Certification work for the category of dentist. Certification work of a dentist therapist of the highest category - abstract Report of a dentist for the first category
Dental care in Langepas is provided by the dental department of the multidisciplinary polyclinic of the MU "City Hospital".
The department has offices for therapeutic, surgical, orthodontic, periodontal, orthopedic care. Help for children is provided in the children's reception room at the polyclinic and treatment and prophylactic rooms in city schools.
In the examination room, assistance is provided for emergency indications, as well as for conducting preventive examinations.
Analysis of work for the reporting period.
Clinical reception is carried out at a therapeutic appointment. The therapy room works in two shifts for three workplaces.
An office with an area of \u200b\u200b14 m² is equipped with the necessary equipment: 1) a Clesta Belmont dental unit;
2) a light-curing lamp from Dentsply Prismatic Lite II;
3) apparatus for removing dental plaque Pieson Master;
4) diathermocoagulator;
5) an EOM-3 electrodontometer;
6) glassperlen sterilizer;
7) apex locator;
8) a device for depophoresis "Original II";
9) a cabinet for storing medicines;
10) a chamber for storing sterile products panmed 1;
11) a device for sterilizing handpieces "Assistina 301 plus";
12) an autoclave for sterilization of instruments;
13) a radiovisiograph;
14) small tools (burs; endodontic sets; grinding and polishing heads, etc.);
15) filling materials:
- cements (phosphate-cement; unifas; adhesor; cimex; argion; baseline; aquaionophil; fritex; silicin-plus; silidont; belacin; whitecor);
- composites of chemical curing (degufil; composite; luxury; CharismaPP-F);
- composites of light curing (Filtek Z250; Charisma; FiltekP-60; Solitaire 2; fluid composites of different companies);
- compomers (direct);
-calcium-containing preparations (Calcimol; Lica);
There is a wall germicidal lamp for air treatment in the office. Sterilization of instruments is carried out by a nurse in a separate office according to the OST.
I receive patients according to coupons, on average 10 people per shift. I try to do the maximum amount of work in one visit, since oral cavity sanitation is important for both the patient and the doctor.
I begin the appointment by finding out the anamnesis of life and illness. I use clinical (probing, percussion, palpation, thermal diagnostics) and paraclinical (electroodontodiagnostics, radiography) examination methods for making a diagnosis. I record all the data in the outpatient card (fN 043 / y), fill out the daily accounting diary (fN 037 / y). I compose a plan of treatment, the ultimate goal of which is the sanitation of the oral cavity.
During the reporting period, 390 shifts were worked, total teeth were cured - 4289, for caries - 3612, for pulpitis - 416, for periodontitis - 260, complicated caries in one visit - 147, non-carious lesions of hard dental tissues - 80.
When treating teeth with non-carious lesions, I use the classification
M.I.Groshikova.
I gr. Dental lesions that occur during the period of follicular development.
- enamel hypoplasia;
- enamel hyperplasia;
- endemic fluorosis;
- hereditary disorders of the development of hard dental tissues.
II gr. Teeth lesions that occur after their eruption.
- teeth pigmentation;
- pathological abrasion;
- wedge-shaped defect;
- tooth erosion;
- necrosis of hard tissues of teeth;
- acute and chronic trauma; ...
MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION
MUZ dental clinic №2
DENTAL DOCTOR'S WORK REPORT
FOR 2008 - 2010
MATVEEVA VALENTINA IOSIFOVNA
Kaliningrad - 2011
Report outline
1. General information ………………………………………………. 3
2. Office equipment and organization of work in
dental office …………………………… .. 4
3. The work of a dentist at a therapeutic
admission. ………………………………………………………… 5-19
4. Sanitary and educational work ... ………………… 19-20
5. Sanitary and epidemiological mode of operation
cabinet ………………………………………………………… .. 21-22
6.Conclusions …………………………………………………… 23-28
1. General information
I have been working in the dental clinic №2 since August 1991. Polyclinic No. 2 provides medical and preventive dental care for the adult population.
The clinic is located in a two-story adapted building at the address: st. Proletarskaya, 114. The polyclinic has a compressor room for supplying compressed air to dental units, a centralized washing and sterilization room, a physiotherapy and X-ray room, and a registry. The polyclinic operates in two shifts from 7.45 to 20.15 Saturday from 9.00 to 15.00 .. There are 2 treatment departments and one denture department. The treatment departments have 6 therapeutic rooms, 1 surgical, 1 periodontal room, and an acute pain room. Treatment rooms are equipped with modern drills. All turbine units are supplied centrally with compressed air.
2. Office equipment and organization of work in the dental office
The office in which I receive dental patients meets the sanitary and hygienic standards. Equipped with a dental unit "Marus". There is cold and hot water, the necessary instruments, a set of modern domestic and imported anesthetics and filling materials.
The load at the admission consists of primary coupons and repeated patients.
I work on the principle of the maximum number of sanctions on the first visit.
The main tasks at the reception are:
1. Provision of qualified assistance to the population.
2. Conducting sanitary and educational work, teaching oral hygiene.
3. Prevention of dental diseases.
3. The work of a dentist at a therapeutic appointment.
In recent years, the work of a dentist has undergone significant changes through the use of:
Turbine installations, which makes it possible to use modern filling materials and makes the preparation of hard tooth tissues painless and fast.
More effective pain relief (alfacaine, ultracaine, orthocoin, ubestezin).
3. Modern filling materials (light and chemical rejection composites).
4. Endodontic filling material: tooth canal filling paste with antiseptic, anti-inflammatory, restorative properties, gutta-percha pins and endodontic instruments.
