109110

108

107

105106

406405

408

407

209210

208

207

205206

104 204

409

410411

404

306305

308

307

309

310311

304

103 203102 202

101 201

403 303402 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 namepatient name

date

#

Right maxillary Left maxillary

Right mandibular Left mandibular

Canine Dental Chart

© Veterinary Information Network / design by Tamara Rees

109 209110 210108 208107 207106 206105 205104 204103 102 101 201 202 203

409410411 408 406407 404405 306305304 307 309308 311310403 402 401 301 302 303

professional teeth scaling/polishing

Procedures and Treatments

plaque barrier gelplaque barrier sealantlocal antimicrobial application

endodontics

restorations

extractions

oral surgery

orthodontics

periodontics

Exam and Findingspresenting 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 30 1 2 30 1 2 30 1 2 3 4

0 1 2 3 4 5

future treatment plan

recommended home care products