-I rauUNIVERSITATEA DE MEDICIN I FARMACIE "GR. T.

POPA IAI
FACULTATEA DE MEDICIN DENTAR

Student

Nespecialist

Nr. fi: ________________

Medic: _________________
Sudent: ________________

Specialist

Primar

FOAIE DE OBSERVAIE
- PARODONTOLOGIE DATE GENERALE
Nume:
Vrsta :
Adresa:
Tel. fix:
Loc munc:

______________________
Prenume:
______________________
Sex
______________________________________
______________________
Tel. mobil:
______________________
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
Debut
Semne de debut
Evoluie
A mai fost tratat?

zile _______
luni _______

lent

provocat

sngerare

durere

stagnant

lent

periodicitate

da

ani _______

brusc

neprovocat

tumefacie

mobilitate

rapid

n pusee (stare de activitate / inactivitate)

nu

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

______________________________________________________________________________________
______________________________________________________________________________________

Antecedente heredo-colaterale stomatologice:

Meniuni: _____________________________________________________________________________________________________________

______________________________________________________________________________________
______________________________________________________________________________________

ANTECEDENTE PERSONALE
Antecedente personale generale:
Meniuni: _____________________________________________________________________________________________________________

______________________________________________________________________________________
______________________________________________________________________________________

Antecedente personale stomatologice:

Meniuni: _____________________________________________________________________________________________________________

______________________________________________________________________________________
______________________________________________________________________________________

CONDIII DE VIA I MUNC

Meniuni: _____________________________________________________________________________________________________________

______________________________________________________________________________________
______________________________________________________________________________________

FACTORII DE RISC PARODONTAL

Vrsta: _______
Obiceiuri vicioase:
fumat
alcool

da

da
nr. igri / zi ______

frecven

cosumator ocazional
tip

bere

vin
Tipul de alimentaie (carbohidrai, etc.):

nu

nu
de cnd ______ luni / ______ ani

frecvent

trii

cronic

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

da

nu
Stresul:
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

dimineaa i seara

neregulat

corect

bass

charters

bass modificat

rotativ

PERIAJUL DENTAR
Ritmicitate:

dup fiecare mas
Tehnica periaj:

incorect

PERIUA DENTAR
Tipul periutei:
Duritate:
Schimbat la:

manual

moale

3 luni

electric

medie

deteriorare

cosmetic

medical

dur

PASTA DE DINI
MIJLOACE SUPLIMENTARE DE IGIENA ORAL
Ape de gur
Fir interdentar
Periue interdentare
Scobitori interdentare
Duuri bucale

cronologia cltirilor ______________________________________

durata cltirii
________________________________________

da

nu

da

nu

da

nu

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 _________________________________________________


ngust

lat

zona _________________________________________________
zona _________________________________________________

Frenuri bride
Inserare:

aproape

mediu

la distan

zona _________________________________________________
zona _________________________________________________
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

absent

la periaj

la sondaj

spontan

migrri

malpoziii

mobilitate

Sngerarea
Dinii

PARODONTOGRAMA INIIAL
Indice de sntate a papilei inter-dentare:

Meniuni: _____________________________________________________________________________________________________________

______________________________________________________________________________________
______________________________________________________________________________________

MAXILAR

Indicele gingival sau GI: indicele lui Le i Silness (0, 1, 1,5)

______________________________________________________________________
Indice de sngerare papilar PBI
______________________________________________________________________
Indice de sngerare gingival
______________________________________________________________________

Indice de hipercretere
______________________________________________________________________
Indicele CPITN - Community Periodontal Index (0, 1, 2, 3, 4, 5, 6)
______________________________________________________________________
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 sngerare papilar PBI
______________________________________________________________________
Indice de sngerare gingival
______________________________________________________________________

Indice de hipercretere
______________________________________________________________________
Indicele CPITN - Community Periodontal Index (0, 1, 2, 3, 4, 5, 6)
______________________________________________________________________
Indice de mobilitate(0, 1, 2, 3)
______________________________________________________________________

Meniuni: _______________________________________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________
6

DIAGNOSTIC PARODONTAL
Cadranul I
Cadranul II
Cadranul III
Cadranul IV
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

