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SUPPLEMENTARY DOCUMENT LEFT UNILATERAL COMPLETE CLEFT LIP AND PALATE PHOTOGRAPH 1 PHOTOGRAPH 2 PHOTOGRAPH 3 PHOTOGRAPH 4 1
SUPPLEMENTARY DOCUMENT
LEFT UNILATERAL COMPLETE CLEFT LIP AND PALATE
PHOTOGRAPH 1 PHOTOGRAPH 2
PHOTOGRAPH 3 PHOTOGRAPH 4
1
RIGHT UNILATERAL COMPLETE CLEFT LIP AND PALATE
PHOTOGRAPH 5 PHOTOGRAPH 6
LEFT UNILATERAL INCOMPLETE LIP
PHOTOGRAPH 7
2
BILATERAL CLEFT LIP AND PALATE
PHOTOGRAPH 8 PHOTOGRAPH 9
PHOTOGRAPH 10 PHOTOGRAPH 11
3
PHOTOGRAPH 12
LEFT SIDE COMPLETE CLEFT PALATE
PHOTOGRAPH 13
CLEFT PALATE ONLY
BLOOD COLLECTION & STORAGE
4
PHOTOGRAPH 14 PHOTOGRAPH 15
PHOTOGRAPH 16 PHOTOGRAPH 17
DNA EXTRACTION
PHOTOGRAPH 18
5
ARMAMENTARIA FOR DNA EXTRACTION
PHOTOGRAPH 19
300 L OF BLOOD SAMPLE IN MICRO-CENTRIFUGE TUBE
PHOTOGRAPH 20
RBC LYSIS
PHOTOGRAPH 21
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CENTRIFUGE MACHINE USED FOR DNA EXTRACTION
PHOTOGRAPH 22 PHOTOGRAPH 23 PHOTOGRAPH 24
PELLET OBTAINED AFTER RBC LYSIS
PHOTOGRAPH 25
PROCEDURE OF CELL LYSIS
PHOTOGRAPH 26 PHOTOGRAPH 27
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STEPS OF DNA BINDING
PHOTOGRAPH 28
VORTEX MACHINE USED
PHOTOGRAPH 29
WARM DRY BATH USED
PHOTOGRAPH 30
8
SPECTROPHOTOMETER (NANODROP)
PHOTOGRAPH 31
RECORDING CONCENTRATION OF DNA
PHOTOGRAPH 32 PHOTOGRAPH 33
DEEP FREEZER USED FOR STORAGE OF SAMPLES
POLYMERASE CHAIN REACTION
PHOTOGRAPH 34
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THERMAL CYCLER (BIO RAD)
PHOTOGRAPH 35
: PCR TUBES LOADED INTO THE PCR MACHINE
PHOTOGRAPH 36
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ARMAMENTARIUM FOR PCR
PHOTOGRAPH 37
PCR PROGRAMME AS SET IN THE PCR MACHINE
PHOTOGRAPH 38
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PROGRAMME SET FOR RFLP
PHOTOGRAPH 39
AGROSE GEL BEFORE ELECTROPHORESIS
PHOTOGRAPH 40
: SAMPLES LOADED INTO THE WELLS FOR ELECTROPHORESIS
PHOTOGRAPH 41:
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ELECTROPHORESIS TANK WITH POWER PACK
PHOTOGRAPH 42, 43
U.V. TRANS-ILLUMINATOR DEVICE
ANNEXURE – 4TAMIL NADU GOVT. DENTAL COLLEGE & HOSPITAL CHENNAI – 3
13
S.NO :
DEPT. OF PUBLIC HEALTH DENTISTRY
TITLE: ASSOCIATION BETWEEN MATERNAL EXPOSURE TO DIFFERENT FORMS OF
TOBACCO, THE PRESENCE OF TGFA GENE AND THE OCCURRENCE OF ORAL CLEFTS.
