Scribd Logo
Upload

Welcome to Scribd!

  • Pemeriksaan Odontogram Praktek Dokter Gigi

    Uploaded by

    Ekowati Tie' Bekti
    28 views1 page
    This document appears to be a dental chart or odontogram used by a dentist to record a patient's dental exam. It includes fields to record the patient's name, gender, date of birth, and exam date. The chart diagrams the teeth in each dental quadrant to record the condition or work done on each tooth. Additional notes sections are included to document the patient's bite, palate, presence of dental anomalies, and other findings. The dentist signs at the bottom to validate the exam.

    Original Description:

    Odontogram

    Original Title

    Odontogram New

    Copyright

    © © All Rights Reserved

    Available Formats

    DOC, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    This document appears to be a dental chart or odontogram used by a dentist to record a patient's dental exam. It includes fields to record the patient's name, gender, date of birth, and exam date. The chart diagrams the teeth in each dental quadrant to record the condition or work done on each tooth. Additional notes sections are included to document the patient's bite, palate, presence of dental anomalies, and other findings. The dentist signs at the bottom to validate the exam.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    28 views1 page

    Pemeriksaan Odontogram Praktek Dokter Gigi

    Uploaded by

    Ekowati Tie' Bekti
    This document appears to be a dental chart or odontogram used by a dentist to record a patient's dental exam. It includes fields to record the patient's name, gender, date of birth, and exam date. The chart diagrams the teeth in each dental quadrant to record the condition or work done on each tooth. Additional notes sections are included to document the patient's bite, palate, presence of dental anomalies, and other findings. The dentist signs at the bottom to validate the exam.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    PEMERIKSAAN ODONTOGRAM

    PRAKTEK DOKTER GIGI


    JENIS TGL
    NAMA : .. KELAMIN : L/P PEMERIKSAAN:
    ALAMAT : .. TTL : ......./......./..............

    11 [51 ] [61] 21
    12 [52] [62] 22
    13 [53] [63] 23
    14 [54] [64] 24
    15 [55] [65] 25
    16 26
    17 27
    18 28

    48 38
    47 37
    46 36
    45 [85] [75] 35
    44 [84] [74] 34
    43 [83] [73] 33
    42 [82] [72] 32
    41 [81] [71] 31

    Occlusi :Normal Bite / Cross Bite / Steep Bite D : .... M : ... F : ...
    Torus Palatinus : Tidak Ada / Kecil/ Sedang/ Besar/ Multiple Jum lah foto yang diambil ............ (digital/intraoral)*
    Torus Mandibularis : Tidak Ada / Sisi Kiri / Sisi Kanan / Kedua Sisi Jumlah rontgen foto yang diambil .. (Dental / PA /
    Palatum : Dalam / Sedang / Rendah OPG/ Ceph)*
    Diastema : Tidak Ada / Ada : (dijelaskan dimana dan berapa lebarnya) ==============================================
    Gigi Anomali: Tidak Ada / Ada : (dijelaskan gigi yang mana, dan bentuknya) .. TANDA TANGAN PEMERIKSA
    Lain-lain : (hal-hal yang tidak yang tidak tercakup

    (......................................................)

    PEMERIKSAAN ODONTOGRAM
    PRAKTEK DOKTER GIGI
    JENIS TGL
    NAMA : .. KELAMIN : L/P PEMERIKSAAN:
    ALAMAT : .. TTL : ......./......./..............

    11 [51 ] [61] 21
    12 [52] [62] 22
    13 [53] [63] 23
    14 [54] [64] 24
    15 [55] [65] 25
    16 26
    17 27
    18 28

    48 38
    47 37
    46 36
    45 [85] [75] 35
    44 [84] [74] 34
    43 [83] [73] 33
    42 [82] [72] 32
    41 [81] [71] 31

    Occlusi :Normal Bite / Cross Bite / Steep Bite D : .... M : ... F : ...
    Torus Palatinus : Tidak Ada / Kecil/ Sedang/ Besar/ Multiple Jum lah foto yang diambil ............ (digital/intraoral)*
    Torus Mandibularis : Tidak Ada / Sisi Kiri / Sisi Kanan / Kedua Sisi Jumlah rontgen foto yang diambil .. (Dental / PA /
    Palatum : Dalam / Sedang / Rendah OPG/ Ceph)*
    Diastema : Tidak Ada / Ada : (dijelaskan dimana dan berapa lebarnya) ==============================================
    Gigi Anomali: Tidak Ada / Ada : (dijelaskan gigi yang mana, dan bentuknya) .. TANDA TANGAN PEMERIKSA
    Lain-lain : (hal-hal yang tidak yang tidak tercakup

    (......................................................)

    You might also like