Features of dental examination of persons suffering from rheumatic diseases. Pediatric therapeutic dentistry_National guidelines

Medical examination is a method of health care for the population, including necessary complex health-improving social-hygienic and treatment-and-prophylactic measures in order to preserve and strengthen the health and increase the working capacity of the clinical populations (T.F. Vinogradova, 1988).

When starting to organize clinical examination of children with dental anomalies and deformities, the orthodontist must examine three groups of children (L.P. Zubkova, F.Ya. Khoroshilkina, 1993):

1) children of preschool and school age who do not have central lesions nervous system, without severe dental diseases;.

2) children with chronic somatic diseases, causing the need for medical examination by an orthodontist;

3) children with dental diseases for whom long-term medical examination is indicated.

The idea of medical examination at the dentist in our country was put forward by A.I. Evdokimov.

To successfully carry out preventive and therapeutic measures acceptance it is necessary to organize medical examination of children in preschool institutions and schools. The organizer of work in dispensary groups of children is the district police officer pediatric dentist. The orthodontist is assigned to several areas (optimally four). During medical examination of children with dental anomalies and deformations, they are grouped according to nosological forms. To carry out orthodontic medical examination, from 1.7 to 3.6 positions of orthodontist per 10,000 children are required.

Basic organizational events during medical examination the following:.

Examination of children to identify dental anomalies and deformations and establish predisposing factors and causes of their development.

Determination of dispensary groups and drawing up a plan of preventive and therapeutic measures.

Timely referral of children with developed anomalies for treatment.

Control over the start and implementation specialized treatment, contact with parents and educators.

Monitoring the elimination of identified factors causing anomalies and deformations.

Organization and conduct of training for children and their parents in children's groups, pedagogical and medical personnel content and methodology of activities aimed at developing hygiene skills and caring for the healthy state of the oral cavity.

Organization and conduct of myogymnastics.

During orthodontic medical examination, children, in addition to being grouped according to nosological forms, are grouped based on the stages of pathology development. Let's consider the most widely used system.

I ipynna. Children with a normal structure of the masticatory apparatus, correct closure of the lips, normal basic functions (biting and chewing food, swallowing, breathing, speech). Possible minor deviations in the structure of the masticatory apparatus can be considered as a variant of the norm. These children are taught hygiene skills that contribute to healthy state organs of the oral cavity. Children in this group are examined by a local pediatric dentist once a year.

Group II Children with no significant morphological changes dental system, but having dysfunction (posture, breathing method, speech, facial expressions, position and articulation of the tongue, iy6, cheeks, muscles of the floor of the mouth and muscles of the perioral area). This also includes children who have bad habits. That is, children of the second group have “risk factors”, a predisposition to the development of dental anomalies. These children need to be eliminated causal factors. In the complex of activities carried out, a significant place in children of this group should be given to myogymnastics. Prescribed as myogymnastic exercises general, and special ones that eliminate the impaired function in a given child.

Children of the second dispensary group are actively observed for three months. After complete elimination of the causes contributing to the development of dentoalveolar anomalies and normalization of all functions, they are usually transferred to the first group. Unfortunately, some children go to the third dispensary group.

III group. Children with mild dental anomalies: incorrect position teeth, changes in the shape of the dentition, small deviations in the relationship of the jaws. Moreover, they have active causal factors. Children in this group need to eliminate causative factors and simple treatment using simple orthodontic appliances and myogymnastics. If in the second dispensary group myogymnastics is independent method treatment, then in the third it is combined with the instrumental method. After eliminating the causes and signs of anomalies, these children are examined, like the children of the first group, once a year.

IV group. It includes children with severe dental anomalies. Causative speakers are eliminated according to the method defined for children of the second and third groups, and the entire complex of orthodontic treatment is carried out. Transfer from this group is carried out after the end of the retention period. Myogymnastics in this group can be used both during the period of active treatment and during the retention period (in combination with hardware and surgical methods).

With this structure of dispensary groups, it is possible, as healing or improvement progresses, to transfer the patient from group to group with the subsequent constant predominance of the signs of the first group, that is, to the group of healthy children.