QUESTIONNAIRE
DEMOGRAPHIC DATA:
1. Name: Surname:2. Age: (Years)3. Date of Birth: / / 4. Place of Birth:5. Religion: Hindu/ Muslim/ Christian/ Sikh/ Buddhist/ Jain/ others specify6. Educational Qualification (Number of years of Formal Education):7. Occupation:
a. Business/Professional and Semiprofessional b. Semiskilled & Unskilled workerc. Unemployedd. Retirede. Housewivesf. Studentsg. Others/ Not Classifiedh. Not Known/ Applicable
8. Marital Status: a. Unmarried b. Married c. Widowed d. Separated to Divorced e. Not Applicable
9. Individual Income (per month): Rs. 10. Per capita Income: Rs. / person11. Area of Residence: 1. Rural 2. Urban12. Address:
Place: Ph.No:
MATERNAL RISK FACTORS
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13. Maternal/Paternal Age (Risk Factor 1):a. Maternal Age during delivery of child? --------------------b. Paternal Age during delivery of child? ----------------------c. Maternal Age during delivery of first child (if any)? ------------d. Paternal Age during delivery of first child? ---------------------e. Duration gap (in years) between previous pregnancy and the present
pregnancy? ---------------------
14. Medical History(Risk Factor 2):
Cardiovascular System:
a. Anginab. Myocardial Infarctionc. Arterial disease d. Hypertensione. Valvular Heart diseasef. Congenital Heart Diseaseg. Disorders of Heart rate, Rhythm and conduction
Respiratory System:
a. Diseases of Nasopharynxb. Diseases of Larynxc. Tracheal Disordersd. Asthma e. COPD f. Bronchiectasisg. Lung Infections
Central Nervous System:
a. Headache b. Facial Painc. Vertigo d. Epilepsye. Cerebrovascular Disease (including Stroke)f. Neurological Disorders g. Cervical Spondylosis
Gastro-Instestinal System:
a. Gastritis/Acid Peptic Disease b. Irritable Bowel Disease c. Inflammatory Bowel Diseased. Reflux oesophagitise. Constipation
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Endocrine System:
a) Diabetes Mellitusb) Hypothyroidism c) Hyperthyroidismd) Hyperparathyroidism e) Hypoparathyroidism / Tetany f) Addison’s Disease g) Cushing’s Diseaseh) Disorders of pituitary gland (including Acromegaly)i) Menstrual Abnormalities
Uro-genital System
a. Renal Disordersb. Urinary Tract Infections
Blood:
a. Anemia’s
b. Bleeding Disorders
c. Venous Thrombosis
Diseases of Bone and Joints:
a. Osteoporosisb. Osteomalacia and Ricketsc. Pagets Diseased. Primary Bone Diseasee. Rheumatoid Arthritis f. Bone and Joint infection
Infectious Diseases during Pregnancy:
a. Syphilisb. Chlamydia Trachomatis infectionc. Cytomegalovirus infectiond. Herpes simplex virus Infectione. Varicella Zoster Infectionf. Hepatitis B virus infectiong. HIV infectionh. Parvo virus infectioni. TORCH complex
Miscellaneous:
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a. History of Trauma and Accidents b. Recent Hospitalization 15. Obsteric History (Risk Factor 3):
a. No. of Pregnancy: First/Second/ Third/ Fourth and beyond
b. History of any abortion? Yes/No
c. History of pre term low birth weight child?Yes/ No
16. Maternal Obesity (Risk Factor 4):a. Did you have substantial weight gain (>8kg) between first and
second Pregnancy?Yes/No
b. Height:Weight:BMI:
17. Drug History(Risk Factor 5): A. Drug use During First Three months of Pregnancy: 1. Yes2. No
S.NO. DRUG DOSAGE FREQUENCY DURATIONANTI COAGULANTS
ACENOCOUMAROLDICOUMAROLWARFARIN SODIUMETHYLBISCOUM ACETATE
ANTI PLATELET DRUGSASPIRINCLOPIDOGRELDIPYRIDAMOLETICLOPIDINEABCIXIMAB
LIPID LOWERING DRUGSATORVASTATIN
CORTICOSTEROIDSPREDNISOLONEBETAMETHASONETRIAMCINOLONEDEXAMETHASONE
ANTI EPILEPTIC DRUGSPHENYTOINCARBAMAZEPINEVALPROATEDIAZEPAMPHENOBARBITONESUCRALFATE
ANTI EMETIC DRUGS
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METOCLOPRAMIDEDOMPERIDONESULFASALIZINELOPERAMIDEPANTOPRAZOLE
DIURETICSFUROSEMIDESPIRONOLACTONEACETAZOLAMIDEAMILORIDE
NUTRITIONAL SUPPLEMENTSFERROUS SULFATEFOLIC ACIDBCTMVTASCORBIC ACIDCALCIUM PREPARATIONSVIT A (ISOTRETINOIN specifically)VIT CVIT K
