The main forms of organization of dental care. Organization and structure of the dental clinic, therapeutic department, dental office. Sanitary and hygienic standards Organization of medical care of the dental clinic
The issues of organization of dental care have always been in the focus of national health care.
The last decade is characterized by technological progress, the introduction of modern equipment and new technologies in the practice of dentists.
The main structure, as before, remains state-owned municipal medical institutions, which, despite the ever-increasing outflow of specialists to the private dental sector, provide the largest amount of dental care.
In the system of state and municipal services of urban health care, there are three levels of dental care.
First level. First-level institutions include: dental departments in multidisciplinary polyclinics, medical and sanitary units, as part of the Central District Hospital (central district hospitals) and other medical institutions, dental offices at enterprises, educational institutions, kindergartens, agricultural enterprises, antenatal clinics and other institutions . At the first level, the main volume of measures for individual prevention and treatment of the most common types of dental pathology is carried out, culminating in the sanitation of the oral cavity and, if necessary, simple dental prosthetics.
Second level It is represented by state and municipal dental clinics of the administrative districts of cities, which provide highly qualified specialized care in the main profiles of the dental specialty: therapeutic dentistry with endodontics, surgical dentistry and dental prosthetics. As a rule, such dental clinics also perform the functions of a kind of methodological and practical centers for the organization of dental care, the implementation of municipal dental programs in the service area.
On the third level highly qualified and specialized consultative, diagnostic and therapeutic care is provided in such narrow areas of dentistry as periodontology, endodontics, diseases of the oral mucosa, stomatoneurology, complex dental prosthetics, orthodontics, maxillofacial orthopedics, dental implantation, plastic surgery, oncostomatology, etc. d. The institutions of this level, first of all, should include dental clinics of the subjects of the Federation, scientific and educational medical institutes, specialized centers. The main flow of patients at the third level should be formed as a result of referrals of specialists from the previous (first and second) levels. At this level, the organizational and methodological management of the dental service of the subject of the Federation is carried out.
DENTAL CLINIC
A special place in the structure of the city dental service is occupied by dental clinics.
The regulation on the dental clinic was approved by order of the Ministry of Health of the USSR dated 10.12.76? 1166.
Regulations on the dental clinic
1. Dental clinic - a medical institution whose activities are aimed at the prevention of dental diseases, timely detection and treatment of patients with diseases of the maxillofacial region.
2. A dental clinic is organized in accordance with the established procedure and operates among the population, at industrial enterprises, in higher and secondary educational institutions, construction and other organizations, including, where appropriate, in children's groups.
3. The boundaries of the area of activity of the polyclinic, the list of organizations that it serves, are established by the health authority according to the subordination of the polyclinic.
4. The main tasks of the clinic are:
a) taking measures to prevent diseases of the maxillofacial region among the population and in organized groups;
b) organizing and conducting activities aimed at early detection of patients with diseases of the maxillofacial region and their timely treatment;
c) provision of qualified outpatient dental care to the population.
5. For the implementation of the main tasks, the polyclinic organizes and conducts:
Complete sanitation of the oral cavity to all persons applying to the clinic for dental care;
Complete sanitation of the oral cavity in pre-conscription and draft contingents;
Emergency medical care for patients with acute diseases and injuries of the maxillofacial region;
Dispensary observation of certain contingents of dental patients;
Qualified outpatient dental care with timely hospitalization of persons in need of inpatient treatment;
Examination of temporary disability of patients, issuance of sick leave certificates and recommendations for rational employment, referral to medical and labor expert commissions of persons with signs of permanent disability;
The whole complex of rehabilitation treatment of pathologies of the maxillofacial region and, above all, dental prosthetics and orthodontic treatment;
Measures to improve the skills of doctors and paramedical personnel.
6. The composition of the dental clinic may include:
Departments of therapeutic and surgical dentistry (including, in appropriate cases, children's);
Mobile dental units;
Department of dental prosthetics;
Organizational method cabinet;
Auxiliary units (X-ray, physiotherapy rooms);
Registry;
Administrative and economic part;
Accounting.
The specific structure of the polyclinic is established by the health authority by subordination.
7. The states of the dental clinic are established according to the current staffing standards and model states.
The traditional structure of the dental clinic includes the following divisions (see diagram below):
1) registry;
2) dental departments: therapeutic, surgical, orthopedic with a dental laboratory, pediatric dentistry;
3) primary examination room;
4) a dental emergency room;
5) physiotherapy room;
6) X-ray diagnostic room.
In addition, departments and offices for the provision of highly specialized dental care to patients can be organized in the clinic. These include a periodontal room, a room for receiving patients with pathological changes in the oral mucosa, rooms for anesthesiology, orthodontics, prevention, acupuncture, hirudotherapy, and functional diagnostics. In large dental clinics (regional, city), departments (offices) of implantology, anesthesiology and resuscitation, restorative therapy, endodontics, clinical diagnostic laboratories, central sterilization, a pharmacy and others are being deployed.
In the structure of the dental clinic there is a general, children's, orthopedic registry.
The task of the registry includes: storage of outpatient cards, regulation of the flow of patients, informing visitors, reference work, storage and execution of sick leave, recording calls to doctors at home.
The dentistry profession is at high risk of contracting infectious diseases. During surgical dental manipulations, infection can be transmitted from patient to patient, dentist and vice versa.
Asepsis is a system of prevention from getting an infection into the wound during operations, preventing the development of nosocomial infection. Asepsis includes a set of measures that ensure the sterilization of instruments, materials
SCHEME
and compliance with the rules during operations and invasive surgical procedures.
Treatment and operating rooms, dressing rooms, treatment rooms should be subjected to current, permanent and general cleaning using chemical disinfectants and physical factors: bactericidal, bacteriostatic and mechanical effects. Drills and other mechanical cutting instruments should be easily aseptically processed. After surgical interventions, a separate collection of used materials in rigid containers is provided: gauze napkins, balls and metal instruments - needles, blades, scalpels.
Doctors working in the surgical polyclinic department and in the hospital should cut their nails short, make sure that there are no cracks and burrs. Before the operation, the doctor, using a sterile brush and soap, washes the hands and forearms, rinses them and, after wiping them with a sterile napkin from the fingertips to the elbows, treats them with a swab moistened with alcohol, an antiseptic solution. In recent years, hand treatment with a 20% chlorhexidine solution, as well as accelerated methods of treatment with antibacterial drugs (cerigel, 96% ethyl alcohol), ND-410 solution, have been common.
Before the operation, the patient's face is treated with alcohol and the oral cavity with a 0.12% solution of chlorhexidine or its derivatives, and the surgical field is isolated with sterile sheets.
The above measures create a barrier to exogenous infection, and in 90% of cases it enters from the external environment in case of violation of sterility during operations: from the air, by a transcendental route, due to infection of the suture material, instruments and devices.
Infection can occur endogenously - from the skin, from the oral cavity, ENT organs. Of great importance in the activation of endogenous infection are the factors of nonspecific protection of the patient and his immunity.
In the conditions of both the clinic and the hospital, especially in inflammatory diseases, a cross-hospital infection acquires, which is often the cause of postoperative purulent complications.
Compliance with asepsis is of great importance for the protection of the doctor and medical personnel, patients from infection with viral hepato-
titans C and group B, syphilis, tuberculosis, tetanus, anthrax, HIV infection.
An important link in asepsis is the sterilization of instruments. It consists of pre-sterilization cleaning, packaging, sterilization, control of its effectiveness and delivery of instruments to the operation site.
Mechanical cleaning of instruments, syringes or carpule holders, apparatus systems is carried out using brushes and sterile detergents, antiseptics. Burs, cutters, circular saws, sharp curettage spoons, rasps, osteotomy instruments should be handled with particular care. Mechanical and antiseptic cleaning of instruments is complemented by their ultrasonic treatment. After purulent interventions, the instruments are especially thoroughly mechanically cleaned and additionally soaked in antiseptic solutions.
Sterilization of instruments is carried out using physical factors or chemicals. The physical methods of sterilization include steam, hot air (dry air), filtration, methods of infrared and radiation exposure. Currently, sterilization in dry steam sterilizers with packaging of each instrument is the most common. For air sterilization, kraft bags are used, for steam sterilization, vegetable multilayer parchment is used. The most reliable multi-layer packaging.
Separate devices (endoscopes, blocks of devices for hemosorption, lymphosorption) are cleaned and sterilized in a gas sterilizer.
The tips of dental drills are sterilized by boiling in liquid paraffin followed by centrifugation.
Chemical sterilization is most appropriate in the form of low-temperature exposure using formaldehyde and ethylene oxide gases. This method is very convenient as it only takes 20 minutes.
Dressings - napkins, tampons, balls, bandages are packed in a towel or sheet and placed in biks, sterilized at a pressure of 2 atm and a temperature of 132.9 ° C for 20 minutes. Bathrobes and sheets are also sterilized. The suture material is first treated in a triple solution, washed with running water, dried and sterilized by boiling in distilled water.
water for 20 min. It is also effective to use packaged disposable needles with suture material.
After rinsing in running water for 1 min, impressions, protective plates, mouthguards, dental splints are disinfected in 0.5% chlorhexidine solution, MD-520 (50% glutaraldehyde and 50% alkylbenzyldimethylammonium chloride), 0.1% deoxone, 6 % hydrogen peroxide solution, as well as plasma disinfection. After treatment with disinfectant, orthopedic medical splints, mouth guards, etc. are washed. in running water.
