To provide a decayed tooth risk check sheet by which a medical care performer of dentistry is able to determine decayed tooth risks of a patient and show the state of the decayed tooth in easily understandable terms.
This decayed tooth risk check sheet comprises a list sheet intended for the conversion of decayed tooth risks to numerical values by collecting and arranging data in order per risk item based on evaluation points given to items selected from among three risk items. These risk items are of three different kinds covering the decayed tooth risks attributed to a power of resistance, the decayed tooth risks due to oral cavity bacteria and the decayed tooth risks originating from dietary habits under respective check items alternatively selected from a plurality of selective items of different rankings. In addition, the check sheet comprises a chart sheet 7 showing drawn indicative circles 13 where the data converted to the numerical values by the list sheet are radially allotted to the three kinds of decayed tooth risks in the 120° direction centered around an origin O including a reference circle 8 centered around the origin O.
NISHIKATA HIROMI
KUMAOKA MASAYUKI
WATANABE YOSHIKO