ANTI TUBERCULOUS DRUGSISONIAZIDPYRAZINAMIDEETHAMBUTOL
IMMUNOSUPPRESSANTSCYCLOSPORINEMETHOTREXATECYCLOPHOSPHAMIDE
ANTI CANCER DRUGSCYCLOPHOSPHAMIDEMETHOTREXATE5-FLUROURACILBLEOMYCINDANORUBICINDOXARUBICINCISPLATIN
18. Family History (Risk Factor no 6):a. Does your husband have similar disease?
1. Yes2. No3. Cannot recall
b. Do your parents/husbands parents have similar disease?1. Yes2. No3. Cannot Recall
c. Do your siblings/ your husband’s siblings have similar disease?1. Yes2. No
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3. Cannot recall d. Is this disease common in your family/husbands family?
4. Yes 5. No6. Cannot recall
e. Do any of your distant relatives known to you have similar disease?1. Yes2. No3. Cannot Recall
19. Consanguinity (Risk factor no.7):a. Did you have a consanguineous marriage?
1. Yes2. No3. Cannot Recall
b. If Yes, what is the degree of consanguinity?1. First Degree2. Second Degree3. Cannot Recall
c. Are consanguineous marriages common in your family?1. Yes2. No3. Cannot Recall
d. If Yes, what is the degree of consanguinity?1. First Degree2. Second Degree3. Cannot Recall
20. Maternal Alcohol Usage (Risk factor no 8):a. Do you consume Alcohol?
1. Yes2. No
b. Alcohol use in last one year (pattern)1. Daily Drinking2. Regular Drinking (3 or more times/week)3. Social Drinking (<3times week)4. None
c. Average amounts per drinking day _______________________*Average units (30ml spirit, 60ml wine/ ½ mug beer = 1 unit)
21. Diet during Pregnancy (Risk Factor no 9):
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a. WHAT IS YOUR STAPLE DIET?
A) RICE B) WHEAT C) MAIZE D) RAGI E) BAJRA CEREALS INTAKE
FREQUENCY OF INTAKE
RICE GROUP RAGI BAJRA JOWARIDLY DOSA UPMA PORRIDGE PONGAL BOILED
RICERAGIPORRIDGE
BAJRA PORRIDGE
JOWAR
NUMBER OF SERVINGS1 TIME / DAY2-3 TIMES / DAY
>3 TIMES/DAY1 TIME / WEEK2-3 TIMES / WEEK
>3 TIMES/WEEK1 TIME / MONTH
2-3 TIMES / MONTH>3 TIMES/MONTH
PULSES INTAKE
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FREQUENCY OF INTAKE
WHEAT GROUP MAIZE GROUPCHAPPATHI POORI BREAD BAROTTA WHEAT
DOSACORN FLAKES SWEET
CORN NUMBER OF SERVINGS
1 TIME / DAY2-3 TIMES / DAY
>3 TIMES/DAY1 TIME / WEEK2-3 TIMES / WEEK
>3 TIMES/WEEK1 TIME / MONTH
2-3 TIMES / MONTH>3 TIMES/MONTH
FRUITS INTAKE
A) DO YOU CONSUME RAW FRUITS ALONG WITH YOUR DIET? A) YES B) NO C) YES, BUT SOMETIMES
B) HOW OFTEN? A) ONE SERVING/ DAY B) TWO SERVINGS/ DAY
