Judetul

Localitatea........................

Nr. Inregistrare

Student: ..
Cadru didactic: ..........................................

FOAIE DE OBSERVATIE
NUMELE................................................PRENUMELE................................Sexu
l M/F
VARSTA

DATA NASTERII :

ziua

luna

anul

Mediul U / R
PROFESIA......................................................................................
Statut asigurat:
C.N.A.S.
Asigurare voluntara
C.N.P. ..
MOTIVUL PREZENTARII:

Neasigurat

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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:

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Antecedente personale
Stomatologice:

Obiceiuri vicioase (daca

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

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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 |
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(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 teg.: elastica (normala) |_|

indurate |_|

flasca |_|

cu anestezie |_|

arii anestezice |

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Contururi
osoase.............................................................................................................................................

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Puncte de emergenta trigeminale :
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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
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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 VERTICAL:

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II. In dinamica
1. Ghidaj anterior

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2. Ghidaj lateral

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Forma arcadelor:
superioara :....................................................................................
inferioara:......................................................................................
Aprecierea curburilor dentare:
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- curba lui
SPEE ......................................................................................................................
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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
DIAGNOSTIC

Fotografii

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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12.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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SEMNATURA :

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