-I rauUNIVERSITATEA DE MEDICIN I FARMACIE "GR. T. POPA IAI Nr.

fi: ________________
FACULTATEA DE MEDICIN DENTAR Medic: _________________
Sudent: ________________

Student
Nespecialist
Specialist
Primar

FOAIE DE OBSERVAIE
- PARODONTOLOGIE -

DATE GENERALE
Nume: ______________________ Prenume: ______________________
Vrsta : ______________________ Sex ______________________
Adresa: ______________________________________ ______________________
Tel. fix: ______________________ Tel. mobil: ______________________
Loc munc: ______________________ Ocupaie: ______________________
Meniuni: _____________________________________________________________________________________________________________

MOTIVELE PREZENTRII

sngerare gingival

probleme estetice legate de recesiuni sau migrri
dentar

tulburri masticatorii legate de mobilitate dentar

halitoz, gust neplcut n cavitatea oral

senzaie tensiune sau prurit la nivelul gingiei

simptomatologie legat de complicaiile bolii
parodontale (abcese parodontale, parestezii,
sindrom endo-parodontal)

probleme odontale (carii simple i complicate)

probleme endodontice (durere cu caracterele
specifice)

ISTORICUL AFECIUNII PARODONTALE

Durat zile _______ luni _______ ani _______
Debut
lent
brusc

provocat
neprovocat
Semne de debut
sngerare
durere
tumefacie
mobilitate
Evoluie
stagnant
lent
rapid

periodicitate
n pusee (stare de activitate / inactivitate)
A mai fost tratat?
da
nu

ANTECEDENTE
ANTECEDENTE HEREDO-COLATERALE
Antecedente heredo-colaterale generale:
Meniuni: _____________________________________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Antecedente heredo-colaterale stomatologice:
Meniuni: _____________________________________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

ANTECEDENTE PERSONALE
Antecedente personale generale:
Meniuni: _____________________________________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

1
Antecedente personale stomatologice:
Meniuni: _____________________________________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

CONDIII DE VIA I MUNC

Meniuni: _____________________________________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

FACTORII DE RISC PARODONTAL

Vrsta: _______
da
nu
Obiceiuri vicioase:
da
nu
fumat nr. igri / zi ______ de cnd ______ luni / ______ ani
alcool
frecven
cosumator ocazional
frecvent
cronic
tip
bere
vin
trii
Tipul de alimentaie (carbohidrai, etc.):
Meniuni: _____________________________________________________________________________________________________________
______________________________________________________________________________________
Igiena oral deficitar:
periaj dentar nr. periaje / zi ______ tip periaj __________________
substane antiplac
folosire zilnic
rar
Tratamente dentare defectuoase:

lucrari protetice
obturaii
Malocluzii:
da
nu
Meniuni: _____________________________________________________________________________________________________________
______________________________________________________________________________________
Respiraia oral:
da
nu
Meniuni: _____________________________________________________________________________________________________________
______________________________________________________________________________________
Istoric de boala parodontal:
da
nu
Stresul:
da
nu
Afeciuni sistemice (teren imunocompromis):

diabet
afeciuni cardiovasculare

afeciuni hematologice
afeciuni virale

infecia HIV
Stri fiziologice:

pubertatea
sarcina
menopauza
Factori ereditari:
Meniuni: _____________________________________________________________________________________________________________
______________________________________________________________________________________
Etnia: _________________________________________________________________________________

IGIENA

bun
medie
necorespunztoare

PERIAJUL DENTAR
Ritmicitate:
dup fiecare mas
dimineaa i seara
neregulat
Tehnica periaj:

incorect
corect

bass
bass modificat

charters
rotativ

2
PERIUA DENTAR
Tipul periutei:
manual
electric
Duritate:
moale
medie
dur
Schimbat la:
3 luni
deteriorare

PASTA DE DINI

cosmetic
medical

MIJLOACE SUPLIMENTARE DE IGIENA ORAL

Ape de gur cronologia cltirilor ______________________________________
durata cltirii ________________________________________
Fir interdentar
da
nu
Periue interdentare
da
nu
Scobitori interdentare
da
nu
Duuri bucale
da
nu