It is not always possible for an orthodontist to see a patient immediately after an examination. active treatment. In this case, the child ends up in a medical treatment group, where he is also monitored and a number of preventive measures are recommended (consultation and treatment with an otorhinolaryngologist, restorative exercises, classes with a speech therapist at a children's dental clinic, consultation and treatment with an ophthalmologist, etc.).

A dental patient’s medical record f.043/u is issued during the patient’s visit when active treatment begins. A control card is filled out for each child dispensary observation f.OZO/u, approved by order of the Ministry of Health of the USSR dated October 4, 1980 No. 1030, which remains in the doctor’s file as long as the child is registered at the clinic.

During the process of orthodontic treatment, its plan sometimes changes, which leads to a change in the design of the orthodontic apparatus, as well as to the need for additional intervention by therapists, surgeons, and the help of speech therapists. All this, in turn, affects the duration of treatment. The duration of treatment and subsequent observation of the patient does not allow the orthodontist to short time find the possibility of admission to active instrumental treatment large quantity sick.

Every month, a doctor who has been working in the department for 2-3 years completes the treatment of 6 to 8 children, they are removed from the dispensary register, transferred to the group of healthy children and remain under observation. Constantly, from groups 3-4, some children with improvement move to groups 2 and 1, which is the 1st place for newly identified children.

Thus, the method of medical examination is not only a method of medical work, but also organizational form, helping to rationally organize the work of an orthodontist.

To assess the organization and effectiveness of clinical examination, the indicators proposed by I.D. Bogatyrev with some modifications are used in relation to dental practice. Akodis Z.M. (1973) proposes to distinguish between two stages of clinical examination:.

Selection of patients for clinical observation.

Direct dispensary observation.

Accordingly, the analysis of the work is carried out in two directions: the organization of clinical examination and the effectiveness of clinical examination.

The methodology for analyzing the first stage of medical examination is expressed by the following indicators (%):.

a) implementation of the plan for dental (orthodontic) examinations;

b) identification of patients per 1000 examined;.

c) activity of identifying patients (the number of actively identified patients with various diseases, the number of actively identified patients with this disease).

d) completeness of dispensary registration coverage;.

e) timely detection of the disease (early preventative measures).

The second stage of medical examination (dispensary observation) is assessed on the basis of such indicators as:.

a) compliance with inspection deadlines (scheduled observation);

b) the activity of the patronage work of the orthodontist at the site;

c) the completeness of the preventive, therapeutic and health-improving measures taken;

d) activity in providing comprehensive medical care and the use of modern treatment device designs to reduce treatment.

Calculations of the effectiveness of clinical examination in orthodontics are made per 100 children of the “average annual” population. In this case, it is necessary to take into account the quantitative shift in dispensary groups. By shift in dispensary groups we mean quantitative changes due to children transferred to the healthy group. These are the so-called “former patients” who have completed active instrumental treatment or a series of preventive measures. This group also includes all dispensary patients who have not had relapses over the past two years or more, and who have not been identified as a result of clinical, radiological and other studies. pathological abnormalities. Next, a persistent improvement in the condition of the dental system, a condition without changes, and a deterioration in condition are taken into account. To analyze and study dispensary work, it is necessary for each orthodontist to provide information about the available data for a certain period.

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2.9. Planned sanitation of the oral cavity

According to the WHO classification, it is customary to divide prevention into primary, secondary and tertiary. Secondary prevention is a set of measures aimed at preventing relapses and complications of diseases. The main measure for secondary prevention of dental diseases is oral sanitation. V.F. Rudko proposed to distinguish between several forms of reorganization: individual, organized (one-time or periodic) and planned.

Individual rehabilitation is carried out according to the appeal of the population, i.e. when the patient turned to a dentist for the treatment of a specific diseased tooth. At the same time, all teeth that need it are treated and existing dental deposits are removed.

One-time, or periodic rehabilitation involves one-stage sanitation of the oral cavity in organized groups (schools, industrial enterprises, etc.) or in certain groups of the population (pre-conscription personnel, pregnant women, veterans and disabled people) with a certain frequency (for example, once a year). This is a more effective form of sanitation; it is aimed at eliminating existing pathological processes.

The opportunity to save teeth, prevent the occurrence of dental diseases, in particular caries, and avoid the development of its complications is provided by planned rehabilitation. It allows you to identify forms of dental damage and achieve their timely and complete cure.

