Periodontal Charting  

Use the perio chart to enter the results of periodontal exams.

In the Chart module, click Perio Chart.

In the upper left is a list of all perio exams for this patient.  Click on an exam, and it will show in the perio chart, along with up to six of the most recent exams.  This allows you to make a comparison.  Probing depths will show for all exams, but for other measurements only the most recent data shows.  Data from prior exams shows in grey; current exam data shows in darker text.  To add an exam, click Add.  Double click an exam to edit the date or provider. 

Types of rows:  Within the perio chart, there are different types of rows:
  - Probing:  Each dated exam shows on its own row.
  - Mobility: Only shows on the buccal. Only allowed one number for each tooth in the middle cell. There is no mechanism yet to show .
  - Furcation: Enter 0-3. Earlier versions will show a V or a triangle instead of the numbers.
  - auto CAL:  Clinical Attachment Level is auto calculated as Probing Gingival Margin. User not allowed to edit.
  - Gingival Margin: Gingival margins are implied negative values (recession). Hyperplasia is represented with ' '.
  - Muco Gingival Junction:  Not present on the palatal.

Missing/Skipped Teeth: When you create the first perio chart for a patient, any teeth marked Missing are automatically marked skipped in the perio chart.  They are indicated with a grey background, but you can still record measurements if you wish. Subsequent exams copy the skipped teeth from the most recent perio exam only.  If you later extract a tooth, you must manually select the tooth and click SkipTeeth to mark it on the perio chart. Press Ctrl while clicking to select many teeth.  Skipped teeth are automatically skipped during auto advance.  Skipped teeth are stored with individual perio exams, so each exam can have different teeth skipped. 

Extra Teeth:  There can be some complex situations with extra teeth.  This can happen with supernumerary teeth and retained deciduous teeth.  If there is no way to enter this information into the existing boxes, notes can be made about specific sites in the Progress Notes. Supernumerary teeth numbers are numbered by adding 50 to the tooth number. For example: For tooth #16 would be 66.

Enter Measurements
All data that is entered is automatically saved.  By default, Open Dental auto advances starting on the left and going right.  It follows this path:  1-16 buccal, 16-1 lingual, 32-17 buccal, 17-32 lingual. You need to start taking measurements in this order if you do not already, since there is no way to change it. To temporarily change the direction (start on right and go left), select the Right radio button in the upper right corner.  To mark teeth as skipped, see Skip Teeth above.

Number Entry:  For all measurements except gingival margins, press the numbers on your keyboard, or use the keypad on the screen.
  - On the keypad:  For numbers greater than 9, click 10 button followed by the second digit (10 9 = 19)
  - On your keyboard:  For numbers greater than 9, press Ctrl the second number (Ctrl 3 = 13).   Backspace and Delete work as normal.

Ging Marg/Hyperplasia: Gingival margins are implied negative values (recession). For numbers larger than 10, you must use the onscreen keypad. Hyperplasia is represented with ' '.  There are two ways to enter a positive ( ) hyperplasia measurement:
1. Check the Ging Marg box, enter the positive value(s) using the keypad or keyboard, then uncheck the box. 
2. On your keyboard, press Ctrl the number (Ctrl 3 = 3).

Plaque, Calculus, Bleeding, and Suppuration:  These are entered on the same rows as the probing depths.  They show as colored dots above each probing number. There is room for all four dots to show.  You can enter as you chart probing depths or separately.  If entering at the same time as the probing depths, enter the probing depth first (e.g. 5-bleeding). When you enter the probing depth, you will automatically advance to the next cell, but if the cell is empty, the program knows to enter the item on the previous probing entry. Customize colors for each by clicking the color boxes on the right.

There are two ways to enter:
Keyboard keys:  Plaque = p, Calculus = c, Bleeding = b or space, Suppuration = s.
Click the corresponding button.

Triplets:  The triplet option is handy for entering lots of plaque, calculus, gingival margins, or any other measurements that tend to be the same for the entire tooth. When in triplet mode, the backspace key deletes three at a time and editing an existing entry will overwrite three at a time, so be careful to turn it off when done.

Calc Index %: Click to recalculate the four index percentages.  Typically there are 6 sites per tooth and 32 teeth, for a total of 192 possible sites.  So if you have 19 of the 192 sites marked as bleeding, then the bleeding index is 10%.   If any teeth are marked 'skipped', those sites are not considered 'available' and are excluded from the calculation.

Numbers in Red:  Flag measurements in the grid with red text when greater than or less than a certain value.

• Red if:  Click the up/down arrows to change the value.  For Probing, Ging Marg, CAL, Furc, and Mobility, measurements will be flagged red when they are greater than or equal to the value.  For MGJ, measurements will be flagged red when less than or equal to the value.  The main concern here is that it show sites with little or no attached gingiva.
• # Teeth:  For each row, shows the number of teeth that are marked in red. The printout will actually list out all the tooth numbers.
• Count Teeth: Click to refresh tooth counts.

Graphical Perio Chart
Click Graphical to view a full screen 3D graphical image of the patient's perio chart.  Your Graphic Preferences must be set to Direct X Tooth Chart. You can set colors, save the image to the Tooth Charts folder in the Images module, or print it.

Save to Images
Click Save to Images to save the current perio chart to the Images module, Tooth Charts folder, named by date.

Print the Chart 
Click Print to print the perio chart as it appears on the screen. 

Voice Recognition
Voice recognition software can be used with Open Dental, however we do not provide any support.  Below are some suggestions if you choose to use it.

Windows 7 comes with voice recognition software.  You can turn it on at Control Panel, Ease of Access, Speech Recognition.  Other software, like Dragon Naturally Speaking or ViaVoice will also work.

In Dragon, it's probably better to switch to numbers mode ("Numbers mode on") to increase recognition of numbers. You can either do bleeding as a separate pass, or you can switch to spell mode ("Spell mode on") so that it will recognize "b" as a bleeding point.per

Numbers greater than 9 will not work until we add support for asterisk (*). For instance, if you say "twelve", you would want that to go in as "asterisk 2", because that's what Open Dental will recognize as 12 rather than 1,2.  Once we add support for asterisk, you may be able to create a macro.

Hardware
Florida Probe sells a hardware and software system that automatically records the probing depths using a special probe. We provide a bridge to their software.  Dental R.A.T. sells a foot pedal that lets the user enter numbers hands-free. It does not require any bridge. It can handle numbers higher than 9 by using the mouse part of the pedal.