VISHNU DENTAL COLLEGE DEPARTMENT OF PERIODONTICS AND IMPLNTOLOGY

Name of the student:

Name of the guide:

Date:Sl.No:OP No:

Name:

Age:Educational status:

Sex:Economic status: APL / BPL Occupation:Address:

Ph.no:

Chief complaint:

History of present illness:

Past Dental & Periodontal History including treatment:

Diagnosis :

Treatment done :

VISUAL ANALOG SCALE : USING EMLA

VISUAL ANALOG SCALE : USING LIDOCAINE HCL 2%

VERBAL RATING SCALE : USING EMLA

VERBAL RATING SCALE : USING LIDOCINE HCL 2%

ADEVERSE EFFECTS USING EMLA

ADVERSE EFFECTS USING LIDOCAINE HCL2%

Signature of staff :Date :