To control sterilization, ampoules with benzoic acid, resorcinol, antipyrine, ascorbic or succinic acid powder, pilocarpine hydrochloride, thiourea are placed between the material and the packaging tool. These medicinal substances have a high melting point (110-200 °C) and their melting indicates the optimum sterilization temperature.
The sterility of preoperative rooms, operating units, materials and instruments is checked by the bacteriological method - inoculation under aerobic and anaerobic conditions, as well as by placing test tubes with a spore-bearing non-pathogenic microorganism culture in bixes. The absence of microorganism growth indicates the sterility of instruments and materials. Constant control of the sterilization process can be carried out by placing biological indicators in the boxes. It should be borne in mind that the endospores of tetanus, anthrax, Mycobacterium tuberculosis, viruses, including the AIDS virus, fungi, Vibrio cholerae are destroyed poorly and disinfectants of high and medium levels are most effective in combating them.
In dental clinics, it is necessary to examine personnel for the carriage of dangerous and viral infections. Personnel must undergo an annual medical examination with a blood test for the presence of hepatitis A, B, C, D, HIV infection, be vaccinated against hepatitis B and diphtheria twice a year.
Considering the increase in the number of patients infected with HIV and AIDS, when operating on urgent patients, it is necessary to take increased precautions and work with double gloves and goggles, use only disposable instruments.
Infectious diseases transmitted at the dental appointment
Basic requirements for the work of a dental office
Before starting work and after the end of the work shift, the manipulation table, the table for storing sterile instruments, dental chairs, sinks, sink taps are disinfected by wiping twice with a rag moistened with 1% chloramine solution, after which the bactericidal lamp is turned on. The sterile table is covered for 6 hours. Sterile instruments can also be stored in sterile packaging, or in a bactericidal chamber of the MicrocidMed type in order to prevent secondary contamination of dental instruments.
Pre-sterilization processing of dental instruments
Conducted by a nurse. Stages:
1. Soaking (separable products are placed disassembled) in a 3% solution of chloramine, or a 6% solution of hydrogen peroxide, or in a 5-8% solution of alaminol for 60 minutes.
2. Washing for 15 with running water.
3. Soaking (full immersion) in a biolot solution heated to 40 °C for 15 minutes.
4. Washing in the same solution with ruffs or cotton-gauze swabs of each instrument for 15 s.
5. Washing sequentially: with tap and distilled water (at the rate of 200 ml of tap water for each product) for 1 and 0.5 minutes, respectively.
6. Drying in the open air.
Points 2, 3, 4 are intended when using solutions of chloramine and hydrogen peroxide.
Soaking of used burs, endodontic instruments is carried out for 30 minutes in des. solution (3% hydrogen peroxide, 10% ammonia and 70% alcohol, mixed in equal amounts), then in a biolot solution (at a temperature of 40 ° C) for 15 minutes.
Soaking used cotton-gauze swabs, gloves, masks, etc. produced in 3% solution of chloramine or 5-8% solution of alaminol for 120 minutes.
Quality control of pre-sterilization treatment evaluate by setting azopyramic (azopyram, 3% hydrogen peroxide solution in a ratio of 1: 1 is applied with a pipette to the instrument or wiped with a swab) or amidopyrine (95 g of alcohol + 5 g of amidopyrine. 2 drops each: amidopyrine, 3% hydrogen peroxide, 30% acetic acid) samples. A blue-violet color indicates the presence of blood. 1% of simultaneously processed products of the same name (but not less than three products) is subject to control.
Disinfection of dental instruments
Dental tips before and after use are wiped twice with 70% alcohol or 3% chloramine solution, then carried through the burner flame. Disinfection of handpieces can also be carried out in the disinfection systems "Terminator", "Assistina", special "pockets", etc.
Dental mirrors are immersed for 60 minutes in a closed container with a 3% solution of chloramine or 6% hydrogen peroxide. Then they are rinsed with distilled water, wiped with a sterile cloth. Mirrors are stored in a sterile tray or in a closed sterile container.
Impressions, nozzles for cavity washing guns, crown cutting knives, Kopa crown remover, etc. disinfected by double wiping with a 1-3% solution of chloramine (or special disinfectant solutions) with an interval of 10 minutes.
Gloves at a therapeutic appointment are washed with running water and soap, wiped with alcohol or a special solution. At the surgical reception, gloves should be disposable, sterile.
Sterilization
Sterilization - the complete destruction of microorganisms and their spores on (in) the object being sterilized.
Requirements for sterilization
Sterilization must be carried out directly at the workplace, or the object to be sterilized must be placed in impervious packaging (before or after sterilization).
After sterilization, the object must not contain live microorganisms. During the sterilization process, the object must not be changed. After sterilization, the object must remain sterile for a long time.
Classification of sterilization methods
1. According to the obligate state of the sterilizing agent:
a) liquid methods;
b) using gaseous substances;
c) plasma sterilization;
d) using radiation.
2. According to the impact factor on the sterilized object:
a) penetrating or bulk (destroy the protein of microorganisms);
b) exerting a superficial effect.
3. According to the method of influencing the sterilized object:
a) chemical;
b) physical;
c) combined.
Types of sterilization used in dentistry
Liquid
Chemical. This type of sterilization includes easy-to-use methods of soaking, treating instruments in solutions (for example, hydrogen peroxide 3%, 6%; hypochlorous acid salts; chloramine 1 - 3%, etc.). Solutions can also be used for processing impressions, during ultrasonic processing. The advantages of the method are the possibility of processing internal channels of small diameter, low processing temperature. Disadvantages of the method are: surface impact, compliance with safety regulations, processing time (minimum 10 hours), mandatory multiple washes, harmful effects on personnel, the problem of waste disposal.
Thermal. Boiling. Sterilization of all-metal dental instruments (burs, needles, pluggers, hooks, reusable syringes, etc.), materials can be carried out by boiling in distilled water with the addition of 1-2% sodium bicarbonate solution for at least 30 minutes. The method is penetrating. Environmentally friendly. However, the duration of the procedure, the impossibility of boiling sharp cutting instruments limits the use of this method.
Sterilization of dental handpieces can be carried out by boiling for 1 hour in vaseline oil with the addition of a 2% solution of oxyquinol, followed by centrifugation. The method is reliable, penetrating, but lengthy and requires special equipment.
Gas
Chemical. Gas sterilization with ethylene oxide. The object to be sterilized is kept in a gas environment for 1 hour, after which it is necessary to ventilate the room for 10 hours. The reliability of the method is very high (100% sterilization). The method is penetrating. It has high productivity, since it is carried out centrally, in large batches of the sterilized object. There are no restrictions on the materials that can be subjected to this method. Sterilization can be carried out in the package. All disposable instruments undergo this treatment. The disadvantages of the method are: the use of highly toxic gas, which can have a harmful effect on the environment, the possibility of current
sic deposits on the surfaces after treatment, the duration of the procedure.
Ozone sterilization. The object is kept in an ozone atmosphere for 1.5 hours (for example, in the SS-5 apparatus). The method has no restrictions on the materials of the sterilized object. However, a large amount of ozone is toxic, and the duration of the process does not add advantages to this sterilization method.
Thermal. Dry heat method. It is the most common in dentistry, because it is easy to use, environmentally friendly, and allows the processing of an object in a package. However, not all instruments can be sterilized by this method. The object is kept at a temperature of 180 °C for 1 hour. The oven must not be stuffed (low reliability). High temperatures require safety precautions.
Steam (autoclaving) method. The sterilizing agent in this case is steam heated to 120 °C under a pressure of 1.1 atm. within 12 minutes, up to 134 °C - within 4 minutes. The method is penetrating, environmentally friendly, the speed is high. However, high temperature and humidity limit its use for cutting tools and require safety precautions. Recently, the method has been widely used.
Glasperlen method. It is also penetrating, but is only used to sterilize small instruments. The working part of the tools is immersed in a medium heated to 240 - 270 ° C for a few seconds.
Plasma sterilization
Plasma is the fourth state of matter. For this type of sterilization, argon is used, passed through alternating current. The method is penetrating. Uses the effect of ball lightning. The bombardment by atoms and molecules of the plasma substance of the sterilized object breaks the bonds between the proteins of microorganisms, resulting in their death. Sterilization takes place at a temperature of 60 - 80 ° C for 10 - 12 minutes. Apparatus "Plasmodin-2".
Sterilization methods using radiation
Radiation sterilization. The use of penetrating ionizing radiation, the source of which is Co 60, is possible only in industrial conditions due to the risk of personnel exposure.
The method has the same positive characteristics as the gas (ethylene oxide) method.
UV sterilization. The use of ultraviolet radiation is only possible for exposed surfaces of the object to be sterilized. The method is simple, but a large amount of ozone is released during long-term operation of the apparatus.
IR sterilization. Infrared radiation is also used to sterilize exposed surfaces (surface exposure) of the object to be sterilized. But the method gives heating of surfaces.
microwave sterilization. Microwave currents (electromagnetic radiation) have a sterilizing effect. The method is ineffective, harmful to personnel, but the effect on the sterilized object is short-term.
Sterilization control
Sterilization control is carried out in one of the following ways:
Selective microbiological control (wash is sown on nutrient media);
The use of chemical indicators (indicator strips that change color at a certain temperature);
The use of biological indicators (strips with test microbial cultures, which, after sterilization, are placed in nutrient media, in the presence of growth, the entire batch is rejected).
Sterilization of the instrument in case of a threat of HIV infection
The virus dies at 46°C within 30 minutes.
