Judetul

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

Nr. Inregistrare

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

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

................PRENUMELE.......

DATA NASTERII :

ziua

luna

Mediul U / R
PROFESIA......................................................................................
Statut asigurat:
C.N.A.S.
Asigurare voluntara
Neasigurat
C.N.P. ..
MOTIVUL PREZENTARII:

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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: ________________________________________
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Obiceiuri vicioase (daca

exista)................................................................................................
..

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

Hiposom
Entomorf
Tare

Slab

Normosom
Mezomorf
; Echilibrat

Hipersom
Ectomorf
Neechilibrat

2. Examenul extremitatii cefalice

INSPECTIE
Forma figurii : 1-muscular

2-respirator

3-cerebral

4-digestiv

Forma fetei: dreptunghiulara |_|

triunghiulara |_|
ovala |_| trapez cu baza sus |_|
(norma frontala)
trapez cu baza jos |_|
rotunda |_|
alte forme |_|
2

Forma fetei

drept |_|

convex sup |_|

convex inf |_|
convex asociat|_|
(norma laterala)
concav sup |_|
concav inf |_|
concav asociat |_|
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
DIAGNOSTIC

Fotografii

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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