Q2. Luster
Q3. Color
Q4. Test1_Magnify
Q4. Test2_AirDry
Q4. Test3_Dental Explorer
Q4. Test4_Xrays
Q4. Test5_Trans-Illumination
Q4. Test6_Caries Detect Dye
Q4. Test7_Intra-Oral Camera
Q4. Test8_Other
Q5. Roughness w/dental explorer
Q6. CH1_Visible Lesions/Xray
Q6. CH2_White spot smooth surfaces
Q6. CH3_Restore in last 3Yr
Q6. CH4_None of above
Q7. RF1_Heavy plaque
Q7. RF2_High cario diet
Q7. RF3_Poor saliva
Q7. RF4_Poor recall
Q7. RF5_None of above
Q8. Rx1_Fl toothpaste
Q8. Rx2_Home FL rinse
Q8. Rx3_Fl varnish
Q8. Rx4_None of above
Q9. Risk level
Q10. How deep lesion before Tx
Q11. Tx1_Monitor
Q11. Tx2_Oral hygiene instructions
Q11. Tx3_Apply FL in office
Q11. Tx4_Rx FL gel or rinse
Q11. Tx5_Sealant
Q11. Tx6_Enamelplasty
Q11. Tx7_Prev resin restoration
Q11. Tx8_Full restoration
Q11. Tx9_Other
Q12. Findings
Q1. Tooth number (2 digits)
Year & month of visit