UDC 616.31 (083.13) BBK 56.6 T35 The National Guide to Therapeutic Dentistry was developed and recommended by the Moscow Dental Association and the Association of Medical Societies by Kagestvo. T35 Therapeutic dentistry: national guide / ed. L.A. Dmitrieva, Yu.M. Makashovsky. - M.: GEOTAR-Media, 2009. - 912 p. - (Series “National Guidelines”). ISBN 978-5-9704-1084-4 National manuals - the first series in Russia practical guides in m major medical specialties, including all the basic information necessary for a doctor for continuous postgraduate education. Unlike other manuals, the national manuals give equal attention to prevention, diagnosis, pharmacotherapy and non-drug methods. . iioni, I" number of illustrations, pharmacological reference and<
I
N 1 1 4
Принижение1 к руководству на компакт-диске включает дополнительные иллюии, in1 пошедшие и состав печатной части, учебный фильм о методах анестезии в
(ширинкой гтмитшюгии, подробные сведения о пломбировочных материалах.
|||.и,|\, которые применяются в эндодонтии и пародонтологии, о различных
Ш.1Ч индииидуалыюй и профессиональной гигиены полости рта.
II ипдготпнкс настоящего издания в качестве авторов-составителей и рецензентов
Принимали участие ведущие специалисты-стоматологи. Все рекомендации прошли
г i.mm имого рецензирования.
Рукшшдстио предназначено врачам-стоматологам, студентам старших курсов
медицинских вузов, интернам, ординаторам, аспирантам.
УДК 616.31(083.13)
ББК 56.6
Авторы, редакторы и издатели руководства предприняли максимум усилий, чтобы
обеспечить точность представленной информации, в том числе дозировок лекарственных средств. Осознавая высокую ответственность, связанную с подготовкой
руководства, и учитывая постоянные изменения, происходящие в медицинской
науке, мы рекомендуем уточнять дозы лекарственных средств по соответствующим
инструкциям. Пациенты не могут использовать эту информацию для диагностики и
самолечения.
Права на данное издание принадлежат издательской группе «ГЭОТАР Медиа*,
Воспроизведение и распространение в каком бы то ни было виде гасти или целом издания
не могут быть осуществлены без письменного разрешения издатспыкоп щруппы>ISBN 978-5-9704-1084-4 © Avtorosh Team, 2008 c Publishing Group I UTAR M e d i a - . ,"i)t)") CONTENTS Preface by the editors Participants of the publication Creation methodology and quality assurance program List of abbreviations Chapter 1. Postgraduate and additional professional education in the dental personnel training system (S.G. Sokhov) Chapter 2. Organization of therapeutic dental care General principles organization of dental care and activities of dental institutions in market conditions (A.V. Alimsky) Modern organization of dental appointments (V.V. Sadovsky) Chapter 3. Equipment and equipment of the dental office (L.A. Dmitrieva, O.A. Georgieva) Chapter 4. Clinical examination of patients in therapeutic dentistry (Z.E. Revazova, T.A. Rizhinashvili) Chapter 5. Dental materials for tooth restoration in a therapeutic dentistry clinic (P.V. Dobrovolsky) Chapter 6. Endodontics (L.A. Dmitrieva, A.E. Romanov, T.V. Zyuzina, I.V. Butenko., G.S. Pashkova) Preventive endodontics Conservative endodontics Repeated endodontic treatment of teeth Surgical endodontics Chapter 7. Modern tooth-preserving biotechnologies (S.D. Arutyunov) Chapter 8. Diseases of teeth of non-carious origin (Yu.M. Maksimovsky).. Adentia Supernumerary teeth Anomalies in the size and shape of teeth Endemic dental fluorosis Disturbances in the formation of teeth Hereditary disorders of dental development Changes in the color of teeth Increased abrasion of teeth Grinding (abrasive wear) of teeth Erosion of teeth Medicinal and toxic disorders of the development of hard dental tissues Odontogenic resorption Deposits (growths) on teeth Changes in color of hard dental tissues after eruption Dentin hyperesthesia Necrosis of hard dental tissues Traumatic damage to teeth 6 7 10 13 15 26 26 35 66 121 142 175 179 181 218 230 23 2 248 251 251 251 252 257 261 267 267 270 273 276 277 277 280 281 283 288 4 CONTENTS Chapter 9. Modern methods of teeth color correction (L.A. Dmitrieva, M.A. Sultanova) Chapter 10. Oral hygiene (L.A. Dmitrieva, T.V. Zyuzina, O.A. Kruzhalova) Individual oral hygiene Professional oral hygiene Chapter 11. Dental caries (E.M. Kuzmina, K.S. Bobr ) Operative technique of dental treatment (L.A. Dmitrieva, V.I. Baisheva, K.S. Bobr) Chapter 12. Inflammation of the dental pulp (E.V. Ivanova) Chapter 13. Diseases of the periapical tissues of the teeth. Periodontitis (A.V. Mitronin) Chapter 14. Periodontal diseases Anatomy and histology of periodontal disease (A.I. Grudyanov, L.Yu. Orekhova) Classification of periodontal diseases (A.K. Grudyanov, L.Yu. Orekhova) Catarrhal gingivitis (A. I. Grudyanov) Ulcerative gingivitis (A.K. Grudyanov) Hypertrophic gingivitis (A.I. Grudyanov) Periodontitis (A.I. Grudyanov) Osteoplastic materials in periodontology (Z.E. Revazova) Gum recession (D.A. Kostryukov) Aggressive forms of periodontitis (A.I. Grudyanov) Periodontal disease (A.I. Grudyanov) Tumor-like lesions (A. I. Grudyanov) Symptoms and syndromes manifested in periodontal tissues (T.D. Chirkova) Chapter 15. Halitosis (O.O. Yanushevig, A.V. Mitronin, KG. Dmitrieva) Chapter 16. Functional