How to write a hygiene recall note
A hygiene recall note records what you reviewed, what you found, what you did, and what happens next. This template covers routine adult and child prophylaxis visits (D1110 and D1120) for patients with a healthy periodontium or gingivitis. It runs in your browser: nothing you type is uploaded.
- Click the first highlighted field and pick an option. The next blank opens automatically, so you can work through the note top to bottom.
- Record findings as you go: medical history review, extraoral and intraoral exam, oral cancer screening, and the periodontal screening.
- Fill in treatment: scaling, polish, fluoride, sealants, and any radiographs with their findings.
- Add education and home care products, then the recall interval and whether the dentist was notified.
- Edit any wording directly in the note, press Copy note, and paste it into the clinical note in your practice management system. Use Start next patient to clear it.
Example hygiene recall note
A fictional patient, filled in with this template and copied as-is.
Jane Doe was seen by Alex Rivera, RDH on October 14, 2026. Visit type: Adult prophylaxis (D1110). Medical history reviewed, no changes. Last dental visit: Within 6 months. The patient reported sensitivity and staining.
Extraoral exam within normal limits. Intraoral soft tissues within normal limits, no lesions noted. Oral cancer screening performed with no abnormalities noted.
Periodontal screening: gingiva mild inflammation; bleeding on probing localized; probing depths WNL (1–3mm) generalized. Localized recession noted.
Plaque: Moderate. Calculus: Light supragingival. Staining: Extrinsic staining, mild.
Supragingival scaling was performed. Rubber cup polish performed. Fluoride varnish applied. No sealants placed.
Bitewings taken, no new findings.
Patient education provided: Flossing/interdental cleaning reviewed and diet and decay risk discussed. Home care products recommended: Soft-bristle toothbrush and prescription fluoride toothpaste.
Tolerated procedure well. Recall interval: 6 months. No findings requiring dentist notification.
What a complete note covers
- Medical history review and the date of the last dental visit.
- Patient concerns in their own terms, or a note that there were none.
- Exam findings: extraoral, intraoral soft tissue, and oral cancer screening.
- Periodontal screening: gingival status, bleeding on probing, probing depths, and recession.
- Deposits: plaque, calculus, and stain.
- Treatment: scaling, polishing, fluoride (or that it was declined), sealants with tooth numbers.
- Radiographs taken and what they showed.
- Education and plan: topics covered, products recommended, tolerance, recall interval, and dentist notification.
Common mistakes
- "Prophy, OHI, RTC 6 months." A note this short doesn't show what you assessed, so it can't support the code or protect you if the chart is reviewed.
- Leaving out probing results. Even when everything is 1–3mm, record it. A future change only means something if there's a baseline.
- Coding D1110 when the findings point to periodontitis. If you record 4mm+ pockets with bleeding and bone loss, the note should also show what happens next, such as a perio evaluation or SRP.
- Not recording declined fluoride or radiographs. An informed refusal belongs in the chart as much as a treatment does.
- No dentist notification. When you note a lesion, a radiographic finding, or new pocketing, document that the dentist was told.
Questions
What is the difference between D1110 and D4910?
D1110 is prophylaxis for a patient without periodontitis. D4910 is periodontal maintenance after active periodontal therapy such as SRP. Use the periodontal maintenance template for D4910 visits.
Can I paste the note into Dentrix, Eaglesoft, or Open Dental?
Yes. Copy note produces plain text, so it pastes into the clinical note field of any practice management system. Fields you haven't filled are copied in capitals between double asterisks, so they're easy to spot.
Does the template remember my settings?
It remembers your provider name and keeps the note in progress in this browser in case the page is closed by accident. The note is deleted when you start the next patient and expires after 12 hours. Nothing is uploaded.
Related templates and guides
Example notes use fictional patients. Coding notes are general guidance; confirm against the current CDT manual and the patient's plan.