C) THREE SERVINGS /DAY D) FOUR SERVINGS/ DAY
E) >FOUR SERVINGS/ DAY
FRUIT ITEMS
FREQUENCY OF INTAKE
1 TIME / DAY
2-3 TIME / DAY
>3 TIMES/DAY
1TIME /WEEK
2-3 TIMES / WEEK
>3 TIMES/WEEK
1 TIME / MONTH
2-3 TIMES / MONTH
>3 TIMES/MONTH
BANANAAPPLEPEARSGUAVA
JACK FRUITPAPAYA
ORANGESGRAPES
PINE APPLEWATER MELONPOMEGRANATE
MANGOSAPOTADATES
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FREQUENCY OF INTAKE
PULSESPLAIN DHAL
SAMBAR BENGAL GRAM
SOYABEAN
PEAS BLACK GRAM
GREEN GRAM
RED GRAM
KHESARI DHAL
COW PEA
NUMBER OF SERVINGS1 TIME / DAY
2-3 TIMES / DAY
>3 TIMES/DAY
1 TIME / WEEK
2-3 TIMES / WEEK
>3 TIMES/WEEK
1 TIME / MONTH
2-3 TIMES / MONTH
>3 TIMES/MONTH
DRY FRUITSJAMBU FRUITWOOD APPLEZIZHYPHUS
PALMYRA
.FOOD FROM ANIMAL SOURCE
1) DO YOU CONSUME FOOD FROM ANIMAL SOURCE ALONG WITH YOUR DIET?
A) YES B) NO C) YES, BUT SOMETIMES
2) MENTION THE FOOD FROM ANIMAL SOURCE DO YOU CONSUME?
A) EGG B) MILK C) MEAT D) SEA FOOD E) POULTRY
3) IF YES, HOW OFTEN?
A) ONE SERVING/ DAY B) TWO SERVINGS/ DAY C) THREE SERVINGS /DAY D) FOUR SERVINGS/ DAY D) >FOUR SERVINGS/ DAY
VEGETABLE INTAKE
1) HOW OFTEN DO YOU EAT VEGETABLES?
A) ONE SERVING/ DAY B) TWO SERVINGS/ DAY C) THREE SERVINGS /DAY D) FOUR SERVINGS/ DAY
E) >FOUR SERVINGS/ DAY
1 TIME / DAY
2-3 TIMES / DAY
>3 TIMES/DAY
1TIME /WEEK
2-3 TIMES / WEEK
>3 TIMES/WEEK
1 TIME / MONTH
2-3 TIMES / MONTH
>3 TIMES/MONTH
NEVER
NUMBER OF SERVINGS
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FREQUENCY OF INTAKE
FOOD FROM ANIMAL SOURCEEGG MILK MEAT FISH OTHER SEA
FOODSPOULTRY
1 TIME /WEEK 2-3 TIMES /WEEK
>3 TIMES/WEEK 1 TIME / MONTH2-3 TIMES / MONTH
>3 TIMES/MONTHNEVER
SPINACHCARROT CURRYPLANTAIN CURRYBRINJAL CURRY WITH OTHER DISH
POTATO CURRY LADY’S FINGER CURRY BEETROOT
TOMATO CURRY RADDISH CURRY
CAPSICUM CURRY BEANS CURRY
BROAD BEANS AS A MIXED VEGCLUSTER BEANS AS A MIXED VEGDOUBLE BEANS
CAULIFLOWER CURRY/WITH OTHER DISHDRUMSTICK CURRY
CABBAGE CURRYBITTER GOUTD CURRYRIDGE GOURD CURRYSNAKE GOURD CURRYSUNDAKKAI CURRYMANGO GREEN AS A MIXED VEGCHO CHO MARROWPUMPKIN AS A MIXED VEGASH GOURD AS A MIXED VEGBROAD BEANS AS A MIXED VEGKOVAI AS A MIXED VEGPLANTAIN FLOWER AS A MIXED VEGPLANTAIN STEM AS A MIXED VEGPLANTAIN GREEN AS A MIXED VEG
22. Exposure to Environmental Pollutants (Risk factor no 10):a. Where there any factories or industrial plants located in nearby area that emitted
fumes, gases or particles of any kind?
