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Facultatea de Medicin Dentar Tirgu-Mures

Disciplina de parodontologie
Student_________________________
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, ZnCl2, 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

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48

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31

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Abces
parodontal

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

II

III

VI

IV

CPITN

Plan de tratament
__________________________________________________________________________________________
__________________________________________________________________________________________

__________________________________________________________________________________________
__________________________________________________________________________________________
_________________________________________________________________________________________