Professional Documents
Culture Documents
1. Muscle Examination
Muscle Palpation (0 – 10) Right Left
Negative (0-10)____ (0-10) ____
Anterior Temporalis (0-10)____ (0-10) ____
Posterior Temporalis (0-10)____ (0-10) ____
Masseter (0-10)____ (0-10) ____
Anterior Digastric (0-10)____ (0-10) ____
Lateral Pterygoid (Provocation test) (0-10)____ (0-10) ____
Diagnosis _______________________________________________
Comments_______________________________________________
_______________________________________________________
3. Doppler Examination
Medial Pole Crepitus Right Left
Lateral Pole Crepitus Right Left
Opening Click Right Left
Closing Click Right Left
4. Joint Examination
Palpation Tenderness Right Left
Opening Click Right Left
Closing Click Right Left
Grating / Crepitus Right Left
Pain with Movement: Opening Yes No
Protrusive Yes No
Lateral Yes No
5. Dental Examination
Tooth Mobility
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
R 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
L
Fractured Teeth
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
R 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
L
Sensitive Teeth
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
R 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
L
Diagnosis _______________________________________________
Comments_______________________________________________
_______________________________________________________
_______________________________________________________
6. Periodontal Examination
Gingival Recession 18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
R 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
L
Periodontal Involvement
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
R 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
L
Diagnosis _______________________________________________
Comments_______________________________________________
_______________________________________________________
_______________________________________________________
7. Esthetic Evaluation
Esthetic Diagnosis_________________________________________
Comments _______________________________________________
_______________________________________________________
_______________________________________________________