INDICI DE IGIEN
Indice de plac: ___________________________________________________________________
Indice de plac PLI (Silness & Loe) ______________________________________________________
Indice de tartru ___________________________________________________________________
Meniuni: _____________________________________________________________________________________________________________
______________________________________________________________________________________

EXAMEN EXOBUCAL
TEGUMENTE / MUCOASE
Aspect _________________________________________________________________________
Culoare _________________________________________________________________________
Integritate _________________________________________________________________________
Sensibilitate _________________________________________________________________________
Tumefacii _________________________________________________________________________
Adenopatii _________________________________________________________________________
Meniuni: _____________________________________________________________________________________________________________
______________________________________________________________________________________

EXAMEN CLINIC PARODONTAL

Parodoniu de nveli
Gingia marginal
Culoarea:
roz-coral
rou intens
rou-violaceu
Consistena:
ferm
moale
Forma: _________________________________________________________________________
Textura:
granitat
neted
Volum: _________________________________________________________________________
Poziia: zona de pe arcad unde apar modificri.
Inflamaie:
localizare
localizat
generalizat
zona _________________________________________________
form:
acut
periodic
cronic
Gingia ataat

absent zona _________________________________________________

3

ngust zona _________________________________________________

lat zona _________________________________________________
Frenuri bride
Inserare:

aproape zona _________________________________________________

mediu zona _________________________________________________

la distan zona _________________________________________________

Indicele PSR / sextani (cod 0, 1, 2.4)

Sextant 1 __________________ Sextant 2 __________________ Sextant 3 __________________

Sextant 6 __________________ Sextant 5 __________________ Sextant 4 __________________

Parodoniul de susinere
Pungi parodontale:
supraosoase
infraosoase
mixte
Sngerarea

absent
la periaj
la sondaj
spontan
Dinii

migrri
malpoziii
mobilitate

PARODONTOGRAMA INIIAL
Indice de sntate a papilei inter-dentare:

Meniuni: _____________________________________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

4
MAXILAR

Indicele gingival sau GI: indicele lui Le i Silness (0, 1, 1,5) Indice de hipercretere
______________________________________________________________________ ______________________________________________________________________
Indice de sngerare papilar PBI Indicele CPITN - Community Periodontal Index (0, 1, 2, 3, 4, 5, 6)
______________________________________________________________________ ______________________________________________________________________
Indice de sngerare gingival Indice de mobilitate(0, 1, 2, 3)
______________________________________________________________________ ______________________________________________________________________
Meniuni: _______________________________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________

5
MANDIBULAR

Indicele gingival sau GI: indicele lui Le i Silness (0, 1, 1,5) Indice de hipercretere
______________________________________________________________________ ______________________________________________________________________
Indice de sngerare papilar PBI Indicele CPITN - Community Periodontal Index (0, 1, 2, 3, 4, 5, 6)
______________________________________________________________________ ______________________________________________________________________
Indice de sngerare gingival Indice de mobilitate(0, 1, 2, 3)
______________________________________________________________________ ______________________________________________________________________
Meniuni: _______________________________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________

6
DIAGNOSTIC PARODONTAL
Cadranul I Cadranul II Cadranul III Cadranul IV
Cod 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8
Integritatea parodontal
1 Anatomo-clinic + forma clinic
Abces parodontal
1.1 Gingivita
1.1.1 necomplicata
1.1.2 modulata
endocrin
medicamentos
1.2 Gingivita ulcero-necrotic
1.3 Parodontita
1.3.1 juvenila
1.3.2 rapid progresiva
1.3.3 a adultului
1.3.3.1 superficiala
1.3.3.2 medie
1.3.3.3 profunda
1.3.4 refractara
1.3.5 din SIDA
1.3.6 ulcero-necrotica
2 Topografie
2.1 Localizat
2.2 Generalizat
3 Etiologie
3.1 Microbian
3.2 Teren
3.3 Stri fiziologice
3.4 Patologii sistemice
3.5 Medicaie
3.6 Traumatic
3.8 Iatrogenic
3.9 Plurifactorial
4 Tulburri funcionale
4.1 Masticatorio
4.2 Fizionomice
4.3 Fonetice
4.4 Deglutiie
5 Evoluie
5.1 Stabilizat
5.2 Lent
5.3 Rapid
6 Complicaii
6.1 Locale
6.2 La distan
6.3 Imediate
6.4 Tardive
7 Prognostic
7.1 Favorabil
7.2 Rezervat
7.3 Nefavorabil
8 Tratament
8.1 Netratat
8.2 Tratat
8.2.1 corect
8.2.2 incorect
8.2.3 complet
8.2.4 incomplet