selective grinding (33. Revazova , A.V. Voinov, E.L. Prosvirova) Chapter 17. Diseases of the oral mucosa Traumatic lesions of the oral mucosa (L.A. Aksamit) Infectious diseases manifested on the oral mucosa (L.A. Aksamit) Allergic diseases (V.I. Spitsyna) Drug allergies Exudative erythema multiforme Chronic recurrent aphthous stomatitis Behcet's disease Sjögren's syndrome Changes in the oral mucosa in some systemic diseases and metabolic disorders ( L.A. Aksamit) Diseases of the digestive system Diseases endocrine system, nutritional disorders and metabolic disorders Hypovitaminosis Diseases of the blood and hematopoietic organs 292 304 304 311 322 359 392 415 463 463 466 467 472 474 476 487 497 506 510 512 515 526 540 553 55 5 575 616 616 633 638 644 645 648 649 652 655 66 ] 0CHAPTER1 5 Diseases of the circulatory system 666 (ui dark lesions of connective tissue 668 1 [lesions of the oral mucosa with dermatoses (V.I. Spitsyna) 670 Anomalies and independent diseases of the tongue (V.I. Spitsyna) 693 Chsylitis (LL. Aksamit) 715 11|and "cancer diseases of the oral mucosa and red lips (LL. Aksamit) 728 Changes in the oral mucosa during exogenous intoxication (DA. Aksamit) 741 Damage to the oral cavity during HIV infection (V.I. Spitsyna) 746 Chapter 18. Local anesthesia in therapeutic dentistry (S.A. Rabinvig, E.V. Zoryan, S. Sokhov, V.I. Stosh, O.N. Moskovets) 760 Chapter 19. Medicines used in therapeutic i HOM1TOLOGY ( E.V. Zoryan) 808 Antiseptics and disinfectants 808 Chemotherapy agents 816 Synthetic chemotherapeutic agents 833 Antifungal agents 839 Antiviral drugs 843 Anti-inflammatory drugs 847 Non-steroidal anti-inflammatory drugs and non-narcotic (non-opioid) analgesics 847 Steroidal anti-inflammatory drugs 851 Enzyme preparations 854 Astringents 855 Antiallergic drugs 857 Immunomodulators 861 Antihypoxants and antioxidants 873 Vitamins 87 6 Homeopathic remedies in dentistry 883 Chapter 20. Principles of interaction between doctors and society ( G. Komarov) Subject index 892 898 LIST OF ABBREVIATIONS c - designation of materials presented on the CD * - designation of trade names of medicines p - designation of medicines not registered in the Russian Federation m - designation of canceled medicines AFP - aggressive forms of periodontitis Bis-GMA - bisphenol-A-glycidyl methacrylate BPP - rapidly progressive periodontitis HIV - human immunodeficiency virus WHO - World Health Organization HSV - herpes simplex virus GAG - glycosaminoglycans BBB - blood-brain barrier DNA - deoxyribonucleic acid GIT - gastrointestinal tract LLP - lichen planus KPU - the sum of all teeth affected by caries (K), filled (P) and removed (U) due to caries complications LDF - laser Doppler flowmetry LSS - sulfur-containing compounds ICD - International Classification of Diseases ICD-C - International Classification of Dental Diseases MEE - multiform exudative erythema NSAIDs - non-steroidal anti-inflammatory drugs PABA - para-aminobenzoic acid GSNL - polymorphonuclear leukocytes PCR - polymer zno-chain reaction RIF - immunofluorescence reaction RNA - ribonucleic acid SGPR - burning mouth syndrome GIC - glass ionomer cement ESR - erythrocyte sedimentation rate SPAC - glass polyalkenate cement AIDS - human acquired immunodeficiency syndrome FIP - functional selective grinding CNS - central nervous system COX - cyclooxygenase EDTA - ethylenedimethyltetraacetic acid EEI - endodontic-endosseous implants Tu - half-life C^x - maximum concentration FDI - World Dental Federation PG - prostaglandin PDGF - platelet growth factor Chapter 1 Postgraduate and additional professional education in the system of training dental personnel The beginning of the implementation of the priority national project “Health” imposes on educational medical institutions a special responsibility for training personnel for the outpatient level, including for the network of dental institutions. The most important component of resource provision for healthcare is human resources. Availability of personnel, their qualifications and distribution, operating conditions, social well-being, logistics and technological support labor process determine the proper level of provision medical care to the population. The last decade of the 20th century. left Russia with many unresolved problems, including an extremely unfavorable demographic situation: life expectancy in Russia is on average 14 years less than in Western Europe. The mortality rate exceeds European indicators by 1.6 times; since 1985, the rate of decline in the birth rate has been 2 times higher than in European countries; Children's health indicators are 2-3 times lower than in Europe. According to L.A. Boqueria (2007), the number of doctors of all specialties in Russian Federation(RF) reaches 688 thousand, the number of doctors per 10 thousand population is 42.7, while in Italy this figure is 27, France - 25, USA - 23, Germany - 21, UK - 16, Japan - 14 In the Russian Federation there are 60.8 thousand dentists, i.e. 8.8% of the total number of doctors with the total number of budgetary and self-supporting dental clinics - 899. In 2006, in the annual address of the President of the Russian Federation to the Federal Assembly V.V. Putin identified the current demographic situation