Judetul ………………… Nr. Inregistrare

Localiatea........................

FOAIE DE OBSERVATIE STOMATOLOGICA

NUMELE................................................PRENUMELE................................Sexul M/F

VARSTA DATA NASTERII : ziua luna anul

Mediul U / R PROFESIA......................................................................................

Statut asigurat: C.N.A.S. Asigurare voluntara Neasigurat

MOTIVUL PREZENTARII:

Istoricul bolii: ............................................................................................................................................................................................................................................................................ ....................................................................................................................................................................................................................................................................................................Antecedente HC generale:

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Antecedente HC Stomatologice:

Antecedente personale generale:

Antecedente personale Stomatologice:

Obiceiuri vicioase (daca exista)................................................................................................

I. EXAMENUL EXOBOCAL

1. GeneralDezvoltare generala: Hiposom Normosom Hipersom Tip constitutional: Entomorf Mezomorf EctomorfSistem nervos: Tare Slab ; Echilibrat Neechilibrat

2. Examenul extremitatii cefalice

INSPECTIE

Forma figurii : 1-muscular 2-respirator 3-cerebral 4-digestiv

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Forma fetei: dreptunghiulara |_| triunghiulara |_| ovala |_| trapez cu baza sus |_|(norma frontala) trapez cu baza jos |_| rotunda |_| alte forme |_|

Forma fetei drept |_| convex sup |_| convex inf |_| convex asociat|_|(norma laterala) concav sup |_| concav inf |_| concav asociat |_|

Alte aspecte patologice.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

PALPARE

Textura tegum: elastica (normala) |_| indurate |_| flasca |_| cu anestezie |_| arii anestezice |_|

Contururi osoase...............................................................................................................................................................................................................................................................................................

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Puncte de E.T. ..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

Grup ganglionar: .........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

Formatiuni tumorale: ..................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

Examenul A.T.M.........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

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II. EXAMENUL ENDOBUCAL

Exaenul oncologic preventive

inspectia:......................................................................................................................................................................................................................................................................................................................................................................................................................................palpare:..................................................................................................................................... ....................................................................................................................................................................................................................................................................................................formatiuni si coloratii deosebite:.................................................................................................................................................................................................................................................................................................................................................................................................. ....................................................................................................................................................................................................................................................................................................

Examenul odontal

APELUL DINTILOR

.1.8 .1.7 .1.6 .1.5 .1.4 .1.3 .1.2 .1.1 .2.1 .2.2 .2.3 .2.4 .2.5 .2.6 .2.7 .2.8

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.4.8 .4.7 .4.6 .4.5 .4.4 .4.3 .4.2 .4.1 .3.1. .3.2 .3.3 .3.4 .3.5 .3.6 .3.7 .3.8

EXAMENUL OCLUZIEI

I. In statica

1. In plan SAGITAL:

2. In plan TRANSVERSAL:

3. In plan VETICAL:

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II. In dinamica

1. Ghidaj anterior

2. Ghidaj lateral

EXAMENUL MODELELOR DE STUDIU

Forma arcadelor: superioara :.................................................................................... inferioara:......................................................................................

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Aprecierea curburilor dentare:- curba lui SPE .............................................................................................................................................................................................................................................................................................................................................................................................................................- curba lui WILSON.....................................................................................................................................................................................................................................................................................................................................................................................................................- curba incizala (vestibulara)...................................................................................................................................................................................................................................................... ..................................................................................................................................................Bolta palatina............................................................................................................................................................................................................................................................................Planseul bucal...........................................................................................................................................................................................................................................................................Alte exemene complementare:

Radiografii Fotografii

DIAGNOSTIC

1.Diagnosticul de urgenta ........................................................................................................................................................................................................................................................2.Diagnosticul odontal .............................................................................................................................................................................................................................................................

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3. Diagnosticul parodontal.......................................................................................................................................................................................................................................................4. Diagnosticul de edentatie.....................................................................................................................................................................................................................................................5.Diagnosticul de ocluzie.........................................................................................................................................................................................................................................................6.Diagnosticul ortodontic.........................................................................................................................................................................................................................................................7.Diagnosticul afectiunilor A.T.M. ..........................................................................................................................................................................................................................................8.Diagnosticul afectiunilor mucoasei bucale............................................................................................................................................................................................................................9.Diagnosticul chirurgical........................................................................................................................................................................................................................................................10.Diagnosticul oncologic.......................................................................................................................................................................................................................................................11.Diagnostic evolutiv.............................................................................................................................................................................................................................................................11.Diagnosticul afectiunilor generale.......................................................................................................................................................................................................................................

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DIAGNOSTICUL COMPLET..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

PLAN DE TRATAMENT......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................TRATAMENT..........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

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EVOLUTIE.........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

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