Periodontal Screening Record
Awaiting input◇ Awaiting input - complete Step 01 on the left to calculate
Diagnostic summary
| Screening determination | - |
|---|---|
| Home-care tier | - |
| Deepest pocket | - |
| Sextants at 5 mm or deeper | - |
| Bleeding sextants | - |
| Elevated risk | - |
| Next step | - |
| Staging & grading | - |
Source measurements
| Sextant | Worst pocket | Bleeding | Mobility | Finding |
|---|---|---|---|---|
| Upper right | - | - | - | - |
| Upper anterior | - | - | - | - |
| Upper left | - | - | - | - |
| Lower right | - | - | - | - |
| Lower anterior | - | - | - | - |
| Lower left | - | - | - | - |
Home-care protocol
-
- -
- -
- -
- -
- -
Guidance & limitations
- -
- -
- -
- -
- -
Chart notes
No chart notes entered.
Clinician -
Practice -
Screening and documentation aid only. Final diagnosis, staging and grading, treatment planning, radiographic interpretation, clinical attachment loss assessment, and professional judgment remain the responsibility of the treating clinician.
Prepared with Chairside Periodontal Screening Desk