|
Muscles and Manual Palpation WNL
|
Muscles and Manual Palpation ABN
|
|
Auricular, pre
• • •
|
Auricular, intra
• • •
|
|
Buccinator insertion
• • •
|
Buccintor origin
• • •
|
|
Carotid arteries
• • •
|
Cervical muscles, deep posterior
• • •
|
|
Cervical vertebra
• • •
|
Collateral ligament, lateral
• • •
|
|
Cornu of the hyoid bone, greater
• • •
|
Coronoid process
• • •
|
|
Digastric, anterior
• • •
|
Digastric, posterior
• • •
|
|
Fibro tender points
• • •
|
lnfrahyoid muscles
• • •
|
|
Joint space, posterior
• • •
|
Levator scapulae
• • •
|
|
Masseter, deep
• • •
|
Masseter, superficial
• • •
|
|
Mylohoid
• • •
|
Occipital
• • •
|
|
Occipital, greater
• • •
|
Occipital, lessor
• • •
|
|
Orbicularis oculi
• • •
|
Orbicularis oris
• • •
|
|
Paravertebrals
• • •
|
Parotid gland
• • •
|
|
Pterygoid, lateral
• • •
|
Pterygoid, medial
• • •
|
|
Scalenes, anterior
• • •
|
Scalenes, middle
• • •
|
|
Scalenes, posterior
• • •
|
Scapularis
• • •
|
|
Splenius capitis
• • •
|
Splenius cervicis
• • •
|
|
Sternocleidomastoid
• • •
|
Styloid process
• • •
|
|
Stylomandibular ligament
• • •
|
Sublingual gland
• • •
|
|
Suprahyoid muscles
• • •
|
Temporal tendon
• • •
|
|
Temporalis, anterior
• • •
|
Temporalis, middle
• • •
|
|
Temporalis, posterior
• • •
|
Teres minor
• • •
|
|
TMJ capsule, lateral
• • •
|
Trapezius neck area
• • •
|
|
Trapezius shoulder area
• • •
|
Zygomaticus major
• • •
|
|
|
|
|
Range of motion WNL
|
Range of Motion ABN
|
|
Max ACTIVE opening WITHOUT pain ___mm
|
Max ACTIVE opening WITH pain ___mm
|
|
Max PASSIVE opening WITHOUT pain ___mm
|
Max PASSIVE opening WITH pain ___mm
|
|
Mandibular dev from mid-sagittal plane __ mm
|
Maximum interincisal opening __ mm
|
|
Max protrusion with click __ mm
|
Max protrusion w/o click __ mm
|
|
Left lateral excursion __ mm
|
Right lateral excursion __ mm
|
|
Deviation to left
|
Deviation to right
|
|
|
|
|
Dental Relationship WNL
|
Dental Relationship ABN
|
|
Left Molar Class
|
Right Molar Class
|
|
Left Skeletal
|
Right Skeletal
|
|
Overjet (CO) ___ mm
|
Overjet (CR) ___ mm
|
|
Overbite (CO) ___ mm
|
Overbite (CR) ___ mm
|
|
|
|
|
Tooth Examination
|
Tooth Exam ABN
|
|
|
Teeth Exam (ABN)
• • •
|
|
Trauma to tooth # ____
|
Missing tooth # ____
|
|
Prothesis present (type)
|
Mobile tooth# ___
|
|
|
Teeth in crossbite # ___
|
|
|
|
|
Occlusal Analysis WNL
|
Occlusal Analysis ABN
|
|
|
Occlusal Analysis (ABN)
• • •
|
|
Trauma to tooth # ____
|
Missing tooth # ____
|
|
Prothesis present (type)
|
Mobile tooth# ___
|
|
|
Teeth in crossbite # ___
|
|
|
|
|
Peridontal Examination WNL
|
Peridontal Examination ABN
• • •
|
|
|
|
|
Joint Sounds (Exam Type)
• • •
|
|
|
Joint Sounds WNL
|
Joint Sounds ABN
|
|
|
Left
• • •
|
|
|
RIght
• • •
|
|
|
Both
• • •
|
|
|
|
|
Cervical Range of Motion WNL
|
Cervical Range of Motion ABN
• • •
|
|
Skeletal Morphology and Posture WNL
|
Skeletal Morphology and Posture ABN
• • •
|
|
Forward head position of ___ cm
|
|
|
Sleeping position
• • •
|
Work Posture
• • •
|
|
|
|
|
Higher Cognitive Functioning WNL
|
Higher Cognitive Functioning ABN
• • •
|
|
Craniomandibular Manipulation WNL
|
Craniomandibular Manipulation ABN
• • •
|
|
Cranial Nerves WNL
|
Cranial Nerves ABN
• • •
|
|
|
|
|
Intraoral and Upper Airway Exam WNL
|
Intraoral and Upper Airway Exam ABN
|
|
|
Tongue
• • •
|
|
Tongue level
|
Tongue level is
• • •
|
|
|
Swallow
• • •
|
|
Mallampati Classification (circle)
|
Mallampati Classification
|
|
Tonsils
|
Tonsils
• • •
|
|
Uvula
• • •
|
Aednoids
• • •
|
|
Soft Palate
• • •
|
Gag Reflex
• • •
|
|
Nasal Passages
• • •
|
Turbinates
• • •
|
|
Maxilla
• • •
|
Mandible
• • •
|
|
|
|
|
Imaging Records
• • •
|
|
|
Diagnostic Records
• • •
|
If other diagnostics:
|
|
|
|
|
Presence of co-morbid CS syndromes
• • •
|
Comments
|