I accept patients with the following diseases:
1. Carious lesion of tooth tissues.
2. Complicated forms of caries.
3. Traumatic damage to the teeth.
4. Non-carious lesions of dental tissues.
5. Combined destruction of tooth tissues.
The office has a set of domestic and imported filling materials. From domestic I use most often the following materials: unifas, phosphate-cement, silidont, silicin, stomafil for fillings.
In case of deep caries, I use medications with an anti-inflammatory effect and promoting the formation of replacement dentin: calmecin, calradent, life, daikal.
In my work I give preference to composite filling materials. Glass ionomer cements stabilize the process due to the fact that fluorine ions are released from them for a long time. I use such cements as stomafil, ketak-molar, vetremer. These cements are used as cushioning, healing and restorative. Their advantages: ease of use, increased adhesion, biocompatibility with tooth tissues, high fluoride release, low solubility, strength.
Composite materials use chemical and light curing.
Of chemical available: alphadent, unifil, compokur, charisma, etc.
Of light-cured: Herculite, Filtek, Valix, Filtek-Supreme, Point, Admira.
They have the following positive properties: color stability, good marginal adhesion, strength, good polishability.
Requirements for composite materials:
1. Good adaptation.
2. Water resistance.
3. Color stability.
4. Simple application technique.
5. Satisfactory mechanical strength.
6. Sufficiency of working time.
7. Required cure depth.
8. R-contrast.
9. Good polishability.
Biological tolerance.
Standard scheme for using composite materials:
1. Preparation of the carious cavity.
2. Choice of color.
3. Applying the gasket.
4. Etching.
5. Acid neutralization.
6. Drying.
7. Applying the adhesive.
8. Restoration of the anatomical shape of the tooth.
9. Toning the seal.
10. Strict adherence to instructions.
Classification of composites
FROM 
curing method Purpose
X 
imic Light - Class A
Powder + curablefor cavities I and II class.
Liquid one paste Class B
Paste-paste for cavities III and
The most common disease in dental practice is dental caries.
The most common classification is clinical and anatomical, which takes into account the depth of the spread of the carious process:
dental caries in the stain stage;
fissure caries;
superficial caries;
medium caries;
deep caries.
Anatomical classification of cavities according to Black, taking into account the surface of the localization of the lesion:
1 class - localization of carious cavities in the area of \u200b\u200bnatural fissures of molars and premolars, in the blind fossa of incisors and molars.
2 class - on the lateral surfaces of molars and premolars.
3 class - on the lateral surfaces of the incisors and canines without violating the integrity of the incisal edge.
4 class - on the lateral surfaces of the incisors and canines with violation of the integrity of the angle and incisal edge of the crown.
5 class - in the cervical region.
Basic principles and sequence of local caries treatment:
Anesthesia. The choice of the method of pain relief is determined by the clinical and individual characteristics of the patient. There are both domestic and imported anesthetics at the workplace.
At the present time, we can firmly say that the problem of dental treatment without pain has been solved. The applied articaine-based painkillers relieve pain both in the treatment of caries of any localization and depth of the cavity, and all forms of pulpitis. The efficiency is approaching 100%. In the upper jaw, infiltration anesthesia is mainly applied in the area of \u200b\u200bthe root apex. On the lower jaw, the greatest effect is achieved by anesthesia near the condylar process of the lower jaw. Method: with the mouth as open as possible, the needle is inserted 2 cm above the chewing surface of the lower molars - upwards medially towards the auditory canal. The duration of anesthesia is 2-4 hours.
2. Opening a carious cavity: removal of the overhanging edges of the enamel, which allows you to expand the inlet into the carious cavity.
3. Expansion of the carious cavity . The enamel edges are leveled, the affected fissures are excised.
4. Necrosectomy . Removal of all affected tissues from the cavity and the use of a caries detector to identify the affected dentin and leave no traces on healthy areas.
5. Formation of a carious cavity. Creation of conditions for reliable fixation of the seal.
The task of operational technology - the formation of a cavity, the bottom of which is perpendicular to the long axis of the tooth (you need to determine the direction of inclination), and the walls are parallel to this axis and perpendicular to the bottom. If the slope to the vestibular side - for the upper chewing teeth and in the oral side - for the lower ones is more than 10-15 °, and the wall thickness is insignificant, then the rule for the formation of the bottom changes: it should have an inclination in the opposite direction. This requirement is due to the fact that occlusal forces directed at the filling at an angle and even vertically have a displacement effect and can contribute to the breaking off of the tooth wall. This requires the creation of an additional cavity in the direction of the bottom to distribute the forces of chewing pressure over thicker and, therefore, more mechanically strong tissue areas. In these situations, an additional cavity can be created on the opposite (vestibular, oral) wall along the transverse intertubular groove with the transition to the side of the main cavity. It is necessary to determine the optimal shape of the additional cavity, in which it is possible to achieve the greatest effect of redistribution of all components of the chewing pressure with a minimum operative removal of enamel and dentin and the least pronounced reaction of the pulp.
MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION
MUZ dental clinic №2
DENTAL DOCTOR'S WORK REPORT
FOR 2008 - 2010
MATVEEVA VALENTINA IOSIFOVNA
Kaliningrad - 2011
Report outline
1. General information ………………………………………………. 3
2. Office equipment and organization of work in
dental office …………………………… .. 4
3. The work of a dentist at a therapeutic
admission. ………………………………………………………… 5-19
4. Sanitary and educational work ... ………………… 19-20
5. Sanitary and epidemiological mode of operation
cabinet ………………………………………………………… .. 21-22
6.Conclusions …………………………………………………… 23-28
1. General information
I have been working in the dental clinic №2 since August 1991. Polyclinic No. 2 provides medical and preventive dental care for the adult population.
