New Patient Consultation

Downloadable forms for New Adult Patients: Downloadable forms for New Child Patients:
   
Adult Printable Forms Child Printable Forms

 

forms require adobe reader (click here to download)

 

There are two goals of the new patient consultation.  First, begin to establish a personal relationship based on trust and an open discussion of issues that may affect your dental health.  There are medical, hereditary, personal, dietary, etc. factors that can benefit or harm your teeth, gums, jaw muscles, salivary glands and jaw joints.

The second goal is the gathering of information used to evaluate and diagnose your current dental health.  The main function of the evaluation is to note any signs of disease or instability.  The following are areas evaluated:

 

  • Dental history and current patient concerns
  • The patient’s desires and goals for her teeth
  • Medical history and current conditions
  • Head and neck exam

Jaw joints (TMJs or temporomandibular joints)

Muscles of the jaw, neck, and shoulders

Parotid salivary glands

Skin of the face and neck

  • Oral Cancer Screening
  • Airway Evaluation/Apnea risk
  • Occlusal Examination
    Bite Issues
    Destructive side-to-side tooth contacts
    Excessive tooth wear or mobility
  • Periodontal (Gum) Disease screening
    Has any tooth supporting bone been lost?
    Are the gums red and inflamed?
    Is the cause local (in the mouth) or systemic (disease and/or medication related)?
    Has periodontal disease been active, but is now stable?
  • Caries (tooth decay) and current conditions of restorations (fillings, crowns, bridges, implants, dentures, etc.)
    Is tooth decay present?
    What are the risks factors driving the decay? Sodas, medicine, dry mouth, etc.
    Are current restorations leaking or broken?
    Should a maintenance plan for aging and failing restorations be made?
  • Functional Issues
    Tooth grinding and clenching habits
    Central nervous system driven tooth destruction from Parkinson’s, cerebral palsy, tardive dyskinesia or certain medications.
    Restrictive bite
    Habits: nail biting, fishing line biting, pen chewing, etc.
  • Radiographic Survey (X-rays)
    Past dental treatment received or current issues determine the appropriate combinations of radiographs.

 

At the end of every new patient evaluation the patient will receive a “ report card” (below)  stating her current diagnosis with any areas of concern and the next recommended steps in her dental care.

 

      Initial Exam Findings

Name: _______________________ Date: ___________________

 

Oral Cancer Screening:              □    Normal             □  Concerns

Caries (Cavities):           □  Present                        □  None:  Congratulations

Caries Risk:                     □  Low                              □  Moderate               □  High

 

Periodontium (Gums and Bone)                           □  Health:  Congratulations

□  Gingivitis                     □  Mild                         □  Moderate       □  Severe

□  Periodontal Disease □  Mild                              □  Moderate       □  Severe

 

TMJs (Jaw Joints)                              □  Normal            □  Follow up

Muscles                                             □  Normal            □  Follow up

 

Tooth Wear/Erosion                                            □  Acceptable

□  Anterior                       □  Mild                         □  Moderate                □  Severe

□  Posterior

                                                                                      


Other Signs of Instability                             □  None 

□  Mobile (Loose) Teeth       □  Tooth Cracks                 □  Gumline Notches

□  Muscle Pain                   □  Drifting Teeth                  □  Clenching/Bruxing

 

Recommended Next Phases

□  Prophy/F/OH            □  Analysis Records     □  Occlusal Guard Records

□  Restorative               □  Comp. Perio Eval.    □  Consult

□  Other:  ______________________        □  Referral:_________________________