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‫==‪= „_·ã˚^=hù=ÔΟ‘=m^É_΃=Óá^Éd‬‬
‫!ﻧﻤﻮذج اﻟﻤﻮاﻓﻘﺔ ﻋﻠﻰ إﺟﺮاء اﻟﻤﻌﺎﻟﺠﺔ اﻟﺘﻘﻮﻳﻤﻴﺔ )ﺗﻘﻮﻳﻢ اﻷﺳﻨﺎن( ﻓﻲ اﻟﻌﻴﺎدات ﻓﻲ ﻛﻠﻴﺔ ﻃﺐ اﻻﺳﻨﺎن ﺑﺠﺎﻣﻌﺔ ﻃﻴﺒﺔ‬
‫‪!"#$%&'$()*+,$-./.'$%0*1.')&'$*2.,34‬‬
‫‪:�ÿ^=⁄såÿ^=fi–á‬‬ ‫^ˇ‪Wfiã‬‬
‫‪€^ȧ^=fi–á‬‬
‫"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""‪!"#$%‬‬ ‫*‬ ‫‪ .١‬أﻧﺎ اﳌﻮﻗﻊ أدﻧﺎﻩ‪:‬‬
‫""""""""""""""""""""""""""""""""""""""""""""""‪&'(')*"#+,&-(./.01"2(3‬‬
‫‪,-"4'(5-($"+4-0",&'"5-66-7.01"-(,&-8-0,.9",('#,$'0,"46#0%‬‬ ‫ﻹﺟﺮاء اﳌﻌﺎﳉﺔ اﻟﺘﻘﻮﳝﻴﺔ اﻟﱵ ﺗﺘﻠﺨﺺ ﻛﻤﺎ ﻳﻠﻲ‪:‬‬ ‫أﺋﺬن‪ /‬أﻓﻮض اﻟﺪﻛﺘﻮر‪/‬‬

‫";‪:(,&-8-0,.9",('#,$'0,"('$#.0;"#0"'6'9,.<'"4(-9'8+('3""!,"6.='"-,&'(",('#,$'0,‬‬ ‫ﻻ ﻳﺰال ﻋﻼج ﺗﻘﻮﱘ اﻷﺳﻨﺎن إﺟﺮاءاً اﺧﺘﻴﺎرﻳﺎً ‪ ،‬ﻣﺜﻠﻪ ﻣﺜﻞ اﻟﻌﻼﺟﺎت اﻷﺧﺮى ﻟﻠﺠﺴﻢ‪ ،‬ﻟﺪﻳﻪ ﺑﻌﺾ اﳌﺨﺎﻃﺮ و اﻟﻘﻴﻮد وﻟﻜﻦ‬ ‫‪.٢‬‬
‫"‪-5",&'")-8*"&#;";-$'".0&'('0,"(.;="#08"6.$.,#,.-0;3"">&';'";'68-$"4('<'0,‬‬
‫"‪,('#,$'0,?")+,";&-+68")'"9-0;.8'('8".0"$#=.01",&'"8'9.;.-0",-"+08'(1-‬‬ ‫ﻗﻠﻤﺎ ﺗﺆدي إﱃ ﺗﻌﺬر اﻟﻌﻼج ‪ ،‬وﻟﻜﻦ ﻳﻨﺒﻐﻲ أﺧﺬﻫﺎ ﺑﻌﲔ اﻻﻋﺘﺒﺎر ﰲ اﲣﺎذ اﻟﻘﺮار ﻟﺘﻠﻘﻲ اﻟﻌﻼج ‪* .‬‬
‫"‪,('#,$'0,3‬‬
‫‪!"#$%&'()*#+,(&'-".+'/('+&(0+(11#&'+'/#+23'&-4#+-1+2"'/-$-0'%&+5"#('4#0'6+‬‬ ‫اﻟﻌﻮاﻣﻞ اﻟﺘﻲ ﻳﻤﻜﻦ اﻟﺘﻨﺒﺆ ﺑﻬﺎ واﻟﺘﻲ ﺗﺆﺛﺮ ﻋﻠﻰ ﻧﺘﺎﺋﺞ اﻟﻌﻼج اﻟﺘﻘﻮﻳﻤﻲ ‪:‬‬