The clinic is located in a two-story adapted building at the address: st. Proletarskaya, 114. The polyclinic has a compressor room for supplying compressed air to dental units, a centralized washing and sterilization room, a physiotherapy and X-ray room, and a registry. The polyclinic operates in two shifts from 7.45 to 20.15 Saturday from 9.00 to 15.00 .. There are 2 treatment departments and one denture department. In the treatment departments there are 6 therapeutic rooms, 1 surgery, 1 periodontal room, acute pain room. Treatment rooms are equipped with modern drills. All turbine units are supplied centrally with compressed air.
2. Equipment of the office and organization of work in the dental office
The office in which I receive dental patients meets the sanitary and hygienic standards. Equipped with a dental unit "Marus". There is cold and hot water, the necessary instruments, a set of modern domestic and imported anesthetics and filling materials.
The load at the admission consists of primary coupons and repeated patients.
I work on the principle of the maximum number of sanctions on the first visit.
The main tasks at the reception are:
1. Provision of qualified assistance to the population.
2. Conducting sanitary and educational work, teaching oral hygiene.
3. Prevention of dental diseases.
3. The work of a dentist at a therapeutic appointment.
In recent years, the work of a dentist has undergone significant changes through the use of:
1. Turbine installations, which makes it possible to use modern filling materials and makes the preparation of hard tooth tissues painless and fast.
2. More effective pain relief (alfacaine, ultracaine, orthocoin, ubestezin).
3. Modern filling materials (light and chemical rejection composites).
4. Endodontic filling material: tooth canal filling paste with antiseptic, anti-inflammatory, restorative properties, gutta-percha pins and endodontic instruments.
I accept patients with the following diseases:
1. Carious lesion of tooth tissues.
2. Complicated forms of caries.
3. Traumatic damage to the teeth.
4. Non-carious lesions of dental tissues.
5. Combined destruction of tooth tissues.
The office contains a set of domestic and imported filling materials. From domestic I use most often the following materials: unifas, phosphate-cement, silidont, silicin, stomafil for fillings.
In case of deep caries, I use medications with an anti-inflammatory effect and promoting the formation of replacement dentin: calmecin, calradent, life, daikal.
In my work I give preference to composite filling materials. Glass ionomer cements stabilize the process due to the fact that fluorine ions are released from them for a long time. I use such cements as stomafil, ketak-molar, vetremer. These cements are used for interlining, healing and restorative purposes. Their advantages: ease of use, increased adhesion, biocompatibility with tooth tissues, high fluoride release, low solubility, strength.
Composite materials use chemical and light curing.
Of chemical available: alphadent, unifil, compokur, charisma, etc.
Of light-cured : herkulite, filtek, valix, filtek-supreme, point, admira.
They have the following positive properties: color stability, good marginal adhesion, strength, good polishability.
Requirements for composite materials:
1. Good adaptation.
2. Water resistance.
3. Color stability.
4. Simple application technique.
5. Satisfactory mechanical strength.
6. Sufficiency of working time.
7. Required cure depth.
8. R-contrast.
9. Good polishability.
10. Biological tolerance.
Standard scheme for using composite materials:
1. Preparation of the carious cavity.
2. Choice of color.
3. Applying the gasket.
4. Etching.
5. Acid neutralization.
6. Drying.
7. Applying the adhesive.
8. Restoration of the anatomical shape of the tooth.
9. Toning the seal.
10. Strict adherence to instructions.
Classification of composites
Method of curing Purpose
Chemical Light - Class A
Powder + curable for cavities I and II class.
Liquid one paste Class B
Paste-paste for cavities III and
The most common disease in dental practice is dental caries.
The most common classification is clinical and anatomical, which takes into account the depth of the spread of the carious process:
· Dental caries in the stain stage;
Fissure caries;
Superficial caries;
· Medium caries;
· Deep caries.
Anatomical classification of cavities according to Black, taking into account the surface of the localization of the lesion:
1 class - localization of carious cavities in the area of \u200b\u200bnatural fissures of molars and premolars, in the blind fossa of incisors and molars.
2nd grade - on the lateral surfaces of molars and premolars.
Grade 3 - on the lateral surfaces of the incisors and canines without violating the integrity of the incisal edge.
4th grade - on the lateral surfaces of the incisors and canines with violation of the integrity of the angle and incisal edge of the crown.
Grade 5 - in the cervical region.
Basic principles and sequence of local caries treatment:
1. Anesthesia. The choice of the method of pain relief is determined by the clinical and individual characteristics of the patient. There are both domestic and imported anesthetics at the workplace.
At the present time, we can firmly say that the problem of dental treatment without pain has been solved. The applied painkillers based on articaine relieve pain in the treatment of caries of any localization and depth of the cavity, as well as all forms of pulpitis. The efficiency is approaching 100%. In the upper jaw, infiltration anesthesia is mainly applied in the area of \u200b\u200bthe root apex. On the lower jaw, the greatest effect is achieved by anesthesia near the condylar process of the lower jaw. Method: with the mouth as open as possible, the needle is inserted 2 cm above the chewing surface of the lower molars - upwards medially towards the auditory canal. The duration of anesthesia is 2-4 hours.
2. Opening a carious cavity: removal of the overhanging edges of the enamel, which allows you to expand the inlet into the carious cavity.