Sanitation of the oral cavity can be carried out using various methods: centralized, decentralized and team (mixed). The choice of method depends on the prevalence and intensity of dental diseases, the state of the dental service, the population served and other factors.

Centralized method planned sanitation is carried out in the conditions of a dental treatment and preventive institution (department) and provides for examination, diagnosis and all types of treatment of dental diseases. The work of a dentist in a hospital setting with good equipment, a sufficient number of instruments and high quality materials allows for centralized planned sanitation at a good level. However, in many cases there are certain difficulties in delivering patients to clinics, especially when we're talking about about children.

These difficulties can be eliminated by using decentralized method planned rehabilitation. In this case, the dentist is sent to organized groups (schools, industrial enterprises, institutions and organizations), in which a dental office is equipped (most often temporarily, in an adapted room). The disadvantage of this method is that the doctor works in unfavorable conditions, most often on poor or portable equipment, with a lack of instruments, the inability to use modern materials, carry out disinfection measures and sterilization. This results in a corresponding decrease in the quality of remediation measures.

To carry out planned sanitation in large teams and reduce the duration of this work, it is used brigade method. It provides for the formation of a team of 3-5 dentists of different specialties, 1-2 nurses. There is experience in using specially equipped buses for these purposes, especially when traveling to settlements rural areas. However, this method has the same disadvantages as the previous one.

Previously, when carrying out sanitation, it was widely practiced to separate the time of examination of the oral cavity and treatment. IN currently It is recommended to treat the patient immediately after the examination, which reduces the number of visits to the doctor.

A number of indicators are used to quantify rehabilitation work.

1. Coverage of preventive examinations (%):

2. Need for sanitation (%):

needs refurbishment/subject to inspection x 100.

3. Rehabilitation coverage from those examined (%):

total inspected/subject to inspection x 100.

4. Sanitation coverage from those in need (%):

total sanitized/subject to inspection x 100.

Properly organized and carried out at a high quality level, planned preventive sanitation can reduce dental morbidity.

The children's dispensary group at the dentist includes children:

WITH birth defects development of the face, jaws and teeth.

With multiple caries and TTZ lesions of non-carious origin (hypoplasia, fluorosis).

With diseases of the pulp and periodontium of permanent teeth with unformed roots.

With periodontal diseases and chronic diseases of the oral mucosa.

With diseases of the salivary glands.

With tumors and tumor-like processes (vascular, fibrous dysplasia, eosinophilic granuloma, lingual myoma).

With facial bone defects after past diseases facial skeleton(trauma, osteomyelitis, ANS diseases).

With bite pathologies, anomalies and deformations of the maxillofacial area.

Examination and treatment of children in this group requires the efforts of many specialists:

pediatricians;

radiologists;

dentists - therapists, surgeons, orthopedists, orthodontists, periodontists;

neurologists;

endocrinologists.

Therefore, children in this group are registered in dental clinics. The dentist determines the timing of follow-up examinations, examinations and treatment. For example, with pulpitis of a tooth with unformed roots, it will appear in 1-2 years, and some diseases require observation before transferring the child to an adult clinic.

According to indications, children are sent to dental clinics to undergo surgical treatment.

Children with general diseases, such as cerebral palsy and other lesions of the central nervous system, because such children cannot have an additional source of infection and they must undergo sanitation in a timely manner.

Children are divided into groups:

Group I - KPU up to 5-6: sanitation once a year, coating of teeth with fluoride varnishes 2 times a year.

Group II - KPU up to 8-9: they are sanitized 3 times, retherapy is carried out 2 times a year.

Group III - KPU up to 9 and higher: 4 times sanitized, 4 times remedial therapy.

Medical examination of children is highest form prevention on modern stage development of dentistry. The entire child population must be taken in for dispensary services.

Clinical examination is a method of health care for the population, which includes a set of social, hygienic, treatment and preventive measures aimed at preserving and strengthening the health of the population and preventing the development of diseases. It is based on dynamic monitoring of the health status of the population.

Medical examination of children at the dentist involves carrying out all age periods:

planned sanitation of the oral cavity.

prevention of caries and malocclusions

Creation favorable conditions for the formation of dental tissue, periodontal tissue and the entire health system.

education of correct hygiene skills.

Stages of medical examination.

Getting to know the site.

