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thumb - Butte Pediatric Dentistry Referral Form - 1

Butte Pediatric Dentistry Referral Form

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Lindsey Todorovich, DDS 401 S. Alabama Street, Suite 3A Butte, MT 59701 Pediatric Dentist pediatric dentistry Dental care for infants, children & teens t: 406-723-KIDS (5437) • f: 406-723-1205 Ryan Todorovich, DDS info@buttepediatricdentistry.com General Dentist www.buttepediatricdentistry.com Date: ________________________________ Patient’s Name: ________________________________________________________________ DOB: ______________________ Parent/Guardian’s Name: __________________________________________________ Relationship: ______________________ Reason for Referral:  X-ray(s) provided:  mailed  emailed  given to parent  X-ray(s) needed  X-ray(s) not possible  Premedication  Special healthcare needs, please explain Referring Doctor ___________________________________________________________________________________________ Welcome to Butte Pediatric Dentistry! We are looking forward to meeting you and your family soon. Feel free to call 406-723-KIDS (5437) to schedule your appointment today! S Alabama St W Park St W Diamond St Chester Steele Park St. James W Gold St W Platinum St 115 S els Exc ior S Montana St Iron St Av Butte Pediatric Dentistry 401 S. Alabama Street, Suite 3A Butte, MT 59701 t: 406-723-KIDS (5437) • f: 406-723-1205 15 90 S Main St 90 e 15

thumb - Demographic Information - Pediatric Dentist Durham, NC 27713 Dr ... - 1

Demographic Information - Pediatric Dentist Durham, NC 27713 Dr ...

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Thank you for choosing Southpoint Pediatric Dentistry for your child’s dental needs. My entire team would like to welcome you! Our goal is to provide the highest quality of pediatric dental care to your child in a fun, safe and compassionate environment. We promise to treat every child as we would our own. As a pediatric dentist, I have had 2 years of specialized training after dental school to provide care to children ranging in age from infancy through the teenage years. I am dedicated to providing outstanding care and I want you to feel confident that here at Southpoint Pediatric Dentistry, our entire team has the training and love for children to make your child’s dental visit enjoyable and fun. To ensure good dental health, the process needs to begin at home prior to the first dental visit. We have found it best for parents to treat the appointment as a normal outing. Explain to your child that Dr. Amy will count his or her teeth and take pictures of them to make sure they are healthy. Please review our “First Visit” page located on our website for helpful hints on preparing your child for their first dental appointment. Your participation in your child’s dental experience will be a vital part of their overall dental health. For this reason, we ask that you accompany your child through each step of the initial visit. This visit will include a head and neck examination, oral hygiene instructions, nutritional counseling, X-rays only if necessary and a comprehensive dental evaluation. We are committed to patient/parent education and to providing excellent dental care for your child. Together we can give your child a beautiful smile and a lifetime of dental health. We look forward to meeting you and your child soon! Sincerely, Dr. Amy C. Davidian

thumb - New Patient Form - Omaha - Smile Station Pediatric Dentistry - 1

New Patient Form - Omaha - Smile Station Pediatric Dentistry

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Smile Station Pediatric Dentistry Dr. Bryan Hohenstein D.D.S. Dr. Matt Schieber D.D.S. 6801 S. 180th Street • Omaha, NE 68135 • (402) 330-5535 • email us at: info@omahakidsdentist.com Tell Us About Your Child Today’s Date: _______________________ Child’s Home Phone #: _____________________________ Child’s Name: _____________________________________ Child’s Birthdate: ___________________ Child’s Age: ______________ Nickname: ___________________________ Male Female School: ____________________________________ Grade: _____ Child’s Home Address:_____________________________________________________________________________________________ What patient or physician can we thank for referring you? _______________________________________________________________ Parent’s Information Parent’s Marital Status: Mother Married Divorced Separated Widowed Remarried Single Partnered Birthdate:______________________________ E-mail Address:__________________________________________________ Home Phone#:_________________________ Work Phone#:_______________________ Cell Phone #:________________________ Name:____________________________________________________Social Security #:_____________________________________ Address:_________________________________________________________________________________________________________ Employer: _________________________________________________________________Length of Employment:_________________ Father Birthdate:_______________________________ E-mail Address:__________________________________________________ Home Phone#:_________________________ Work Phone#:_______________________ Cell Phone #: ________________________ Name: ____________________________________________________Social Security #:_____________________________________ Address:_________________________________________________________________________________________________________ Employer: _________________________________________________________________Length of Employment:_________________ Insurance Information Primary Insurance Dental Coverage? Yes No Insurance Co. Name:____________________________ Phone #:_____________________ Group # (Plan, Local, or Policy#): _____________ Insurance Co. Address:_______________________________________________________________________________________________ Insured’s Name:____________________________________________Relationship to Patient:________________________________ Insured’s Birthdate:__________________ Insured’s ID #: _____________________ Insured’s Employer: ________________________ Employer’s Address:________________________________________________________________________________________________ Secondary Insurance Dental Coverage? Yes No Insurance Co. Name:____________________________ Phone #:_____________________ Group # (Plan, Local, or Policy#): _____________ Insurance Co. Address:_______________________________________________________________________________________________ Insured’s Name: ____________________________________________Relationship to Patient:________________________________ Insured’s Birthdate:__________________ Insured’s ID #: _____________________ Insured’s Employer: ________________________ Employer’s Address: _______________________________________________________________________________________________ _

thumb - Pediatric Dentistry and Orthodontics - California Kids Dental and ... - 1

Pediatric Dentistry and Orthodontics - California Kids Dental and ...

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Dr. Kevin Badii and the team of dental professionals at Badii Orthodontics and California Kids Dental & Orthodontics have your smile covered. With eight practices conveniently located around Southern California, our orthodontic specialists offer treatment for all ages in a neighborhood near you. Our pediatric dental specialists are skilled in a range of procedures and perform both restorative and preventative dental care for infants, children, and teens, including free school screenings. “We always say, ‘prevention is the best treatment.’ This treatment philosophy factors into everything we do, every day in our practice,” says Dr. Badii. Badii Orthodontics and California Kids Dental & Orthodontics have grown purely from word of mouth and doctor referrals because the doctors take the time to listen to and educate each patient. Each practice fosters a fun and friendly environment, while focusing on the patient’s comfort. Some locations even offer separate areas for adults, complete with video games, movies and big screen televisions. How else does Dr. Badii make dentistry fun? “We always have office and online games and contests with really cool prizes,” he says. Dental care is our passion, and like a smile, that’s just something you can’t fake. “Your smile is our passion!”

thumb - Chapter 4 Pediatric Dentistry - Safety Net Dental Clinic Manual - 1

Chapter 4 Pediatric Dentistry - Safety Net Dental Clinic Manual

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Treating a pediatric patient requires special attention to the following: • early childhood caries (ECC) and baby bottle tooth decay • behavior management principles • child abuse and neglect • restorative procedures • pulp therapy and trauma • managing the developing occlusion and space maintenance This chapter will cover the following topics: Section A B C Topic Etiology of Dental Caries in Children Baby Bottle Tooth Decay (BBTD) and Nursing Caries Rampant Decay Other Sources of Decay Prevention Behavior Management Communicative Management Nitrous Oxide--Oxygen Inhalation Sedation Physical Restraint Hand-Over-Mouth Technique Conscious Sedation General Anesthesia Practical Tips in the Behavior Management of Children Pediatric Diagnosis and Treatment Planning Examining the Infant Dental Radiographs Pediatric Treatment Planning Individual Prevention Treating Early Childhood Caries Child Abuse and Neglect (CAN)