Judetul

Localitatea........................

Nr. Inregistrare

Student: ..
Cadru didactic: ..........................................

FOAIE DE OBSERVATIE
NUMELE................................................PRENUMELE................................Sexul M/F
VARSTA

DATA NASTERII :

Mediul U / R

ziua

luna

anul

PROFESIA......................................................................................

Statut asigurat: C.N.A.S.

Asigurare voluntara
C.N.P. ..
MOTIVUL PREZENTARII:

Neasigurat

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Istoricul bolii: ..........................................................................................................................

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Antecedente HC generale:
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Antecedente HC
Stomatologice:

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Antecedente personale
generale:

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Antecedente personale
Stomatologice:

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

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I. EXAMENUL EXOBOCAL
1. General
Dezvoltare generala:
Tip constitutional:
Sistem nervos:

Hiposom
Entomorf
Tare

Slab

Normosom
Mezomorf
; Echilibrat

Hipersom
Ectomorf
Neechilibrat

3-cerebral

4-digestiv

2. Examenul extremitatii cefalice

INSPECTIE
Forma figurii : 1-muscular

2-respirator

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

drept |_|

convex sup |_|

convex inf |_|
convex asociat|_|
concav sup |_|
concav inf |_|
concav asociat |_|
2

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

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PALPARE

Textura teg.: elastica (normala) |_|

indurate |_|

flasca |_| cu anestezie |_| arii anestezice |_|

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

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Puncte de emergenta trigeminale : ......................................................................................
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Grup ganglionar: ...................................................................................................................
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Formatiuni tumorale: ............................................................................................................
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Examenul A.T.M...................................................................................................................
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II. EXAMENUL ENDOBUCAL

Exaenul oncologic preventive
inspectia:..................................................................................................................................
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palpare:.....................................................................................................................................
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formatiuni si coloratii deosebite:..............................................................................................
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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
.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:

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2. In plan TRANSVERSAL:

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3. In plan VERTICAL:

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II. In dinamica
1. Ghidaj anterior

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2. Ghidaj lateral

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Forma arcadelor:

superioara :....................................................................................
inferioara:......................................................................................

Aprecierea curburilor dentare:

- curba lui SPEE ......................................................................................................................
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- curba lui WILSON.................................................................................................................
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- curba incizala (vestibulara)....................................................................................................
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Bolta palatina..........................................................................................................................
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Planseul bucal.........................................................................................................................
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Alte exemene complementare:
Radiografii

Fotografii
6

DIAGNOSTIC
1.Diagnosticul de urgenta .......................................................................................................
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2.Diagnosticul odontal ............................................................................................................
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3. Diagnosticul parodontal......................................................................................................
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4. Diagnosticul de edentatie....................................................................................................
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5.Diagnosticul de ocluzie........................................................................................................
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6.Diagnosticul ortodontic........................................................................................................
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7.Diagnosticul afectiunilor A.T.M. .........................................................................................
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8.Diagnosticul afectiunilor mucoasei bucale...........................................................................
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9.Diagnosticul chirurgical.......................................................................................................
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10.Diagnosticul oncologic......................................................................................................
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11.Diagnostic evolutiv............................................................................................................
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12.Diagnosticul afectiunilor generale......................................................................................
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DIAGNOSTICUL COMPLET...........................................................................................
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PLAN DE TRATAMENT...................................................................................................
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EVOLUTIE
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SEMNATURA :
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