NAME: ___________________________

SCHOOL HEALTH CARD

DENTITION STATUS AND TREATMENT NEEDS

TREATMENT RECORD

DATE TOOTH NO. NATURE OF OPERATION DENTIST

PERMANENT TEETH

Date of Visit
Index d.f.t 1st Visit 2nd Visit
No. T/decayed
No. T/Filled
Total d.f.t

Date of Visit
Index D.M.F.T
No. T/decayed
No. T/missing
No. T/filled
Total D.M.F.T
Total sound teeth

SYMBOLS FOR MOUTH EXAMINATION SYMBOLS FOR AN ACCOMPLISHMENT

X – Carious tooth indicated for extraction OP – Prophylaxis
F – Carious tooth indicated for filling XT – Extracted permanent tooth
RF – Root Fragment Extracted temporary tooth Amaigam filling
O – Missing Tooth
F2 – Permanent filled tooth with recurrence of decay SY P – Synthetic Porcelain Filling
Heavy Shade – Permanent Filling GIC – Glass ionomer cement
Outline of Filling – tooth with temporary sound/erupted Zno F – Zinc Oxide Filling xt-
Permanent tooth Corrected – correction of Ag F-all defects

ARTIFICAIL RESTORATION
JC – Jacket Clown I – Inlay CD – Complex Denture
AB – Abutment RPD – Remove Partial Ventura TF – Treatment of Eugenol in Cotton
P – Pontic FB – Fixed Bridge R – Referred to private dentist