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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="utf-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1">
<title>Dental RAG Score</title>
<link href="css/bootstrap.min.css" rel="stylesheet">
<!-- HTML5 Shim and Respond.js IE8 support of HTML5 elements and media queries -->
<!-- WARNING: Respond.js doesn't work if you view the page via file:// -->
<!--[if lt IE 9]>
<script src="https://oss.maxcdn.com/html5shiv/3.7.2/html5shiv.min.js"></script>
<script src="https://oss.maxcdn.com/respond/1.4.2/respond.min.js"></script>
<![endif]-->
</style>
</head>
<body>
<div class="container">
<div class="container-fluid">
<h1>Dental RAG Score</h1>
<div class="form-group">
<label for="patient_name">Patient Name</label>
<input type="text" class="form-control" id="patient_name"
placeholder="Firstname Lastname">
</div>
<div class="form-group">
<label for="patient_nhs_number">NHS Number</label>
<input type="text" class="form-control" id="patient_nhs_number"/>
</div>
<div class="form-group">
<label for="caries_age">Patient age</label>
<input type="number" class="form-control"
id="surface_loss_patiemt_age" min="0" max="140"
style="width: 10%;"/>
</div>
</div>
<hr/>
<div id="caries" class="container-fluid">
<h2>Caries (Tooth Decay)</h2>
<form role="form" id="caries_clinical" class="col-md-5">
<h3>Clinical Factors</h3>
<div class="radio">
<label>
<input type="radio" name="caries_clinical_lesions" id="caries_clinical_lesions" value="with_lesions"> Teeth with carious lesions
</label>
</div>
<div class="radio">
<label>
<input type="radio" name="caries_clinical_lesions" id="caries_no_lesions" value="no_lesions"> No teeth with carious lessions
</label>
</div>
</form>
<form role="form" id="caries_patient" class="col-md-5">
<h3>Patient Factors</h3>
<div class="checkbox">
<label>
<input type="checkbox" id="caries_patient_symptoms">
Symptoms
</label>
</div>
<div class="checkbox">
<label>
<input type="checkbox" id="caries_patient_diet">
Diet - Excess sugar / frequent sugar
</label>
</div>
<div class="checkbox">
<label>
<input type="checkbox" id="caries_patient_plaque_control">
Unsatisfactory Plaque control
</label>
</div>
<div class="checkbox">
<label>
<input type="checkbox" id="caries_patient_sibling">
Sibling experience
</label>
</div>
</form>
<div class="col-md-2">
<h3>Risk</h3>
<span id="caries_result" class="label label-success">green</span>
</div>
</div>
<hr/>
<div id="surface_loss" class="container-fluid">
<h2>Tooth Surface Loss </h2>
<form role="form" id="surface_loss_clinical" class="col-md-5">
<h3>Clinical Factors</h3>
<div class="radio">
<label>
<input type="radio" name="surface_loss_clinical"
id="surface_loss_excessive" value="excessive">
Excessive
</label>
<span class="help-block">Tooth surface loss causing
symptoms or wear of dentine more than 1/3 of crown
height.</span>
</div>
<div class="radio">
<label>
<input type="radio" name="surface_loss_clinical"
id="surface_loss_moderate" value="moderate">
Moderate
</label>
<span class="help-block">Wear of dentine up to 1/3 of the
crown height without symptoms.</span>
</div>
<div class="radio">
<label>
<input type="radio" name="surface_loss_clinical"
id="surface_loss_commensurate" value="appropriate">
Appropriate
</label>
<span class="help-block">Tooth surface loss commensurate
with age.</span>
</div>
</form>
<form role="form" id="surface_loss_patient" class="col-md-5">
<h3>Patient Factors</h3>
<div class="checkbox">
<label>
<input type="checkbox"
id="surface_loss_patient_symptoms">Symptoms
</label>
</div>
<div class="checkbox">
<label>
<input type="checkbox"
id="surface_loss_diet">Diet - fizzy / acidic
drinks or food