Disinfectants (WHO, 1986): ethyl alcohol 70° - 10 min, 50° - 12 min; propyl alcohol 75 ° - 1 min, ethyl alcohol with acetone 1: 1 - 10 min; chlorhexidine 4% - 5 min, 3% - 10 min; sodium hypochlorite 0.5% - 1 min, 0.1% - 10 min; hydrogen peroxide 3% - 1 min, 0.3% - 10 min; formaldehyde 0.2% - 5 min, 2% - 1 min; phenol 5% - 1 min; lysol 0.5% - 10 min; paraformaldehyde 0.6% - 25 min.; polyvinylpyralidone 10% - 1 min; chloramine 2%, formaldehyde 40% 1:1 - 10 hours for mirrors.
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The most important tasks of dental organizations are a set of dispensary measures for the prevention, early detection, treatment and rehabilitation of patients with diseases of the oral cavity. salivary glands and jaws.
More than 90% of patients receive general and specialized dental care at ASTU, which include:
. state and municipal dental clinics for adults and children (republican, regional, district, regional, city, district);
. dental departments (as part of multidisciplinary hospitals, medical units, departmental institutions, etc.);
. dental offices (in dispensaries, antenatal clinics, general medical (family) practice centers, health centers of industrial enterprises, educational institutions, etc.):
. private dental organizations (clinics, offices, etc.).
Patients receive stationary specialized dental care in the departments of maxillofacial surgery of multidisciplinary hospitals.
The availability of dental care to the population depends on many factors: pricing policy, organizational forms of its provision, provision of the population with dentists (dentists), etc. Currently, dental care is provided to the population in the following organizational forms: centralized, decentralized, outreach.
With a centralized form, the reception of the population is carried out directly in the dental clinic or in the dental department (office) as part of another medical institution.
A decentralized form of providing dental care to the population provides for the creation of permanent dental offices at the health centers of industrial enterprises, in educational institutions. This form is most suitable for organizing dental care for the working population and students. The advantage of this form is undeniable, but it is advisable to organize such classrooms at enterprises with 1,200 or more employees and educational institutions with 800 or more students.
The exit form is most effective for providing dental care to rural residents, children in preschool institutions, the disabled, lonely and elderly citizens. It allows you to bring both general and specialized dental care to these categories of citizens as close as possible.
Persons suffering from acute toothache, traumatic injuries of the teeth, jaws and other acute dental pathology should be provided with emergency dental care. Round-the-clock provision of emergency dental care to the population in large cities is carried out by emergency departments for adults and children (in the structure of dental clinics) and rooms operating in the structure of ambulance stations (departments).
The main task of specialists working in dental organizations, regardless of the form of ownership and departmental affiliation, is the sanitation of the oral cavity of patients.
Sanitation of the oral cavity (from Latin sanus - healthy) is a comprehensive improvement of the organs and tissues of the oral cavity, which includes the treatment of caries, the elimination of defects in tooth tissues of a non-carious nature by filling, the removal of tartar, the treatment of periodontal diseases, the removal of decayed teeth and roots, not subject to conservative treatment, orthodontic and orthopedic treatment, oral hygiene training, etc.
There are two forms of sanitation of the oral cavity: negotiable and planned.
Sanitation of the oral cavity by negotiability is carried out by patients who independently applied to the dental clinic (department, office) for medical care.
Planned sanitation of the oral cavity is carried out at the place of study, work in a dental office or in a clinic. First of all, the oral cavity is sanitized by people working in hazardous industries or at enterprises with such working conditions that contribute to the intensive development of dental diseases: for example, dental caries in workers confectionery or flour mills, acid necrosis of enamel in persons in contact with acid fumes, gingivitis in greenhouse workers, etc.
Planned sanitation is also indicated for persons suffering from various chronic somatic diseases in order to avoid the formation of foci of odontogenic infection. Planned rehabilitation is carried out for children in kindergartens, schools, boarding schools, sanatoriums, health camps, pediatric hospitals.
Depending on the contingent of the population served, the prevalence of dental diseases and the availability of dental care in a particular area, planned oral health can be carried out by the following methods:
. centralized;
. decentralized;
. brigade;
. mixed.
Centralized Method
Planned sanitation of the oral cavity is carried out directly in the dental clinic or the dental department in the structure of a medical institution (HCF), which allows organizing the reception of patients with the necessary laboratory and instrumental studies, consultations of specialists. However, in some cases it is difficult to organize a visit to the polyclinic by persons subject to planned sanitation, especially children. In this case, a decentralized method of planned rehabilitation is used.decentralized method
Sanitation of the oral cavity is carried out directly in preschool institutions, schools and enterprises by organizing dental offices. With an insufficient number of students in schools (less than 800 people), a dental office is opened in one of them, which serves children from 2-3 nearby attached schools.This ensures the necessary level of accessibility of dental care to children, the maximum coverage of their sanitation and preventive measures. The weak side of the method lies in the insufficient equipment of dental offices with special equipment, so children with complex diseases and, if necessary, additional diagnostic tests are sent to a dental clinic.
brigade method
Planned sanitation of the oral cavity is carried out by a mobile team of dentists of a district or regional dental clinic. Teams, as a rule, consist of 3-5 doctors and one nurse, they go directly to schools, preschool institutions, enterprises, where children and adults are sanitized for the required period of time. For these purposes, specially equipped vehicles are used.mixed method
It provides for a combination of certain methods of planned sanitation of the oral cavity based on the capabilities of the territorial healthcare system, the availability of dental institutions, their provision with qualified personnel, the necessary diagnostic and treatment equipment.In children, the method of planned rehabilitation, as a rule, is implemented in two stages.
The first stage is an examination of the child's oral cavity and determination of the necessary types of dental care.
The second stage is the provision of dental care as soon as possible until complete sanitation.
In some cases, planned rehabilitation provides for a third stage - subsequent active dynamic monitoring of sick children.
Planned sanitation of the oral cavity in children should be considered as the main means of preventing dental caries and timely correction of maxillofacial anomalies. Planned rehabilitation, regardless of the forms and methods used, provides for mandatory repeated (control) examinations of children every 6 months.
The success of the planned rehabilitation of children in organized children's groups largely depends on the coordinated actions of the leaders of children's dental clinics and preschool and school educational institutions. To do this, planned sanitation schedules are drawn up in advance, organization and control of their implementation are provided.
O.P. Shchepin, V.A. Medic
Oral health is an important condition for the normal general physical condition of the human body. It is known that there is a close relationship of almost all non-communicable diseases with damage to the teeth and oral cavity. The occurrence in people of various types of pathology of the cardiovascular system, rheumatism, nephropathy, many infectious and allergic conditions, diseases of the gastrointestinal tract and liver is considered by clinicians in connection with dental diseases.
In the presence of foci of chronic infection in the oral cavity, the frequency of somatic diseases increases by 2-4 times, and if an unsatisfactory index of oral hygiene is also detected, it increases by more than 5 times. Therefore, the task of protecting public health cannot be solved without eliminating dental pathology.
Dental care has long been one of the most popular types of medical care. At the same time, in 99% of cases, patients are served in outpatient clinics. In the structure of dental diseases requiring hospitalization (about 1% of patients), the leading place is occupied by odontogenic inflammatory diseases, neoplasms and injuries of the maxillofacial region.
Today, the Ministry of Health of Russia, the health authorities of the country's regions and municipal councils, within their competence, carry out planning activities for the development of dental care for the population and control over the activities of subordinate dental services. At all administrative levels of health management, a chief specialist in dentistry is appointed.
Training of dentists is carried out at the dental faculties of medical universities. Along with this, the production of dentists with a secondary medical education is still continuing in Russia. Today, the indicator of staffing of all doctors, dentists is on average 4.7 (in a number of large cities - more than 5) specialists per 10 thousand inhabitants.
According to the current nomenclature in Russia, dentists with higher education can work in healthcare institutions both in the main specialty "dentistry" and in specialties that require in-depth training: "orthodontics", "children's dentistry", "therapeutic dentistry", "orthopedic dentistry". ”, “surgical dentistry”.
Outpatient dental care for the urban population is provided in various types of specialized medical institutions. These include:
1) state and municipal dental clinics (for adults and children);
2) dental units (departments and offices) as part of other state health care institutions (territorial polyclinics, medical units, hospitals, dispensaries, women's clinics, etc.);
3) dental offices in non-medical organizations (schools and preschool institutions, higher and secondary specialized educational institutions);
4) private dental clinics.
There have been no major changes in the network of public dental institutions in the country over the past ten years. The total number of dental clinics during these years remained virtually unchanged and today is about 950 institutions. At the same time, the number of dental units (departments and offices) within other organizations has somewhat decreased.
The transition to market relations in the healthcare sector, price liberalization, the development of new civil legislation - all this contributed to the rapid growth of private dental clinics over the past decade. Today, the private sector of dental care is represented both by commercial structures of various legal forms (production cooperatives, business companies and partnerships), and by individual entrepreneurs who carry out their activities to provide dental services individually (without forming a legal entity).
The bulk of private dental services are small outpatient clinics (an average of 2-3 chairs) and separate rooms. Less common are larger clinics and even entire chains of clinics, which can be found almost exclusively in large cities.
In the conditions of the free market of medical services, the population has a real opportunity to choose a dental institution and a doctor. And today, paid dental care has already become the most important factor in the financial condition of not only private, but also public dental institutions. In these conditions, there is already competition between clinics for attracting a patient, which to a certain extent contributes to improving the quality of dental care in general.