‫"‪!""#$%&'(")*+!0",&'"<#;,"$#@-(.,*"-5"-(,&-8-0,.9"9#;';?";.10.5.9#0,‬‬ ‫اﻟﺘﻌﺎون ‪ :‬ﰲ اﻟﻐﺎﻟﺒﻴﺔ اﻟﻌﻈﻤﻰ ﻣﻦ ﺣﺎﻻت ﺗﻘﻮﱘ اﻷﺳﻨﺎن ‪ ،‬ﳝﻜﻦ أن ﻳﻜﻮن ﲢﺴﻦ ﻛﺒﲑ وﻧﺘﺎﺋﺞ ﺟﻴﺪة ﰲ ﺣﺎل ﺗﻌﺎون اﳌﺮﻳﺾ ﺧﻼل‬
‫‪.$4(-<'$'0,"9#0")'"achieved with the patient’s cooperation.+‬‬
‫"‪!&%(),+-"%+.##/(&)0$1*+A--(")(+;&.01".09('#;';",&'"(.;="-5"8'9#*"7&'0‬‬ ‫ﻓﱰة اﻟﻌﻼج‪.‬‬
‫"‪7'#(.01")(#9';3"BC9'66'0,"-(#6"&*1.'0'?"('8+9,.-0".0";+1#(?")'.01";'6'9,.<'".0‬‬
‫"'‪8.',?"#08"('4-(,.01"#0*"6--;'")#08;"#;";--0"#;"0-,.9'8?"7.66"&'64"$.0.$./‬‬
‫اﻟﻌﻨﺎﻳﺔ ﺑﺎﻷﺟﻬﺰة اﻟﺘﻘﻮﳝﻴﺔ ‪:‬ﻗﻠﺔ اﻟﻌﻨﺎﻳﺔ وﻋﺪم ﺗﻨﻈﻴﻒ اﻷﺳﻨﺎن ﺑﺎﺳﺘﺨﺪام اﻟﻔﺮﺷﺎة ﻳﺰﻳﺪ ﻣﻦ ﺧﻄﺮ ﺗﺴﻮس اﻷﺳﻨﺎن ﰲ وﺟﻮد أﺟﻬﺰة ﺗﻘﻮﱘ‬
‫('&‪8'9#*?"7&.,'";4-,;?"D8'9#69.5.9#,.-0E?"#08"1+$"8.;'#;'F4(-)6'$;3""!"#$%‬‬ ‫اﻷﺳﻨﺎن ‪ .‬اﻟﻌﻨﺎﻳﺔ ﺑﺼﺤﺔ اﻟﻔﻢ‪ ،‬واﻟﺘﺨﻔﻴﻒ ﻣﻦ اﻟﺴﻜﺮﻳﺎت ‪ ،‬و اﻧﺘﻘﺎء اﳌﺎﻛﻮﻻت اﳌﻨﺎﺳﺒﺔ‪ ،‬و إﺑﻼغ اﻟﻄﺒﻴﺐ ﻋﻦ ﲣﻠﺨﻞ ﰲ اﻟﻌﺼﺎﺑﺎت‬
‫('‪)%*%$*(')'+,(-./(0"&$1*($"(,"#+(2'&$%*$(3"+(45'6&%&7(6&2(46)%$,(41'48*(6+‬‬
‫‪)%$65(2#+%&7($+'6$0'&$999+‬‬ ‫ﻓﻮر ﻣﻼﺣﻈﺔ ذﻟﻚ‪ ،‬ﻳﺴﺎﻋﺪ ﰲ ﺗﻘﻠﻴﻞ ﺗﺴﻮس اﻷﺳﻨﺎن واﻟﺒﻘﻊ اﻟﺒﻴﻀﺎء )ﺑﺪاﻳﺔ اﻟﺘﺴﻮس ( ‪ ،‬وﻛﺬﻟﻚ ﳚﻨﺐ ﻣﺸﺎﻛﻞ وأﻣﺮاض اﻟﻠﺜﺔ‪.‬‬
