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Oral Health Examination Record

This document contains an oral health examination record for teaching and non-teaching personnel. It collects information such as name, age, gender, medical history, dentition status using an index to track decayed, missing and filled teeth, and records any dental treatments provided such as fillings or extractions. Standard symbols are provided to document the oral examination and any dental work accomplished. The form is used to systematically track the oral health of school employees.

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eugene.camahin
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62 views2 pages

Oral Health Examination Record

This document contains an oral health examination record for teaching and non-teaching personnel. It collects information such as name, age, gender, medical history, dentition status using an index to track decayed, missing and filled teeth, and records any dental treatments provided such as fillings or extractions. Standard symbols are provided to document the oral examination and any dental work accomplished. The form is used to systematically track the oral health of school employees.

Uploaded by

eugene.camahin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines

Department of Education
HEALTH AND NUTRITION SECTION
Schools Division of
Isabela

ORAL HEALTH EXAMINATION RECORD FOR TEACHING


AND NON-TEACHING PERSONNEL

Name: Age: ____ Gender:


Date of Birth: Marital Status:
Region: 02 Division: SDO – ISABELA District: LD – 4 School:
Position:

Medical History:
Hypertension Epilepsy Allergies
Diabetes Bleeding Disorder Others:
Cardio Vascular Dis. Asthma
Please Specify

DENTITION STATUS INDEX: DMFT

Status X-
No. of T/Decayed
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 F-
No. of T/Missing

No. of T/Filled
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
Total
Status

TREATMENT RECORD
DATE TOOTH NO. NATURE OF OPERATION REMARKS DENTIST

Periodical Condition: DENTAL PROSTHESES


Normal Denture wearer: Y N Remarks:
Gingivitis Please Specify:
Periodontal Disease Need for Denture: Y N Remarks:
Other Abnormal Conditions Please Specify: Remarks:

Please Specify

SYMBOLS FOR MOUTH EXAMINATION Artificial Restoration: SYMBOLS FOR ACCOMPLISHMENT


X - Carious tooth indicated for F2 - Permanently filled tooth JC - Jacket crown OP - Oral Prophylaxis
extraction with recurrence of decay AB - Abutment Xt - Extracted permanent tooth
F - Carious tooth indicated for Heavy shade - Permanent P - Pontic Ag F - Amalgam Filling
filling filling I - Inlay Sy F - Synthetic porcelain
RF - Root fragment Outline of filling - tooth with RPD - Removable Partial Denture GIC - Glass Ionomer
O - Missing tooth temporary filling Cement FB - Fixed Bridge ZnO F - Zinc Oxide Filling
CD - Complete Denture R - Referred to private dentist
TREATMENT RECORD
DATE TOOTH NO. NATURE OF OPERATION REMARKS DENTIST

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