109 110 108 107 105 106 406 405 408 407 209 210 208 207 205 206 104 204 409 410 411 404 306 305 308 307 309 310 311 304 103 203 102 202 101 201 403 303 402 302 401 301 canine canine 1st premolar 1st premolar 2nd premolar 2nd premolar 3rd premolar 3rd premolar 4th premolar 4th premolar 1st molar 1st molar 2nd molar 2nd molar 3rd molar 1st incisor 1st incisor 2nd incisor 2nd incisor 3rd incisor 3rd incisor client name patient name date # Right maxillary Left maxillary Right mandibular Left mandibular Canine Dental Chart © Veterinary Information Network / design by Tamara Rees 109 209 110 210 108 208 107 207 106 206 105 205 104 204 103 102 101 201 202 203 409 410 411 408 406 407 404 405 306 305 304 307 309 308 311 310 403 402 401 301 302 303 professional teeth scaling/polishing Procedures and Treatments plaque barrier gel plaque barrier sealant local antimicrobial application endodontics restorations extractions oral surgery orthodontics periodontics Exam and Findings presenting complaint periodontal disease test strip perio pockets gingivitis Index plaque Index calculus Index occlusion class gingival recession osseous recession mobile teeth missing teeth fractured teeth radiographs taken other pathology / findings 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 4 0 1 2 3 4 5 future treatment plan recommended home care products