EXT:

Topical applied. Anesthetized with 2 carpules of 2% Lidocaine with 1:100k epi. Elevated tissue
with periosteal elevator. Elevated tooth #2 with small/large straight elevator. Extracted tooth with
forceps. Curretaged and irrigated the socket. Hemostasis achieved with 2x2 gauze. Gave post-op
instructions. Pt was released in stable condition.

Level 2 Sedation:

The patient's behavior is:

Poor- Enteral and N2O/O2 inhalation sedation (see sedation record) for behavior modification. 35% N2O
during tx, 100% O2 for 5 min post tx.

Prior to tx and sedation risks/benefits discussed. Explained that cardiac arrest/death/permanent brain
damage can result from sedation. Referral option given. Pre and post op discussed. NPO Confirmed.
Guardian and RDA(Daisy) present when sedation medicine was given. Medically necessary to prevent
caries from spreading and future infection forming

Level 2 Moderate Sedation Achieved that was Effective.

The following anesthetic was administered:

Lidocaine 2% with 1:100k epi was given, 1 carpule.
Short needle 27 gauge, local infiltration.

The following cavities were restored:

OL - #3
OB - #30
DO - #19

Removed decay, isolation, etch, rinse, bond, composite placed, light cured, occlusion adjusted, polished.

Sealants were placed on teeth # 2, 15, 18, 31

All plaque and calculus removed with air sonic scaler, prophy polish completed and fluoride
applied.Patient tolerated procedures well and was released to guardian. Post-op instructions given.

Next Visit: 6 month recall.

Level 1 Sedation (Nitrous):

The patient's behavior is:

Fair- N2O/O2 inhalation sedation for behavior modification. 35% N2O during tx, 100% O2 for 5 min post
tx.

Start Time: 9:15am am End Time: 9:45am

The following anesthetic was administered:

Lidocaine 2% with 1:100k epi was given, 1 carpule.
Short needle 27 gauge, local infiltration.

The following cavities were restored:

OL - #3, 14
OB - #18, 19

Removed decay, isolation, etch, rinse, bond, composite placed, light cured, occlusion adjusted, polished.

Sealants were placed on #2, 15, 31

All plaque and calculus removed with air sonic scaler, prophy polish completed and fluoride
applied.Patient tolerated procedures well and was released to guardian. Post-op instructions given.

BP: 122/72
P: 80

Next Visit: 6 month recall.

The patient's overall Oral Hygiene is: Poor.

Today's exam shows the following.

Plaque: Moderate
Calculus: Normal
Stain: Normal
Food Impaction Areas: Normal

dwp OHI, diet, prevention, development.

Caries Risk: High

Perio diagnosis: Normal

Dental diagnosis: patient exhibits Class I decay, Class II decay and Recurrent decay and decalcification with
explorer stick, clinical and radiographic evidence.

The patient is missing the following teeth: #None. Restoration options were discussed, rba given.

The following teeth are non-restorable and extractions are recommended: #None. Restoration options
discussed, rba given.

The patient has the following additional restorative issues: None

A Soft Tissue Exam shows the following.
Extraoral Head/Neck: Normal
Lymph Chain: Normal
Lips: Normal
Labial/Buccal Mucosa: Normal
Tongue: Normal
Floor of Mouth: Normal
Palate, Hard/Soft: Normal
Pharynx: Normal

The patient has no evident oral pathology.

There is no evident tooth-related oral pathology.

A Functional Evaluation of the patient's TMJ shows the following.

Motion/Deviation: None
Subluxation/Crepitus: None
Symptoms Reported: None
Diagnosis: TMJ Issues Not Present

A Functional Evaluation, Myofunctional Analysis shows the following.

Tongue Habits: Normal
Lip Habits: Normal
Speech: Normal

The patient's behavior is:

Poor- Enteral and N2O/O2 inhalation sedation (see sedation record) for behavior modification. 35% N2O
during tx, 100% O2 for 5 min post tx.

Prior to tx and sedation risks/benefits discussed. Explained that cardiac arrest/death/permanent brain
damage can result from sedation. Referral option given. Pre and post op discussed. NPO Confirmed.
Guardian and RDA(Daisy) present when sedation medicine was given. Medically necessary to prevent caries
from spreading and future infection forming

Level 2 Moderate Sedation Achieved that was Effective.

The following anesthetic was administered:

Lidocaine 2% with 1:100k epi was given, 1 carpule.
Short needle 27 gauge, local infiltration.

Tx: All caries was removed from teeth #4, 5, 14 and 15 and all teeth were etched bonded and restored with
vertise flowable composite. Occlusion was checked and adjusted as needed.

Tx: teeth #2 were etched and a sealant was applied to all grooves and pits.

Tx: all supragingival calculus was removed with a sonic instrument. All teeth were polished with a rubber
cup and prophy paste. OHI reviewed. Dietary practices reviewed. Fluoride varnish applied and pt was
instructed to not eat or drink for 30 minutes.

Pt dismissed in stable condition

NSRCT #4:
Reviewed medical history. Vitals WNL. Reviewed informed consent/risks with patient. Took pre-op
radiograph from 2 angles. Anesthetized with 2 carpules or 2% lidocaine with 1:100k epi. Checked for
profound anesthesia. Rubber dam installed – isolated and clamping #4 only. Estimated pulp chamber
depth. Performed access opening. Located canals. Scouted with #10 hand file. Orifice shaped canals.
Took radiograph with hand files in place to verify WL. Prepared initial apical preparation with #20 hand file.
Cleaned and shaped canals with Primary waveone file, recapitulating between each with 3% NaOCl
throughout procedure. Reconfirmed WL with size verifier radiograph.

Dried canals with paper points. Lightly coated canal walls with sealer. Heated gutta core and inserted to WL
one at a time (B - 20mm, P - 20mm). Severed handles and compacted obturation. Took radiograph to
confirm obturation. Cut off carriers at orifices.

Buildup completed with composite. Removed rubberdam. Took X-ray.

Prepped #4 for PFM crown. Packed retraction cord. Removed retraction cord. Took final PVS impression.
Fabricated provisional - checked occlusion and adjusted. Pt was released in stable condition.