Patient Dental Chart & Ongoing Care Record

This is the practice’s standing record for this patient. Clinicians and the front desk both keep it current — it is updated in place after every appointment and is never re-filled from scratch. Anything time-limited (a single consent, a one-off estimate) belongs in its own document; what lives here is the picture of the mouth and the care around it.

Section 1 — Patient Identification

Full name:

Patient reference / chart number:

Date of birth:

Registered with the practice since:

Primary dentist:

Hygienist:

Emergency contact (name, relationship, phone):

Section 2 — Medical Alerts & Allergies

Reviewed and confirmed with the patient at every recall. Tick every flag that is currently active.

Drug allergy (antibiotic, analgesic or anaesthetic)

Latex allergy

Cardiac history — valve, pacemaker or endocarditis risk

Anticoagulant therapy or bleeding disorder

Diabetes

Bisphosphonate or antiresorptive therapy

Immunosuppression, radiotherapy or chemotherapy history

Pregnancy or breastfeeding

Detail of every flag ticked above, including severity and the reaction seen:

Medical history last reviewed:

Section 3 — Current Medications

One line per medicine, with dose and prescriber. Strike through and date anything that stops rather than deleting it.

Section 4 — Periodontal Status

Screening / BPE recorded on:

Sextant	Score	Findings and action
Upper right
Upper anterior
Upper left
Lower right
Lower anterior
Lower left

Bleeding on probing, mobility, recession and other periodontal notes:

Section 5 — Tooth-by-Tooth Status

One row per tooth that carries a restoration, a diagnosis or planned work. Sound, untreated teeth need no row. Add rows as the mouth changes.

Tooth	Existing restoration	Diagnosis / planned work	Updated

Section 6 — Radiograph History

Every image taken, with the justification recorded at the time. Check this list before exposing any new film.

Date	Type / region	Justification and report

Attach radiographs, referral letters, lab prescriptions and clinical photographs here:

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Section 7 — Ongoing Treatment Plan

The live plan, in the order we intend to work through it. Mark each item off as it is completed rather than removing it.

Plan rationale, options discussed and anything the patient has declined:

Section 8 — Hygiene & Recall

Examination recall interval (months):

Hygiene recall interval (months):

Last examination:

Last hygiene appointment:

Next recall due:

Oral-hygiene instruction given, risk factors (smoking, diet, grinding) and home-care products advised:

Section 9 — Treatment & Notes Log

One dated entry per appointment — presenting complaint, what was found, what was done, materials and batch where relevant, anaesthetic used, advice given and what happens next. Append; never overwrite an earlier entry.

Correspondence, consent copies and lab documents relating to the entries above:

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Chart last updated by:

On:

This chart is a clinical record. Keep it current at every appointment and retain it for the period required by your local regulator.

Dental Clinic

Patient Dental Chart & Ongoing Care Record

Section 1 — Patient Identification

Section 2 — Medical Alerts & Allergies

Section 3 — Current Medications

Section 4 — Periodontal Status

Section 5 — Tooth-by-Tooth Status

Section 6 — Radiograph History

Section 7 — Ongoing Treatment Plan

Section 8 — Hygiene & Recall

Section 9 — Treatment & Notes Log

Templates in this pack

Patient Dental Chart & Ongoing Care Record

Patient Registration & Medical History

Treatment Consent Form

Post-Treatment Care Instructions

Follow-Up & Satisfaction Survey

Dental Treatment Plan & Fee Estimate

Dental Services & Practice Guide

Frequently asked questions

Done	Planned item	Stage / status