In accordance with Decree of the Government of the Russian Federation of November 26, 1999 No. 1194 “On the program of state guarantees for providing citizens of the Russian Federation with free medical care”, citizens are provided with assistance in case of diseases of the teeth and oral cavity at the expense of compulsory medical insurance. In addition, at the expense of the budgets of all levels, preferential prosthetics of teeth are carried out for certain categories of citizens, including children under 18 years old, old-age pensioners, war invalids, disabled children, disabled workers of groups I and II, heroes of the Soviet Union, heroes of the Russian Federation, full gentlemen orders of Glory, residents of besieged Leningrad, veterans of military operations on the territory of other countries, etc.
When providing citizens with free care, it is necessary to combine the well-known principles of centralization and decentralization in the organization of dental services. With a centralized form, the reception of the population is carried out directly in the dental clinic or in the dental department (office) of another medical institution.
A decentralized form of service provides for the creation of permanent dental offices at enterprises and organizations. The advantage of this form is that, firstly, the public is served on the spot and constantly; secondly, there is the possibility of full medical care for workers or students; thirdly, the possibility of closer contact between the doctor and the patient increases. In providing dental care to children, a decentralized form of its organization on the basis of educational institutions is advisable.
Organization of the work of the dental clinic
Among all medical institutions providing dental care, a special place is occupied by a dental clinic. A dental clinic is a medical and preventive institution whose activities are aimed at the prevention of dental diseases, the timely detection and treatment of patients with diseases of the maxillofacial region. Dental clinics differ:
1. By the level of service: republican, regional, regional, city, district.
2. By subordination: territorial, departmental.,
3. According to the source of financing, budgetary, self-supporting.
A dental clinic is created in accordance with the established procedure and operates as an independent healthcare institution. The boundaries of the area of activity of the polyclinic, the list of organizations that it serves, are established by the health management body according to the subordination of the polyclinic. The main tasks of the dental clinic are:
a) taking measures to prevent diseases of the maxillofacial region among the population and in organized groups;
b) organizing and conducting activities aimed at early detection of patients with diseases of the maxillofacial region and their timely treatment;
c) provision of qualified outpatient dental care to the population. To carry out the main tasks, the polyclinic organizes and conducts:
In a planned manner, according to schedules agreed by the heads of enterprises and organizations, preventive examinations of employees of industrial enterprises, construction organizations, students of higher and secondary educational institutions, employees and students of other organized groups with simultaneous treatment of identified patients;
Implementation of a complete sanitation of the oral cavity to all persons applying to the clinic for dental care;
Complete sanitation of the oral cavity in pre-conscription and draft contingents;
Providing emergency medical care to patients with acute diseases and injuries of the maxillofacial region;
Dispensary observation of certain contingents of dental patients;
Provision of qualified outpatient dental care with the implementation of timely hospitalization of persons in need of inpatient treatment;
Examination of temporary disability of patients, issuance of sick leave certificates and recommendations for rational employment, referral to medical and labor expert commissions of persons with signs of permanent disability;
The whole complex of rehabilitation treatment of pathologies of the maxillofacial area and, above all, dental prosthetics and orthodontic treatment;
Analysis of the incidence of the population with dental diseases, including the incidence of temporary disability of workers and employees working at industrial enterprises located in the serviced area, as well as the development of measures to reduce and eliminate the causes that contribute to the occurrence of diseases and their complications;
Selection of patients in need of sanatorium treatment;
Introduction of modern methods of diagnostics and treatment, new medical equipment and equipment, medicines;
Sanitary and educational work among the population with the involvement of the public, the Red Cross and Red Crescent Society and the use of all media (print, television, radio broadcasting, cinema, etc.);
Measures to improve the skills of doctors and paramedical personnel.
The dental clinic may include the following units (Scheme 1):
Registry;
Departments of therapeutic and surgical dentistry (including, in appropriate cases, children's);
Department of prosthetic dentistry with a dental laboratory;
Auxiliary divisions (rooms of X-ray diagnostics, physiotherapy);
Mobile dental offices;
Emergency dental care;
Administrative and economic part;
Accounting.
The structure of dental clinics provides for the creation of examination rooms. The doctors working in them provide a reasonable referral of patients to the doctors of the polyclinic, who provide specialized dental care. Doctors-stomatologists of examination rooms can themselves provide assistance to patients in the absence of the possibility to send them to the appropriate department.
In addition, departments and offices for providing highly specialized care to dental patients can be organized in the clinic. These include rooms for prevention, periodontology, orthodontics, a room for receiving patients with pathological changes in the oral mucosa, a room for functional diagnostics, and an allergological room.
In the structure of republican, regional, city dental clinics, organizational and methodological offices are being created, whose employees, together with the main specialists, carry out organizational and methodological work in dentistry, its planning, analysis of the activities of institutions, and develop measures to improve the quality of dental care to the population.
Dental polyclinic of republican, regional, regional subordination:
Carries out organizational and methodological management of dental clinics, departments and offices located in the relevant territory;
Analyzes the incidence in this territory, the need for dental care and develops measures aimed at its improvement;
Provides, in necessary cases, visits of specialists to rural areas to carry out the entire complex of therapeutic and preventive measures in them.
The direct management of the dental clinic is carried out by the head physician, whose rights and obligations are determined by the relevant regulation. The administration of the polyclinic, together with public organizations, establishes the rules of internal labor regulations. The mode of operation of the polyclinic is determined by the health authority by subordination, taking into account the needs of the population and specific conditions.
The dental clinic, equipped with modern equipment, staffed by qualified personnel who own modern methods of diagnosing and treating dental diseases, provides the highest quality of medical care.
An important section of the work of dental care is preventive activities. In order to actively combat dental caries and other most common dental diseases, dental clinics carry out planned dental and oral hygiene for children in schools and preschool institutions, university students and students of technical schools, vocational schools, adolescent workers, workers associated with occupational hazards, conscripts, pregnant women and other populations
The registry plays an important role in organizing the reception and regulating the flow of patients, which is carried out by issuing coupons or pre-booking an appointment. Primary coupons are issued for an appointment with a surgeon or for a scheduled appointment with a therapist, a narrow specialist (periodontist, specialist in diseases of the oral mucosa). Orthopedic and pediatric departments usually have their own registries.
In addition to regulating visits, the registry performs a number of other important functions: registration and storage of outpatient case histories, their selection, delivery to offices and layout after admission, registration of temporary disability sheets and their registration; has a reference and information service; carries out financial settlements with patients for payment of paid medical services.
In organizing the reception of patients in a dental clinic, an important role belongs to the duty dentist. He provides, if necessary, emergency dental care, examines the patient and determines the amount of further dental care he needs, directs patients to other specialists in the clinic.
Repeated visits by patients to the polyclinic are appointed and regulated by the attending physicians. With proper organization of work, the patient is observed by one doctor until complete sanitation. Some dental clinics work according to the district principle, which increases the responsibility of each doctor, allows you to evaluate the effectiveness of his work and control the quality of care.
In a number of polyclinics, the improvement of the quality of dental care is ensured by introducing a guarantee system of service: at the end of treatment and complete sanitation of the oral cavity, the patient is issued a so-called “sanation” coupon, which gives the patient the right to consult a doctor in case of defects, at any time out of turn during the year from the date of issue of the ticket.
The main sections of the work of a dentist working in a clinic are:
Provision of therapeutic and prophylactic, surgical or orthopedic care upon request;
Consultations for doctors of other specialties;
Dispensary observation of certain groups of dental patients;
Carrying out planned sanitation of the oral cavity in certain contingents of the population;
Sanitary and educational work.
The children's dental department works mainly according to the planned sanitation method. This method is implemented in two steps:
Stage 1 - examination of the oral cavity, determination of the need for various types of dental care and its volume;
Stage 2 - providing the necessary medical and preventive care as soon as possible until complete rehabilitation. In some cases, planned rehabilitation also provides for a third stage - subsequent systematic active monitoring of patients, i.e. dispensary observation.
Planned reorganization of organized children's groups is carried out according to a special schedule. For the implementation of this schedule, not only the dental clinic is responsible, but also the administration of schools and kindergartens.
Planned sanitation also covers some contingents of the adult population: invalids of the Great Patriotic War, pregnant women, pre-conscripts, somatic patients who are under dispensary supervision of a therapist, students of vocational schools, technical schools, university students, representatives of some professions.
The organization of the work of the orthopedic department deserves special attention. Dental care is provided at the final stage of treatment of dental patients, after a complete sanitation.
The orthopedic department has its own registry, examination room, offices of prosthetists, a dental laboratory, and may have an orthodontist's office. A patient in need of dentures applies to the registry of the orthopedic department. If there is a certificate of full sanitation, a special outpatient card is entered for him and a ticket is issued for an appointment with a doctor in an examination room. In the examination room, a prosthetic plan is drawn up, after which the patient is sent to an appointment with the attending orthopedic dentist, who examines the patient, gets acquainted with the prosthetic plan and draws up an order for the manufacture of prostheses. After payment for dental work in the laboratory, the manufacture of prostheses begins.
In addition to the manufacture of new prostheses, the orthopedic department repairs and replaces old prostheses, provides consultations on prosthetics and orthopedic treatment of dental diseases. Some large polyclinics provide specialized orthodontic care.
Free dentures are provided to disabled veterans of the Great Patriotic War, labor disabled groups I and II, personal pensioners, children and some other contingents of the population.