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1. Yes2. No3. Cannot Recall
b. If so what was the type of factory (eg. Chemical plant, cotton textile plant):
--------------------------------------------------------------------------c. Is there any water nearby your home that is polluted by an industrial plant?
1. None2. Phosphate Fertilizer Plant3. Pesticide plant4. Cement Plant5. Chemical Plant6. Electroplate plant7. Other plant
d. If yes, was this plant polluting the soil, eg. via waste residues?1. Yes2. No
e. Where does the water used for drinking/cooking comes from?1. Pure water2. Public Water Supply3. Deep well water4. Shallow well water5. Rain water6. River water7. Ditch Water8. Pond Water9. Other (Specify)
f. Did you drink un boiled water during pregnancy?1. No2. Occasionally3. Sometimes4. Usually
g. Have you been exposed to diagnostic X rays during pregnancy?1. Yes2. No
h. Did you undergo Radiotherapy before?a. Yesb. No
23. Maternal Tobacco usage (Risk factor no.11):
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a.Whether used any form of tobacco (Smoking/ Smokeless) during Pregnancy?a. Yes b. Noc. Cannot Recall
b. Was tobacco used regularly during the First Trimester of Pregnancy? 1. Yes2. No3. Cannot Recall
c. Where you exposed to Second Hand Smoke during the time of pregnancy?1. Yes2. No3. Cannot Recall
a. Details of Tobacco Use: (Maternal/Paternal)
Type Age of Onset
Average No. of cigs/ bidis/ sachets used per day
No. of years of Regular Tobacco use
Sachet/ Cigarette years(No. of cigs. Bidis/ sachets used per day X No. of years of regular tobacco used)
Average number of cigarettes/ sachets, amount of tobacco chewed per day in the last one month
Smoking1.
2.
3.Smokeless1.
2.
3.
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b. Severity: (Maternal/Paternal)
Fagerstrom Addiction Scale for Smokers1. How soon after you wake up do you smoke your first cigarette?
Within 5 minutes 3 6 to 30 minutes 2 31 to 60 minutes 1 More than 60 minutes 0
2. Do you find it difficult to refrain from smoking in places where it is forbidden (eg. Church, at library, at the movie)?
Yes 1 No 0
3. Which of the cigarettes would you most hate to give up?
First one in the morning 1 Any others 0
4. Do you smoke if you are so ill that you are in bed most of the day?
Yes 1 No 0
5. How many cigarettes per day do you smoke?
10 or less 0 11-20 1 21 to 30 2 31 or more 3
6. Do you use tobacco more frequently during the first hours after waking than during the rest of the day?
Yes 1 No 0
Your score =The highest possible score = 10. The Closer to zero your score, the less dependent you are on tobacco. The higher the score, the more strongly you are addicted.
Fagerstrom Questionnaire for Smokeless Tobacco Users1. After a normal sleeping period, do you use smokeless
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tobacco within 30 minutes of waking? Yes 1 No 0
2. Do you use smokeless tobacco when you are sick or have mouth sores?
Yes 1 No 0
3. How many times do you use per week? Less than 2 times 0 More than 2 times 1 More than 4 times 2
4. Do you intentionally swallow your tobacco juices rather than spit?
Never 0 Sometimes 1 Always 2
5. Do you keep a dip or chew in your mouth almost all the time?
Yes 1 No 0
6. Do you experience strong cravings for a dip or chew when you go for more than two hours without one?
Yes 1 No 0
7. On average, how many minutes do you keep a fresh dip or chew in your mouth?
10-19 minutes 1 20-30 minutes 2 More than 30 minutes 3
8. What is the length of your dipping day (total hours from the first dip/ chew in a.m. to last dip/ chew in p.m.
Less than 14.5 hours 0 More than 14.5 hours 1 More than 15 hours 2
9. On average, how many dips/ chew do you take each day? 1-9 times 1 10-15 times 2 >15 times 3
Your score:The Highest Possible score = 16. The Closer to zero your score, the less dependent you are on tobacco. The higher the score, the more strongly you are addicted.
