DENTAL

CHARTING
AFP DS Form #2
Dental Health Record

- basic permanent record of an

individual’s dental health while on
active duty in the military service

-chronological record of dental

treatments received and all dental
conditions noted on examination.
It will contain the following:

1. A record of initial examination,

showing the dental condition of the
individual at the time of entry into
active duty.
2. A continuous record of treatment
rendered and subsequent diseases
and abnormalities noted while on
active duty beginning with the time
of initiation of the dental record.
3. On separation, a record of
separation examination showing
the dental condition before
release from active military
duty.
IMPORTANCE/ REASONS
1. To provide valuable assistance to
both medical and dental personnel
in conducting examinations,
evaluating physical fitness,
diagnosing injuries or diseases, and
in rendering medical or dental
care.
2. To enable dental officers to
better advise commanding officers
concerning utilization and retention
of military personnel whose
records give evidence of special
problems.
3. To protect the government, the
individual concerned and the
individual’s dependents in
adjudicating claims.
4. To facilitate appraisal of the
physical fitness or eligibility for
benefits of members of the AFP
by making available the
information contained in the
Dental Health Record to physical
evaluation boards.
5. It is valuable in the
identification of deceased
personnel when other means may
be inadequate or may fail
completely.
6. To reduce correspondence by
documenting records of previous
treatment.

7. To provide important source of

dental research data.
COMPOSITION
a. dental folder

b. permanent dental records of

each officer and enlisted
personnel
c. temporary records – recordings
made on Record of Dental
Attendance, AFP DS Form Nr 4,
due to unavailability of the
patient’s health record at the time
of treatment or examination.
d. dental x-rays considered
essential to the future treatment
of follow-up observation of a
patient.
e. any records of treatment not on
Dental Health Record received
from civilian or foreign military
facilities.

f. medical forms, reports of

consultation, and medical
laboratory forms.
FOR WHOM APPLICABLE
- the Dental Health Record will be
prepared for all military personnel on
active duty and for cadets of AFP
military schools and cadets on active
military training in any AFP military
installation.
 AFD DS Form Nr 2
The DENTAL HEALTH
RECORD
1. General
Permanent Black or Blue-Black ink and a fine pointed
pen will be used to record dental defects and
restorations in dental charts and lines will be distinct
to obtain visual and photographic clarity
 PROPER CHARTING
Dental Health Record is divided into 4
major sections:
(a) Section I – Patient’s Data
(b) Section II – Dental Examination
(c) Section III – Attendance Record
(d) Section IV – Endorsement Portion
 Section I – Patient Data

DELA CRUZ, JUAN VALENCIA 24 Mar 90 O4 O-13789

1301st PAFDD PAF “Reg” / “Res” x

When Grade or Unit of patient is changed…

O5
DELA CRUZ, JUAN VALENCIA 24 Mar 90 O4 O-13789

520th ABW
1301st PAFDD PAF “Reg” / “Res” x
Section II – Dental Examination
Section II – Dental Examination

x APE x x

>Major Surgical Procedure

>Fractures
>Allergies
120/80

9. Type of Exam
Type 1 – Ideal Examination (mouth mirror, explorer, natural / artificial light, full-
mouth intraoral, periapical, bitewing x-rays, electric test, trans illumination, cast.
Type 2 – Routine Examination (mouth mirror, explorer, natural / artificial light, x-
rays.
Type 3 – Modified Routine Examination (mouth mirror, explorer, natural /
artificial light.
Type 4 – Screening Examination (mouth mirror, explorer, tongue depressor,
available light
 DENTAL CLASSIFICATION
Class 1 – individuals requiring emergency dental
treatment for conditions such as:
1) injuries
2) acute oral infections (acute parietal and
periodontal abscesses, Vincent infections, acute
gingivitis, acute stomatitis, etc)
3) painful conditions of the dento-oral tissues
4) cases requiring surgical procedures such as
removal of teeth, cyst, alveolectomy, impacted teeth
Class 2 – individuals requiring early treatment of
conditions, such as:
1) moderate and heavy calculus
2) extensive and advance caries
3) extensive or advance periodontal diseases
4) pulpal or apical infection
5) chronic oral infection
6) oral conditions requiring
corrective and preventive measures
7) prosthetic cases not included in class 3
Class 3 – individuals requiring essential prosthetic
appliances, including:
1) those with insufficient teeth to masticate the
service food
2) others in need of appliance essential to their
duty

Class 4 – individuals requiring no dental treatment.