A list of children is compiled by age group: children under 1 year; preschoolers; pupils primary group 7-10 years; older 11-18 years old. Kindergartens and schools related to the site are identified, and dental work stations are equipped in each institution.

Specialized examination and sanitation of the oral cavity of each child.

Carrying out sanitation of the oral cavity: treatment of caries, elimination of defects in dental tissues by filling, removal of damaged teeth and roots, removal of tartar, anti-inflammatory therapy for periodontal diseases, preparation for orthodontic treatment, prosthetics.

Sanitation:

According to appealability. Conducted at the initiative of the patient.

Planned rehabilitation. It is carried out for all children in organized groups: kindergartens and schools. The frequency of planned sanitation is determined by the intensity of caries development and the degree of its activity.

There are 2 methods of sanitation:

Centralized method.

It takes place in a clinic, where children are brought by teachers or educators as part of a whole class or group.

Decentralized method.

Sanitation is carried out on site (at a school or in a kindergarten), where there is a stationary or mobile dental office.

3 degrees of caries activity.

1st degree. The index KPU +kp does not exceed the average caries intensity of the corresponding age group. None initial forms caries identified special method. The detected carious cavities are localized on surfaces typical for caries, and the carious process tends to be limited. The child belongs to health groups 1 and 2 or has a compensated condition chronic disease. The permissible period for medical examinations is 13 months.

2nd degree. KPU+KP does not exceed the average value of caries intensity for this age group. Carious process in typical areas, tendency to limit the process, dentin is moderately pigmented, no initial caries in the cervical region and in the area of immune zones, GI is less than 2. The permissible period for medical examinations is 7 months.

3rd degree. The KPU+KP indicators exceed the maximum indicator. Multiple chalk spots are detected, active development of caries (in the area of immune zones, light soft dentin, pathological process has no tendency to limit). The permissible period for medical examinations is 3 months.

Data obtained during examination and sanitation of the oral cavity serve as the basis for the formation of clinical examination groups.

The effectiveness of sanitation is assessed by the following indicators: coverage of sanitation for children, a high percentage of those in need of sanitation and compliance with the frequency of sanitation according to the degree of caries.

3 clinical examination groups:

First group.

Healthy and practically healthy children who do not have dental or periodontal diseases.

Children with a compensated form of caries, gingivitis caused by poor hygiene oral cavity, abnormalities of the frenulum of the lip, tongue, small vestibule of the oral cavity.

Conditions after traumatic injury h/l area, excluding damage to teeth with unformed roots. The first group is examined once a year.

Second group.

Children with obstructions internal organs who do not have posterior teeth and periodontal disease, or malocclusions.

Children with subcompensated caries, gingivitis caused by malocclusions, teeth treated for complicated caries.

Children who have undergone osteomyelitis, odontogenic lymphadenitis, surgery to remove a supernumerary tooth, or surgery to remove a benign tumor. Group 2 is examined 2 times a year.

Third group.

Children with chronic diseases of internal organs, sub- and decompensated forms of caries.

Healthy and practically healthy children with: decompensated f-m of caries, initial f-m of caries detected by a special method, localized or generalized periodontal disease/Parodontitis, periodontal obstructions caused by obstructions of internal organs, injuries of teeth with unformed roots, active effective causes malocclusions (swallowing, breathing, speech, bad habits).

Children who are on complex treatment dental problems with pathology in severe cases.

Those undergoing follow-up for cancer pathologies.

For each child, a dispensary observation card (form No. 30) and a rehabilitation card (form No. 267) are created.

State educational institution

higher professional education

"Tyumen State Medical Academy

Federal Agency for Health and Social Development"

(GOU VPO TyumGMA Roszdrav)

Department of General Dentistry

« Evaluation of long-term results of caries treatment. Dispensary observation"

Guidelines for students

Tyumen, 2009

Compiled by: Candidate of Medical Sciences, Associate Professor Kuman O.A.

Methodological instructions for the lesson for students were compiled at the Department of General Dentistry (head of the department - Doctor of Medical Sciences, Associate Professor A.V. Bragin) based on the requirements of the State educational standard of higher professional education in specialty 060105 “Dentistry” (2000), curriculum(2004), a standard program for “Pediatric Dentistry”.