‫"*'&‪G'#(.01"H'#81'#("#08F-("B6#;,.9;%"">&';'"#('"5-(9';"46#9'8"-0",'',&";-",‬‬
‫ﻣﺮاﺟﻌﺔ ﻃﺒﻴﺐ اﻷﺳﻨﺎن اﻟﺮوﺗﻴﻨﻴﺔ ﻣﺮة ﻛﻞ ‪ ٦-٣‬أﺷﻬﺮ ﻟﺘﻨﻈﻴﻒ اﻷﺳﻨﺎن وﻓﺤﺺ اﻟﺘﺴﻮس ﻣﻬﻢ ﺟﺪاً ﺧﻼل ﻋﻼج ﺗﻘﻮﱘ اﻷﺳﻨﺎن‪* !.‬‬
‫""‪7.66"$-<'".0,-",&'.("4(-4'("4-;.,.-0;3"">&'"#$-+0,"-5",.$'"7-(0"#55'9,;"(';+6,;3‬‬
‫"(‪IJK>"GBLM"LK"!NK>MJO>B2P""!5"&'#81'#(".;"8',#9&'8"5(-$",&'",+)';"-‬‬ ‫ارﺗﺪاء اﻷﺟﻬﺰة اﻟﺘﻘﻮﳝﻴﺔ ﺧﺎرج اﻟﻔﻢ واﳌﺜﺒﺘﺔ ﻋﻠﻰ اﻟﺮأس و ‪ /‬أو اﻷﺷﺮﻃﺔ اﳌﻄﺎﻃﻴﺔ ‪ :‬ﻫﺬﻩ اﻟﻘﻮى ﺗﻄﺒﻖ ﻋﻠﻰ اﻷﺳﻨﺎن ﻟﻮﺿﻌﻬﺎ ﰲ‬
‫"‪#(9&7.('"7&.6'",&'"'6#;,.9"5-(9'".;"'01#1'8?".,"9#0";0#4")#9="#08"9#+;'".0@+(*3‬‬
‫"‪.##"()'2$)'1+341'+5$+6$#'*+I.;;'8"#44-.0,$'0,;"9('#,'"$#0*";9&'8+6.01‬‬ ‫أﻣﺎﻛﻨﻬﺎ اﻟﺼﺤﻴﺤﺔ ‪ .‬ﻣﻘﺪار اﻟﻮﻗﺖ اﻟﺬي ﺗﺮﺗﺪى ﻓﻴﻪ ﻫﺬﻩ اﻷﺟﻬﺰة ﺗﺆﺛﺮ ﻋﻠﻰ اﻟﻨﺘﺎﺋﺞ‪ .‬ﳚﺐ ارﺗﺪاء ﻫﺬﻩ اﻷﺟﻬﺰة ﺣﺴﺐ ﺗﻌﻠﻴﻤﺎت‬
‫"‪4(-)6'$;+#08"6'01,&'0",('#,$'0,",.$'3"Q#.6+('",-"9--4'(#,'".0"=''4.01‬‬ ‫اﻟﻄﺒﻴﺐ ! ﻗﺪ ﺗﺴﺒﺐ ﻫﺬﻩ اﻷﺟﻬﺰة إﺻﺎﺑﺎت ﰲ ﺣﺎل اﻧﻔﺼﺎﳍﺎ ﻣﻦ أﻣﺎﻛﺎﻬﻧﺎ‪.‬‬
‫"(‪#44-.0,$'0,;"5-(",&(''"#44-.0,$'0,;"7.,&-+,"'C9+;'"$#*"5-(9'"+;",-"'08"*-+‬‬
‫"‪,('#,$'0,"4(-1(#$3‬‬ ‫ﳚﺐ اﳊﻔﺎظ واﻻﻟﺘﺰام ﺑﺎﳌﻮاﻋﻴﺪ‪ :‬اﳌﻮاﻋﻴﺪ اﻟﻔﺎﺋﺘﺔ ﺗﺆدي إﱃ اﻟﻌﺪﻳﺪ ﻣﻦ اﳌﺸﺎﻛﻞ وأﻳﻀﺎً ﺗﺆدي إﱃ إﻃﺎﻟﺔ وﻗﺖ اﻟﻌﻼج‪ .‬و ﺗﻜﺮار‬