3. Expansion of the carious cavity . The enamel edges are leveled, the affected fissures are excised.
4. Necrosectomy . Removal of all affected tissues from the cavity and the use of a caries detector to identify the affected dentin and leave no traces on healthy areas.
5. Formation of a carious cavity. Creation of conditions for reliable fixation of the seal.
The task of operational technology - the formation of a cavity, the bottom of which is perpendicular to the long axis of the tooth (you need to determine the direction of inclination), and the walls are parallel to this axis and perpendicular to the bottom. If the slope to the vestibular side - for the upper chewing teeth and in the oral - for the lower ones is more than 10-15 °, and the wall thickness is insignificant, then the rule for the formation of the bottom changes: it should have a slope in the opposite direction. This requirement is due to the fact that occlusal forces directed at the filling at an angle and even vertically, have a displacement effect and can contribute to the breaking off of the tooth wall. This requires the creation of an additional cavity in the direction of the bottom to distribute the forces of chewing pressure over thicker and, therefore, more mechanically strong tissue areas. In these situations, an additional cavity can be created on the opposite (vestibular, oral) wall along the transverse intertubular groove with the transition to the side of the main cavity. It is necessary to determine the optimal shape of the additional cavity, at which it is possible to achieve the greatest effect of redistribution of all components of the chewing pressure with a minimum operative removal of enamel and dentin and the least pronounced reaction of the pulp.
The regularity of the action of the forces of chewing pressure on the tooth tissue and filling material.
a - the tooth is located vertically; b - the tooth is tilted.
R, Q, P - direction of forces.
Often the pathological process goes beyond the carious cavity and the pulp and periodontium are involved in the process.
In recent years, the emotional perception of visiting the dentist's office has changed for the better thanks to the use of modern pain relievers based on articaine. Low toxicity of the drug, rapid penetration into tissues, rapid elimination of it from the body, high anesthetic effect allows the treatment of dental patients in a wider range: pregnant women, the elderly, children. Ultracaine does not contain a preservative that causes allergic reactions. The concentration of metabisulfate-antioxidant, a substance that prevents the oxidation of adrenaline, is minimal and amounts to 0.5 mg per 1 ml of solution. Ultracaine is 6 times more effective than novocaine and 2-3 times more effective than lidocaine, rapid onset of anesthesia - 0.3-3 minutes. allows you to maintain a favorable psychoemotional background, the possibility of replacing conductive anesthesia with infiltration when working on the lower jaw. The properties of ultracaine listed above allow it to be used in a wide range of dental diseases, in particular, in the treatment of pulpitis.
Pulpitis classification:
· Limited;
· Diffuse.
2. Chronic
Fibrous;
• gangrenous;
· Hypertrophic.
3. Exacerbation of chronic pulpitis
Pulpitis treatment:
I. No pulp removal.
1. Preservation of the entire pulp.
2. Vital amputation.
II. With the removal of the pulp.
1. Method of vital extirpation.
2. Method of devital extirpation.
3. Method of devital upmutation.
The canal is sealed, not reaching the apex of 2 mm (according to the Semashko Moscow Medical Institute), taking into account the state of the periapical tissues. Filling materials
1. Plastic:
Non-hardening;
Hardening.
2. Primary solid.
Plastic curing materials are called endo-sealants or sealers.
They are divided into several groups:
1. Zinc phosphate cements.
2. Preparations based on zinc oxide and eugenol.
3. Materials based on epoxy resins.
4. Polymer materials containing calcium hydroxide.
5. Glass ionomer cements.
6. Preparations based on resorcinol-formalin resin.
7. Materials based on calcium phosphate.
Canal filling can be done with modern pastes and gutta-percha pins. In my practice, I most often use endometasone, zinc-eugenol paste and paste based on resorcinol-formalin resin. I especially want to note the work with endometasone.
Endometasone is a filling paste containing hormones, thymol, paraformaldehyde on a liquid basis of eugenol, anise drops. When filling the canals with this paste, a good therapeutic effect is achieved. The antibacterial properties of formaldehyde allow it to be used in the treatment of chronic periodontitis with bone destruction at the apex of the roots. Hormonal drugs reduce pain and inflammation, act plastically on the periodontium.
Filling of root canals is carried out by the method of lateral condensation, which is as follows.
1. Selection of the main gutta-percha pin (Master-point).
A standard gutta-percha nail of the same size as the last endodontic one used to cut the apical part of the canal (Master-file) is taken and fitted in the canal. The pin does not reach the physiological apex by 1mm.
2. Selection of a spreader.
The spreader should be the same size as the Master file, or one size larger so as not to go beyond the apex opening. The working length of the spreader should be 1-2mm. shorter than the working length of the canal.
3. Introduction of endo-sealant into the canal.
As an endo-sealant I use AN +, endometasone. The material is introduced into the canal up to the level of the apical foramen and is evenly distributed along the canal walls.
4. Introduction of the main pin into the canal.
The post is covered with a filling material and is slowly inserted into the canal to the working length.
5. Lateral condensation of gutta-percha.
A previously selected spreader is inserted into the root canal, while the gutta-percha is pressed against the canal wall.
6. Removing the spreader and inserting an additional pin.
7. Lateral condensation of gutta-percha, removal of the spreader and introduction of the second additional pin.
The operation is repeated until a complete obturation of the canal is achieved, i.e., until the spreader stops penetrating into the canal.
8. Removal of excess gutta-percha and paste.
9.X-ray control of the filling quality.
10. Applying a bandage.
Classification of periodontitis:
I. Acute periodontitis
Serous;
· Purulent.
II. Chronic periodontitis
Fibrous;
· Granulating;
Granulomatous.
