When to use this re-evaluation template
Use it at the follow-up visit, usually 4–8 weeks after the last quadrant of scaling and root planing. The re-evaluation is the point where you show SRP worked, or that it didn't and something else is needed. It's also the visit that justifies moving the patient to periodontal maintenance (D4910) instead of a regular prophylaxis.
What the re-evaluation note should show
- A comparison to baseline: pocket depths and bleeding before and after, not just today's numbers.
- Residual sites 5mm or deeper, listed by tooth and surface.
- Home care and plaque control, since they explain much of the response.
- A clear next phase: maintenance, retreatment, or referral, with the interval.
Example re-evaluation note
Patient seen for periodontal re-evaluation, 6 weeks after SRP. Baseline diagnosis: generalized Stage III, Grade B periodontitis. Patient reports sensitivity resolved. Home care compliance good, plaque minimal. Full-mouth 6-point probing completed. Compared to baseline: generalized reduction of 1–2mm. Residual pockets localized to #3 MB 6mm and #14 DL 5mm. Bleeding on probing reduced from baseline, 12% (baseline 45%). Response favorable. Next phase: begin periodontal maintenance (D4910) at 3 months. Findings reviewed with dentist.