Facultatea de Medicin Dentar Constana

Disciplina DIAGNOSTIC ORO-DENTAR SI ERGONOMIE

Student_________________________
Cadru Univ. dr.______________________
FI DE CONSULTAIE
Nr.__________.Data__________
1. Anamneza:
a. Numele i prenumele________________________________ CNP________________
b. Vrsta_____Sexul_____ Adresa__________________________________
Tel._______________ Profesia___________.
c. Motivele prezentrii_____________________________________________________
_____________________________________ trimis de_______________________________
d. Antecedente personale fiziologice__________________________________________
Grupa sangvin_____ Tip constituional__________ Tipul sistemului nervos
(echilibrat / neechilibrat) Condiii de via i de munc _________________________
Tipul alimentaiei (diet, alimente preferate, consisten, felul masticaiei)__________
___________________________________________________________________________
e. Antecedente heredo-colaterale dentare ______________________________________
f. Antecedente heredo-colaterale sistemice ____________________________________
g. Istoricul afeciunilor dentare (debut, evoluie, tratament) _______________________
___________________________________________________________________________
h. Anamneza sistemic:
Afeciuni virale: hepatit epidemic, HIV, poliomielit, .a.___________________________
Afeciuni bacteriene: pneumonii, tuberculoz pulmonar, RAA, .a.____________________
Afeciuni cardio-vasculare: congenitale, HTA_____________, aritmii, cardiopatie ischemic,
infarct miocardic (cnd, cte)____________, valvulopatii, flebite, .a.___________________
Afeciuni sangvine: leucemie acut/cronic, agranulocitoz, anemie feripriv / pernicioas /
hemolitic, leucopenie, trombocitopenie, coagulopatii, sindroame hemoragice .a.
___________________________________________________________________________
Afeciuni respiratorii: sinuzite, bronite, astm bronic ________________________________
Afeciuni digestive: leziuni precanceroase ale cavitii bucale, disfagie, gastrit, ulcer gastric /
duodenal, colecistit, pancreatit, apendicit .a. ____________________________________

Afeciuni metabolice: diabet zaharat insulino-dependent / non-insulino-dependent, obezitate,

dislipidemii, rahitism, hipocalcemie, hipovitaminoze, osteoporoz .a.
__________________________________________________________________________
Afeciuni ale sistemului nervos: nevralgii, migrene, epilepsie, schizofrenie, nevroze.
__________________________________________________________________________
Afeciuni endocrine: hipertiroidism, hipotiroidism, hiperparatiroidism, hipoparatiroidism,
nanism hipofizar, acromegalie, hipercorticism, hipocorticism .a.
__________________________________________________________________________
Afeciuni uro-genitale: IRA, infecii urinare, cistit, nefrit, litiaz renal, menopauz,
amenoree, infecii venerice-lues, gonoree .a. ______________________________________
Afeciuni locomotorii: spondilit reumatoid / ankilopoetic, distrofii musculare .a.
___________________________________________________________________________
Afeciuni ale tegumentelor i mucoaselor: infecii cutanate, micoze, dermatite, psoriazis,
lichen plan, leucoplazie, erizipel .a.______________________________________________
Alergii: alimentare, medicamentoase-sulfamide, antibiotice, anestezice, ZnCl2, Iod .a.
___________________________________________________________________________
Tratamente medicamentoase care afecteaz parodoniul: hidantoin, nifedipin, ciclosporine,
anticoncepionale_____________________________________________________________
2. Examen obiectiv
a. Exobucal:
Inspecie:
Norm Frontal (simetrie, proporia etajelor, anuri peri orale)
___________________________________________________________________________
Aspectul tegumentelor ________________________________________________________
Norm Lateral ______________________________________________________________
Obiceiuri vicioase: respiraie oral, mixt, deglutiie infantil, interpoziia limbii / obiecte
ntre dini, onicofagie s.a.: ______________________________________________________
Palpare:
Adenopatie: localizare____________________ sensibilitate ___________________
____________, aderen ______________________, consisten ______________________
Contururi osoase_____________________________________________________________
Muchi masticatori ___________________________________________________________
Palpare puncte sinusale ________________________________________________________
Palpare puncte de emergen trigeminale __________________________________________
Examen ATM: Inspecie: ______________________________________________________
2

Amplitudinea deschiderii gurii, excursia mentonului, devieri

Palpare: ___________________________________________________________________
Ascultaie: ________________________________________________________________
(zgomote la deschidere, intermediare, la nchidere)
b.

Endobucal:

Examen oncologic preventiv: ___________________________________________________

___________________________________________________________________________
Mucoase: jugal, palatinal, lingual _____________________________________________
Limba ________________________________ Frenuri ______________________________
Abraziune/atritie
Hiperplazie
Hipertrofie
gingival
Congestie /
staz
Migrri
secundare
Edentaii
Hiperestezie
Lacune
cuneiforme
Leziuni carioase
18

17

16

15

14

13

12

11

21

22

23

24

25

26

27

28

48

47

46

45

44

43

42

41

31

32

33

34

35

36

37

38

Leziuni carioase
Lacune
cuneiforme
Hiperestezie
Edentaii
Migrri
secundare
Congestie /
staz
Hipertrofie
gingival
Hiperplazie
Abraziune/atritie

Analiza ocluzal: contacte premature n RC/IM:_____________________________________

interferene n: propulsie: ________________________________________
lateralitate: _______________________________________
parafuncii: bruxism, ncletarea dinilor ____________________________
ANALIZA OCLUZIEI STATICE
M dr

C dr

C stg

M stg

Plan sagital
Plan transversal
Plan vertical
ANALIZA OCLUZIEI DINAMICE
Conducere
Lateralitate dreapta

Parte lucratoare
Parte nelucratoare
Conducere

Lateralitate stanga

Parte lucratoare
Parte nelucratoare
Conducere

Propulsie

Interferente dr
Interferente stg

Anomalii: dento-maxilare:n plan sagital, transversal, vertical: _________________________

dento-alveolare:incongruen cu nghesuire/spaiere:_________________________
dentare izolate:numr,volum,form,poziie,erupie,structur: __________________
Diagnostic:
- de urgen_____________________________________________________
odontal ___________________________________________________________
chirurgical_________________________________________________________
protetic ___________________________________________________________
ocluzie____________________________________________________________
4

ortodontic _________________________________________________________
-parodontal_________________________________________________________
ATM______________________________________________________________
functional_________________________________________________________
evolutiv___________________________________________________________
3. Examene complementare:
Analize de laborator: hematologice: hemoleucograma, VSH, TS, TC, TH, TQ
biochimice: glicemie, calcemie, transaminaze, electroforeza, creatinina, acid uric,
lipide totale, colesterol, trigliceride, examen de urin:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Examen cito-bacteriologic______________________________________________________
Examene medicale de specialitate ________________________________________________
Examene imagistice: RX _______________________________________________________
Modele de studiu________________
Fotografii______________
EXAMENUL IGIENEI ORALE

Plan de tratament
___________________________________________________________________________
___________________________________________________________________________
5

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
__________________________________________________________________________

Sunt de acord cu tratamentul efectuat n acest cabinet.

Tratamente efectuate

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