III. Exacerbation of chronic periodontitis.
I treat acute periodontitis and exacerbation of chronic periodontitis of single-rooted teeth under anesthesia in one visit using one of the listed pastes and gutta-percha pins, and send them to the surgery room for an incision in the projection of the root apex.
Treatment of destructive forms of periodontitis is carried out in several stages. For temporary filling of canals I use calcium-containing preparations: "Kollapan", "Kalasept", which can successfully cope with peri-apical infection and destruction of bone tissue. Repeated R-images after 6 months show either a decrease in the destruction of bone tissue or restoration of the structure of the bone beams, which subsequently form bone, which depends on the state of the patient's immune system. If the conservative method did not lead to the desired effect, then the patient is sent to the surgical room to remove the cyst or cystogranuloma.
I check long-term results in 3-6 months together with the surgeon. After the operation, the teeth become immobile, and after 3-6 months, bone tissue is visible at the site of the cyst on the R-image.
When treating teeth with impassable root canals, I use copper-calcium hydroxide depophoresis. In addition, this method is used when the contents of the canal are severely infected, the instrument is broken off in the canal lumen (without going beyond the apex).
While working with the patient, I explain to him the chosen method of treatment and possible complications, the need for root removal and timely prosthetics. I explain the influence of bad habits on the state of the oral cavity.
The constant improvement of the equipment of the office and the clinic with equipment and dental materials makes it possible to receive patients at a modern level.
Working with modern filling materials
Filling is the final stage in the treatment of caries and its complications, which aims to replace the lost tooth tissues with a filling.
The success of treatment largely depends on the ability to choose the right material and use it rationally.
Recently, light-curing composite materials have become widespread, for a number of indicators they perfectly imitate tooth tissues. Properties such as color scale, transparency, abrasion resistance and polishability have significantly expanded the possibilities of tooth restoration without prosthetics. The process of restoring decayed teeth directly in the oral cavity in one visit is called restoration.
Filling is a purely medical procedure, while restoration combines elements of medical and artistic work.
Stages of restoration (filling):
1. Preparing the patient.
2. Tooth preparation.
3. Restoration (filling).
The patient should be taught to properly brush his teeth, remove dental deposits, if necessary, send to the periodontal office. All surgical interventions should be performed before treatment. The improvement of gum tissue is also important because the maximum effect is achieved with a combination of even healthy teeth and pale pink gums.
The main requirement for the restoration of teeth with light-curing materials is accurate and methodical adherence to the instructions. Only when all technological stages are performed will the necessary adhesion of the composite to the tooth tissues be achieved and a good cosmetic result will be obtained. Despite some differences in the use of composites from different companies, there are general principles in work.
Preparing a tooth for restoration includes the following manipulations:
1. Removal of altered tissues.
2. Forming the edges of the enamel.
3. Removal of plaque from the tooth surface.
4. Opening of prisms.
5. Insulation from moisture and drying.
6. Applying the gasket.
7. Formation of the basis for the restoration.
8. Etching of tooth enamel.
9. Adding a primer.
10.Application of the adhesive.
It is necessary to dwell on some stages of tooth preparation, namely, the disclosure of enamel prisms. This somewhat conventional expression implies the removal of the superficial thinnest structureless enamel layer, which covers the prism bundles. It is believed that the removal of the structureless layer and subsequent etching of the enamel with acid will create favorable conditions for the fixation of the composite. This is especially important in cases where the composite is applied to a significant enamel surface (in case of hypoplasia, erosion, chipping of a part of the crown).
Tooth enamel etching produced in accordance with the instructions attached to the material. It should be remembered that excessive etching must not be allowed, since the changing structure of the enamel does not provide optimal conditions for adhesion. Careful removal of the acid or gel is essential. In time, the washing of the etching area should be at least 20 seconds. This is followed by thorough air drying.
Dentin etching is performed simultaneously with enamel etching. This achieves the removal of the lubricated layer and the formation of inter-collagen spaces, which are filled with a primer.
Apply the primer with a clean brush on dentin, and after 30 sec. air from the pistol removes unnecessary volatile components of the preparation, the ingress of the primer on the enamel does not affect the adhesion of the composite.
Adhesive application is the final stage of preparing the tooth for filling. The adhesive is applied into the cavity with a brush and then with a stream of air
evenly distributed along the walls. If the adhesive is chemically cured (two-component), then it does not need glare, if it is light-cured (one-component), then it is gleamed by a lamp. This is usually 10 seconds.
Restoration (filling) of a tooth
This stage includes:
1. Introduction of the anchor.
2. Introduction of the composite.
3. Curing of the composite.
4. Formation of the restoration surface.
5. Final highlighting.
1. In case of significant tooth decay, I use anchor pins. Anchor pins are of various types, sizes - length and cross-sectional diameter vary from 1 to 10 units. An important step in the restoration is the fitting of the anchor. The anchor must fit tightly into the channel to a certain depth. I consider the most optimal 2/3 of the root in the anterior group of teeth and up to ½ in the lateral ones. Anchor pins are screwed in all the way, with a special tool, loosening the petals. I must cover the anchors with the light-curing Opaque material to avoid its transmission through the layer of the base composite.
2. The application of the composite is carried out with the help of smoothing trowels without defects. For deep cavities, the composite is applied in layers (up to 3 ml). This is especially important with light-curing materials. A "drop" formed on the surface of the composite, called the “oxygen inhibited layer," allows the layers of the composite to be bonded without an adhesive. This layer cannot be damaged - washed, dirty. Curing of a material is associated with shrinkage that appears in the direction away from the light source.