c. Family History in first – degree relatives:
Tobacco use 1. Yes 2. No If Yes, ______________________________
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d. Details of Passive Smoking: 1. Where do you get exposed to second hand smoke?
a. At homeb. At Work Placec. Public placesd. Cannot Recall
2. How many cigarettes does your husband/ members of family smoke per day?a. 1-10 cigarettesb. 11-20 cigarettesc. 20-30 cigarettesd. More than 30 cigarettese. Cannot Recall
3. No of years of exposure to Second Hand smoke? a. <5 years;b. 5-10 years;c. > 10 years
4. Duration of exposure to Second Hand Smoke per day? a. < 30 min;b. 30 min – 1 hour;c. > 1 hour
e. Details of use of Nicotine Replacement Therapy: 1. Do you use any Nicotine Replacement therapy?
a. Yesb. Noc. Cannot Recall
2. Did you use the same during Pregnancy (First Trimester)?a. Yesb. No c. Cannot Recall
f. Details of quitting Tobacco: 1. Did you stop tobacco usage during Pregnancy?
a. Yesb. No
2. Did you experience with-drawl symptoms on quitting tobacco during pregnancy?a. Yesb. No
ANNEXURE – 5
TAMILNADU GOVT. DENTAL COLLEGE & HOSPITAL CHENNAI -3
28
S.NO :
DEPT. OF PUBLIC HEALTH DENTISTRY
TITLE: ASSOCIATION BETWEEN MATERNAL EXPOSURE TO DIFFERENT FORMS OF TOBACCO, THE PRESENCE TGFA GENE AND THE OCCURRENCE
OF ORAL CLEFTS.
CASE RECORD FORM
OP.NO :
DATE : : : 20
NAME : Mr / Ms/ :
AGE : YEARS
SEX : MALE / FEMALE
DATE OF BIRTH :
PLACE OF BIRTH :
RELIGION : HINDU / MUSLIM / CHRISTIAN / JAINISM / BUDDHISM / OTHERS
ADDRESS :
CITY : STATE : PIN :PHONE :
CHIEF COMPLAINT
HISTORY OF PRESENTING ILLNESS
MEDICAL HISTORY
DRUG HISTORY
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DENTAL HISTORY
GENERAL EXAMINATION :
I RESPIRATORY SYSTEM a) RESPIRATORY RATE :
b) RESPIRATORY RHYTHM : c) CLUBBING : d) CYANOSIS : e) SHAPE OF CHEST : f) CHEST MOVEMENTS : g) USE OF ACCESSORY RESPIRATORY MUSCLES : h) INTERCOSTAL RECESSION : i) TRAILE’S SIGN : j) VENOUS PULSES : k) VOCAL FREMITUS :
II CARDIOVASCULAR SYSTEM a) PULSE RATE : b) PULSE RHYTHM : c) PULSE VOLUME : d) PULSE CHARACTER : e) PULSE SYMMETRY : f) CYANOSIS : g) CLUBBING : h) PYREXIA : i) COLDNESS OF EXTREMITIES : j) PITTING OEDEMA : k) JUGULAR VENOUS PRESSURE :
III GASTRO-INTESTINAL TRACT a) SHAPE OF ABDOMEN : b) CONTOUR OF ABDOMEN : c) MOVEMENT OF ABDOMINAL WALL : d) CLUBBING : e) PALMAR ERYTHEMA : f) JAUNDICE : g) SPIDER NAEVI : h) PAROTID SWELLING : i) GUARDING : j) RIGIDITY : k) REBOUND TENDERNESS : l) PROMINENT SUPERFICIAL VEINS : m) DISTENDED VEINS
AROUND UMBLICUS : n) MURPHY’S SIGN :
IV CENTRAL NERVOUS SYSTEM
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a) GAIT : b) CONSCIOUSNESS : c) ORIENTATION : d) EMOTIONAL STATE : e) VISUAL FIELDS : f) REFLEXES : g) ANY INVOLUNATRY MOVEMENTS : h) SENSORY SYSTEM : i) MOTOR WEAKNESS : j) DELUSIONS : k) HALLUCINATIONS : l) CO-ORDINATION OF MOVEMENTS : m) ROMBERG’S SIGN : n) CRANIAL NERVES : o) SPECIAL SENSES :
V ENDOCRINE SYSTEM a) FACIAL APPEARANCE : b) DISTRIBUTION OF FAT : c) SKELETAL PROPORTIONS : d) PALMAR ERYTHEMA : e) PIGMENTATION : f) PALMAR CONTRACTURES : g) PHERIPERAL NEUROPATHY : h) SWELLING IN NECK : i) DROP IN BLOOD PRESSURE : j) CORNEAL CALCIFICATION : k) VIOLACEOUS STRIAE : l) CHVOSTEK’S SIGN :
VITAL SIGNS : i) PULSE RATE : /MIN ii) RESPIRATORY RATE : /MIN iii) TEMPERATURE : 0C iv) BLOOD PRESSURE : mm of Hg
NUTRITIONAL STATUS : i) HEIGHT : ii) WEIGHT : iii) BODY MASS INDEX (BMI) : Wt. in Kg / (Ht. in mt.)2 (QUETELET’S FORMULA) : INFERENCE :
LOCAL EXAMINATION : a) EXTRA ORAL i) SYMMETRY : YES / NO
ii) CLEFT LIP : PRESENT/ NOT PRESENT iii) SEVERITY OF CLEFT LIP : UNILATERAL/ BILATERAL ii) TMJ 1) MOUTH OPENING : mm
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2) CLICKING SOUND : PRESENT / NOT PRESENT 3) PAIN : PRESENT / NOT PRESENT 4) TENDERNESS : PRESENT / NOT PRESENT 5) DEVIATION : PRESENT / NOT PRESENT
6) MOVEMENTS a) PROTRUSION : b) RETRUSION : c) DEPRESSION : d) ELEVATION : e) LATERAL :
iii) CERVICAL LYMPHADENOPATHY : b) INTRA ORAL i) SOFT TISSUE 1) LABIAL MUCOSA : 2) BUCCAL MUCOSA : 3) PALATAL MUCOSA : 4) FLOOR OF THE MOUTH : 5) PILLAR OF FAUCES : 6) TONGUE : 7) TONSILS : 8) FRENAL ATTACHMENT : UPPER :
LOWER : ii) HARD TISSUE 1) MAXILLA : 2) MANDIBLE : 3) CLEFT PALATE : PRESENT/ABSENT
4) SEVERITY OF CLEFT PALATE (USING KERNAHANS CLASSIFICATION)
5) TYPE OFDENTITION : DECIDOUS / PERMANENT / MIXED 6) NO: OF TEETH PRESENT : 7) MISSING TEETH : a) REASON : 8) DENTAL CARIES : 9) FILLED TEETH :
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10) ENAMEL HYPOPLASIA i) HEREDITARY : ii) ENVIRONMENTAL :
I F FLUOROSIS PRESENT SCORE : 11) MALOCCLUSION : SKELETAL / DENTAL / COMBINATION
ANGLE’S CLASS I / CLASS II / CLASS III 12) SUPERNUMERARY TEETH : 13) FRACTURED TEETH : YES / NO IF YES , ELLIS CLASS: 16) PERIODONTAL STATUS a) GINGIVA i) COLOUR : ii) SHAPE : iii) CONTOUR : iv) CONSISTENCY : v) SURFACE TEXTURE : vi) BLEEDING ON PROBING : vii) EXUDATE : b) PERIODONTAL POCKET :
c) MOBILITY : YES / NO, IF YES, MILLER’S CLASS :
PROVISIONAL DIAGNOSIS :
INVESTIGATIONS : a) MODELS : b) RADIOGRAPHS
i) INTRA ORAL : ii) EXTRA ORAL : c) PHOTOGRAPHS : d) OTHERS :
TREATMENT PLAN :
I EMERGENCY PHASE :
II CURATIVE PHASE :
III THERAPEUTIC PHASE :
IV PREVENTIVE PHASE :
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