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MOD 2 Dental Records

Matching 2 MOD 2 Dental Records

QuestionAnswer
Written Permission As a dental auxillary you must obtain this before tranfering a copy of the patients record to another dentist office.
Valuable Information The patients recall history, patients previous dental care, and dates of the patients last dental treatment all included in the patients Dental History.
Red/Blue The two colors of pencil used to chart on a manual dental chart.
Care Plan Also called the treatment plan, when the DDS evaluates, accesses and diagnoses dental disease of the oral cavity.
Signed Informed Consent Materials found in the patients chart would include this form.
Medical History Provides information on the patients existing medical conditions, list of drugs and interactions.
Extraoral/Intraoral Exam This involves the observation and palpation of the neck, face and lips, and oral cavity.
Complete oral exam armamentarium This includes a mirror, explorer, perio probe, articulating paper and holder, and gauze squares.
Periodontal Exam This is where the DDS takes 6 measurements of each tooth sulcus and records the depths.
Infection A sure sign of this is when a DDS palpates the extraoral area and finds swelling.
Chief Complaint This is what prompts a patient to seek a dentist.
Electronic Patient Charts The disadvantage to using this is there is no universal standard set within the U.S. for all DDS to follow.
Progress Notes This includes date of treatment, tooth treated, and treatment performed. Also can include broken and canceled appointments, compliance issues, and conversations about treatment.
Dental Assistant This is the person who sits and talks with the patient prior to treatment, this is important.
S.O.A.P. Subjective, objective, assessment and plan.
Objective and unemotional This type language should be used to chart patient information.
Created by: mgarrett
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