3. The next step is grinding and polishing. First of all, it is necessary to remove excess materials with burs. It is important to create the basic details of the surface shape: longitudinal stripes of incisors, cusps and fissures of molars. After correcting errors and re-finishing, the surface of the restoration is polished with plastic or rubber heads. The contact surfaces are polished using strips and floss. The final processing of the restoration is carried out with sponges and polishing pastes. At the end of the work, finishing flashing is carried out. The maximum effect is achieved when the light beam is perpendicular.
4. Sanitary and educational work
For any country, preventing a disease is cheaper than curing it, so health education should be a government program.
The dentist is obliged to conduct sanitary and educational work with the population. 70% of the condition of the oral cavity depends on the patient himself. First of all, how and with what he brushes his teeth. Domestic pastes use highly alkaline chalk with low whiteness and a high content of highly abrasive aluminum and iron oxides. Therefore, our pastes do not foam well and have a grayish color. If used constantly, they can lead to thinning of the enamel. The chalk used by Western firms is free from these drawbacks. Antimicrobial components, plant extracts, mineral resins, fluorine are introduced into the pastes.
Russian, Bulgarian, Indian pastes are 90% hygienic.
I recommend to my patients the Colgate, Blend and Honey, Signal, Pepsodent pastes. These pastes contain chlorhesedin - which helps fight bacterial plaque, cleaning agents, fluoride. The effectiveness of fluoridated pastes in the fight against caries is 30%.
I conduct interviews with patients. List of conversations:
1. Oral hygiene.
2. How to choose the right toothbrush and paste.
3. Prevention of dental diseases.
I conduct explanatory work about bad habits.
Over the three reporting periods, I have prepared and heard at medical conferences abstracts on the topic:
1. HIV infection in the oral cavity.
2. Technique of treatment of root canals.
3. Errors and complications in channel instrumentation.
5.Sanitary and epidemiological regime in the office
The dental office in which I work meets the sanitary standards (24 sq. M.). Availability of cold and hot water. The cabinet is equipped with a germicidal lamp, which is switched on 3 times a day for 30 minutes. Centralized air sterilizers are available. A journal of their work is kept. I use disposable masks, gloves, glasses.
Daily three times wet cleaning using 5% lysitol or alominal 5% or septodor-forte.
General cleaning once a month.
The rules of personal hygiene and measures for the prevention of self-infection of AIDS and VH "B" are observed. If blood gets on the intact skin of the hands, the blood must be removed with a dry swab, then wiped with a 70 ° solution of alcohol or 0.5% alcoholic solution of chlorhexidine 2 times, wash hands with soap and alcohol.
If blood gets on damaged skin, it is necessary to squeeze out the blood from the wound, lubricate with 5% iodine solution, wash hands with soap and treat with 70% alcohol solution.
All manipulations with patients are carried out in rubber gloves, a mask, and glasses.
If saliva gets on the mucous eyes, they must be rinsed with a stream of water or 1% boric acid solution and a few drops of silver nitrate should be injected. It is recommended to treat the nasal mucosa with 1% protargol solution, mouth and throat additionally (after rinsing with water) 70% alcohol solution or 1% boric acid solution.
After removing the gloves, hands are treated with 70% alcohol and soap.
Tips for drills, pusters, ultrasonic instruments, needleless syringes after each patient are wiped with a sterile swab moistened with 70% alcohol (twice). At the end of the shift in 6% hydrogen peroxide for 1 hour.
Sight mirrors are collected in a storage glass with a 6% hydrogen peroxide solution, then washed with water, a detergent-disinfecting solution for 15 minutes, rinsed, dried with a swab and immersed in a 0.5% alcohol solution of chlorhexidine or 70% alcohol for 30 minutes. After that, "clean mirrors" are transferred to the container.
Modern aseptic solutions such as septador-forte, lysitol (5%) do not require pretreatment with a cleaning solution.
Burs - after use, they are immersed in a container with a septador-forte solution for 1 hour. Then rinse with a brush with a swab for 3-5 minutes. After that, the burs are pre-sterilized and exposed for 15 minutes. The burs are then washed with a brush. Irrigation for 10 minutes with distilled water, sterilization-air method at 180 ° and 1 hour in a Petri dish. The used burs are placed in the "Disinfection of burs" container.
All other instruments used in treatment are subject to a full cycle of treatment for the prevention of viral hepatitis and AIDS. Immediately after use, the instruments are rinsed in a disinfectant solution marked "Washing in a disinfectant solution" and immersed in a container "Disinfection of instrumentation" with lysitol or alominal for 1 hour. Then they are washed under running water for 3-5 minutes.
All instruments, including pulp extractors and canal fillers (newly obtained), must be disinfected with alcohol, rinsed with water, pre-sterilized and sterilized.
There should be nothing superfluous on the doctor's table. The table should be wiped with a 6% hydrogen peroxide solution or disinfectant solution.
Cotton swabs must be sterile (steam sterilization at 120 degrees for 20 minutes, change after 6 hours).
conclusions
The reforms carried out in our country since the 90s have also affected the dental service. – market factors began to work, competition appeared, the ability for patients to choose a clinic and attending physician.
At the present time, we can firmly say that the problem of dental treatment without pain has been solved. Used painkillers such as
"Ultracaine" relieve pain in the treatment of caries of any localization and depth of the cavity, and all forms of pulpitis. The efficiency is approaching 100%.
