Periodontal chart

Free version, no sign-up. We do not keep any patient data: whatever you enter is seen only by you and is gone as soon as you close the tab. To keep the chart, print it or save it as a PDF.

Created with the support of

WHITE

TePe

HuFriedyGroup

Patient details

Optional — they only appear in the header of the printed chart.

Last name

First name

Date of birth

Sex

Visit

Visit date

Examining clinician

The chart is best filled in on a computer or a tablet with a screen of 1024 px or wider — on a phone it can only be viewed.

Patient

Periodontal chart

Created with the support of

WHITE

TePe

HuFriedyGroup

Set the status of each tooth

Change a tooth's status with the drop-down menu above it

BUCCAL

Tooth status

Present

Present

Present

Present

Present

Present

Present

Present

Present

Present

Present

Present

Present

Present

Present

Present

Gingival margin

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

Probing depth

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

Furcation

0

0

0

0

0

0

Mobility

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

BleedingPlaque

18

17

16

15

14

13

12

11

21

22

23

24

25

26

27

28

BleedingPlaque

Furcation

00

00

00

00

00

00

00

00

Probing depth

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

Gingival margin

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

LINGUAL / PALATAL

Tooth status

Present

Present

Present

Present

Present

Present

Present

Present

Present

Present

Present

Present

Present

Present

Present

Present

Gingival margin

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

Probing depth

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

Furcation

0

0

0

0

0

0

Mobility

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

BleedingPlaque

48

47

46

45

44

43

42

41

31

32

33

34

35

36

37

38

BleedingPlaque

Furcation

0

0

0

0

0

0

Probing depth

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

Gingival margin

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

BUCCAL

Bleeding on probing

0.00%

Plaque

0.00%

Suppuration

0.00%

Pockets

1-3 mm deep - 0.00%4-5 mm deep - 0.00%≥ 6 mm deep - 0.00%

To get a PDF, choose “Save as PDF” in the print dialog. Want to keep your patients' charts and compare exams? Join the association

The first version of the periodontal chart engine was developed with the support of Oral-B

Oral-B

© 2026 UAPeriO. All rights reserved. The chart's code, images and design may not be copied or published on other websites without the association's written permission.