Basic principles of organization of dental care. Basic principles of organizing a clinic of therapeutic dentistry
11.1 Organization of dental care for the urban population
Dental care for the urban population is provided in a variety of institutions or departments, starting with a dental office and ending with an independent specialized dental clinic.
The beginning of this organizational hierarchy is the dental office - the most massive structural unit of the service. The pinnacle of organization and concentration of all its types is an independent specialized dental clinic with departments of therapeutic, surgical and orthopedic dentistry, a department or office of pediatric dentistry, orthodontic, physiotherapy, x-ray rooms and a laboratory.
Such a highly specialized institution with a sufficient number of highly qualified specialists makes it possible to comprehensively address the issues of diagnosing and treating patients, to make the most of property, equipment, tools, and to be able to consult patients with various specialists in one institution.
The capacity of dental clinics varies and is determined by the number of full-time medical positions.
Table number 3. Categories of independent dental clinics and staffing standards for medical personnel (approximate distribution by departments and offices)
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Name of departments and offices | |||||
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1. Chief physician | |||||
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2. Deputy chief physician | |||||
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3. Heads of departments | |||||
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4. Branches: | |||||
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Therapeutic | |||||
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Surgical | |||||
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Orthopedic | |||||
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5. Cabinets: | |||||
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orthodontic | |||||
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Physiotherapy | |||||
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X-ray | |||||
The vast majority of patients is treated in the therapeutic department, therefore, from 30 to 15% of the entire medical staff of the polyclinic are directly involved in the treatment of diseases of the oral cavity and teeth. The proportion of dentists-surgeons is 7-8%, dentists-orthopedists - 16-18%.
urgentdental care during the opening hours of the polyclinic it is a dentist on duty, and at night - doctors of special dental emergency centers organized in several polyclinics of the city.
In addition to the budgetary network of dental clinics, self-supporting polyclinics are being opened in the cities, which provide highly qualified dental care to all residents, regardless of age, place of work and residence.
Chief physician of the dental clinic manages all medical and preventive, organizational and methodological, economic and financial activities, controls the implementation of measures aimed at improving the quality and culture of medical care for the population, analyzes the performance of the institution and individual specialists, appoints and dismisses medical and administrative personnel, imposes disciplinary sanctions on employees for violation of labor discipline.
As a manager of loans, he controls the correct use of the budget, is responsible for the sanitary condition and the implementation of fire prevention measures, etc.
Deputy for medical and preventive work is responsible for the quality of examination and treatment of patients, medical expertise, rational use of medicines, equipment, advanced training of medical staff. He solves the issues of hospitalization of patients together with the organizational and methodological office, studies the experience of other dental clinics, and holds production meetings.
Each department is headed manager, which ensures the organization of correct and timely diagnostics, high-quality treatment and prevention of diseases, appropriate maintenance of medical records, advanced training of doctors and nursing staff, preservation and use of equipment, tools and medicines.
Staffing standards for medical personnel of dental clinics are determined by decree of the Ministry of Health of Ukraine No. 33 dated 23.02.2000. According to him, in urban dental clinics for adults located in cities with a population of more than 25 thousand people, they are as follows:
1-4 positions of dentists and dentists-surgeons in the amount of 10 thousand people of the adult population of the city where the polyclinic is located;
2.5 positions in total per 10 thousand people of the adult rural population;
2.7 positions in total per 10 thousand people of the adult rural population;
2 positions of dentists-orthopedists, which are self-supporting or on special funds, are established on the basis of:
1 position per 10 thousand people of the adult population of the city where the polyclinic is located;
0.7 positions per 10 thousand people of the adult rural population;
0.8 positions per 10 thousand people of the adult rural population.
Positions of heads of departments are established:
dental department - 1 position for every 12 positions of dentists and dentists-surgeons, but not more than 3 positions per clinic;
denture department (maintained on self-financing or at the expense of special means) - 1 position per clinic, in which, according to the current staffing standards, at least 4 positions of orthopedic dentists are established.
The position of deputy chief physician for the medical unit is provided for in the state of the polyclinic, where there are at least 40 medical positions, taking into account the position of the head physician.
