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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:
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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 ________________________________________


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generale:

Antecedente personale ________________________________________


Stomatologice: ________________________________________
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Obiceiuri vicioase (daca


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

I. EXAMENUL EXOBOCAL

1. General
Dezvoltare generala: Hiposom Normosom Hipersom
Tip constitutional: Entomorf Mezomorf Ectomorf
Sistem nervos: Tare Slab ; Echilibrat 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 |_|
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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 tegum: elastica (normala) |_| indurate |_| flasca |_| cu anestezie |_| arii anestezice |_|

Contururi osoase.............................................................................................................................................
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Puncte de E.T. ........................................................................................................................


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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

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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:

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2. In plan TRANSVERSAL:

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3._____________________________________________________________
In plan VETICAL:
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II. In dinamica

1. Ghidaj anterior
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2. Ghidaj lateral

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EXAMENUL MODELELOR DE STUDIU

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


inferioara:......................................................................................

Aprecierea curburilor dentare:


- curba lui SPE .........................................................................................................................

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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

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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11.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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