VS .NET Database edition lets you import the entire test database schema into a VS project and perform schema comparisons between any combination of: VS project, test db, and production db.
The general process I follow is:
1. Check out code modules required for change (may include client, web app, or db items).
2. Comment changes with issue number assigned.
3. Release to test environment (keep code checked out).
4. Have functional team test the corrections.
5. Request release to production environment.
6. Check code back into VSS and provide issue number and brief description as comment.
My solution contains both the Database project and the Web application project.
The initial DB schema is designed in SQL server manager and imported into VS .NET Database project.
After the initial import, any alterations are done within the VS .NET UI.
I can perform a schema comparison between the code and the test db.
Results of schema comparison:
From here, you can push your database schema changes to the target database.