‫‪708"#$%&'()*#+1(&'-".+'/('+&(0+(11#&'+'/#+-3'&-4#+-1+-"'/-$-0'%&+'"#('4#0'6+++‬‬
‫"'‪3410/$+7&5('1*""I-+,&")('#,&.01?",&+$)?"5.01'(?"-("6.4";+9=.01?",-01+‬‬ ‫اﻟﺘﺨﻠﻒ ﻋﻦ اﳊﻀﻮر ﺛﻼث ﻣﺮات ﻣﺘﺘﺎﻟﻴﺔ ﺑﺪون ﻋﺬر ﻗﺪ ﻳﻀﻄﺮﻧﺎ آﺳﻔﲔ اﱃ إﻬﻧﺎء ﺑﺮﻧﺎﳎﻜﻢ اﻟﻌﻼﺟﻰ‪.‬‬
‫"&‪,&(+;,.01?"D#)0-($#6";7#66-7.01E?"#08"-,&'("+0+;+#6"&#).,;"9#0"4('<'0,",'',‬‬ ‫اﻟﻌﻮاﻣﻞ اﻟﺘﻲ ﻻﻳﻤﻜﻦ اﻟﺘﻨﺒﺆ ﺑﻬﺎ و اﻟﺘﻲ ﻳﻤﻜﻦ أن ﺗﺆﺛﺮ ﻋﻠﻰ ﻧﺘﺎﺋﺞ اﻟﻌﻼج اﻟﺘﻘﻮﻳﻤﻲ ‪:‬‬
‫"'(‪5(-$"$-<.01",-",&'.("9-(('9,'8"4-;.,.-0;"-("9#+;'"('6#4;'"#5,'(")(#9';"#‬‬
‫""‪('$-<'83‬‬ ‫اﻟﻌﺎدات اﻟﻌﻀﻠﻴﺔ‪ :‬اﻟﺘﻨﻔﺲ ﻣﻦ اﻟﻔﻢ ‪ ،‬ﻣﺺ اﻹﻬﺑﺎم أو اﻻﺻﺒﻊ‪ ،‬أو اﻟﺸﻔﺔ ‪ ،‬واﻧﺪﻓﺎع اﻟﻠﺴﺎن اﳌﺘﻜﺮر) اﻟﺒﻠﻊ اﻟﻐﲑ ﻃﺒﻴﻌﻲ( ‪ ،‬و ﻏﲑﻫﺎ ﻣﻦ‬
‫"(‪8&0(&/+9%":';+<&''$%)1*+J0+;+#6";='6',#6"4#,,'(0;"#08".0;+55.9.'0,"-‬‬
‫"‪+08';.(#)6'"5#9.#6"1(-7,&"9#0"9-$4(-$.;'",&'"8'0,#6"(';+6,;R"#55'9,"#"5#9.#6‬‬ ‫اﻟﻌﺎدات اﻟﻐﲑ ﻃﺒﻴﻌﻴﺔ ﳝﻜﻦ أن ﲤﻨﻊ اﻷﺳﻨﺎن ﻣﻦ اﻟﺘﺤﺮك ﻟﺘﺼﺤﻴﺢ أوﺿﺎﻋﻬﺎ أو ﺗﺴﺒﺐ اﻧﺘﻜﺎﺳﺔ ﺑﻌﺪ إزاﻟﺔ اﻷﺟﻬﺰة اﻟﺘﻘﻮﳝﻴﺔ‪.‬‬
‫"')"*‪9&#01'"#08"9#+;'";&.5,.01"-5",'',&"8+(.01"(','0,.-03""K+(1.9#6"#;;.;,#09'"$#‬‬ ‫أﳕﺎط ﳕﻮ اﻟﻮﺟﻪ ‪ :‬أﳕﺎط ﳕﻮ اﻟﻮﺟﻪ اﻟﻐﲑ ﻋﺎدﻳﺔ أو اﻟﻐﲑ ﻣﻜﺘﻤﻠﺔ اﻟﻨﻤﻮ ﻟﻌﻈﻢ اﻟﻮﺟﻪ ﳝﻜﻦ أن ﺗﺆﺛﺮ ﺳﻠﺒﺎً ﻋﻠﻰ ﻧﺘﺎﺋﺞ ﺗﻘﻮﱘ اﻷﺳﻨﺎن‪،‬‬
‫‪('9-$$'08'8".0",&';'";.,+#,.-0;3"+‬‬