Dental polyclinics provide, if necessary, assistance to patients at home on the call of doctors from territorial polyclinics. To provide dental care at home, the clinic has portable equipment. All necessary types of assistance are provided at home, including dentures. Room calls are served either by doctors specially allocated for this, or by all doctors of the polyclinic in order of priority.
Emergency dental care during the opening hours of the polyclinic is provided by duty dentists, on weekends and holidays, as well as at night - in special emergency dental care centers, which are organized in several polyclinics of the city.
A large place in the work of the dental clinic is the medical examination of dental patients. Patients with active dental caries, diseases of the periodontium and oral mucosa, chronic osteomyelitis of the jaws, malignant neoplasms of the face and oral cavity, congenital cleft lip and palate, anomalies in the development and deformation of the jaws, etc. are under dispensary observation. The selection of such patients is carried out as during preventive examinations and planned sanitation, and when contacting dentists for medical care.
The polyclinic works according to plans that provide for specific organizational and treatment and preventive measures. Accounting for the activities of the polyclinic is carried out in the manner established by the health authorities according to accounting and reporting documents approved by the Ministry of Health of the Russian Federation.
Accounting and evaluation of the activities of the dental service
Solving the problems of organizing dental care for the population is impossible without analyzing the statistical data on the work of medical institutions (HCI) contained in the reporting and accounting documentation. The activities of individual doctors, institutions and the dental service as a whole are evaluated using certain statistical indicators. It is important not only to master the methodology for calculating these indicators, but also to evaluate them in dynamics, to compare them with standards, average indicators for the region, and indicators of other single-profile institutions. It should be noted that along with peer review and medical standards, performance indicators are also the most important means of monitoring the quality of dental care. Analysis of the activities of the dental service is carried out for:
1) improving the organization of work of dental institutions, current and long-term planning of their activities and resource provision;
2) determining the effectiveness of various methods of treatment and diagnosis, new medical technologies and new forms of organization of work of personnel;
3) assessment of all components (structure, technology and results) of the quality of dental care for the population.
The main role in the organization of primary statistical accounting in medical institutions and in the preparation of reporting documentation is performed by medical statistics offices. The functions of the medical statistics office are:
1) organization of statistical accounting in the departments of the institution;
2) instructing employees filling out reporting documentation and monitoring the correct maintenance of documentation and the reliability of the information contained in it;
3) compilation of summary (daily, monthly, quarterly, etc.) accounting documents and calculation of indicators necessary for operational management;
4) drawing up periodic (monthly, quarterly, semi-annual) reports and annual reports and submitting them to the addresses and terms provided for by the state statistical reporting sheet;
5) carrying out special statistical developments on the instructions of the management;
6) preparation of statistical materials and participation in the work on the analysis of the activities of the institution in the preparation of business plans;
7) preparation of statistical materials for licensing and accreditation of the institution;
8) rational organization of storage of accounting documents and control over the uninterrupted supply of all departments with the necessary accounting statistical documents.
The main reporting document of a medical institution of any profile is the annual report "Information on the medical institution for __ year" (form No. 30) and inserts to the report:
- "Information on medical personnel" (form No. 17);
- "Information on the activities of the medical institution in the compulsory medical insurance system for __ year" (form No. 52, form No. 14).
It should be noted that the annual report contains only the most elementary, general information that does not reveal all the specific aspects and qualitative characteristics of the dental service. For this reason, in each specific dental institution, various inserts to the annual report are usually filled out, which characterize in more detail the features of the work on providing dental care to the population.
Reporting documents are compiled in the office of medical statistics based on the data of accounting statistical documents, which are filled in by employees of the relevant departments.
Currently, a system based on measuring the volume of work in conventional units of labor intensity (LTU) is used to record the work of dentists.
Order of the Ministry of Health of the USSR No. 50 dated January 25, 1988 “On the transition to a new system of accounting for the work of dentists and improving the form of organization of dental appointments” defines a list of 183 types of work with their corresponding assessment in the UET, which are the economic equivalent of labor costs for the implementation of treatment and prophylactic dental care activities. For example, the imposition of a filling in case of superficial or medium caries is taken into account as 1 UET, complex tooth extraction as 1.5 UET, and splinting for fractures of the jaws will be 4 UET.
Accounting for the work of doctors by conventional units of labor intensity provides:
1. Orientation of the work of doctors to obtain a specific result, expressed in the UET.
2. Stimulating work to provide maximum assistance in one visit.
3. The possibility of developing an adequate system of material incentives for the work of doctors, taking into account the final result.
4. Obtaining a cost estimate for each case of sanitation of one patient.
5. Development of a planned assessment of the labor costs of doctors for one sanitation.
6. Differentiation of highly labor-intensive types of work according to UET.
7. The possibility of obtaining an economic assessment of labor costs and funds.
8. Clear criteria for the transition to differentiated remuneration of doctors, depending on the volume and quality of work.
The list of types of work expressed in the UET is divided into two groups:
1. Adult reception.
2. Children's reception.
Types of work on adult reception, in turn, are divided into general and related to therapeutic, periodontal, surgical and preventive receptions.
It should be noted that for the evaluation of each individual type of work in pediatric dentistry, a larger number of UETs has been established. For example, such a type of work of a pediatric dentist as the treatment of pulpitis with filling 2 root canals of a permanent tooth with cement is estimated at an adult appointment at 4.5 UET, and at a children's appointment - at 5 UET. These differences in the assessment of labor costs at adult and children's appointments are explained by specific factors that take place when helping children: mental characteristics, behavioral lability, etc.
In accordance with existing standards, a dentist with a six-day working week must perform work equivalent to 21 UET, with a five-day one - 25 UET per working day.
The main accounting statistical documents currently used in dental institutions are:
Medical card of a dental patient (f. No. 043 / y);
Sheet of daily accounting for the work of a dentist, dentist of a dental clinic, department, office (f. No. 37 / y-88);
a sheet of daily records of the work of a dentist-orthopedist (f. No. 037-1 / y);
diary of the work of a dentist-orthodontist (f. 039 - 3 / y -88);
Diary of accounting for the work of an orthopedic dentist (f. 039; 4 / y);
Control card of dispensary observation 030/y;
Referral for consultation and auxiliary offices (form No. 028/y);
Journal of recording outpatient operations;
Journal for records of KEK conclusions (035 / y);
Book of registration of issued certificates of incapacity for work (0366 / y);
A coupon for the final case of temporary disability (f. 025-9 / 4-y-96), etc. Based on the data of the accounting documentation, an annual report is compiled (f. 30), in which (in section P, p. 5. “The work of the dental (dental) office") provides information on the activities of dental units.
The use of these forms of statistical records allows you to obtain the necessary information to analyze the activities of dental institutions at all levels. With the rational use of the information contained in these documents, it is possible to obtain a number of quantitative and qualitative indicators that characterize the treatment and preventive work of the dental service as a whole and its individual institutions, departments and doctors.
Indicators of preventive work of dental institutions
Number of sanitations per day per doctor:
Total sanitized in the order of planned sanitation and on request Number of working days
The share of sanitation by referral (calculated for a doctor, department, polyclinic):
Number of primary patients sanitized by negotiability 100\%
Total number of admitted primary patients
The proportion of rehabilitation for preventive work:
Number of sanitized out of those identified
with planned sanitation 100\%
__________________________________________________
The number of those in need of sanitation among those examined
Certain indicators of preventive work are of the greatest importance in servicing the child population.
Percentage of children who received drug prevention of caries:
Number of children who received drug prophylaxis 100\%
The total number of those examined in a planned manner
Sanitation coverage of children (\%):
(healthy + previously sanitized + sanitized) 100\%
Number of children on the list
The number of cases of complicated caries per 1000 children:
Number of cases of complicated caries for
teeth of temporary (or permanent) bite 1000
Number of children examined
Percentage of children with satisfactory oral hygiene:
Number of children with satisfactory
hygienic condition of the oral cavity 100\%
Number of children examined
General indicators of medical work
Average number of visits per day:
The total number of admitted patients in just
specific period (month, year)
The ratio of cured and extracted teeth:
Total teeth filled
(temporary and permanent bite)
Removed permanent occlusion teeth
The average number of LUTs (conventional units of labor intensity) per day per doctor:
The total number of developed UET for the reporting period
Number of working days in the period
The number of UET per visit:
The total number of produced UE
performed by a doctor
for a certain period _______________
Total doctor visits
Of particular importance are the indicators of clinical examination, which include the following:
Completeness of coverage by dispensary supervision:
The number of patients with a certain disease (periodontitis, leukoplakia, etc.) under observation at the beginning of the year + the number of patients newly taken under observation during the year - the number of patients not observed
In the reporting year 100\%_________
Number of registered patients with this disease
Timeliness of coverage of patients with dispensary observation:
The number of patients taken under observation from among
newly identified 100\%
The number of newly diagnosed patients with this disease
To assess the effectiveness of clinical examination determine:
Percentage of patients withdrawn from dispensary observation due to cure:
The number of patients withdrawn from dispensary observation due to
Healed 100\%
Percentage of patients whose health status remained unchanged:
Number of patients, state of health
which remained unchanged 100\%
Total number of patients registered at the beginning of the year
The frequency of relapses in patients who received a course of treatment:
Number of exacerbations (relapses) in people who received treatment 100\% Number of people who received treatment
Indicators of work in therapeutic dentistry
Average number of filled teeth per doctor per day:
Total teeth filled during this period
Number of working days in the period
The average number of visits for the treatment of one tooth (including for caries, pulpitis, periodontitis):
Total number of visits
Number of filled teeth
The ratio of cured teeth with uncomplicated caries to cured teeth with complicated caries:
Number of treated teeth with uncomplicated caries
Number of treated teeth with complicated caries
The frequency of complications after endodontic treatment (separately for pulpitis and periodontitis):
Number of complications after endodontic treatment 100%
Total number of endodontic interventions
The frequency of alterations of seals:
Number of reworked fillings 100\%
Total number of applied fillings
Performance indicators for surgical dentistry
Average number of tooth extractions performed per day:
Total number of tooth extractions (temporary and permanent bite)
for a certain period __________________
Number of operations per day (except for tooth extractions):
The total number of transactions performed for a certain period
The number of working days of the surgeon in the period
The percentage of patients hospitalized according to indications in specialized hospitals (by department, polyclinic):
Number of patients hospitalized in
specialized hospitals 100\%
The total number of patients admitted for surgery
The frequency of complications after surgical interventions:
The number of complications after surgical interventions 100\%
Total number of surgical interventions
The frequency of discrepancy between the diagnoses of the polyclinic and the hospital:
The number of discrepancies between the diagnoses of the polyclinic and the hospital 100\%
Total number referred for inpatient treatment
Indicator of operational activity (in\%):
Number of performed operations 100\%
Total number of patients
The frequency of discrepancy between clinical and cytological diagnoses after removal of tumors and tumor-like formations of the maxillofacial region:
Number of discrepancies between clinical and cytological diagnoses 100\% Total number of surgeries performed to remove tumors
Considering that an important part of the work of dentists at a surgical appointment is the examination of disability, it is more important to study the corresponding incidence rates with temporary disability.
