Infant Oral Assessment Checklist Form
Complete this checklist to assess key indicators of infant oral health and development.
Oral Hygiene Observations
*
Clean gums
Plaque present
Visible debris
No oral cleaning observed
Gum and Mucosa Appearance
*
Healthy (pink, firm, moist)
Red or swollen
Ulcerated or bleeding
Other (describe in comments)
Tooth Eruption Status
*
No teeth present
Erupted teeth visible
Delayed eruption suspected
Other (describe in comments)
Tongue Anatomy
*
Normal mobility and shape
Tongue-tie suspected
Abnormal shape or color
Other (describe in comments)
Lip Anatomy
*
Normal appearance
Lip-tie suspected
Lesion or abnormality present
Other (describe in comments)
Palate Examination
*
Normal (intact, high arch, no cleft)
Cleft or abnormal shape
Lesion or discoloration present
Other (describe in comments)
Presence of Oral Lesions
*
No lesions observed
White patches (e.g., thrush)
Ulcers or sores
Other (describe in comments)
Feeding Behaviors Observed
*
Normal suckling
Difficulty latching
Clicking sound during feeding
Prolonged feeding time
Other (describe in comments)
Overall Oral Health Rating
*
1
2
3
4
5
Additional Comments or Observations
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