Approved at a meeting of the Department of General Dentistry

"___" _____________ 20 ____

Dentistry childhood

semester 6

practical lesson 13/7

Subject: Evaluation of long-term results of caries treatment. Dispensary observation.

Relevance of the topic: Sanitation of the oral cavity must be carried out with elements of primary prevention, medical examination for favorable outcome caries diseases.

Learning objectives:

Learn to evaluate the results of treatment of dental caries in children in the long term.

Learn to assign children to various dispensary groups, depending on their dental status and physical health.

Learn to determine the frequency of visits to the dentist during dispensary observation.

Independent work of students:

A) Questions of basic disciplines necessary for mastering the topic:

1. anatomy and histology of hard dental tissues

2. classification of carious cavities

3. Features of the preparation of carious cavities

4.dental instruments and devices used for filling carious cavities

5. anatomical and functional structure of the pulp

6. concept of anatomical and functional restoration of a tooth

B) Task for checking and correcting the initial level of knowledge (input control):

Test control of students' initial level of knowledge:

According to the classification of T.F. Vinogradova, the following are distinguished:

A. Compensated, subcompensated, decompensated activity of the carious process.

B. Low, moderate, high activity of the carious process.

B. Acute, chronic, chronically recurrent caries activity.

2. The activity of the carious process is determined by:

A. Individual intensity of caries.

B. Average group intensity of caries.

B. The relationship between individual and group average intensity of caries.

D. Age of the child.

3. The individual intensity of caries is determined by the index:

V. KPU, kp, KPU+ kp

4. The group of persons with compensated caries activity includes children who have individual CP:

A. Equal to the group average.

B. Less than the group average by three sigma deviations.

B. More than the group average.

Answers: 1-A; 2-A; 3-B; 4-B;

C) Topic content structure

Diagram of the Indicative Framework for Action

Stages	Facilities		Self-control criteria
Evaluation of long-term results of caries treatment.
	Interview with child and parents		No complaints of pain. loss of fillings and feelings of discomfort indicate satisfactory results of caries treatment
Assessing the quality of the filling	Examination of the treated tooth using a dental probe and mirror		With a satisfactory result of caries treatment, the following should be observed: The color of the tooth is not changed. The filling has not changed in color. The marginal seal of the filling is not broken. If the filling is on the contact surface there should be no signs of inflammation of the interdental papilla. Tight interdental contact.
Dispensary groups according to T.F. Vinogradova:
		Somatically healthy children with compensated caries activity, who do not have periodontal diseases (except for catarrhal gingivitis caused by poor hygiene and dental anomalies.		Observed by a dentist - once a year.
		Children with compensated or subcompensated caries activity, having hygiivitis (except for chronic generalized hypertrophic ginigivitis), having anomalies of individual teeth, or having somatic pathology that does not require long-term follow-up with a pediatrician.
		Children with compensated, subcompensated or decompensated caries activity, with periodontal diseases, malocclusions, and chronic somatic pathology.		They are seen by the dentist 3-4 times a year.
		All preschoolers		See a dentist 2 times a year.

Output control:

Test control:

1. Long-term results caries treatment is assessed by: A. Absence of complaints.

B. Assessing the quality of the filling.

B. USP Index. D. Increase in the intensity of caries. The frequency of preventive visits to the dentist is determined by: A. Dispensary observation group. B. The patient's wishes. B. The more often the better.

Criteria for distributing children according to dispensary groups serve: A. Age of the child. B. Intensity of caries. B. Presence of periodontal diseases and dentofacial anomalies D. Intensity of caries, presence or absence of periodontal diseases, dentofacial anomalies. somatic health.

Child. 9 years old, with KPU+KP = 2. RMA = O. without dental anomalies and

somatic pathology

seen by dentist A. once a year. B. 2 times a year. B. 3-4 times a year.

Teenager. 14 years old, KPU = O, KPI = 2, without dental anomalies and identified somatic pathology, is observed by dentist A. 1 time per year. B. 2 times a year. B. 3-4 times a year.

Child. 5 years old, CP = 2. no periodontal disease. dental anomalies.

somatic pathology is observed at the dentist A. 1 time per year B. 2 times per year. B. 3-4 times a year.
001.To reduce caries susceptibility, the following drug is prescribed orally:

002.

calcium lactate or gluconate

methyluracil

lactobacterin

somatic pathology is observed at the dentist A. 1 time per year B. 2 times per year. B. 3-4 times a year.