Indicators of work on dental prosthetics
Number of visits per day per orthopedic dentist:
Number of working days in the period
Average terms of orthopedic treatment (separately for fixed and removable dentures):
Total number of days of orthopedic treatment
Number of people receiving orthopedic treatment
Specific weight of esthetic single crowns:
Number of esthetic single crowns 100\%
Total number of single crowns
Average number of abutment crowns in a bridge:
Number of abutment crowns in bridges
Number of bridges
Specific gravity of clasp prostheses:
Number of clasp prostheses 100% ____________
The sum of all partial lamellar removable and clasp dentures
Average number of visits per patient receiving prostheses:
Number of visits for prosthetics
Number of people who received prostheses
Frequency of denture rework (before warranty expires):
Number of reworked dentures 100\%
Total number of manufactured prostheses
Removable dentures repair frequency:
Number of removable dentures repaired 100\%
Total number of removable dentures
Share of free dentures:
Number of persons who received prostheses free of charge 100\%
Total number of people who received prostheses
Orthodontics performance indicators
Average number of visits per day per orthodontist:
The number of all visits for a certain period
Number of working days in the period
Orthodontic completion rates:
Number of children who completed orthodontic treatment 100%
Number of children receiving orthodontic care
Specific weight of intraoral non-removable devices of mechanical action:
mechanical action 100\%
Total number of orthodontic appliances
Specific weight of intraoral non-removable functional-guiding devices:
Number of intraoral non-removable devices
functionally guiding action 100\%
Total number of manufactured orthodontic appliances
The specific weight of intraoral removable devices of functional action:
Number of intraoral removable appliances
functional _action 100\%
Total number of intraoral removable devices
The proportion of manufactured prostheses:
Number of dentures (removable and non-removable) 100\%
Total number of orthopedic structures
Performance indicators of the auxiliary units of the dental clinic
Average number of physiotherapy sessions per day:
The number of released procedures for a certain period
Number of working days of physiotherapy
office in the period (doctor or nurse)
Average number of x-rays per day:
Total number of X-rays in a given period
The number of working days of the X-ray room in the period
(doctor or X-ray technician)
Indicators of provision of the population with dental care
It is advisable to calculate indicators characterizing the level of provision of the population with dental care on the scale of a specific service area (city, region, district, etc.). At the same time, information regarding the population's accessibility for dental care and the level of accessibility of the latter is of particular value.
Population's rate of seeking dental care:
Number of first visits per year 100\%
Number of residents in the service area
Dental care accessibility index:
Number of first visits 100\%
Number of people in need of dental care
To assess the possibilities of dental care, it is of great importance to determine the indicator of the provision of the population with dental jobs and dentists.
Provision of the population with existing dental jobs per 10,000 inhabitants:
Number of dental jobs 10000
Provision of the population with dentists (dentists) per 10,000 inhabitants:
Number of dentists (dentists) 10000
Population served
The staff standards of the dental clinic approved by the order of the Ministry of Health of the USSR dated 01.10.1976 No. 950 are advisory in nature and provide for:
4.0 positions of doctors in total for therapeutic and surgical dentistry per 10,000 adult urban population;
4.5 positions - doctors in total for therapeutic, surgical dentistry and orthodontics per 10,000 urban children;
1.0 positions of an orthopedic dentist per 10,000 urban adults;
To determine the capabilities of a dental hospital, you can calculate the indicator of the provision of the population with dental beds:
Number of dental hospital beds 10000 Average annual population
Dental Care Level Indicator
To assess the effectiveness of the dental service, along with the above coefficients, you can use a special indicator proposed by P. A. Leus - the index of the level of dental care (USP):
where: K - the average number of untreated unfilled carious lesions of the teeth; A - the average number of extracted teeth not restored with prostheses, KPU - the average value of the intensity coefficient of the carious process (caries, filling, removal).
Criteria for assessing the level of dental care:
>10% - low level,
10-49\% - insufficient level;
50-74\% - a satisfactory level;
75% and > are good levels.
Features of dental care for residents of rural areas
The relatively large proportion of rural residents in the overall structure of the country's population and the high prevalence of dental diseases oblige health authorities to provide the rural population with affordable and highly qualified dental care.
The specifics of working conditions, the seasonality of agricultural work, the remoteness of a number of settlements, and low population density make it difficult to provide dental care to rural residents. In addition, the provision of the rural population with dentists is significantly lower than the provision of the urban population. In this regard, the search and implementation of the most effective forms of organizing dental care and bringing it closer to rural residents remains one of the most important tasks of health authorities.
Given the specific difficulties in providing dental care to the rural population, it is necessary to strive to ensure that it is provided in a planned manner at all levels of medical institutions in medical outpatient clinics, district and district hospitals, dental clinics, as well as in mobile offices working directly in villages. Therefore, the organizational feature of providing dental care to rural residents is its phasing.
Most of the visits to dentists (except for visits to orthopedic dentistry) by rural residents are in the dental offices of district hospitals and outpatient clinics. Therefore, the volume and quality of dental care for the rural population as a whole significantly depends on the level of its organization in the rural medical area. It is this link in the organization of dental care that should be given special attention by the health authorities.
The most effective method of work of a rural dental office is a differentiated reception of dental patients in the presence of 4-5 thousand inhabitants on the site. The following office work schedule is recommended: 2 days a week are allotted for the appointment of therapeutic patients, and 1 day for the reception of surgical patients. Planned preventive sanitation of organized groups of the population should be carried out 3 times a week. It is quite clear that for patients with acute pain, assistance is provided on request.
For planned sanitation of the oral cavity of organized groups of children and adults living in villages where there is no dentist, it is advisable to organize stationary dental offices at feldsher-obstetric stations, dispensaries or schools, where the dentist of the district hospital, medical outpatient clinic or central district hospitals.
In the dental office for patients, the work schedule of the dentist, both in the district hospital and at the paramedical station, should be posted. The organization of such offices allows saving the doctor's working time for relocation, increases the shelf life of the equipment, improves the work of the doctor and creates the opportunity to provide qualified dental care.
Almost one third of the total volume of dental care for the rural population is provided in the central district hospitals, which operate dental departments and offices, as well as mobile offices directly in rural areas. The work schedule of dentists in the district hospital should be designed in such a way that rural residents can receive assistance in the first half of the day. In this case, the principle of maximum assistance in one visit should be observed using single-session methods for the treatment of complicated forms of dental caries. Experience shows that a rural resident goes to the district hospital mainly during a period of acute pain. However, after the dentist relieves the pain, the patient often does not come to the end of the treatment. Therefore, in rural areas, and especially during the period of active agricultural work, it is necessary to widely use single-session methods of treatment, thanks to which it becomes possible to prevent complications from incomplete treatment.
In the regional polyclinic, the rural population receives consultative and medical assistance in the direction of doctors from regional dental institutions. Specialists of regional polyclinics also provide dental care during scheduled visits to the regions and as part of specialized teams directly in the villages.
During the period of planned visits of the leading specialists of the regional polyclinic, along with the provision of organizational and methodological assistance to rural institutions, advisory and medical assistance is provided to the population. The schedule of departures is reported to the district medical institutions in advance, so that preparatory work is carried out on the ground. By the arrival of specialists, patients are invited for a consultation, lists of dispensary patients registered both in the regional and district hospitals are checked, who are also invited to an appointment with a specialist,
Patients in need of treatment by regional specialists should be referred directly to regional polyclinics, and not to the inpatient departments of regional hospitals, since patients who can be treated in outpatient settings are often referred there. The procedure for hospitalization of patients requiring inpatient treatment is approved by the regional health authority.