The positions of dentists-surgeons in the departments of maxillofacial surgery are established at the rate of 1 per 25 beds. According to the standards for providing the population with hospital beds for certain profiles, beds for dentistry are not provided. They are deployed in large cities in one of the city hospitals in agreement with local health authorities. The position of the head of the surgical dental department is established instead of 0.5 of the position of a doctor if there are less than 60 beds in the department.
To serve patients in hospitals of regional, central city, city hospitals, medical units organize dental offices at the rate of 1 position for 600 beds, in tuberculosis hospitals - 0.5 for every 250 beds, but not less than 0.5 positions in hospitals.
The positions of nurses in medical offices are established at the rate of one position for:
1 position of a dentist-surgeon;
2 positions of dentists and orthodontists;
3 positions of dentists-orthopedists.
In dental offices, where the state provides for 1 position of a dentist, at least 1 position of a nurse is being introduced.
In dental laboratories, which are self-supporting, the number of dental technicians is set depending on the amount of work on prosthetics at the rate of 2-3 positions per orthopedic dentist. The position of a senior dental technician of a dental laboratory is provided for every 10 positions of dental technicians, but not less than 1 position for 3 dental technicians instead of one of them.
The positions of junior nurses are established at the rate of 1 position for 1 position of a dental surgeon, or for 3 positions of dentists of other specialties.
An obligatory structural department of any dental clinic is the registry (with a medical archive), which regulates the flow of patients, carries out accounting and statistical and reference and information activities.
The front desk works in two shifts. Her work should begin in 20-25 minutes. prior to admission of patients. Depending on the capacity of the polyclinic, several registrars may work in one shift in the registry. The registrar fills in the passport part of the dental patient's medical record, writes out a coupon for an appointment with a doctor, which indicates the date and time of the appointment, the doctor's name, room number, floor. Medical cards are transferred to the offices. Registrars supervise self-registration of patients for admission, provide information about the work of other medical institutions of the city.
The registrar positions are calculated according to the principle of 1 registrar for every 5 positions of doctors who receive appointments, but not less than 1 position per shift.
To save time, an examination room is organized in the clinic, the dentist of which provides a reasonable referral of patients to other rooms, and if necessary, provides emergency care.
The therapeutic department has rooms for the treatment of diseases of the teeth, periodontium and oral mucosa. Large polyclinics may have 2 therapeutic departments.
The room of the cabinet of therapeutic dentistry, when installing one chair in it, must have an area of at least 14 square meters. m. For each additional seat you need to allocate at least 7 square meters. m. The doctors of the department of therapeutic dentistry work in 2 shifts according to the schedule. The most effective was the provision of therapeutic dental care on a precinct-territorial basis.
In view of the patient's right to choose a doctor, outpatient appointments are carried out according to the principle of free appointment, and according to the precinct-territorial principle, only dispensary work is carried out.
The dentist is appointed by the chief physician of the clinic. In his daily work, he reports to the head. department, deputy head physician for the medical unit and head physician. Orders of the doctor are obligatory for the middle and junior staff of the department within the limits of their functional duties.
The dentist must:
ensure effective and high-quality provision of dental care to patients;
provide emergency care in cases of anaphylactic shock, collapse, loss of consciousness and other emergency conditions;
take part in medical examinations of the population;
conduct an examination of temporary disability;
conduct dispensary observation of certain contingents;
systematically improve their professional level, using modern methods of diagnosis, treatment and prevention of dental diseases;
constantly take care of improving the professional theoretical skills of middle and junior staff;
to carry out sanitary and educational work among the population;
Adhere to workplace safety rules.
The dentist is responsible for:
non-fulfillment of the production plan and poor-quality treatment of patients;
the occurrence of complications after treatment due to his fault;
poor-quality and untimely maintenance of the necessary medical documentation;
irrational use of medical and diagnostic equipment that is available, tools and other medical equipment.
The results of medical examinations, data of observation of patients during outpatient appointments allow to allocate dispensary groups for further registration, observation and treatment.