Cod

Integritatea parodontal
Anatomo-clinic + forma clinic
Abces parodontal
1.1 Gingivita
necomplicata
1.1.1
modulata
1.1.2
1

endocrin
medicamentos

1.2
1.3
1.3.1
1.3.2
1.3.3
1.3.3.1
1.3.3.2
1.3.3.3
1.3.4
1.3.5
1.3.6
2
2.1
2.2
3
3.1
3.2
3.3
3.4
3.5
3.6
3.8
3.9
4
4.1
4.2
4.3
4.4
5
5.1
5.2
5.3
6
6.1
6.2
6.3
6.4
7
7.1
7.2
7.3
8
8.1
8.2
8.2.1
8.2.2
8.2.3
8.2.4

Gingivita ulcero-necrotic
Parodontita
juvenila
rapid progresiva
a adultului
superficiala
medie
profunda

refractara
din SIDA
ulcero-necrotica
Topografie
Localizat
Generalizat
Etiologie
Microbian
Teren
Stri fiziologice
Patologii sistemice
Medicaie
Traumatic
Iatrogenic
Plurifactorial
Tulburri funcionale
Masticatorio
Fizionomice
Fonetice
Deglutiie
Evoluie
Stabilizat
Lent
Rapid
Complicaii
Locale
La distan
Imediate
Tardive
Prognostic
Favorabil
Rezervat
Nefavorabil
Tratament
Netratat
Tratat
corect
incorect
complet
incomplet

PLAN DE TRATAMENT
TRATAMENTUL ETIOLOGIC

1
2
3

Nr. edine
1 2 3 4 5 6 7 8

Manopere

Cod (A)

Consultatia in cadrul dispensarizarii (include si educatia pentru sanatatea

bucodentara, determinarea indicelui de placa bacteriana si a indicilor de inflamatie
parodontali)
Educatia pentru individualizarea tehnicilor de indepartare a placii bacteriene / sedinta
Periaj dentar profesional / sedinta

Igiena oral:
Periua de dini:
Metoda de periaj:
Periua interdentar:
Firul interdentar:
Cltiri antiseptice:
Cod (E)
1
1.1
1.2
1.3
1.4
1.5
1.6
1.7

Manopere

soft

circular

da

da

da

medium

Charters

nu

nu

nu

Cadranul I

Cadranul II

hard

Bass

Cadranul III

Cadranul IV

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

Profilaxia i tratamentul antimicrobian

Detartraj manual supra si
subgingival per dinte
Detartraj mecanic supra si
subgingival per dinte
Detartraj ultrasunete
Surfasaj radicular / dinte

Periaj profesional / dinte

Tratament medicamentos local
Tratamentul abcesului
parodontal

TRATAMENTUL CORECTIV
2
2.1
2.2
2.3
2.4
2.5
3
3.1
3.2
3.3
3.4
3.5
3.6
3.7

Tratamentul chirurgical
Chiuretaj in camp inchis
Chiuretaj parodontal in camp
deschis / sextant
Echilibrare ocluzala prin slefuire
selectiva per sedinta
Tratamentul aftei bucale per
sedinta
Tratamentul gingivo stomatitelor per sedinta
Contenie / imobilizare
Contentie provizorie prin ligaturi
de sarma
Imobilizare cu compozite
Imobilizare cu amalgam
Imobilizare cu compozit i srm
Imobilizare cu compozit i plas
de srm
Imobilizare cu compozit i band
de polifibr
Puni stabilizatoare

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

Cod (A)
1

Manopere

Nr. edine
1 2 3 4 5 6 7 8

Consultatia in cadrul dispensarizarii (include si educatia pentru sanatatea

bucodentara, determinarea indicelui de placa bacteriana si a indicilor de inflamatie
parodontali)

MAXILAR

Indicele gingival sau GI: indicele lui Le i Silness (0, 1, 1,5)

______________________________________________________________________
Indice de sngerare papilar PBI
______________________________________________________________________
Indice de sngerare gingival
______________________________________________________________________

Indice de hipercretere
______________________________________________________________________
Indicele CPITN - Community Periodontal Index (0, 1, 2, 3, 4, 5, 6)
______________________________________________________________________
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 sngerare papilar PBI
______________________________________________________________________
Indice de sngerare gingival
______________________________________________________________________

Indice de hipercretere
______________________________________________________________________
Indicele CPITN - Community Periodontal Index (0, 1, 2, 3, 4, 5, 6)
______________________________________________________________________
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