One of the important sections of the activity of all dental institutions in rural areas, as well as in the city, is the planned sanitation of the oral cavity and teeth. Children of preschool and school age, adolescents, pregnant women, agricultural workers, whose working conditions may contribute to the development of dental diseases, are subject to mandatory sanitation. Examinations for this purpose are often carried out on the spot, for which the work of mobile dental offices is organized at the regional hospital or the Central District Hospital
Each mobile office should have all the main types of dental care, including orthopedic. The work is planned in such a way that the cabinet will work in each farm for 2 months. In the spring and autumn of the year. In mobile offices, assistance is provided primarily to organized groups of children and adults
The work schedule of mobile offices should be drawn up taking into account the employment of the population in agricultural work and be brought to the attention of citizens in advance. At the same time, it is imperative to take into account the population density, the availability and quality of roads, the operation of public transport, the prevalence of dental diseases and other local features of a particular territory.
PURPOSE OF THE LESSON: to know the current state of dental care, the structure, tasks and organization of the city dental clinic, to master the methodology for calculating and evaluating general and special indicators of the clinic, to use the information received to analyze and plan the activities of the institution.
LESSON METHODOLOGY: Students independently prepare for a practical lesson using the recommended literature and do individual homework. The teacher within 10 minutes checks the correctness of the homework and points out the mistakes made, checks the degree of preparation using testing and oral questioning. Then the students independently, according to the annual report of the medical institution, calculate the main indicators of the polyclinic's activity. Analyze the obtained data and formulate a conclusion. At the end of the lesson, the teacher checks the independent work of students.
CONTROL QUESTIONS:
1. What types of medical institutions provide outpatient dental care to the population?
2. What are the main tasks of the dental clinic.
3. What is the structure and organization of work of the city dental clinic?
4. What is the organization of work of the polyclinic registry?
5. What are the functional duties of a dentist?
6. How is dispensary observation of patients of the city dental clinic organized?
7. What is the anti-epidemic work in the dental clinic?
8. What are the main types of documentation used by dentists?
9. Name the general and special performance indicators of the dental clinic. What is the method of their calculation and evaluation?
Dental care is a type of specialized medical care provided for diseases and injuries of the teeth, jaws and other organs of the oral cavity and maxillofacial region. Dental care includes therapeutic, orthopedic and surgical dentistry and is one of the most popular types of specialized medical care. The bulk of dental care (more than 90%) is provided on an outpatient basis. Outpatient dental care is provided by:
In specialized state and municipal dental clinics (for adults and children);
In dental departments (offices) that are part of other public health institutions: territorial polyclinics, medical units, dispensaries, women's clinics;
In dental offices deployed in non-medical organizations: preschool and school institutions, higher and secondary specialized educational institutions;
In private dental organizations, institutions, offices.
The dental clinic is the main medical and preventive institution in the system of outpatient dental care, whose activities are aimed at the prevention of dental diseases, the timely detection and treatment of patients with diseases of the maxillofacial region. The work here is based mainly on the district principle, and the leading method should be the dispensary method.
Depending on the number of medical positions, polyclinics are divided into categories.
As part of the dental clinic in the department of orthopedic and orthodontic dentistry, as a rule, a dental (denture) laboratory is deployed, in which complex technological processes associated with the manufacture of dentures are carried out: casting, stamping, soldering, grinding, polishing, polymerization and artistic modeling. In addition, mobile dental offices equipped with special vehicles can be created in the regional (regional) dental clinic.
The main tasks of the city dental clinic:
Providing highly qualified and specialized dental care in the clinic and at home.
Organization and implementation of measures for the prevention of diseases of the maxillofacial region - medical examination of the population, sanitary and educational work, promotion of a healthy lifestyle, anti-epidemic measures.
Carrying out rehabilitation treatment of pathologies of the maxillofacial area and, above all, dental prosthetics and orthodontic treatment.
High-quality conduct of clinical and expert work - examination of temporary disability and timely detection of signs of permanent disability.
Timely hospitalization of persons in need of inpatient treatment.
Compliance with successive ties with other health facilities.
The main tasks of a dentist are to provide qualified medical and diagnostic care on an outpatient basis to patients with diseases of the teeth and oral cavity, living in the area of the clinic, as well as workers and employees of attached enterprises. The dentist in his work reports directly to the deputy chief physician for medical affairs, and in his absence, to the chief physician of the polyclinic.
Functional duties of a dentist:
1. Conduct outpatient appointments according to the schedule approved by the administration of the polyclinic, regulating the flow of visitors through the rational distribution of repeat patients.
2. Provide qualified and timely examination and treatment of patients with diseases of the teeth and oral cavity.
3. Carry out preventive examinations and sanitation of the oral cavity among patients who are under dispensary observation in the clinic.
4. Provide out-of-turn emergency assistance to patients with acute toothache, as well as war and labor veterans.
5. Ensure the correct examination of temporary disability.
6. Refer patients, if indicated, to additional types of research (laboratory, x-ray, functional, etc.).
7. Timely present patients with unidentified forms of diseases or those who are ill for a long time for a consultation with other specialist doctors of the polyclinic and CEC.
8. Advise patients on the referral of other specialists of the institution, including at home.
9. Carry out, in accordance with the indications, timely hospitalization of patients.
10. Follow the principles of deontology in your work.
11. Monitor and manage the work of the paramedical staff of the dental office.
12. Systematically improve their professional skills by studying the relevant literature, participating in conferences and seminars.
13. Participate in the promotion of sanitary and hygienic knowledge among the population on the prevention of diseases of the teeth and oral cavity.
14. Keep medical records of dental patients, a diary of the work of a dentist, a sheet of daily records of the work of a dentist, a log of preventive examinations of the oral cavity, etc.
The dentist has the right:
Make proposals to the administration of the polyclinic on improving the organization of preventive dental care for the population, the organization and conditions of their work and the work of the paramedical staff of the dental office;
Participate in meetings on the organization of dental care;
Prescribe and cancel any therapeutic and preventive measures, based on the patient's condition;
Receive information necessary for the performance of official duties;
Improve your qualifications in advanced training courses in the prescribed manner.
The dentist is responsible both for poor-quality work and erroneous actions, as well as for inaction and failure to make decisions that fall within the scope of his duties and competence, in accordance with applicable law.
An important part of the dentist's work is preventive activity. Disease prevention is a system of medical and non-medical measures aimed at preventing deviations in health status, slowing down the progression of diseases and reducing their adverse effects. In dentistry, it is customary to subdivide preventive measures into primary, secondary and tertiary prevention.
Primary prevention: a set of general measures to improve human health in combination with special ones aimed at preventing dental caries, periodontal disease, dental anomalies (sanitary and educational work, balanced nutrition, water fluoridation, elimination of occupational hazards).
Secondary prevention is a set of measures for the timely treatment of caries and its complications, periodontal disease and dental anomalies. The main organizational method of secondary prevention is the planned provision of dental care (scheduled sanitation).
Tertiary prevention is the restoration of the lost function of the dentition as a result of tooth loss.
In order to actively prevent dental caries and other common dental diseases, polyclinics carry out planned dental and oral hygiene for decreed groups of the population (children and adolescents in organized groups, students, industrial workers, pregnant women, etc.)
Planned rehabilitation methods:
Centralized - provides for examination, diagnosis of diseases and all types of treatment in a dental clinic. This method allows you to carry out high-quality medical and preventive work, since the clinic has modern special equipment, materials and medicines, the best diagnostic capabilities.
Decentralized - planned sanitation is carried out in existing dental offices at enterprises, organizations and educational institutions with at least 2,000 employees and at least 1,500 students.
Brigadier (visiting) - a team of 3-4 doctors, 1 nurse and 1 nurse is formed in the dental clinic to provide dental care to rural residents, children in preschool institutions, and the elderly. This method uses specially equipped transport.
The assessment of the work of a dentist is carried out by the deputy chief physician of the polyclinic for the medical unit based on the results of work for the quarter (year) based on the qualitative and quantitative indicators of his work, his compliance with the requirements of fundamental official documents, labor discipline rules, moral and ethical standards, social activity. To account for the work of dentists, a system is used based on measuring the amount of work in conventional units of labor intensity (LTU). Labor accounting according to the UET is aimed at raising the interest of doctors in the final results of their own work, stimulating their productivity growth and developing a preventive focus in their work. For 1 UET, the amount of work of a doctor is taken, which is necessary for applying a filling with an average caries. Labor costs increase when performing more complex types of work. So, when applying a filling with deep caries, the doctor performs 1.5 UET, in the treatment of pulpitis of a single-root tooth in one visit 4.0 UET (two-root tooth - 5.0 UET, three-root tooth - 6.0). Treatment of periodontitis of a single-rooted tooth in one visit is estimated at 3.5 UET, a two-root tooth - 4.5 UET, a three-root tooth - 5.5 UET.
A doctor with a six-day working week must perform 21 conventional units of labor intensity per working day, with a five-day working week - 25 UET. The norm of annual workload per 1 doctor is 5500 UET.
The use of the principle of conventional units of labor intensity (LUT) provides for the following opportunities for intensifying the activities of dental institutions, taking into account budget financing and financing under compulsory medical insurance programs:
1. reduction in the number of visits to the patient for the provision of dental care, which, in turn, provides each patient with savings in his personal and working time spent on receiving this care, in the amount of 30% to 60% by reducing travel time, registration , waiting for reception; providing more assistance in one visit: treatment of 2-3 teeth for caries in one visit, treatment of pulpitis - in one visit, etc.;
2. saving the doctor's working time by reducing the time spent on non-productive elements of the labor process (calling the patient, preparing the workplace, preparing the operating field, working with documentation, etc.);
3. reduction in the number of such auxiliary elements of the labor process as the selection of tools necessary for the performance of work, its sterilization (reduction in the number of directions of tools for sterilization from 2-5 times, according to the number of visits, to 1);
4. increase in the number of fillings applied per shift, from 6 (according to standards oriented to assessment by visits) to 10-12 due to the rational use of the real working time of dentists.
