Dental Treatment Plan Template

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Some patients are taking for granted the need for dental care. But for a dentist like you, you want to make sure that your patients will be able to recognize the importance of visiting an orthodontist. Get to create a personalized dental treatment plan for your patients using our Dental Treatment Plan Template.

Because it’s ready-made, what you have to do is to fill it up with your patient’s details and match it up with his specific dental care needs. Our template is easy to download and customize on your chosen device, be it a computer or a mobile one.

Don’t miss out on this great template; get it now!

DENTAL TREATMENT PLAN

PATIENT INFORMATION

1. Name
Lawson, Martha J.

2. Date of Birth
08/15/1980

3. Phone Number
908-289-1357

4. Permanent Address
2258 Williams Mine Road, Elizabeth, NJ 07201

5. Medicaid Number
460699102

6. Gender
Female

7. Ethnicity
White

PROVIDER INFORMATION

1. Provider Name
Christina D. Ramos, MD, Dentistry

2. Medicaid Number
414400282

DIAGNOSIS

1. Gingivitis; heavy plaque; halitosis; white spots on some teeth, indicating teeth decalcification
2. Localized chronic periodontitis with generalized gum recession.

MEDICATION

Chlorhexidine Gluconate:

• Dosage - 15 ml
• Frequency - For 30 seconds, twice a day, for 6 months
• Indication - Gingivitis

Doxycycline Hyclate:

• Dosage - 20 mg
• Frequency - 1 tablet every 12 hours for 9 months
• Indication - Gum bleeding

Response to the Medication and Other Treatments:
The patient had a good response to the treatment and medication. The patient’s plaque build-up has not worsened with the regular use of chlorhexidine oral rinse. There is also some healing of gum tissue from the doxycycline.

PROBLEM & TREATMENT GOALS

Problem/Symptoms 1:
The patient has irritated gums around teeth, with red and swollen gum tissue in the lower and upper teeth. The patient also has white spots in some teeth, indicating the initial signs of enamel decalcification.

Long-Term Goal:
Improved dental hygiene through regular brushing and flossing.

Short-Term Objectives:

• Teach the patient how to floss properly.
• Reduce the patient’s plaque with regular flossing and the use of antiseptic mouthwash.
• Reduce the white spots on the patient’s teeth.
• Reduce the patient’s gum swelling and redness.

Initial Date - 09/10/2019

Date Completed - 09/30/2019

Problem/Symptoms 2:
The patient has halitosis and showed a gum recession. There are also deep pockets from the upper lateral incisor to the first molar and the surrounding gums.

Long-Term Goal:
Stop the progression of the patient’s chronic periodontitis and prevent recurrence through regular flossing, proper brushing, and dental cleaning.

Short-Term Objectives:

• Remove the bacteria build up between the patient’s gums and teeth.
• Cure the patient’s halitosis.
• Promote the healing of the patient’s gum tissue.

Initial Date - 09/10/2019

Date Completed - 09/30/2019

INTERVENTIONS

The patient came in complaining of halitosis and gum bleeding. She was advised to do proper flossing and regular brushing at least three times a day. She was also instructed to use an oral rinse to prevent plaque build-up. The dentist also showed her some techniques on how to effectively clean teeth without experiencing pain from her swollen gums.

The patient was also advised to control or eliminate her smoking habit. The attending dentist did a brief 4-minute counseling session to convince the patient to stop smoking, suggesting techniques, coping strategies, and alternatives.

REVIEW

Review Date: 09/10/2019

The patient’s plaque build-up and gum redness and swelling have reduced. Halitosis is still present but is expected to disappear with a significant reduction of plaque and bacteria.

The patient is still in the process of considering tobacco cessation. The dentist will continue with the counseling sessions, taking care not to pressure the patient.

Provider Name and Signature
Christina D. Ramos, MD, Dentistry

Date
September 10, 2019