‫"'‪<"1'+=%$&'2$)'+=""';+3">$2$)'*+>'',&"&#<'"#",'08'09*",-";&.5,"-(";',,6‬‬ ‫وﻫﻲ ﺗﺆﺛﺮ ﻋﻠﻰ ﺷﻜﻞ اﻟﻮﺟﻪ وﺗﺆدي إﱃ ﲢﺮك اﻷﺳﻨﺎن ﺧﻼل اﻟﺘﺜﺒﻴﺖ ﺑﻌﺪ اﻧﺘﻬﺎء اﻟﻌﻼج‪ .‬ﻟﺬا ﻗﺪ ﳛﺘﺎج إﱃ اﻟﺘﺪﺧﻞ اﳉﺮاﺣﻲ ﰲ‬
‫";('&‪#5,'(",('#,$'0,"#;"7'66"#;"#5,'("(','0,.-03""K-$'"9&#01';"#('"8';.(#)6'R"-,‬‬
‫"'&‪#('"0-,3"+M-,#,.-0;"#08"9(-78.01"-5",&'"6-7'("5(-0,",'',&"-(";6.1&,";4#9'".0",‬‬
‫ﺑﻌﺾ اﳊﺎﻻت‪.‬‬
‫‪'C,(#9,.-0";.,'"#('"9-$$-0"'C#$46';3"+‬‬ ‫ﲢﺮك اﻷﺳﻨﺎن إﱃ أوﺿﺎﻋﻬﺎ ﻛﻤﺎ ﻛﺎﻧﺖ ﻋﻠﻴﻪ ﻗﺒﻞ اﻟﻌﻼج‪ :‬اﻷﺳﻨﺎن ﻟﺪﻳﻬﺎ اﻟﻘﺎﺑﻠﻴﺔ ﻟﻠﺤﺮﻛﺔ ﺑﻌﺪ اﻧﺘﻬﺎء اﻟﻌﻼج وﻛﺬﻟﻚ ﺑﻌﺪ اﻟﺘﺜﺒﻴﺖ ‪،‬‬
‫";‪=$2#"2&)?(54/&%+<%"5/$21@+A=3BC*+A-;;.)6'">IS"-("@#7"@-.0,"4(-)6'$‬‬
‫"?;‪$#*"8'<'6-4")'5-('?"8+(.01?"-("#5,'("-(,&-8-0,.9",('#,$'0,3"">--,&"4-;.,.-0‬‬ ‫ﺑﻌﺾ ﻫﺬﻩ اﻟﺘﺤﺮﻛﺎت ﻣﺴﺘﺤﺴﻨﺔ وﺑﻌﻀﻬﺎ ﻟﻴﺴﺖ ﻛﺬﻟﻚ‪ .‬اﻟﺘﻔﺎف و ﺗﺮاﻛﺐ اﻷﺳﻨﺎن اﻟﺴﻔﻠﻴﺔ اﻷﻣﺎﻣﻴﺔ وﻛﺬﻟﻚ ﺑﻌﺾ اﻟﻔﺮاﻏﺎت ﰲ‬
‫‪).,'?"-("4('T'C.;,.01">IS"4(-)6'$;"9#0")'"#"5#9,-(".0",&.;"9-08.,.-03"+‬‬ ‫أﻣﺎﻛﻦ ﺧﻠﻊ اﻷﺳﻨﺎن ﺗﻌﺘﱪ أﻣﺜﻠﺔ ﻋﻠﻰ ذﻟﻚ‪.‬‬
‫"‪D2#&0'$?+=$$';*+!0"#0"#,,'$4,",-"$-<'".$4#9,'8",'',&?"D,'',&"+0#)6'",-"'(+4,‬‬
‫";‪0-($#66*E?"';4'9.#66*"9+;4.8;"#08",&.(8"$-6#(;?"D7.;8-$",'',&E?"<#(.-+‬‬ ‫ﻣﺸﺎﻛﻞ اﳌﻔﺼﻞ اﻟﻔﻜﻲ اﻟﺼﺪﻏﻲ ‪:‬ﻣﺸﺎﻛﻞ اﳌﻔﺼﻞ اﻟﻔﻜﻲ اﻟﺼﺪﻏﻲ اﶈﺘﻤﻠﺔ ﻗﺪ ﺗﻨﺸﺄ ﻗﺒﻞ أو أﺛﻨﺎء أو ﺑﻌﺪ اﻟﻌﻼج اﻟﺘﻘﻮﳝﻲ‪ .‬أوﺿﺎع‬
