Periodontal Charting Record
Patient Name
Date
Dentist / Hygienist
Periodontal Measurements
Tooth
Buc. Depth 1
Buc. Depth 2
Buc. Depth 3
Ling. Depth 1
Ling. Depth 2
Ling. Depth 3
MGJ
Furcation
Mobility
Note
18
17
16
15
General Notes