D1– healthy and practically healthy persons who do not have dental diseases, periodontal disease and malocclusion. This also includes patients who have a compensated form of caries, mucosal diseases associated with unhygienic maintenance of the oral cavity and patients after traumatic damage to the dentoalveolar system. They are sanitized once a year.
D 2- persons who have subcompensated numerous caries, dental fluorosis, increased fragility, gingivitis, periodontitis, leukoplakia, trigeminal neuralgia, after surgical interventions and dentoalveolar injuries, those who have inflammatory processes (osteomyelitis, odontogenic lymphadenitis, etc.) are undergoing orthodontic treatment, etc. They are inspected and sanitized at least 2 times a year.
D3- persons with sub- and decompensated forms of caries, generalized periodontal disease and periodontitis, diseases of the marginal periodontium caused by diseases of the internal organs (periodontal syndrome), as well as those who require complex dental treatment with a severe course of the disease, with chronic recurrent aphthous stomatitis, etc. d. This group is examined and sanitized 3 times a year or more.
Surgical Dental Department provided only in large dental clinics if there are 6 or more dental surgeons in the staff of the clinic.
The structure of such a department includes: operating room, preoperative room, sterilization room and rooms for temporary stay of patients after surgery. The area of the surgical department with one dental chair is 23 sq.m. for each subsequent chair - +7 sq.m.
Category II-V dental clinics have only a surgical room.
In recent years, the structure of the surgical departments of dental clinics has included rooms for restorative treatment and rehabilitation. This makes it possible to ensure continuity in the outpatient and inpatient treatment of patients, increase its effectiveness and reduce the duration of temporary disability.
The main responsibilities of the surgeon-stomatologist of the polyclinic are:
reception of primary and secondary patients, diagnosis of diseases, provision of emergency and planned surgical care;
advisory assistance to patients;
referral of patients for consultation to specialized institutions and for inpatient treatment;
conducting examinations in the oral cavity;
clinical examination of patients according to profiles;
examination of temporary disability;
conducting medical rehabilitation at the stage of aftercare of patients with injuries, inflammatory processes in the tissues of the maxillofacial region.
Dental orthopedic care is one of the foundations of tertiary prevention. Without orthopedic intervention, it is impossible to consider dental patients cured, because. almost all of them have damage to the dentoalveolar apparatus.
The relevance of orthopedic dental care for the child's body is confirmed by scientific observations, which show that among preschool children, 20-25% have various disorders in the development of the jaw system, and 5-7% of them require emergency orthopedic care.
Orthopedic care is provided in departments or offices of dental clinics. Doctors of the orthopedic department provide medical care to adults and children in cases where there are no children's dental institutions.
For orthopedic treatment, contingents of patients are formed by self-referral for help, as well as by patients referred by dentists of other specialties.
The activities of the orthopedic department are supported by self-supporting or special means. Free or preferential treatment is used by participants in the liquidation of the Chernobyl accident, war and labor invalids and persons who are equated to them, pensioners, children.
The orthopedic department includes rooms for receiving patients, a dental laboratory and a foundry.
The doctor on duty examines the patient and selects the design of the necessary prosthesis. If the patient needs oral sanitation, he is referred to a general practitioner or surgeon who treats and prepares for prosthetics.
The orthopedic doctor takes an impression after processing the teeth for prostheses and passes it through the nurse to the production manager. The manager determines the period of the intermediate stage of manufacturing the prosthesis and appoints the patient for the next visit. Depending on the organization of the work of dental technicians, orthopedic care can be provided in three forms:
individual - when the dental technician completely manufactures the denture himself;
brigade - when there is a distribution by type of prosthesis;
phased - when there is a distribution of operations on one prosthesis.
In each regional, city and district dental clinic (department), an orthodontist is organized for the treatment and prevention of malocclusion and jaw deformities in children. The positions of orthodontists are distinguished from the positions of children's dentists. With a standard of 5.0 doctors per 10 thousand of the child population, 0.5 positions are allocated for orthodontics.
The positions of dental technicians for servicing the work of orthodontists are set at the rate of 1:1.
Surgical dental inpatient departments are organized in regional and large city hospitals. The number of beds in them depends on the population that lives there and on the use of a hospital as a clinical base for universities.
