Restorative/Treatment Form

Date: 2025-12-01    Time: 14:36   

Patient Name: Olivia    Age: 2    Sex: female    

Planned Treatment: Urgent referral to pediatric dental specialist (Children's Dental Clinic) for evaluation and management of dental trauma and possible infection involving upper front teeth (51 and 61). Possible sedation and removal or repair of affected teeth.

Pharmacological Support: 

Treatment Provided:
- Composite: 
- Composite Crown: 
- IPC: 
- Pulpotomy: 
- SSC: 
- Extraction: 
- Space Maintainer: 
- Fissure Sealant: 

Contacts and occlusion verified. Excess cement removed.

Behavior: Patient was crying and appeared restless during examination.

Post-operative instructions reviewed.

Additional Notes: Olivia, a 2-year-old female, presented with a history of dental trauma to her upper front teeth (51 and 61) following two separate falls, the most recent occurring three weeks ago. Initially, there was no pain or color change, but over the past 2-3 days, she began avoiding eating and contact with the affected teeth. Yesterday, she developed a fever and her mother noted discoloration and swelling of the gum around the affected teeth. Examination revealed broken, chipped, and intruded teeth 51 and 61, with surrounding gum swelling and tenderness to percussion and palpation. Findings are suggestive of a possible infection. The situation was explained to the mother and an urgent referral to Children's Dental Clinic was completed for further management.

Next Visit: I recommend urgent evaluation and management by a pediatric dental specialist as soon as possible.

Dr. Riley Bennett  
Dentistry