‫"‪4(-)6'$;""#('";-$',.$';"'09-+0,'('8"7&.9&"$#*"6'#8",-"4'(.-8-0,#6‬‬
‫‪4(-)6'$;?"('6#4;'?"-("6-;;"-5",'',&3"+‬‬ ‫اﻷﺳﻨﺎن واﻹﻃﺒﺎق أو اﳌﺸﺎﻛﻞ اﳌﺘﻮاﺟﺪة أﺻﻼً ﰲ ﻣﻔﺼﻞ اﻟﻔﻚ ﻗﺪ ﺗﻜﻮن ﻟﻌﻮاﻣﻞ ﳊﺪوث ﻣﺜﻞ ﺗﻠﻚ اﳌﺸﺎﻛﻞ‪.‬‬
‫"‪E""'+E$1"%#'(")%"K&-(,'0.01"-5"(--,"'08;"9#0"-99+("7&'0",'',&"#('"$-<'8‬‬ ‫اﻷﺳﻨﺎن اﳌﻨﻄﻤﺮة‪ :‬ﰲ ﳏﺎوﻟﺔ ﻟﺘﺤﺮﻳﻚ اﻷﺳﻨﺎن اﳌﻨﻄﻤﺮة )اﻷﺳﻨﺎن اﻟﻐﲑ ﻗﺎدرة ﻋﻠﻰ اﻟﺒﺰوغ ﺑﺸﻜﻞ ﻃﺒﻴﻌﻲ( وﺧﺎﺻﺔ اﻷﻧﻴﺎب و اﻟﻀﺮس‬
‫";‪8+(.01"-(,&-8-0,.9",('#,$'0,3""J08'("&'#6,&*"9-08.,.-0;",&'";&-(,'0'8"(--,‬‬
‫"(‪#('"+;+#66*"0-"4(-)6'$3"">(#+$#?".$4#9,.-0?"'08-9(.0'"8.;-(8'(;?"-‬‬ ‫اﻟﺜﺎﻟﺚ) ﺿﺮس اﻟﻌﻘﻞ ( ‪ ،‬ﻗﺪ ﺗﺆدي ﻟﺒﻌﺾ اﳌﺸﺎﻛﻞ ﰲ ﺑﻌﺾ اﻷﺣﻴﺎن ﻣﺜﻞ ﻣﺸﺎﻛﻞ اﻟﻠﺜﺔ‪ ،‬أو اﻻﻧﺘﻜﺎﺳﺔ‪ ،‬أو ﺣﱴ ﻓﻘﺪان ﻫﺬﻩ‬
‫"‪.8.-4#,&.9?"D+0=0-70E?"('#;-0;"#6;-"9#+;'",&.;"4(-)6'$3""K'<'('"(';-(4,.-0"9#0‬‬
‫""‪.09('#;'",&'"4-;;.).6.,*"-5"4('$#,+('",--,&"6-;;3‬‬ ‫اﻷﺳﻨﺎن‪.‬‬
‫"‪F")G>('&/+"%+H$&?+=""';*+L",--,&",(#+$#,./'8"-("-,&'("9#+;';"9#0"8.'"-<'("#‬‬ ‫اﻣﺘﺼﺎص اﳉﺬر‪ :‬ﳝﻜﻦ أن ﳛﺪث ﻗﺼﻮر ﻣﻦ ﻃﺮف اﳉﺬر ﻋﻨﺪﻣﺎ ﻳﺘﻢ ﲢﺮﻳﻚ اﻷﺳﻨﺎن أﺛﻨﺎء اﻟﻌﻼج اﻟﺘﻘﻮﳝﻲ‪ .‬ﰲ اﻟﻮﺿﻊ اﻟﻄﺒﻴﻌﻲ‬
‫"(‪6-01"4'(.-8"-5",.$'"-("7.,&-+,"-(,&-8-0,.9",('#,$'0,3"">&.;",--,&"$#*"8.;9-6-‬‬