5. increase in the overall labor productivity of dentists by 15-20%, and in some regions by 25%.
Performance indicators of the dental clinic
1. Security of the population with dental outpatient care:
Number of occupied medical positions of dentists in the clinic? 10000
Population in the area of operation of the polyclinic
The standard is 5.0 per 10,000 adults and 5.0 per 10,000 children
2. Staffing of doctors - dentists
Number of occupational positions of dentists? 100
Number of full-time medical positions of dentists
Norm - 100%
3. Average number of visits to dentists per inhabitant per year:
The number of all visits of the residents of the district to dentists
Population in the area of operation of the polyclinic
The average number of visits per 1 adult to dentists is 1.9; for 1 child - 1.4; in total - 1.79.
4. The average number of ULs produced by one doctor per day:
The total number of conventional units of labor intensity generated for the reporting period
Number of working days in the period? number of occupied medical positions
A doctor with a six-day working week must perform 21 conventional units of labor intensity per working day, with a five-day working week - 25 UET
5. Share of initial visits
Number of initial visits to the dental clinic? 100
Number of all visits made to the dental clinic
The average number of first visits is about 45%
6. The ratio of cured and extracted teeth
Total teeth filled
Removed permanent occlusion teeth
In the context of the use of modern technologies is
7. The proportion of those who were sanitized out of those who applied to the polyclinic
Number of sanitized by negotiability? 100
Total number of admitted primary patients
Must be at least 55-60%
8. The proportion of those in need of sanitation, among those examined in a planned manner
The number of those in need of sanitation among those examined? 100
The total number of those examined in a planned manner
On average reaches 70%
9. The proportion of sanitation for preventive work
Number of sanitized out of those identified during planned sanitation? 100
The number of those in need of sanitation among those examined
This figure should be close to 100%.
TASK FOR INDEPENDENT WORK:
Task number 1.
According to the annual report of the medical institution, calculate the performance indicators of the dental clinic. Analyze the data obtained and draw a conclusion about the features of the organization of the work of the dental clinic.
Lisitsyn Yu.P. Public health and healthcare. M, 2002.
Lisitsyn Yu.P. Social hygiene (medicine) and healthcare organization. Kazan, 1999. -p. 321- 339
Yuriev V.K., Kutsenko G.I. Public health and healthcare. S-P, 2000. - p. 399-415.
Public health and healthcare. Ed. V.A. Minyaeva, N.I. Vishnyakova M. "MEDpress-inform", 2002. - p. 296-312.
Ministry of Health of the Russian Federation
GBOU VPO St. Petersburg State
BASICS OF ORGANIZATION
DENTAL CARE TO THE POPULATION
Saint Petersburg
Fundamentals of organizing dental care for the population(Teaching aid for students of the Faculty of Dentistry). , . - St. Petersburg: GPMU, 2016. - 67p.
Honored Worker of Science of the Russian Federation,
Doctor of Medical Sciences, Professor
Candidate of Medical Sciences, Associate Professor
candidate of medical sciences, professor
Candidate of Medical Sciences, Associate Professor
Candidate of Medical Sciences, Associate Professor
PhD, assistant
Reviewers:
Head of the Department of Social Pediatrics and Health Organization of the FP and FVE of the St. Petersburg State Pediatric Medical University, Honored Worker of Science of the Russian Federation, Doctor of Medical Sciences, Professor ,
Head of the Department of Humanitarian Disciplines and Bioethics of St. Petersburg State Pediatric Medical University, Doctor of Medical Sciences, Professor
Introduction…………………………………………………………………..5
Chapter 1
logical help
1.1. General principles of organization of dental outpatient care………………………………..........................................6
1.2. Organization of outpatient care for adults
to the scrap population…………………………………………………………………9
1.2.1. The procedure for providing medical care to the adult population
with dental diseases…………………………………………...9
1.2.2. Organization of the work of the dental clinic for
adult population…………………………………………………………..11
1.2.3. Organization of the work of departments (offices, laboratories)
dental profile in medical organizations, providing
providing outpatient medical care……………………………..16
1.3. Organization of outpatient care for children
to whom the population…………………………………………………………..18
1.3.1. The procedure for providing medical care to children with stomato -
logical diseases……………………………………………….........18
1.3.2. Organization of the work of a children's dental clinic ........ 19
1.3.3. Organization of the work of the children's dental office……….23
1.4. Organization of the activities of the dental office in
educational institutions…………………………………………..24
1.4.1. Organization of the activities of the dental office in
educational institutions of secondary, higher and postgraduate
and in organizations……………………………………………………………….24
1.4.2. Organization of the work of the dental office in children's
educational institutions…………………………………………………..25
Chapter 2. Organization of inpatient dental care
2.1. General principles of organization of hospital care…………………27
2.2. Organization of inpatient dental care .................................... 32
2.3. Organization of inpatient dental care for children……….35
Chapter 3. Organization of dental care for residents
countryside
3.1. General principles for the organization of medical care for residents
countryside.…………………………………………………………...38
3.2. Organization of dental care for the rural population……..39
3.3. Organization of dental care at the level of FAP, doctor-
3.4. Organization of dental care at the department level,
offices of the central district hospital (CRH), district dental clinics………………………………………………………….42
3.5. Organization of dental care at the regional level
(regional, district, republican) dental clinic..43
3.6. Staff standards for medical personnel to provide
dental care for residents of rural areas…………………45
3.7. Organization of the activities of a mobile dental office
neta (brigades)…………………………………………………………………….46
3.8. Dentist (general practitioner dentist)…………………..49
Chapter 4
its rules
4.1.Medical card of a dental patient ……………………..53
4.2. Dentist's Daily Record Sheet...............................................................57
doctor) dental clinic, department, office…………….57
4.4. Register of preventive examinations of the oral cavity………………58
4.5. Sheet of daily record of the work of a dentist-orthopedist .......... 58
4.6. Diary of accounting for the work of an orthopedic dentist……………………59
4.7. Medical record of an orthodontic patient…………………… ....59
4.8. Diary of accounting for the work of a dentist-orthodontist…………………..59
Chapter 5Statistical analysis of the activities of the dental
Russian organizations
5.1. Dental morbidity……………………………………..60
5.2. Analysis of the activities of dental organizations………………..63
Introduction
Dental care in our country is organized, directed, controlled and planned by the Ministry of Health of the Russian Federation, the ministries of health of the region (territory), city and district health departments. At all administrative levels of healthcare management, the most qualified and well-versed specialist in the organization of dental care for the population is appointed as the chief specialist in dentistry.
Currently, dental care, which includes therapeutic, orthopedic and surgical dentistry, is one of the most popular types of medical care. The share of dental morbidity among the general morbidity of the population reaches 20-25%, amounting to 345-550 cases per 1000 inhabitants; Applicability for dental care ranks second after the appeal to general practitioners. Dentists and dentists are second only to general practitioners in the health care system.
The most important tasks of dental organizations are to conduct a set of dispensary measures for the prevention, early detection, treatment and rehabilitation of patients with diseases of the oral cavity, salivary glands and maxillofacial region.
Dental institutions where patients receive general and specialized dental care include:
· State and municipal dental clinics for adults and children (republican, regional, district, regional, city, district).
· Dental offices in dispensaries, antenatal clinics, general medical (family) practice centers, health centers of industrial enterprises, educational institutions, etc.
· Dental departments and departments of maxillofacial surgery for adults and children as part of multidisciplinary hospitals, medical units, departmental institutions, etc.
· Clinical divisions of educational, research institutions.
· Private dental organizations (clinics, offices, etc.).
Chapter 1
Organization of an outpatient clinic
dental care.
1.1. General principles of organization of dental
outpatient care.
Outpatient care is received by about 80% of all patients who apply to healthcare organizations. The main types of outpatient clinics (APU) include: polyclinics, including dental ones for adults and children, dispensaries, general medical (family) practice centers, women's consultations, etc.
Dental clinics are divided by level of service, by subordination, by category.
1) By service level:
Republican, regional, district, regional;
urban;
District.
2) By subordination:
Territorial;
Departmental.
The main principles for the provision of outpatient care are:
· locality;
· availability;
preventive orientation;
Continuity and staging of treatment.
Precinct. Most of the outpatient clinics operate on a district basis , i.e. certain territories are assigned to the institutions, which in turn are divided into territorial sections. Plots are formed depending on the population. A local doctor (therapist, pediatrician) and a local nurse are assigned to each site. When forming sites to ensure equal working conditions for district doctors, not only the population is taken into account, but also the length of the site, the type of development, remoteness from the clinic, transport accessibility and other factors. In dental practice, the principle of locality is used extremely rarely.
The organization of dental care according to the district principle allows the dentist to study the main indicators of morbidity in the population (prevalence, intensity and increase in the intensity of caries), timely identify risk factors for oral diseases, early forms of pathology and develop a plan for preventive and therapeutic measures.
Availability . The implementation of this principle is ensured by a wide network of outpatient clinics operating in the Russian Federation. Any resident of the country should not have obstacles to applying to the APU, both at the place of residence and in the territory where they are currently located. The availability of outpatient care is also ensured by its free of charge within the framework of the Program of State Guarantees for the Provision of Free Medical Care to Citizens.
