Unit title: Dental Nursing: Orthodontics Unit code: H0BN 35

Record of Orthodontic Patient Case

Removable Appliances
Active Log sheet Number:
Passive
Functional
Patient Identifying Number Age Sex Date

Previous Medical/ Dental History

Orthodontic Assessment
Skeletal IOTN (DHC) Incisor
relationship relationship
Purpose of Appointment

Patient Records made available for use

Patient Study Models
Records

Radiographs: Photographs
(state) OPT,
Lateral Ceph
Components of Appliance (list)

Dental Nurse Role in preparation for procedure (list equipment and materials required )

Dental Nurse’s Role during procedure (list stages of procedure and chair side support provided to
clinician and support provided to patient)

Detail Oral Hygiene and appliance care advice given to patient

Reflection:
 What went well?
 Problems encountered (if any) and how this might have been avoided?
 What will you do differently next time?

Supervising Registrant’s comments

Dental Nurse Signature GDC Number Supervising Dentist GDC Number

Date Date
Assessor Comments Signature
Date