In the competition for patients, attention should be paid to the provision of highly qualified dental care in the shortest possible time, as a result of which the number of visits to the dentist is reduced to a minimum due to the effective use of modern technology and materials; somehow carpool anesthesia, which allows completely removing the patient's sensitivity to instrumental manipulations of the doctor and restoration of teeth with composite materials, whose advantage is that the work is carried out in one visit and the patient does not experience the discomfort associated with the presence of grinded teeth. Every six months, the patient visits the dentist to polish the surface.
When carrying out restoration work, high-class materials and equipment are used that allow opening the tooth cavity without vibrations.
Among the patients of dental clinics and offices, interest in the aesthetic side of dental treatment has recently increased, the desire to have fillings that do not differ in color from natural teeth at all.
In this regard, training in methods of working with composite materials remains a serious problem. At present, the creation of an image of a high-class specialist is impossible without the introduction of new generations of light-cured composite materials into practice.
Participation in all-Russian dental forums, seminars of dentists, medical conferences in the polyclinic allows us to become more familiar with the achievements in dentistry, and also makes it possible to master modern methods of treating dental diseases.
During the three reporting years 2002 - 2004 at a therapeutic appointment.
| Work days | 165 | 134 | 187 |
Accepted by the sick |
1894 | 1425 | 1526 |
| Primary patients accepted | |||
| Filled teeth (total) | 1930 | 1465 | 1767 |
| Sealed teeth due to caries | 1540 | 1167 | 1315 |
| Complicated forms of caries | 390 | 298 | 452 |
Cured teeth in one complicated visit |
283 | 223 | 290 |
| Total sanitized | 228 | 133 | 150 |
| Developed by UET | 8101,95 | 6900,25 | 10446,45 |
| UET for 1 visit. | 4,3 | 4,8 | 6,8 |
| UET for 1 sanitation | 35,5 | 51,8 | 69,6 |
QUALITATIVE INDICATORS
CONCLUSIONS
1. There is a decrease in the number of working days in 2003, as the clinic was undergoing major repairs. This was also affected by the increase in the number of vacation days due to the provision of 12 additional days for working with hazardous materials.
2. In 2003, there was a decrease in the number of patients admitted per day due to the reconstruction of the polyclinic, re-equipment of offices with modern dental units. In their work have become
more modern light-polymer materials are used, which require a longer time for this work.
3. The number of delivered fillings per day has decreased due to preventive and restoration work using modern light-polymer materials that require more time to work with.
4. The treatment for caries decreased by 14.6%, as the treatment of teeth with complicated forms of caries for previously treated teeth with amputation methods and retreated root canals increased by 15.8%.
5. The rate of treatment of teeth with complicated forms of caries increased due to the use of modern endodontic instruments, filling materials for root canals.
6. The use of modern anesthetics and endodontic instruments made it possible to use the method of one-session treatment of complicated forms of caries more widely in comparison with 2003 by 10.5% in 2004. We treat more than 64% of complicated forms of caries in 1 visit.
7. Reception of patients is carried out mainly on request. This can explain the decrease in the number of sanitized patients.
8. To increase the number of UETs per day in 2004. the transfer of work by order No. 277 and the treatment of complicated forms of caries in 1 visit affected.
9. Thanks to the use of modern filling materials, endodontic instruments, depophoresis, which require repeated visits to a doctor-stamatologist, UET has increased by 1 sanitation. Also, this was affected by the work on order No. 277.
In 2004. the number of teeth treated with a conservative method for chronic granulomatous periodontitis has increased due to the use of modern filling materials for root canals, which contain calcium-containing preparations.
If in 2002. the conservative method was successfully treated 11 teeth with DS: chronic granulomatous periodontitis, then already in 2004. 19 teeth. The depophoresis method was also used in the treatment of these teeth. The use of the depophoresis method and calcium-containing preparations allows you to successfully cope with peri-apical infection and destruction of bone tissue. Repeated R-images after 6 months show a reduction in bone destruction. Of 19 teeth, after 12 months, 14 showed restoration of the structure of the bone beams, and after 24 months, complete restoration of the bone structure in all cured teeth with DS: chronic granulomatous periodontitis.
In addition to the treatment of pulpitis and periodontitis, I carry out endodontic preparation of teeth before prosthetics: I depulp under the crowns, process the previously sealed canals under the tabs. Such work is carried out at the request of an orthopedic surgeon after a joint examination of the patient. Sometimes, orthopedists and orthodontists consult with me about the possibility of performing certain therapeutic procedures for the optimal treatment of patients.
Non-carious tooth damage
In recent years, the number of patients with non-carious dental lesions (erosion, pathological abrasion, enamel hypoplasia, hyperplasia, etc.) has increased. Toxic necrosis of tooth tissues appeared as a result of substance abuse and drug addiction. In such cases, correct diagnosis is very important in order to eliminate the cause of the disease and prescribe a comprehensive treatment. Often a cosmetic restoration is required, which I do using light-curing materials. In addition to eliminating cosmetic defects, I prescribe general and local treatment and, in some cases, put patients on dispensary records.
Other pathology of the oral cavity
In addition to dental treatment, my responsibilities include detecting pathological processes in the oral mucosa, their preliminary diagnosis. During the examination of the patient, I determine the presence of neoplasms or manifestations of venereal diseases in the oral cavity, periodontal disease, periodontitis, gingivitis, stomatitis, fungal diseases, etc. If a pathology is found, I refer the patient to a specialist-periodontist. In addition, I have mastered splinting teeth with Glasspan threads.
The polyclinic has a physiotherapy room, where I send patients, if necessary, for additional medical procedures (remotherapy, laser, etc.). If the patient has general diseases, specialist consultations are required before providing dental care. For severe cardiovascular diseases, I send patients to the day hospital of Hospital No. 15, for blood diseases - to the Institute of Hematology, for allergological tests - to the 1st City Polyclinic.
