Clinical sheet

Clinical sheet

A-Anamnesis

I- Civil status:

• First and last name:
• Age:
• Occupation
• Address:          

II- General background:

• Family:
• Staff:

III- Stomatological history:

• Family:
• Staff:

IV-Reason for consultation:

V- History of the disease:            

B-Exorbital examination:

I- Inspection:

• Facial symmetry:
• Coloring of the integuments:
• Lips:
• Others:

II- Palpation:

1- the temporomandibular joints:

• Joint noises:
• The condylar game:
• Joint pain:
• Others:

2- muscles:

• The masseter:
• The temporal:
• The external pterygoid:
• The internal pterygoid:
• Others

3- the ganglion chains:

• Under chin strap:
• Subangular-maxillary:
• The chain masses:
• The occipital chain 

4- Others:

C- Intraoral examination:

1- mouth opening:

2- oral hygiene:

3- saliva:

4- condition of the mucous membranes:

• Labial:
• Palatine:
• Jugale:
• Lingual
• From the lingual floor
• Alveolar:

5- Insertion of brakes and clamps:

D- Gingival examination:

Upper jaw

	Right posterior block	Anterior block	Left posterior block
Color
Volume
Outline
Consistency
Appearance
HGA
PMA
GI
PI
SBI

special features:

Mandible

	Right posterior block	Anterior block	Left posterior block
Color
Volume
Outline
Consistency
Appearance
HGA
PMA
GI
PI
SBI

special features:

E-Probing the gingivo-dental sulcus:

1. Upper jaw:

	11			12			13			14			15			16			17			18
Vestibular faces
Palatal faces
Vestibular recessions
Palatal recession

Presence of pus:

	21			22			23			24			25			26			27			28
Vestibular faces
Palatal faces
Vestbular recessions
Palatal recessions

Presence of pus:

1. Upper jaw:

	31			32			33			34			35			36			37			38
Vestibular faces
Palatal faces
Vestibular recession
Palatal recession

Presence of pus:

	41			42			43			44			45			46			47			48
Vestibular faces
Palatal faces
Vestibular recession
Palatal recession

Presence of pus:

F-Dental examination:

1-The dental formula:

2- Dental caries:

3- Dental malpositions:

4- Dental malformations:

5- Tooth sensitivity:

6- Dental abrasions (abrasion index according to Agual):

Degree 1:

Degree 2:

Degree 3:

Degree 4:

Degree 5:

7- Dental mobility (according to ARPA):

Degree 1:

Degree 2:

Degree 3:

Degree 4:

G- Occlusion analysis:

1. Static occlusion:

	Incisors	Canines	molars
Sagittal direction
Transverse direction
Vertical direction

Prematurity:

2. Dynamic occlusion:

• Opening path:
• Laterality: right 

• Working side:
• Non-working side:
• Laterality: left

• Working side:
• Non-working side:
• The protrusion: 

• Working side:
• Non-working side:

3. Review of functions:

• swallowing:
• phonation:
• breathing:
• chewing :​ 

H-Summary of additional examinations:

The etiological diagnosis:

The positive diagnosis:

The differential diagnosis:

The treatment plan:

The prognosis:

Tracking sheet

First name, last name and age	Acts	Appointment	OBS

Clinical sheet

  Early cavities in children need to be treated promptly.
Dental veneers cover imperfections such as stains or cracks.
Misaligned teeth can cause difficulty chewing.
Dental implants provide a stable solution to replace missing teeth.
Antiseptic mouthwashes reduce bacteria that cause bad breath.
Decayed baby teeth can affect the health of permanent teeth.
A soft-bristled toothbrush preserves enamel and gums.
 

Clinical sheet