Headings
Medical history update · Periodontal findings · Scaling and polishing · Oral hygiene instruction · Fluoride · Findings for the dentist · Recall interval
When to use it
Use this for a routine prophylaxis appointment run by the hygienist. It keeps the cleaning, home care coaching and fluoride in one place, and has a section for anything the dentist should look at during the exam. For patients with a history of periodontitis, the periodontal maintenance note fits better.
Example
Fictional example
Medical history update
No changes. Takes low-dose aspirin daily.
Periodontal findings
Generalized 2 to 3 mm. Bleeding on lower anteriors. Moderate lingual calculus #23 to #26.
Scaling and polishing
Full mouth ultrasonic and hand scaling. Polished with coarse paste.
Oral hygiene instruction
Showed floss threader under bridge #19 to #21. Suggested a powered toothbrush.
Fluoride
5% sodium fluoride varnish applied with patient’s consent.
Findings for the dentist
Dark occlusal stain #15, possible decay. Small chip on incisal edge #8.
Recall interval
6 months.