An independent department is created if it has from 40 to 60 beds. For inpatient treatment of patients with pathology of the maxillofacial region in small settlements, specialized beds are deployed in one of the surgical departments of a city or district hospital with the consent of local health authorities. According to the standard standards, there are 25 beds per one dentist-surgeon in the hospital.
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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 in outpatient settings. 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 primary 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.
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, where appropriate, 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 dentists on duty, 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.
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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, visiting.
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
Dental clinic headed by the chief physician. (40 or more medical posts are allocated the rate of the deputy chief)
Distinguish:
Service level: republican, regional, regional, city, district.
By subordination: territorial and departmental.
By source of funding: budgetary, self-supporting
By form of ownership: federal, municipal, private
Main goals :
Carrying out activities to prevent diseases of the maxillofacial region among the population and in organized groups
Carrying out and organizing activities aimed at early detection of patients with diseases of the maxillofacial region and their timely treatment
Provision of qualified outpatient dental care to the population
Structure :
Registry
Specialized departments: therapeutic dentistry, surgical dentistry, orthopedic dentistry with a dental laboratory, pediatric dentistry
Primary examination room
Dental emergency room
X-ray room
Physiotherapy room
Works on territorial principle: The entire polyclinic service area is divided into sections with a certain population, each of which has its own permanent local dentist. At the dentist, the population on the site corresponds to two therapeutic ones and is about 3400 people.
Work according to the district principle ensures the dynamics of monitoring patients, increases the responsibility of doctors for the quality of work, allows you to evaluate the performance of each doctor and control the quality of care.
Dental polyclinics, if necessary, provide assistance at home on the call of doctors from territorial polyclinics. To provide dental care at home, the clinic has portable equipment. All types of assistance are provided at home, including dentures.
In the clinic, doctors work on rolling chart. It is compiled in such a way that the reception is carried out both in the morning and in the afternoon for the convenience of patients.
Labor accountingdentists based on measuring the volume of their work in conditional units of labor input (UET). For 1 UET, the amount of work of a doctor is taken, which is necessary for applying a filling with an average caries.
A doctor with a six-day working week must perform 21 UETs, with a five-day working week - 25 UETs per working day.
One of the most important sections of the doctor's work in the clinic is examination of working capacity. In case of temporary disability, when the violations are reversible, doctors issue certificates of disability to working persons, taking into account both the patient's condition and the nature of the work performed by him. The medical institution maintains a special "Book of registration of certificates of incapacity for work" (form OZb / y), which are stored in the same way as monetary documents.
Held health education and preventive work, all medical personnel are involved. The doctor, with the help of a nurse, conducts lectures and talks for the population on the following topics: prevention of caries in children, prevention of dental diseases, etc.
REGIONAL MEDICAL INSTITUTIONS
:
. regional hospital with a consultative polyclinic
. regional specialized centers
. regional dispensaries and specialized hospitals
. Regional Center for Sanitary and Epidemiological Surveillance
. clinics of medical institutes, research institutes and other medical institutions of the regional center
On the basis of these institutions, the rural population is provided highly qualified, including highly specialized medical care.
The main tasks of the regional hospital are:
. providing the population of the region with highly qualified specialized advisory, polyclinic and inpatient care
. provision of emergency and planned advisory medical care by means of air ambulance and ground transport with the involvement of specialists from various institutions
Providing organizational and methodological assistance to the health care facilities of the region in improving
health care for the population
Management and control over statistical accounting and reporting of health care facilities of the region.
A feature of the organization of stomatology. assistance that is provided in a specialized clinic of the medical university, which acts as a regional medical and advisory specialized center. Dental outpatient and inpatient care for residents of the region (adults and children) is provided for all types of activities: therapeutic, surgical, orthopedic, orthodontic, highly qualified care on a paid basis.
An important section is the planned sanitation of the oral cavity and teeth. Mandatory rehabilitation is subject to children of pre-school and school age, adolescents, pregnant women, as well as specialists engaged in agricultural production and working at industrial enterprises. For on-site examinations of the listed contingents, mobile dental rooms are organized in the Central District Hospital and regional medical institutions.
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