</label>
</div>
<div class="checkbox">
<label>
<input type="checkbox"
id="surface_loss_brushing">Unsatisfactory tooth
brushing technique
</label>
</div>
<div class="checkbox">
<label>
<input type="checkbox"
id="surface_loss_para">Para function
</label>
</div>
<div class="checkbox">
<label>
<input type="checkbox" id="surface_loss_reflux">Reflux / medical
</label>
</div>
</form>
<div class="col-md-2">
<h3>Risk</h3>
<span id="surface_loss_result" class="label label-success">green</span>
</div>
</div>
<hr/>
<div id="periodontal" class="container-fluid">
<h2>Periodontal Disease (Gum Disease) </h2>
<form role="form" id="periodontal_clinical" class="col-md-5">
<h3>Clinical Factors</h3>
<div class="radio">
<label>
<input type="radio" name="periodontal_clinical"
id="periodontal_severe" value="severe">
Severe
</label>
<span class="help-block">One code 4 for BPE and bleeding
<strong>or</strong> more than two code 3s for BPE and
bleeding.</span>
</div>
<div class="radio">
<label>
<input type="radio" name="periodontal_clinical"
id="periodontal_moderate" value="moderate">
Moderate
</label>
<span class="help-block">One or more code 2s for BPE and
bleeding <strong>or</strong> two or less code 3s for
BPE and bleeding.</span>
</div>
<div class="radio">
<label>
<input type="radio" name="periodontal_clinical"
id="periodontal_healthy" value="healthy">
Healthy
</label>
<span class="help-block">BPE all less than code 2 except
lower anterior.</span>
</div>
</form>
<form role="form" id="periodontal_patient" class="col-md-5">
<h3>Patient Factors</h3>
<div class="checkbox">
<label>
<input type="checkbox"
id="periodontal_patient_symptoms">Symptoms
</label>
</div>
<div class="checkbox">
<label>
<input type="checkbox"
id="periodontal_patient_plaque_control">Unsatisfactory plaque control
</label>
</div>
<div class="checkbox">
<label>
<input type="checkbox"
id="periodontal_patient_smoking">Smoking
</label>
</div>
<div class="checkbox">
<label>
<input type="checkbox"
id="periodontal_patient_poor_diabetes">Poorly
controlled Diabetes
</label>
</div>
</form>
<div class="col-md-2">
<h3>Risk</h3>
<span id="periodontal_result" class="label label-success">green</span>
</div>
</div>
<hr/>
<div id="cancer">
<h2>Soft Tissue (Mouth Cancer) </h2>
<form role="form" id="soft_tissue_clinical" class="col-md-5">
<h3>Clinical Factors</h3>
<div class="radio">
<label>
<input type="radio" name="soft_tissue_clinical"
id="soft_tissue_referral" value="referral">
Lesion requiring referral.
</label>
</div>
<div class="radio">
<label>
<input type="radio" name="soft_tissue_clinical"
id="soft_tissue_lesion" value="lesion">
Lesion.
</label>
</div>
<div class="radio">
<label>
<input type="radio" name="soft_tissue_clinical"
id="soft_tissue_healthy" value="healthy">
No lesions.
</label>
</div>
</form>
<form role="form" id="soft_tissue_patient" class="col-md-5">
<h3>Patient Factors</h3>
<div class="checkbox">
<label>
<input type="checkbox"
id="soft_tissue_patient_symptoms">Symptoms
</label>
</div>
<div class="checkbox">
<label>
<input type="checkbox"
id="soft_tissue_patient_site">Site of lesion -
floor of mouth / tongue
</label>
</div>
<div class="checkbox">
<label>
<input type="checkbox"
id="soft_tissue_patient_tobacco_use">Tobacco use
</label>
</div>
<div class="checkbox">
<label>
<input type="checkbox"
id="soft_tissue_patient_alchohol">Alcholol intake
above safe limit
</label>
</div>
</form>
<div class="col-md-2">
<h3>Risk</h3>
<span id="cancer_result" class="label label-success">green</span>
</div>
</div>
</div>
</div>
<script src="js/jquery.min.js"></script>
<script src="js/bootstrap.min.js"></script>
<script src="js/dental_logic.js"></script>
</body>
</html>