CABINET MEDICAL INDIVIDUAL

DR. RADUCANU VALENTIN

Pacient:_____________________

FI DE CONSULTAIE
Nr.________Data_______
1.

Anamneza:
a.

Numele i prenumele _______________

Vrsta_

Sexul_____ Adresa__________________________________

Tel._______________ Profesia___________.
b.

Motivele prezentrii_____________________________________________________

_____________________________________ trimis de_______________________________

c.

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)__________
___________________________________________________________________________
d.

Antecedente heredo-colaterale dentare ______________________________________

e.

Antecedente heredo-colaterale sistemice ____________________________________

f.

Istoricul afeciunilor dentare (debut, evoluie, tratament) _______________________

___________________________________________________________________________
g.

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. ______________________________________
Alergii: alimentare, medicamentoase-sulfamide, antibiotice, anestezice, ZnCl 2, Iod .a.
___________________________________________________________________________

2.

Examen obiectiv
a.

Exobucal:

Inspecie:
Aspectul tegumentelor ________________________________________________________
Obiceiuri vicioase ______________________________________________________
Palpare: Adenopatie: localizare____________________ sensibilitate ___________________
____________, aderen ______________________, consisten ______________________
Examen ATM: Inspecie: ______________________________________________________
Amplitudinea deschiderii gurii, excursia mentonului, devieri
Palpare: ___________________________________________________________________
Auscultaie: ________________________________________________________________
Mucoase: jugal, palatinal, lingual _____________________________________________
Limba _______________________ Frenuri _______________________________
Abces
parodontal
Abces
periapical
Resturi
radiculare
Hiperplazie
gingival
Edentaii
Hiperestezie
Lacune
cuneiforme
Leziuni
carioase

Leziuni
carioase
Lacune
cuneiforme
Hiperestezie
Edentaii
Hiperplazie
gingival
Resturi
radiculare
Abcesul
periradicular
Abces
parodontal

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

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

dento-alveolare:incongruen cu nghesuire/spaiere:_________________________
dentare izolate:numr,volum,form,poziie,erupie,structur: __________________
Diagnostic: odontal ___________________________________________________________
chirurgical_________________________________________________________
protetic ___________________________________________________________
ocluzie____________________________________________________________
ortodontic _________________________________________________________
ATM______________________________________________________________
functional_________________________________________________________
evolutiv___________________________________________________________
Circumstane etiopatogenice generale i locale: _____________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
_________________
Diagnostic parodontal______________________________________________________
________________________________________________________________________
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______________

STATUS PARODONTAL NAINTE DE TRATAMENT

Parodontometria

CPITN

II

III

VI

IV

Plan de tratament
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
_________________________________