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TÀI LIỆU THAM KHẢO
1.
Romano,
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The
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cương nghiên cứu khoa học, Nhà xuất bản y học, Hà Nội.
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PHIẾU ĐIỀU TRA VÀ BỆNH ÁN RHM
Đề tài: "Thực trạng và một số yếu tố liên quan đến tổn thương
đốm trắng quanh mắc cài trong điều trị nắn chỉnh răng"
Mã số phiếu:
A. PHIẾU TRA CỨU BỆNH ÁN
I.Hành chính:
Địa điểm thực hiện:
- Bệnh viện Đại học Y
- Bộ môn nắn chỉnh răng
+ Họ và tên bệnh nhân: ................................................Mã số BN:.....................
+ Tuổi (Tính theo năm sinh): .............................................................................
+ Giới: 1:Nam ; 2: Nữ
+ Nghề nghiệp:....................................................................................................
+ Dân tộc: ...........................................................................................................
+ Địa chỉ (Ghi theo địa giới):.............................................................................
+ Điện thoại:........................................................................................................
+ Ngày khám: .....................................................................................................
II.Quá trình nắn chỉnh răng:
+Thời gian bắt đầu gắn khí cụ: Ngày..........Tháng.............năm..........................
+Loại mắc cài sử dụng: 1:Mắc cài thường 2:Mắc cài tự buộc
+Vật liệu mắc cài: 1:Kim loại
2:Sứ
B. PHIẾU PHỎNG VẤN
Mã số
Câu hỏi
A1
Bạn cho biết lý do bạn nắn chỉnh răng?
A2
A3
Đáp án
1.Thẩm mỹ:Răng chen
chúc,vẩu,móm…
2.Lý do khác: ghi cụ thể
Bạn hãy cho biết từ khi nắn chỉnh răng
1.Chải < 3 lần/ngày.
bạn chải răng với kem chải răng bao
2.Chải ≥ 3 lần/ngày.
nhiêu lần một ngày ?
Bạn hãy cho biết từ khi nắn chỉnh răng bạn 1. Thỉnh thoảng hoặc không.
có hay ăn vặt ngoài 03 bữa ăn chính không ? 2.Thường xuyên
C. PHIẾU KHÁM BỆNH NHÂN
- Cặn bám:
có □
không □
- Chất gắn thừa:
có □
không □
- Viêm lợi:
có □
không □
- Khám tổn thương đốm trắng:
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2. Răng hàm dưới
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3.3
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3.5
4.4
Ngày
TTĐT
4.5
tháng năm 2014
Người khám
Bác sỹ Vũ Văn Tuồng
TTĐT