Judetul

Localiatea........................

Nr.
Inregistrare

FOAIE DE OBSERVATIE
STOMATOLOGICA
NUMELE................................................PRENUMELE...................
.............Sexul M/F
VARSTA
anul

DATA NASTERII :

ziua

luna

Mediul U / R
PROFESIA......................................................................................
Statut asigurat:
Neasigurat

C.N.A.S.

MOTIVUL PREZENTARII:

Asigurare voluntara

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Istoricul
bolii: .....................................................................................................
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Antecedente HC generale:

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1
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Antecedente HC
Stomatologice:
Antecedente personale ________________________________________
generale:

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Antecedente personale ________________________________________
Stomatologice: ________________________________________
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Obiceiuri vicioase (daca

exista)................................................................................................
I. EXAMENUL EXOBOCAL
1. General
Dezvoltare generala:
Tip constitutional:
Sistem nervos:

Hiposom
Entomorf
Tare

Slab

Normosom
Mezomorf
; Echilibrat

Hipersom
Ectomorf
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 |_|
Forma fetei
_|
(norma laterala)

drept |_|

convex sup |_|

concav sup |_|

convex inf |_|

concav inf |_|

convex asociat|

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

.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:...............................................................................
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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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TRATAMENT
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EVOLUTIE
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