Records of these cases should be filed for future
references or in the event the individual requires
treatment in the future.
12. MISSING TEETH AND EXISTING RESTORATIONS
Apicoectomy
Root Canal W/ Composite Resto
Gold Restoration
Partial Denture
Post and Crown

Amalgam Filling
Composite Restoration

Partial Denture

Complete Denture

Porcelain Jacket Crown

Missing / Extracted Teeth
a. Edentulous Arch - inscribe two crossing lines, each
running from the uppermost aspect of one third molar
to the lowermost aspect of the third molar on the
opposite side. The lines are drawn on the roots aspect
only on the anatomic diagram
Individual Missing Tooth – draw
an “X” on the roots of each natural
tooth that does not appear in the
mouth at the time of examination.
This applies to extracted, or
congenitally missing teeth,
regardless of whether they have
been replaced by partial dentures
or fixed bridge.
Deciduous Teeth – if only the deciduous teeth are
present, inscribe a block letter “D” around the number
of the corresponding permanent tooth.

DD D
6
D
Restorations – In the diagram of the tooth, draw the
restoration, show approximate size, location and
shape. Identify restorative materials in accordance
with:

1. Amalgam Restoration – outline the

restoration and block in solidly.
2. Gold Restoration – Inscribe
horizontal parallel lines within
the restorations.

3. Non – Metallic (Silicate,

Porcelain, Acrylic) Permanent
Fillings, crowns and Facings-
Draw only outline of size,
location and shape of restoration
on each aspect of crown or
facing.
Post Crown – Outline crown
indicating restorative materials used.
Outline approximate size,
shape and location of the post.
Root Canal Filling – Outline each
canal solidly.

Apicoectomy – Draw a small triangle,

apex away from the crown and base
line at the approximate level of the
root amputation
Partial Dentures and Removable Bridges – Place a
horizontal line directly above the numerals
designating teeth replaced by partial dentures only
Under “Remarks” describe briefly whether maxillary or
mandibular, type of appliance, indicate specific type of
alloy, the denture base material and type of artificial
teeth used, state whether the appliance is serviceable or
unserviceable.
Full Dentures – Draw a horizontal line directly above
the numbers designating the teeth replaced by the
prosthesis.
Under “ Remarks” describe whether maxillary or
mandibular, materials used in the fabrication,
serviceable or unserviceable.
Fixed Bridges – Outline each
aspects including abutments
and pontics, show partition at
the junction of material.
>Ongoing U/L Orthodontic
Treatment

 Max unilateral par dtr, acr

base, pl pontic, svc

 Max bilateral par dtr, acr

base, pl pontic, svc

 Mand unilateral par dtr, acr

base, pl pontic, svc
13. DISEASES, ABNORMALITIES AND X-RAYS
Drifted Tooth
Root Fragments
Diastema

Cyst / Abscess

Fistula

7 Tdec Indicated for Extraction

D
D Deciduous Teeth
Caries

Impacted tooth
Indicated for Extraction

Indicated for Extraction

Root Resorption
Gingival Recession
Fractured Crown
Fractured Root
Impacted / Unerupted Tooth
Caries - in the diagram of the
tooth affected draw an outline of
the carious portion black in
solidly with irregular outline of
the periphery.
Unerupted / Impacted Tooth –
Outline all aspects of tooth and
roots with single oval. The long axis
of the tooth, if known, should be
indicated with a small arrow
pointing in the direction of the
crown, the arrow will be drawn on
the facial view of the crown.
Indicated for Extraction – Draw 2 parallel vertical lines
through all aspects of the tooth and roots. This also
applies to unerupted teeth when extraction is
indicated.
 c. Extraction indicated – draw two
parallel vertical lines through all aspects of
the tooth and roots involved
Drifted Tooth – Draw a small
arrow from the number of
the tooth which has drifted,
the point of the arrow
indicates the approxiamte
position to which it has
moved (do not draw
horizontal arrow)
Abscess or Cyst – outline
approximate size, form and
location relative on the dental
chart.

Fistula – draw a straight line from

the abscess area, ending in a small
circle in a position on the chart
corresponding to the location of
the fistulous opening in the
mouth.
Fractured Crown / Root – trace a jagged fracture line
in the relative position of the crown of roots. Place an
“X” case the crown is missing only at the facial aspect
of the diagram.
Retained Roots or Root Fragments –
Indicate in the same manner as for
fractured root. Place an “X” on the
missing crown on the facial aspect only.
If extraction is indicated, draw vertical
parallel lines through that portion of the
root which remains below the fracture
line
Root Resorption – Draw an even
line showing extent of resorption of
root

Diastema – Draw a small “v” or

inverted “v-shaped” mark over each
such space between crowns on facial
aspect of diagram.
Periodontoclasia – indicate extent of gingival
recession with a continuous line drawn across the
roots in the areas involved. Indicate the extent of the
alveolar crest resorption with a second, but broken line
across the roots of the teeth at the proper level,
gingival or apical to the line showing gingival
recession, base on clinical or roentgenographic
findings.
 x

Erosion Nr 14
Abrasion Nr 6
Rotation Nr 26
Labioversion Nr 21
Linguoversion Nr 25
Section III – Attendance Record
 2015
02 Feb Nr 23 car Tem Filling dentist
13 Jul
02 Aug

2016
02 Feb
13 Jul
 Section IV – Endorsement Portion

For physical examination purposes

DENTAL SURGEON