol gum 4. Decision Point: Perio re-eval (≥85% plaque free surfaces) - (open flap debridement for PDs >5mm) & Bacteriologic testing e. Endo Retreatment #9; Amal rest #‘s 3,4,5,14,21,28,31 f. Fixed Ortho Appliances Mx/Md arch (Correct OB/OJ, Intrude #14, Close Md diastemas) for 12-18 months i. 1 stage implant - Md arch opposing tooth #14 - ortho anchorage (if required) & RDP Locator abutment g. Clinical Crown Lengthening (#’s 6-11,14, 21, 28) 5. Corrective: a. Cast Post/Core #9 b. PFM #’s 3,6,7,8,9,10; Surveyed PFMs #’s 21/28 c. PFM FDP #’s 11-14; #‘s 22&27 incisal composite d. Locator Abutment placement on Md implant + final impression for Md RDP e. Implant supported Mandibular Kennedy Class III RDP f. Nocturnal Bruxism appliance 6. Maintenance: Perio - 3 mos for 1 yr., 6 mos thereafter; Prostho - 6 mos, then yearly; Endo - yearly 13. DATE 14. TREATMENT FACILITY 15. SIGNATURE OF DENTIST RECORDING TREATMENT PLAN SECTION II - PATIENT IDENTIFICATION 16. SEX 17. RACE 18. GRADE 19. ORGANIZATION 20. PATIENT'S LAST NAME - FIRST NAME - MIDDLE INITIAL 21. DATE OF BIRTH 22. IDENTIFICATION NUMBER DA FORM 3984, DEC 72 REPLACES DA FORM 8-276, 1 AUG 62 WHICH WILL BE USED. USAPA V1.01