003. interferron

calcinova
interferon
Child. 5 years old, CP = 2. no periodontal disease. dental anomalies.

004. interferron

suprastin

To reduce caries susceptibility, children are prescribed the following drug orally:

bifidobacterin

lactobacterin

005. potassium iodide

acyclovir

erythromycin

vitafluor

In order to prevent caries in children, the diet should be limited.

006. In order to prevent caries in children, the following should be limited in the diet:

007. For For preventive treatment of the enamel of erupted permanent teeth in caries-susceptible children, the following is used:

30% silver nitrate solution

10% calcium gluconate solution, 1-2% sodium fluoride solution

2% baking soda solution

Safari

interferon

008.For preventive treatment of the enamel of erupted permanent teeth in caries-susceptible children, the following is used:

Safari

2% methylene blue solution
40% glucose solution
Schiller-Pisarev district

009.For For sealing the fissures of permanent teeth, the following are used:

silidont

compomers

amalgam

010. It is recommended to seal the fissures of the first permanent molarschild at age:

any age

011. Sodium fluoride tablets for the prevention of caries are recommended to be given to children:

1 once a week

every day

in one day

2 times per week

1 once a month

citrus

dairy products

013. To prevent candidiasis, nystatin is prescribed during treatment with the following drugs:

antiviral

anti-inflammatory

antibiotics

antihistamines

analgesics

014. The doctor’s task during medical examination of children under 1 year of age in a clinical group is to:

eliminating risk factors

prevention of risk factors

improving health

prescribing corrective (therapeutic) measures

identifying risk factors

015. For high-quality oral hygiene it is necessary to use:

toothbrushes and pastes

toothbrushes, pastes and floss

toothbrushes, pastes, flosses and rinses

toothbrushes, pastes, floss and chewing gum

toothbrushes, toothpastes, chewing gums

016. The simplest and effective technique preparing teeth for application therapy:

hygienic treatment of teeth with special abrasive powder

treating teeth with 2% hydrogen peroxide solution

hygienic treatment of teeth using a brush and paste

hygienic treatment of teeth with special devices and instruments

rinsing the mouth with water

017. It is most advisable to carry out endogenous prevention of caries in primary teeth in:

antenatal period

first half of life

second half of the first year of life

second year of life

third year of life

018. Hygienic training of a child must begin:

during the eruption of the first temporary teeth

during the eruption of the first permanent teeth
among first-graders

019. Junior schoolchild with intact teeth living in an area with opoptimal fluoride content in drinking water, hydration agents are prescribed

oral hyenas:

therapeutic and prophylactic toothpaste containing fluoride

hygienic tooth powder

hygienic toothpaste

therapeutic and prophylactic toothpaste containing phosphorus-calcium

5) therapeutic and prophylactic toothpastes with medicinal herbal extracts

020.Child withIIIhygiene products are prescribed according to the degree of caries activity:

salt toothpastes

therapeutic and prophylactic toothpastes containing fluoride compounds

therapeutic and prophylactic toothpastes containing extracts of medicinal

hygienic dental elixirs

hygienic toothpastes and elixirs

Homework: The topic is errors and complications in the treatment of dental caries in children.

Main literature:

1. Kuryakina N.V. Therapeutic dentistry of children: textbook. Benefit / N.V. Kuryakina - M.: honey. Book, N. Novgorod NGMA - 2007

Additional literature:

1.T.F.Vinogradova Atlas of dental diseases in children: Tutorial- M.: “MEDpress-inform” 2007

2. Features of aesthetic restoration in dentistry: Series of methodological films: Films 1-10 (Electronic resource). - St. Petersburg: ShchShShch "Man", 2005-3 electronic. wholesale disk (CD - ROM) 2006

3. Tkachuk O.E. Pediatric dentistry: a practical guide \ O.E. Tkachuk – Rostov on Don: Phoenix (Medicine for you) 2006

4.Ivanova E.N. Dental composite filling materials: textbook. Benefit / E.N. Ivanova, I.A. Kuznetsov – Rostov on Don: Phoenix (Medicine for you) 2006

Features of dental examination of persons suffering from rheumatic diseases. Pediatric therapeutic dentistry_National guidelines

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