Pediatric Dentistry Case Complete Appointment – Quality Assessment Check List

Discipline/Quality Assessment Area

Unacceptable

Additional Treatment Needed

Pediatric Dentistry:

• Dental and Medical History and Patient Examination

• Patient & Parent Counseling, Motivation & Prevention

• Diagnosis and Plan of Treatment

• Control of Pain and Apprehension

• Preventive Maintenance

• Restorative Treatment

• Pulp Therapy

• Periodontics

• Removable Prosthodontics

• Crowns

• Oral Surgery

• Treatment of Traumatized Patients

• Space Maintenance

• Interceptive Services

·          Vital Pulp Therapy

·          Root Canal Therapy

·          Access/Obturation

Discomfort:

Appropriateness of Care:

Other Comments: