Case history: Surface caries. Enamel caries stage of white (chalky) spot, initial caries
Diary
Industrial practice
"Dentist's Assistant - Therapist"
For 4th year students
Student______________________________
Groups_______ subgroups______________
Address of the base institution _____________
______________________________________
Start of practice________________
End of practice_____________
NALCHIK - 2016
In the Kabardino-Balkaria, the basic medical institutions are RSP, GPS-1, GSP-2, the polyclinic of the SPH KBSU, dental clinics in Prokhladny, Baksan, Nartkala, Tyrnyauz.
Students living outside the Kabardino-Balkaria region may be sent to practice at their place of residence upon submission of a personal application and written notification to the head of the medical institution where the practice will be conducted that they agree to accept the student for practice.
Industrial practice pursues the following goals:
1) test knowledge and consolidate practical skills related to the diagnosis, treatment and prevention of dental caries and periodontal diseases;
2) practical development of the structure of the dental clinic;
3) organization of its work to provide dental care to the population;
4) gaining experience in hygienic training.
The practice is carried out after the completion of the spring examination session in the VI semester for all students.
During the internship period, students work according to the schedule of the medical institution, adhering to the internal rules established for employees of this medical institution. The student trainee is busy seeing patients every day for 6 hours as a dental assistant and independently sees patients under the guidance of a doctor in the therapeutic department.
When undergoing internship, a student is obliged to:
Comply with the internal labor regulations in force at the institution;
Study and strictly follow the rules of labor protection, safety and industrial sanitation;
Be responsible for the work performed and its results; Must remember and follow the basics of deontology;
Show a sensitive and attentive attitude towards patients;
Strictly adhere to the principles of professional ethics, correctly build your relationships with the staff of the medical institution;
Take part in health education and professional events;
Participate in medical scientific and practical conferences.
The student must complete the following documentation:
Outpatient medical history of the dental patient;
Diary of daily records of patients;
Patient appointment log;
A student’s practical training diary in which to record the results of their work daily.
During the internship as a dental assistant, the student must:
know:
– organization of a therapeutic room (department);
– sanitary and hygienic requirements;
– anatomical and histological structure of primary and permanent teeth;
– structure of the pulp and periodontium;
– topography of the cavity of various groups of teeth;
– dental instruments;
– etiology, clinic, pathological anatomy of caries, pulpitis, periodontitis, non-carious lesions of hard dental tissues;
– new research methods used in therapeutic dentistry (rheodentography, rheoparodontography, Doppler flowmetry, radiovisiography, etc.);
– modern filling materials used in therapeutic dentistry;
– modern methods of treatment.
be able to:
– carry out pain relief (application, injection);
– carry out retherapy for the purpose of prevention and treatment of initial forms of caries, application of remineralizing drugs (fluoride-containing varnishes, gels, etc.);
– prepare carious cavities of classes I-V, atypically located cavities;
– carry out antiseptic treatment and drying of carious cavities;
– mix filling materials for temporary and permanent fillings, root canals, therapeutic and insulating pads;
– apply therapeutic and insulating pads, temporary fillings and bandages;
– filling carious cavities with cement, amalgam, composite materials;
– grind and polish fillings;
– apply pastes to devitalize the pulp;
– remove temporary and permanent fillings;
– open the cavities of teeth of all groups, trepanate the crowns of intact teeth;
– carry out amputation and pulp extirpation;
– carry out mechanical treatment of root canals for pulpitis;
– carry out mechanical treatment of root canals for periodontitis;
– carry out medicinal treatment and drying of the root canal;
– filling root canals with pastes;
– filling root canals using pins (lateral and vertical condensation);
– fill root canals with thermophile;
– prepare a resorcinol-formalin mixture;
– impregnate difficult-to-pass channels with a resorcinol-formalin mixture;
– justify the choice of instruments for mechanical treatment of the root canal using the Step back method;
– justify the choice of instruments for mechanical treatment of the root canal using the Crown down method.
own:
– examination of the patient:
– collecting anamnesis;
– examination of the maxillofacial area;
– percussion;
– probing and palpation;
– differential diagnosis;
– drawing up an examination and treatment plan;
– determining the type of plaque on the teeth, tartar, its color, consistency;
– carrying out professional oral hygiene;
– conducting training and monitoring oral hygiene;
– determination of the working length of the root canal using an x-ray method;
– determining the presence of destructive processes in periodontal tissues on an x-ray;
– determination of indications for various methods of treating dental diseases;
– preparation of documentation (outpatient dental record, daily record sheet of the dentist’s work, diary of treatment and preventive work, etc.).
– preparation of recipes and directions.
At the end of the internship, the student is required to submit a written report to the internship supervisor on the completion of all tasks, as well as:
Diary of industrial practice;
Medical history;
Abstract;
Conclusion of the head of the medical institution;
Sanitary education work
2. Complete a health bulletin.
Educational and research work
In order to increase creative activity, each student during practical training is required to carry out research that has current scientific and practical significance.
Subjects of UIRS
1. Basic performance indicators of a dentist-therapist.
2. The scope of work of a dentist-therapist working on a differentiated therapeutic appointment.
3. The local principle of serving the population. Main types of work.
4. Analysis of accounting for the work of a dentist-therapist.
5. Dental morbidity of the population served.
6. Analysis of morbidity with temporary disability.
7. Dispensary services by a dentist-therapist.
8. Clinical examination of patients with dental and general somatic diseases.
9. The effectiveness of clinical examination of dental patients.
10. Errors and complications in the treatment of dental caries.
11. Errors and complications in the treatment of pulpitis.
12. Errors and complications in the treatment of periodontitis.
13. New methods for diagnosing dental caries.
14. New methods for diagnosing caries complications.
15. Preventive work of the dentist-therapist.
16. Consultative work of a dentist-therapist.
17. Sanitary educational work of a dentist-therapist.
18. Analysis of scientific articles in periodicals on therapeutic dentistry over the past year.
Abstract topics
1. Methods of examining a dental patient.
2. Caries, etiology, pathogenesis.
3. Caries, clinical picture, differential diagnosis, treatment.
4. Modern filling materials, their properties, indications for use.
5. Non-carious lesions of hard tooth tissues.
Topics of health education work:
1. Means and methods for preventing dental caries.
2. Prevention of complications of dental caries.
3. Condition of teeth and human health.
4. Hygienic oral care and brushing your teeth.
5. What is dental caries?
6. Toothpastes, their classification, selection criteria.
7. Bad habits and their impact on the condition and position of teeth, alveolar arches and oral mucosa.
8. Bleeding gums: causes, treatment, prevention measures
Literature
Main
1. Therapeutic dentistry: A textbook for students of medical universities / Ed. E.V. Borovsky. – M.: MIA, 2011. – 840 p.
Additional
1. Borovsky E.V., Zhokhova N.S. Endodontic treatment: A manual for doctors. – M., 1997. – 64 p.
2. Yakovleva V.I., Davidovich T.P., Trofimova E.S., Posveryak G.P. Diagnosis, treatment, prevention of dental diseases. – Minsk, 1992. – 628 p.
3. Dental caries and its complications: Conference materials. – Omsk, 1996. – 146 p.
4. Ivanov V.S., Urbanovich L.I., Berezhnoy V.P. Inflammation of the dental pulp. – M., 1990. – 208 p.
Medical history on the topic "CARIES"
Federal Agency for Health and Social Development Russian FederationDepartment of Pediatric Dentistry
Head of the department: Ph.D. Shkavro T.K. Checked by: Ass. Tarakanova O.N.
DISEASE HISTORY
FULL NAME. Patient: G.S.A.
Curator: pediatric student Faculty 401 group Asharapova N.A.
Co-curators: Sibogatova T.V.
Badmaev T.V.
Mintasov B.A.
Irkutsk 2011
Passport details
Patient: Gagarov Sergey Andreevich
Age: 13 years
Gender: male
School: Municipal Educational Institution Secondary School, grade - 7 b
Diagnosis on admission: dystonia
Final diagnosis: average caries of tooth 46
Complaints: preventative dental examination Anamnesis
morbi
:
Anamnesis vitae:
Child from second pregnancy, first birth. The pregnancy was difficult, with toxicosis in the first half of pregnancy. The mother had no infectious diseases and followed her diet. The birth was urgent and occurred on time - at 40 weeks. No surgical interventions were performed. The baby is full term. Apgar score at 1-5 minutes is 8-9 points. In childhood, he developed according to his age. I went to school at the age of seven. Studying well at school, but there are also C grades in mathematics. There were no injuries or operations. Denies the presence of mental disorders, alcoholism, syphilis, or tuberculosis in the family and among close relatives.
Status
praesens
objectivus
:
General condition of the patient: satisfactory. Body temperature: 36.6 o C. Height 150 cm, weight 35 kg. Position in bed: active. Consciousness: clear. Facial expression: normal. Patient's behavior: normal. Body type: normasthenic type. Chest shape: regular, oblique course of ribs, epigastric angle Nutritional nature Nutrition is correct, balanced and regular.
Skeletal system
The position is free, active. The gait is correct and stable. Bone structures without pathologies. The joints are unchanged. There are no deformities of the spine, chest, arms, or legs.
The lymph nodes
Cervical, submandibular, sublingual, supra- and subclavian, axillary and popliteal lymph nodes are not palpable.
The cardiovascular system
An objective examination did not reveal any disproportions in the development of the upper and lower half of the body. The color of the skin and visible mucous membranes is pale pink. There is no disproportion in the development of the upper and lower halves of the body. Swelling (on the feet and legs), ascites are not visually detectable. RR = 20/min, the rhythm is correct, there is no shortness of breath.
The shape of the fingers and nails is not changed, the symptom of “drumsticks” and “watch glasses” is absent.
Inspection of the vessels of the neck; the veins of the neck are not dilated or swollen; there is no positive venous pulse or “carotid dancing” symptom.
Examination of the heart area: the chest in the area of the heart is not changed, there is no cardiac hump. There is no visible pulsation (apical, cardiac impulse, epigastric pulsation and pulsation in the jugular fossa).
The apex beat is palpated in the fifth intercostal space 1 cm medially from l. mediaclavicularis; moderate strength and height. Cardiac impulse, epigastric pulsation, pulsation at the base of the heart, aorta in the jugular fossa and trembling in the region of the heart are not detected. There are no areas of palpation pain or hyperesthesia.
Arterial pulse on both aa. radialis is the same, rhythmic. Heart rate = 98 per minute. Blood pressure 118/70 mm Hg. Art.
Respiratory system
The chest is symmetrical. Breathing is deep and rhythmic. Breathing is deep and rhythmic. The respiratory rate is 20 per minute at rest. Both halves of the chest participate in breathing symmetrically.
The chest is painless and elastic.
Breathing is of a mixed type, there is no lag of one of the halves of the chest when breathing. Voice tremor is carried out equally on symmetrical areas of the chest. There is no shortness of breath or cough.
Vesicular breathing is heard in symmetrical areas of the chest.
No wheezing, crepitations, pleural friction rub, or pleuropericardial murmur are heard. Bronchophony is the same in symmetrical areas of the chest. Digestive system
Appetite preserved, no weight loss. No dyspeptic symptoms were detected. Swallowing is free. The stool is normal. No gastrointestinal bleeding was observed.
Genitourinary system
There are no complaints of pain in the lower abdomen and lumbar region. No headaches, low-grade fever. There is no pain when urinating. There is no change in frequency of urination or volume of urine excreted.
Nervous system
Consciousness is clear, mood is good, not irritable, not distracted, not withdrawn. Sleep is restful, of normal duration (9-10 hours), transitions from wakefulness to sleep no more than 30 minutes. There are no headaches or fainting. The mood is calm.
Skin sensitivity, vision, hearing, taste, smell and functions of the vestibular apparatus are without impairment.
In the school community he is sociable, has many friends, and is friends mainly with boys. Loves to draw and read science fiction literature.
Dental status
Visual inspection: Posture is not impaired. The face is relatively symmetrical and proportional. Functions: Breathing is mixed. Swallowing is somatic. Chewing is active. Speech is not impaired.
Bad habits: Sucking fingers, tongue, cheeks, foreign objects, biting lips, cheeks, placing a fist under the cheek during sleep is not. Oral care: Brushing your teeth 2 times a day for 1 minute. Rinse the mouth once a day. Oral examination: Oral mucosa: color - pale pink, moisture - moderate. The vestibule of the oral cavity is small. The frenulum of the upper lip is an anomaly of attachment. The frenulum of the lower lip is without features. The frenulum of the tongue is without any features. Jaw ratio: There are no features in the sagittal, vertical and transverse directions. The formation of the dentition of the upper and lower jaw is normal. There are no abnormalities in the position of the teeth.
Dental formula
7 6 5 4 3 2 1
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1 2 3 4 5 6 7
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7 6k 5 4 3 2 1
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1 2 3 4 5 6p 7
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Intensity index: KPU= 2 Condition of hard dental tissues: yellow. There is no hypoplasia, fluorosis, spots or streaks. Hygienic condition of the oral cavity: IG according to Fedorov-Volodkina – 3 points (staining 1/2 of the surface of the tooth crown) Degree of caries activity– I degree of activity. Diagnosis: Average caries of 46 teeth. Plan of treatment and preventive measures: sanitation of the oral cavity (hygiene containing calcium and fluoride, using additional hygiene products). |
Federal Agency for Health and Social Development of the Russian Federation
State educational institution of higher professional education
Far Eastern State Medical University of Roszdrav
Faculty of Dentistry
Department of Therapeutic Dentistry
Academic medical history
Clinical diagnosis: 2.1 tooth, superficial caries K02.0.
Enamel caries stage of white (chalky) spot, initial caries
Head department:
Teacher:
Khabarovsk 2012
Passport part
FULL NAME: ***************
Female gender
Age: 69 years old, 03/04/1941
Education: Secondary
Profession: Group III disabled person
Family status: Married
Home address:
Date of visit to the clinic: 01/11/2012
Complaints
At the time of admission to the clinic:
Appearance of a white (chalky) spot
· Slight sensitivity
· Sensation of grinning from chemical irritants
Anamnesis morbi
The patient considers herself sick for about a month, when she first noticed the appearance of a white (chalky) spot on the distal-vestibular surface of the central upper incisor on the left; the tooth had not previously bothered her. I applied on January 11, 2012 to the Dental Clinic "UNI-STOM" located at the address: st. **** for the purpose of sanitation of the oral cavity. She was admitted for treatment with a preliminary diagnosis of superficial caries of the 21st tooth.
1. General biographical information: Born on ***. Born into a complete family, she was the second child of three. The family's material security and nutritional conditions were unsatisfactory. She grew and developed normally, and did not lag behind her peers in physical and mental development.
2. Work history: she started working at the age of 16, worked on a collective farm doing agricultural work. Since 1972 she worked as a tram driver. Occupational hazards: work involving prolonged sitting. Retired since age 55.
3. Family-gender: Lives in the city of Khabarovsk in a comfortable two-room apartment, in which three people live. Two daughters and a patient. My husband died 10 years ago. Meals are regular and the regimen is followed. Gynecological history: Menstruation began at the age of 13, regular, painless. Beginning of sexual activity at age 18. 3 pregnancies, 2 births. Menopause since 45 years.
4. Past diseases: Viral hepatitis, Botkin's disease, tuberculosis, HIV, sexually transmitted diseases denies, contact with infectious patients and high fevers denies. Denies injuries or blood transfusions. Surgery to remove a brain tumor in 2008. Polyarthritis.
5. Allergic history: there were no allergic reactions to medications or foods.
6. Chronic intoxication: smokes for more than 20 years, rarely drinks alcohol, does not use drugs.
Visual inspection
face is symmetrical, proportional,
· skin of physiological color, clean,
· nasolabial and chin folds are moderately pronounced.
· The corners of the mouth are lowered, the lips are closed freely.
· Mouth opening is complete, free, painless.
· When opening the mouth, the movement of the temporomandibular joints is free, painless, there is no crunching or clicking in the joint when opening the mouth. Nature of movement: smooth, normal amplitude, synchronous in both joints.
· Palpation of the masticatory muscles is painless.
· Regional lymph nodes are not enlarged, the consistency is soft - elastic, mobile, not fused to the skin and surrounding tissue.
Oral examination
Examination of the vestibule of the oral cavity
· During an intraoral examination of the vestibule of the oral cavity, the mucous membrane of the cheeks is pale pink in color and well moisturized. No swelling or loss of integrity was detected.
· The frenulums of the upper and lower lips and tongue are quite pronounced.
· The gums are pale pink in color, there is no swelling, loss of integrity, ulceration or other pathological changes.
· Gingival papillae are pale pink in color, normal in size, without breaking their integrity. When pressed with a tool, the print quickly disappears.
· Orthognathic bite.
Examination of the oral cavity itself
· The mucous membrane of the lips, cheeks, hard and soft palate is pale pink, normally moisturized, without pathological changes, no swelling is observed.
· The tongue is of normal size, the mucous membrane of the tongue is pale pink, well moisturized. The dorsum of the tongue is clean, there are no desquamations, cracks, or ulcers. Soreness, burning, and swelling of the tongue are not detected.
· Condition of the follicular apparatus of the tongue without pathological changes.
· The pharynx is pale pink in color, normally moisturized, without swelling.
· The tonsils are not enlarged, no purulent plugs in the lacunae were detected.
U P P K P U
8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8
U P P P P P U
Clinical picture
· On the vestibular-distal surface of tooth 2.1 in the cervical area there is a white spot, loss of enamel shine
· When probing, the enamel surface is rough
reaction to cold water is painless
· vertical and horizontal percussion is painless
· the mucous membrane of the transitional fold in the area of the root apex is pink, moderately moist, painless on palpation
Additional examination methods
KPU caries intensity index
Conclusion: decompensated form
Hygienic index according to Fedorov-Volodkina
GI = 1+1+2+1+2+2 = 1.5/6
Conclusion: the hygienic condition of the oral cavity is normal.
Vital staining method
The lesion is stained with a 2% solution of methylene blue and 5% alcohol tincture of iodine.
Conclusion: the lesion is stained.
Remineralization index
IR = 1.3 points
Conclusion: there are remineralization processes.
Caries markers
Presence of staining
Conclusion: the presence of staining indicates the presence of a carious process
Electroodontometry
The tooth pulp reacts to a current of 3 µA.
Conclusion: absence of inflammatory process in the pulp
Luminescent diagnostics
When examining the causative tooth in the area of the stain, the luminescence is extinguished against the background of the bluish glow of intact enamel
Conclusion: area of demineralized enamel
Clinical diagnosis
Based on the patient’s complaints, history of life and illness, examination and additional examination methods, a diagnosis was made
2.1 Superficial caries
By 02.0 enamel caries “white (chalky) spot stage” initial caries
Differential diagnosis
Systemic enamel hypoplasia
· symmetry of damage to teeth of the same name, due to the simultaneity of origin, development and mineralization
localization on the vestibular surface of the frontal teeth, dental cusps of molars and premolars
stain stability
· whitish spots, clear border, shiny dense surface, painless
Local hypoplasia
· disruption of the formation of enamel of permanent teeth as a result of inflammation or mechanical trauma of the buds of permanent teeth
endemicity of the lesion
Teeth are rarely affected by caries
stain stability
· spots are dense, painless, shiny, smooth
· not stained with caries marker
Spotted form of fluorosis
pigmented spots
endemicity of the lesion
Average caries
· cavity in the mantle layer of dentin
The dentin-enamel junction is destroyed
· dentin is affected
· painless probing along the dentino-enamel border
Erosive form of fluorosis
pigmented spots
clear borders on matte enamel
· enamel wears off quickly
Dentin is affected
Enamel erosion
The vestibular surface is affected
symmetry of the lesion
· most often the incisors of the upper jaw
Dentin is affected
dish-shaped defect
· smooth shiny bottom
Acid necrosis of enamel
The vestibular surface of the anterior teeth is affected
symmetry of the lesion
· often has a professional character
· sensitivity to chemical irritants
feeling of teeth sticking together
dentin is soft when probing
Pigmented plaque
Removable when cleaning with specialized brushes and pastes
· the intact enamel surface is exposed
Treatment
Treatment plan
1. Cleaning the tooth surface from plaque
2. Insulation from moisture
3. Treatment of the tooth surface with a 0.5-1% solution of H 2 O 2
4. Drying
5. Application of remineralizing drugs for 15-20 minutes (10% calcium gluconate solution, 3% Remodent solution)
6. Drying the tooth surface for 3-5 minutes
7. Application of fluoride-containing preparations (2% sodium fluoride solution, Sol.Fluocali, Sol.Fluocal-gel)
8. Drying the tooth for 3-5 minutes
· The course consists of 10-15 procedures
· Carried out within 3-4 weeks
· Dispensary observation is carried out
Preparations for the prevention of dental caries
Fluorine compounds
Rp.: Sol. Natrii fluoridi 0.05% - 50 ml
D.S. For rinsing the mouth.
D.S. For applications on the surface of tooth enamel or for electrophoresis, a course of 4-7 procedures.
Rp.: Phthorlacum 25 ml
D.S. Apply to the surface of the tooth.
Rp.: Tab. Sodium fluoridi 0.0011 No. 50
D.S. 1 tablet per day.
Rp.: Tab. Natrii fluoridi 0.0022 No. 50
D.S. 1 tablet per day.
Rp.: Vitaftori 115 ml
D.S. 1 teaspoon 1 time per day with meals for 3 months.
Remineralizing agents
Rp.: Sol.Calcii gluconatis 10% - 10 ml
D.t.d. No. 20 in amp.
S. For applications on hard dental tissues.
Rp.: Sol. Natrii fluoridi 0.2% - 50 ml
D. S. For applications on hard dental tissues.
Rp.: Remodenti 3.0
D.t.d. No. 10 in pulv.
S. For rinsing the mouth (dissolve 1 powder in 100 ml of boiled water) for 1-2 minutes.
Rp.: Remodenti 3% - 100.0
D. S. For applications on hard dental tissues, 20 minutes.
The course of treatment is 20 procedures.
Rp.: Sol.Calcii glycerophosphatis 0.5
D.t.d. No. 90 in tab.
S. 1 tablet 3 times a day.
Rp.: Sol.Calcii glycerophosphatis 2.5% - 100.0
D. S. For electrophoresis in hard dental tissues, 20 procedures.
Rp.: Tab.Unicap-M No. 30
D.S. 1 tablet once a day after meals for 20-30 days.
Rp.: Tab. “Ascorutini” 0.1 No. 180
D.S. 2 tablets 3 times a day for a month.
Rp.: Phytini 0.25
D.t.d. No. 50 in tab.
Rp.: Methionini 0.1
D.t.d. No. 90 in tab.
S. 1 tablet 3 times a day after meals.
Epicrisis
Patient *** *** year of birth applied for oral sanitation on January 11, 2012 to the UNI-STOM Dental Clinic located at the address: st. ***. Based on complaints, general and additional examination methods, a diagnosis was made: 2.1 tooth, superficial caries K02.0 Enamel caries stage of white (chalky spot) initial caries. It was decided to carry out therapeutic treatment using remineralizing therapy using fluoride-containing drugs using the deep fluoridation technique. The patient was given recommendations on oral hygiene rules.
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Ministry of Health and Social Development of the Russian Federation
State educational institution of higher professional education
First Moscow State Medical University named after I.M. Sechenov
Department of Therapeutic Dentistry
Disease history
Diagnosis: Dentin caries K02.1 tooth 3.5
Passport part
Age: 20 years old 01/16/1995
Profession: nurse
Address: Moscow city st.
Date of admission - 04.12.2015
Complaints:
Complaints of pain from cold and sweet stimuli
Aesthetic defect in area 3.5
Anamnesis of life:
Previous and concomitant diseases. Children's infectious diseases (chicken pox, rubella, measles, scarlet fever, pneumonia), influenza, ARVI. According to the patient, he denies an allergic reaction to food and medicinal products. Allergy to animals and dust.
According to the patient, he denies the presence of diseases such as tuberculosis, syphilis, alcoholism, mental illness, malignant neoplasms, periodontitis, and periodontal disease in his parents and relatives.
Denies smoking, drinking alcohol, or using drugs.
According to the patient, he brushes his teeth 2 times a day, with a brush with soft bristles, and does not use floss.
Development of the present disease. According to the patient, tooth 3.5 began to bother me 1 month ago. I didn’t go to the doctor. The last time I visited a dentist was 7 months ago, for the removal of tooth 4.8.
History of the disease:
Painful sensations persist for two weeks.
A painful reaction to sweets, which quickly passes after the stimulus is eliminated. No previous treatment was carried out.
Visual inspection:
1. General condition of the patient. General condition is satisfactory. The skin is pale pink, normally moisturized, elastic.
Dryness, rash, scratching, hemorrhages, peeling and ulcers on the skin were not detected.
2. External examination of the maxillofacial area.
The configuration of the face is not changed, the skin is pale pink and normally moisturized. There are no skin rashes or swelling. The red border of the lips is without pathological changes, the lips are normally moisturized, there are no cracks, erosions, or ulcerations.
The corners of the mouth are without visible pathological changes.
Occipital lymph nodes: not palpable.
Postauricular lymph nodes: not palpable.
Parotid lymph nodes: not palpable.
Submandibular lymph nodes: number 4, not palpable.
Mental lymph nodes: nodes are not palpable.
Cervical lymph nodes: not palpable.
Lateral surfaces of the neck: not palpable
Supraclavicular and subclavian lymph nodes: not palpable
HFNS - mouth opening freely, without any peculiarities.
Oral examination:
1. Inspection of the vestibule of the oral cavity. During an intraoral examination of the vestibule of the oral cavity, the mucous membrane of the cheeks is pale pink in color and well moisturized. No swelling or loss of integrity was detected. The frenulums of the upper and lower lips and tongue are quite pronounced.
2. The mucous membrane of the lips, cheeks, hard and soft palate is pale pink, moderately moisturized, without pathological changes, no swelling is observed.
3. The gums are pale pink in color, there is no swelling, loss of integrity, ulceration or other pathological changes. The gingival papillae are normal; when pressed with an instrument, the imprint quickly disappears. There is no increased bleeding. There are no pathological pockets.
4. The tongue is pink, clean, papillae are without pathological changes, the tongue is normally moisturized, the integrity is not compromised, no desquamations, cracks, or ulcers are found, no tooth marks are found on the surface of the tongue.
5. The tonsils are not enlarged, there are no purulent plugs in the lacunae, no plaque.
Hygiene index:
Hygienic index according to Fedorov-Volodkina
IG=1.6 is satisfactory.
Clinical picture:
On the chewing surface of tooth 3.5 there is a carious cavity of medium depth. Probing of the enamel-dentin border is painful, the reaction to cold is painful and passes quickly, percussion is painless.
Examination of the oral cavity. Condition of teeth.
Legend: caries (C), pulpitis (P), periodontitis (Pt), tooth root (R), filling (P), extracted tooth (O), artificial tooth (I), periodontitis (A), mobility I, II , III degree; crown (K).
S P P P P P P P S
8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8
S P P S S/P O S/P S
Definition of bite:
Orthognathic bite
Preliminary diagnosis: tooth 3.5-K02.1 Dentin caries.
The diagnosis was made based on:
Complaints: pain in the area of tooth 3.5 from a chemical irritant (sweet), which goes away after the irritant is eliminated, presence of a cavity, food buildup
Clinical examination: a shallow carious cavity is noted on the chewing surface of tooth 3.5.
Percussion of the tooth is painless. There is no pathological tooth mobility.
Differential diagnosis of dentin caries
Acute pulpitis
For short-term pain from all types of irritants (thermal, mechanical, chemical). The pain goes away quickly after eliminating the irritants.
Acute spontaneous, paroxysmal pain, intensifying at night and from all types of irritants, which does not go away for a long time after the irritant is eliminated. The attack is short, intermissions are long. Hurts during
Probing
Uniform pain throughout the bottom.
Sharply painful at one point (in the projection of the pulp horn)
Thermodiagnostics
Pain in response to cold and hot temperatures, which goes away immediately after the stimulus is removed
Painful, the pain does not go away for a long time after the stimulus is removed, it turns into an attack
caries pulpitis diagnostics prevention
Chronic pulpitis
For short-term pain from mechanical, chemical and temperature stimuli, which quickly disappear after their elimination
For pain from all types of irritants that does not go away for a long time. Pain when changing temperature, when inhaling cold air
There were no spontaneous pains
Spontaneous paroxysmal pain is possible in the past as acute pulpitis
Objective research data
A deep carious cavity does not communicate with the tooth cavity
A deep carious cavity often communicates with the tooth cavity
Probing
Probing is painful all over the bottom
Sharp probing is painful at the point of communication, the pulp bleeds
Thermodiagnostics
Pain from temperature stimuli goes away quickly after they are eliminated
Pain from temperature stimuli does not go away for a long time after its elimination
Final diagnosis:
Dentin caries K02.1
Before the actual treatment, professional oral hygiene was carried out and the color range of the patient’s teeth was determined (A3 on the Vita scale).
Sol infiltration anesthesia was performed. Articaini 4% 1.7 ml. Preparation and formation of a carious cavity according to class I of the Black classification. Etching with 37% phosphoric acid. (Travex 37) for 15 sec. Rinse off the etching for 15 seconds. Apply adhesive system (OptiBond Solo Plus (Kerr)) for 20 seconds and cure for 20 seconds. Application of liquid light-curing composite material (EsFlow A3) to the bottom of the cavity.
Layer-by-layer application of material (no more than 2 mm). Installation of a light-curing Filtek ultimate filling, color A3 (OA3 + enamel A3). The exposure time for the opaque layer is 40 seconds, for the enamel layer - 20 seconds. Grinding and polishing the filling (Copy paper, polishing burs, silicone heads, discs, etc. Polishing pastes.)
Prevention of this disease:
Regular brushing of teeth (morning and evening), using dental floss, regular visits to the dentist (2 times a year).
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