Odontograma Canino

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Canine Dental Chart date

patient name
client name
#

110 109 108 107 106 105 104 103 102 101 201 202 203 204 205 206 207 208 209 210

1st incisor
Right maxillary 101 201 Left maxillary
102 2nd incisor 202
Exam and Findings 103 3rd incisor 203 Procedures and Treatments
presenting complaint
104 canine 204 professional teeth
periodontal disease test strip
105 1st premolar 205 scaling/polishing
plaque barrier gel
0 1 2 3 4 5 106 2nd premolar 206 plaque barrier sealant
missing teeth
local antimicrobial application
107 3rd premolar 207
mobile teeth
periodontics
108 4th premolar 208
fractured teeth
endodontics
109 1st molar 209
radiographs taken
110 2nd molar 210
restorations
other pathology / findings 411 3rd molar 311
410 2nd molar 310 extractions
perio pockets
409 1st molar 309 oral surgery
gingival recession

408 4th premolar 308 orthodontics


osseous recession

407 3rd premolar 307 recommended home care products


gingivitis Index 0 1 2 3 406 2nd premolar 306
plaque Index 0 1 2 3
405 1st premolar 305 future treatment plan
calculus Index 0 1 2 3
occlusion class 0 1 2 3 4 404 canine 304
403 3rd incisor 303
402 2nd incisor 302
Right mandibular 401 301 Left mandibular
1st incisor

411 410 409 408 407 406 405 404 403 402 401 301 302 303 304 305 306 307 308 309 310 311
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