‫"‪-("56#('8"+4"8+(.01"-(,&-8-0,.9",('#,$'0,3""!,"9-+68"8','(.-(#,'"8+(.01‬‬ ‫اﻟﺴﻠﻴﻢ ﻳﻌﺘﱪ ﻗﺼﻮر اﳉﺬور ﻟﻴﺲ ﻣﺸﻜﻠﺔ‪ .‬أﻣﺎ اﻟﺼﺪﻣﺎت أو اﻧﻄﻤﺎر اﻷﺳﻨﺎن أو اﺿﻄﺮاﺑﺎت اﻟﻐﺪد اﻟﺼﻤﺎء‪ ،‬أو ﻟﺴﺒﺐ ﻏﲑ ﻣﻌﺮوف‬
‫"‪,('#,$'0,"9#+;.01"6-;;"-5")-0'"#(-+08",&'",'',&3""BC9'66'0,"-(#6"&*1.'0'"#08‬‬
‫‪5('U+'0,"96'#0.01;")*"*-+("8'0,.;,"9#0"&'64"9-0,(-6",&.;";.,+#,.-03"+‬‬
‫ﻗﺪ ﺗﺴﺒﺐ ﺗﻠﻚ اﳌﺸﻜﻠﺔ‪ .‬ﻟﻜﻦ اﻻﻣﺘﺼﺎص اﻟﺸﺪﻳﺪ ﻟﻠﺠﺬور ﳝﻜﻦ أن ﻳﺰﻳﺪ ﻣﻦ إﻣﻜﺎﻧﻴﺔ ﻓﻘﺪان اﻷﺳﻨﺎن‪.‬‬
‫"‪I)414&/+J004%%$)0$1*+K7#66-7.01"#446.#09';?"9&.44'8",'',&?"8.;6-81.01‬‬ ‫ﲤﻮت أو اﻷﺳﻨﺎن اﳌﺘﻤﻮﺗﺔ ‪ :‬اﻷﺳﻨﺎن اﻟﱵ ﺗﻌﺮﺿﺖ ﻟﺼﺪﻣﺎت ﺳﺎﺑﻘﺔ أو أﺳﺒﺎب أﺧﺮى ﳝﻜﻦ أن ﲤﻮت اﻷﺳﻨﺎن ﻋﻠﻰ اﳌﺪى اﻟﺒﻌﻴﺪ‬
‫‪(';,-(#,.-0;3+‬‬
‫‪D+0")1$)'+'"+';$+'&K(),+"-+#;"'",%&#;1+&)?+LG%&M1+5$-"%$@+?4%(),+&)?+&-'$%+‬‬ ‫ﺑﺪون ﻋﻼج ﺗﻘﻮﱘ اﻷﺳﻨﺎن‪ .‬ﻫﺬﻩ اﻷﺳﻨﺎن ﻗﺪ ﻳﺘﻐﲑ ﻟﻮﻬﻧﺎ أو ﻗﺪ ﺗﱪز أﺛﻨﺎء اﻟﻌﻼج اﻟﺘﻘﻮﳝﻲ ‪ .‬وﳝﻜﻦ أن ﺗﺘﻔﺎﻗﻢ ﺧﻼل ﻓﱰة اﻟﻌﻼج‬
‫‪'%$&'2$)'+&)?+'"+';$+41$+"-+1&2$+5M+';$+?"0'"%+()+10($)'(-(0+#&#$%1+"%+‬‬
‫‪?$2")1'%&'(")1N+++‬‬
‫وﺗﺆدي إﱃ ﻓﻘﺪان ﰲ اﻷﻧﺴﺠﺔ اﶈﻴﻄﺔ ﺑﺎﻷﺳﻨﺎن ‪ .‬اﻟﻌﻨﺎﻳﺔ ﺑﺼﺤﺔ اﻟﻔﻢ ﺑﺸﻜﻞ ﳑﺘﺎز وﻓﻌﺎل واﻟﺘﻨﻈﻴﻒ ﺑﺸﻜﻞ ﻣﺴﺘﻤﺮ ﻋﻨﺪ ﻃﺒﻴﺐ‬
‫‪D+0$%'(-M+';&'+D+;&>$+%$&?+"%+;&?+%$&?+'"+2$+';$+0")'$)'1+"-+';(1+-"%2+&)?+‬‬ ‫اﻷﺳﻨﺎن ﺗﺴﺎﻋﺪ ﻋﻠﻰ اﻟﺴﻴﻄﺮة ﻋﻠﻰ ﻫﺬا اﻟﻮﺿﻊ‪.‬‬