7
PLAN DE TRATAMENT
TRATAMENTUL ETIOLOGIC
Nr. edine
Cod (A) Manopere
1 2 3 4 5 6 7 8
Consultatia in cadrul dispensarizarii (include si educatia pentru sanatatea
1 bucodentara, determinarea indicelui de placa bacteriana si a indicilor de inflamatie
parodontali)
2 Educatia pentru individualizarea tehnicilor de indepartare a placii bacteriene / sedinta
3 Periaj dentar profesional / sedinta

Igiena oral:
Periua de dini:
soft
medium
hard
Metoda de periaj:
circular
Charters
Bass
Periua interdentar:
da
nu
Firul interdentar:
da
nu
Cltiri antiseptice:
da
nu

Cadranul I Cadranul II Cadranul III Cadranul IV

Cod (E) Manopere
1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8
1 Profilaxia i tratamentul antimicrobian
Detartraj manual supra si
1.1
subgingival per dinte
Detartraj mecanic supra si
1.2
subgingival per dinte
1.3 Detartraj ultrasunete
1.4 Surfasaj radicular / dinte
1.5 Periaj profesional / dinte
1.6 Tratament medicamentos local
Tratamentul abcesului
1.7
parodontal

TRATAMENTUL CORECTIV
2 Tratamentul chirurgical
2.1 Chiuretaj in camp inchis
Chiuretaj parodontal in camp
2.2
deschis / sextant
Echilibrare ocluzala prin slefuire
2.3
selectiva per sedinta
Tratamentul aftei bucale per
2.4
sedinta
Tratamentul gingivo -
2.5
stomatitelor per sedinta
3 Contenie / imobilizare
Contentie provizorie prin ligaturi
3.1
de sarma
3.2 Imobilizare cu compozite
3.3 Imobilizare cu amalgam
3.4 Imobilizare cu compozit i srm
Imobilizare cu compozit i plas
3.5
de srm
Imobilizare cu compozit i band
3.6
de polifibr
3.7 Puni stabilizatoare

ETAPA DE MENINERE / CONTROL (la 3 luni, 6 luni, 1 an)

Nr. edine
Cod (A) Manopere
1 2 3 4 5 6 7 8
Consultatia in cadrul dispensarizarii (include si educatia pentru sanatatea
1 bucodentara, determinarea indicelui de placa bacteriana si a indicilor de inflamatie
parodontali)

8
MAXILAR

Indicele gingival sau GI: indicele lui Le i Silness (0, 1, 1,5) Indice de hipercretere
______________________________________________________________________ ______________________________________________________________________
Indice de sngerare papilar PBI Indicele CPITN - Community Periodontal Index (0, 1, 2, 3, 4, 5, 6)
______________________________________________________________________ ______________________________________________________________________
Indice de sngerare gingival Indice de mobilitate(0, 1, 2, 3)
______________________________________________________________________ ______________________________________________________________________
Meniuni: _______________________________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________

9
MANDIBULAR

Indicele gingival sau GI: indicele lui Le i Silness (0, 1, 1,5) Indice de hipercretere
______________________________________________________________________ ______________________________________________________________________
Indice de sngerare papilar PBI Indicele CPITN - Community Periodontal Index (0, 1, 2, 3, 4, 5, 6)
______________________________________________________________________ ______________________________________________________________________
Indice de sngerare gingival Indice de mobilitate(0, 1, 2, 3)
______________________________________________________________________ ______________________________________________________________________
Meniuni: _______________________________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________

10
EVOLUIA PACIENTULUI + DEVIZ

NR. CRT. DATA MANOPER (COD) TARIF MATERIAL

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

DIAGNOSTIC FINAL
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

Caz terminat Medic, Pacient,

11