Supporting document for patient X 1

BEFORE
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Photos taken 3.11.19

Post treatment

AFTER
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Appendix 1 –Health History

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Appendix 2 – Tooth Chart

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Appendix 3-Perio Chart

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Appendix 4 -FMX
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Appendix 5 – Resto Treatment Plan

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Appendix 6 – Assessment Log

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Appendix 7 – DHDX
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Appendix 8 -Risk Assessment

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Appendix 9 – DHDX Plan

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Appendix 10--Referral form

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Appendix 11-Intraoral photos

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Patient X Food intake record – 7 days total

Day 1/Time Amount Description of food, preparation and ingredients
Breakfast 3 oz cereal -wheat bran, soy grits, rice, wheat gluten, soybean oil, soy

8 oz milk 2 % protein isolate, whole grain wheat

Diet soda 12oz -carbonated water, caramel color, aspartame, phosphoric

acid, potassium citrate, natural flavors, citric acid, and

caffeine
Breakfast 1 bagel -wheat flour, salt, water, and yeast leavening

snack Cream cheese 2tbs -Pasteurized Nonfat Milk and Milkfat, Whey Protein

(.24 oz fat) Concentrate, Cheese Culture, Salt…

Diet Coke 12oz

Lunch McDouble 2 beef patties, pickle, chopped onions, ketchup, mustard,

Small French fries cheese

Diet coke 12oz Potatoes, Vegetable Oil, Salt/fried

Lunch Medium popcorn Popcorn, corn oil, sugar, corn syrup, butter, salt, lecithin

snack Diet coke 12oz

Dinner Half a chocolate 2 scoops vanilla or chocolate ice cream-1cup

milkshake 1/4 cup milk.

2 Oz Peanuts 1/8 cup chocolate Syrup.

After dinner Diet coke

Day Amount Description of food, preparation and ingredients

2/Time
Breakfast 3 oz cereal -wheat bran, soy grits, rice, wheat gluten, soybean oil, soy

8 oz milk 2 % protein isolate, whole grain wheat

Diet soda 12oz -carbonated water, caramel color, aspartame, phosphoric acid,

potassium citrate, natural flavors, citric acid, and caffeine

Lunch Samples from -Meat trimmings and fat, e.g. mechanically separated meat,
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Costco pink slime, meat slurry. Flavorings, such as salt, garlic, and

Hotdog 6oz and paprika.

soda 12oz -wheat flour

Lunch Gram cracker 3 Wheat flour, honey, sugar

snack oz

Chocolate milk

8oz

Diet Soda 12oz

Dinner TV dinner Rice 2oz, chicken4oz, veges 2oz

Grilled chicken

alfredo
After Ice-cream 5 oz

dinner

Day Amount Description of food, preparation and ingredients

3/Time
Breakfast 3 oz cereal -wheat bran, soy grits, rice, wheat gluten, soybean oil, soy

8 oz milk 2 % protein isolate, whole grain wheat

Diet soda -carbonated water, caramel color, aspartame, phosphoric acid,

potassium citrate, natural flavors, citric acid, and caffeine

Lunch Burger King 4 oz (110 g) beef patty, sesame seed bun, mayonnaise, lettuce,

Whopper tomato, pickles, ketchup, and sliced onion

Fries Potatoes, Vegetable Oil, Salt

Diet soda
Dinner TV dinner Rice 2oz, chicken4oz, veges 2oz

Grilled chicken

alfredo
After Diet soda
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dinner

Day Amount Description of food, preparation and ingredients

4/Time
Breakfast 3 oz cereal -wheat bran, soy grits, rice, wheat gluten, soybean oil, soy

8 oz milk 2 % protein isolate, whole grain wheat

Diet soda -carbonated water, caramel color, aspartame, phosphoric

acid, potassium citrate, natural flavors, citric acid, and

caffeine
Lunch Wendys burger 4 oz (110 g) beef patty, sesame seed bun, mayonnaise,

and curly fries lettuce, tomato, pickles, ketchup, and sliced onion

Diet soda Potatoes, Vegetable Oil, Salt,…

Dinner Frozen Pizza Meat, cheese, Pepperoni Made with Pork, Chicken and Beef

Diet soda
After 5 oz ice cream

dinner

Day Amount Description of food, preparation and ingredients

5/Time
Breakfast 3 oz cereal -wheat bran, soy grits, rice, wheat gluten, soybean

8 oz milk 2 % oil, soy protein isolate, whole grain wheat

Diet soda -carbonated water, caramel color, aspartame,

phosphoric acid, potassium citrate, natural flavors,

citric acid, and caffeine

Lunch Canned chili Water, Beef and Pork, Beans, Bell Peppers,

Diet Soda Tomatoes in Juice sugar, salt, onions…

Dinner Hungry-Man Classic Fried Tender white and dark chicken portions with home-

Chicken Frozen Dinner - style mashed potatoes and sweet corn -includes a

16oz chocolate brownie

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After Diet soda

dinner

Day Amount Description of food, preparation and ingredients

6/Time
Breakfast 3 oz cereal -wheat bran, soy grits, rice, wheat gluten, soybean oil,

8 oz milk 2 % soy protein isolate, whole grain wheat

Diet soda -carbonated water, caramel color, aspartame,

phosphoric acid, potassium citrate, natural flavors,

citric acid, and caffeine

Lunch McDouble -2 beef patties, pickle, chopped onions, ketchup,

Small fries mustard, cheese

Strawberry sundae -Potatoes, Vegetable Oil, Salt

-Milkfat And Nonfat Milk, Sugar, Strawberry Topping

Sliced Strawberries, Sugar…

Dinner Marie Callenders - Salisbury steak

Salisbury Steak Dinner - -traditional brown gravy

14oz -oven-roasted potatoes, vegetables, creamy cheese

sauce
After Diet soda

dinner

Day Amount Description of food, preparation and ingredients

7/Time
Breakfast 3 oz cereal -wheat bran, soy grits, rice, wheat gluten, soybean

8 oz milk 2 % oil, soy protein isolate, whole grain wheat

Diet soda -carbonated water, caramel color, aspartame,

phosphoric acid, potassium citrate, natural flavors,

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citric acid, and caffeine

Lunch Burger King Whopper 4 oz (110 g) beef patty, sesame seed bun,

Fries mayonnaise, lettuce, tomato, pickles, ketchup, and

Diet soda sliced onion

Potatoes, Vegetable Oil ,Salt

Dinner Hungry-Man Classic Fried Tender white and dark chicken portions with home-

Chicken Frozen Dinner - style mashed potatoes and sweet corn -includes a

16oz chocolate brownie

After Diet soda

dinner
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Initial impressions taken on 11.1.2018