‫‪?"+%$&/(O$+';$+%(1K1+&)?+/(2('&'(")1+()>"/>$?@+&)?+?"+0")1$)'+'"+‬‬
‫‪"%';"?")'(0+'%$&'2$)'+&00"%?(),+'"+';$+'%$&'2$)'+#/&)+;&1+#%">(?$?+5M+‬‬ ‫ﺑﻌﺾ اﳊﻮادث اﻟﻐﲑ ﻋﺎدﻳﺔ ‪ :‬ﺑﻠﻊ أﺟﺰاء اﻷﺟﻬﺰة اﻟﺘﻘﻮﳝﻴﺔ ‪ ،‬ﺗﻜﺴﺮ أﻃﺮاف اﻷﺳﻨﺎن‪ ،‬وﺗﻜﺴﺮ وﲣﻠﺨﻞ اﳊﺸﻮات اﻟﺴﻨﻴﺔ‪.‬‬
‫‪"%';"?")'(1'N‬‬ ‫أواﻓﻖ ﻋﻠﻰ أﺧﺬ اﻟﺼﻮر اﻟﻔﻮﺗﻮﻏﺮاﻓﻴﺔ‪ ،‬و اﻷﺷﻌﺔ اﻟﺴﻴﻨﻴﺔ ﻗﺒﻞ وأﺛﻨﺎء و ﺑﻌﺪ اﻟﻌﻼج و اﺳﺘﺨﺪاﻣﻬﺎ ﻛﻤﺎ ﻫﻲ ﻣﻦ ﻗﺒﻞ اﻟﻄﺒﻴﺐ‬
‫اﻟﻤﻌﺎﻟﺞ ﻓﻲ ورﻗﺔ ﻋﻠﻤﻴﺔ أو اﻟﺸﺮح واﻟﻌﺮض‪.‬‬
‫أﻗﺮ ﺑﺄﻧﻨﻲ ﻗﺪ ﻗﺮأت أو ﻗﺪ ﻗﺮأ ﻟﻲ ﻣﺤﺘﻮﻳﺎت ﻫﺬا اﻟﻨﻤﻮذج وأدرك ﺗﻤﺎﻣﺎً ﻣﺎﻳﺤﺘﻤﻞ ﻣﻦ اﻟﻤﺨﺎﻃﺮ واﻟﻘﻴﻮد ‪ ،‬و أواﻓﻖ ﻋﻠﻰ إﺟﺮاء‬
‫ﺗﻘﻮﻳﻢ اﻷﺳﻨﺎن ﺑﻨﺎءاً ﻋﻠﻰ اﻟﺨﻄﺔ اﻟﻌﻼﺟﻴﺔ اﻟﺘﻲ ﻗﺪﻣﻬﺎ ﻟﻲ اﻟﻄﺒﻴﺐ ﻟﺤﺎﻟﺘﻲ‪.‬‬

‫اﻟﺘﺎرﯾﺦ )‪:(Date‬‬ ‫اﻟﺘﻮﻗﯿﻊ )‪:(Signature‬‬ ‫ا ﺳﻢ اﻟﻤﺮﯾﺾ أو وﻟﻲ اﻷﻣﺮ )‪:( Name or Guardian Name‬‬

‫اﻟﺘﺎرﯾﺦ )‪:(Date‬‬ ‫اﻟﺘﻮﻗﯿﻊ )‪:(Signature‬‬ ‫ا ﺳﻢ اﻟﻄﺒﯿﺐ اﻟﻤﻌﺎﻟﺞ )‪:( Doctor’s Name‬‬

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‫!‬
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‫اﻟﺘﺎرﯾﺦ )‪:(Date‬‬ ‫اﻟﺘﻮﻗﯿﻊ )‪:(Signature‬‬ ‫ا ﺳﻢ اﻟﻤﺮﯾﺾ أو وﻟﻲ اﻷﻣﺮ )‪:( Name or Guardian Name‬‬

‫اﻟﺘﺎرﯾﺦ )‪:(Date‬‬ ‫اﻟﺘﻮﻗﯿﻊ )‪:(Signature‬‬ ‫ا ﺳﻢ اﻟﻄﺒﯿﺐ اﻟﻤﻌﺎﻟﺞ )‪:( Doctor’s Name‬‬