Aesthetic dental restoration
The development of dentistry, materials science, the development of modern treatment technologies have opened up fundamentally new possibilities for clinical practice for dentists. Today, not only tooth treatment is of great importance, but also its aesthetic restoration, that is, reproduction of the anatomy of color and transparency. The manufacture of veneers has become an important direction in dentistry.
Veneers is an aesthetic restoration of the vestibular surface of the teeth. They can be straight (made directly in the oral cavity from composites or ormockers) and indirect (made of composite or ceramics, made on the model and cemented on the tooth).
Indications for making veneers:
- Change in tooth color (natural, associated with the presence of a non-carious lesion or with previous pulp).
- The patient's desire to change the shape of the tooth.
- Dystopia.
- The presence of a class IV cavity or an angle fracture occupying more than 1/3 of the tooth crown
- The presence of two significant Class III cavities on the medial and distal edges.
Relative contraindications:
- decrease in height or pathology of the bite;
- bruxism;
- bad habits;
- poor oral hygiene.
Before preparation, we clean the tooth surface, evaluate the opacity, basic tone and color shades and the location of the transparency zones along the incisal edge. When periodontitis occurs, surgical intervention is required prior to the restoration. We isolate the tooth with a rubber dam or a retraction thread. For preparation we use a torpedo bur. In the cervical region, we form a shoulder of at least 2 mm. Its depth depends on the degree of staining of the tooth. The more the tooth is stained, the more hard tissue needs to be removed. To change the position of a tooth in a row, we prepare the amount of hard tissue individually.
Then we process the body of the tooth, form grooves on the medial and distal edges. Shorten the cutting edge by 2 mm or more. From the palatal surface, we prepare a retention groove 2 mm deep and wide. With a thin fissure bur, we mow the enamel surface adjacent to the ledge. After finishing the preparation, we proceed to the restoration:
- we condition the enamel and dentin surfaces with gel;
- we make an adhesive system;
- we restore the vestibular surface.
There are several ways to restore the vestibular surface:
- Layered restoration: from the neck to the cutting edge; the incisal edge and palatal surface are treated last.
- Restoration by anatomical elements: after the cervical area, restore the enamel ridges, fill in the area between them, then form the incisal edge, then the palatal surface.
- Mixed restoration combines elements of the first and second methods.
We select the color of the materials according to the tables: from the darkest on the neck of the tooth to the transparent one on the cutting edge. The material is overlaid. To restore the contact point, we use contoured plastic matrices.
A very important stage is polishing. We use finishes, polishers, discs, silicone and rubber heads. Polishing starts from the palatal surface. The cutting edge is polished with discs only. We invite the patient to re-grind in two or three days.
Restorative materials for veneers: Filtek A-110, Filtek Z-250, Filtek Supreme, Prodigy, Admira.
Dental restoration with veneers allows the patient to quickly and relatively cheaply get a beautiful smile and, in addition, it is an interesting, creative job for the dentist.
Training
Currently, new technologies, materials, tools are constantly appearing, and the doctor needs to use the novelties of the dental industry in his work, to be aware of all the discoveries and achievements. I learn about them from the Internet from the Russian Dental Portal (http://www.stom.ru), from the newspapers Dentist, Medical Review, Monthly Newspaper for Dentists, and so on.
In addition, I attend lectures and seminars held by the Training Center of JSC "Amfodent", the Medical Academy of Postgraduate Education and conferences that are held in our clinic.
Conclusion
Based on the attestation report on my work for 2001-2003, one can judge how the work of a dentist has changed recently.
The level of dental health of the population has grown significantly. Whereas in 2001 the number of seals per sanitation was 14.5, in 2003 it was only 4.7. This is due to a higher level of dental care.
With the development of insurance medicine, patients have become more attentive to their health. The number of patients increased from 1,932 in 2001 to 2,520 in 2003. The number of primary patients increased from 26.5% to 42.2% of the total. That is, now even those patients who have not applied before come for treatment.
The number of endodontic jobs increased from 588 in 2001 to 711 in 2003. This is due to the fact that a lot of endodontic work is done for prosthetics.
Thus, we can conclude that modern therapeutic dentistry is changing qualitatively. Now it is impossible without communication with other branches of medicine. The number of works for prosthetics and orthodontics has increased. The number of cosmetic procedures (veneers, restorations) has increased. In addition, the dentist-therapist works in contact with doctors of other profiles (hematologists, allergists, mycologists, etc.)
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Work description
The clinic is located in a two-story adapted building at the address: st. Proletarskaya, 114. The polyclinic has a compressor room for supplying compressed air to dental units, a centralized washing and sterilization room, a physiotherapy and X-ray room, and a registry. The polyclinic operates in two shifts from 7.45 to 20.15 Saturday from 9.00 to 15.00 .. There are 2 treatment departments and one denture department. In the treatment departments there are 6 therapeutic rooms, 1 surgery, 1 periodontal room, acute pain room. Treatment rooms are equipped with modern drills. All turbine units are supplied centrally with compressed air.
1. General information ………………………………………………. 3
2. Office equipment and organization of work in
Dental office …………………………… .. 4
3. The work of a dentist at a therapeutic
Reception. ………………………………………………………… 5-19
4. Sanitary and educational work ... ………………… 19-20
5. Sanitary and epidemiological mode of operation
Cabinet ……………………………………………………… .. 21-22
6.Conclusions …………………………………………………… 23-28