in Russia as a key problem that poses a threat to the progressive socio-economic development and national security of the country. The mortality rate of the population has increased, including from preventable factors (diseases of the circulatory system, neoplasms, other chronic non-infectious diseases, injuries and poisonings). Life expectancy in patients with aggravated chronic pathology, in the European Union countries is 18-20 years, in Russia does not reach 7 years. The observed deviations in the health of the population are mainly due to the difficult economic situation Russian state . However, the prospects for positive change depend to a large extent on the contribution that effective health care and social development systems can make to public health. The national project “Health”, aimed at achieving effective performance of the industry, provides for targeted improvement of the resource provision of medical institutions in general and, first of all, its personnel infrastructure as the main factor in deciding the accessibility, effectiveness and quality of medical care provided. The main problem of personnel policy is the insufficient level of funding, leading to low efficiency of medical care provided and unsatisfactory quality of training of medical and nursing personnel. At the same time, increasing the educational knowledge and practical skills of modern medical personnel and the rational use of their potential systemically affects other significant volumetric parameters of healthcare: financial and production resources. Doctors, including dentists, are trained in 47 medical universities, the total graduation rate of doctors of all specialties and pharmacists is on average 25 thousand per year, of which more than 3 thousand are dentists. The nomenclature list of activity profiles includes 125 specialties, 7 of them - dental profile (in European countries - up to 57). Every year, in the system of the Ministry of Health and Social Development of the Russian Federation, more than 180 thousand doctors can improve their qualifications free of charge in the established network of postgraduate education institutions, in advanced training faculties for doctors at medical universities, as well as on the basis of research institutes and large practical healthcare institutions. In the course of professional activity, a doctor can acquire a new specialty through professional retraining provided for by the nomenclature of specialties approved by the Ministry of Health and Social Development of Russia. In 1970, the USSR Ministry of Health created a nomenclature of medical specialties and a nomenclature of medical positions, which included 51 specialties and 75 medical positions (Order of the USSR Ministry of Health dated May 4, 1970 No. 280). The professional activities of medical personnel in the healthcare system are based in accordance with developed legal, regulatory and policy documents that provide for the provision of medical and nursing personnel to the population of the Russian Federation from the perspective of the multifaceted functions they perform. The formation of the new nomenclature is based on a three-stage training of specialists with the preservation of continuity in the acquisition of specialties, the presence of objective and significant features that establish, on the one hand, connections between individual specialties, and, on the other, differences. Obtaining a specialty is possible if you have a higher diploma medical or pharmaceutical education and subsequent training in internship, clinical residency, graduate school, as well as in institutions of additional education. The first stage: studying at a university, obtaining a basic specialty and qualifications with a diploma. P1.1 "LIYING..- 17 Second stage: training in internship, ordination, graduate school ( postgraduate education), obtaining a BASIC specialty. Third stage: training in residency, postgraduate studies or in institutions of additional education ( professional retraining), get me an additional specialty. Mri is the basic specialty - the totality of knowledge, ideas, abilities and skills of a university graduate in the main professional MMM educational programs that provide the opportunity for professional activity and compliance with the assigned qualifications. The basic specialty 1 HI and i.i fibiTb is based on educational standards. i >(new specialty is part of the basic specialty, within which it i o 1/|.t.|. (>it involves obtaining more in-depth professional knowledge and field of activity in the profile of this specialty. Additional specialty is part of the main specialty, representing further deepening knowledge and skills in a chosen narrow field of professional activity. OCHI IBI [th document regulating professional education, - Constitution |(I 1>. 11| and n i of December 12, 1993 Article 43 guarantees the universal availability and free of charge of secondary vocational education, free receipt higher n|||1.1 iniunini n state or municipal institutions at the competitive Hi pin 1"f establishes federal state educational countries, supports various shapes education and self-education.
. Article 56 “Right to engage in private medical practice”). Multi-level training in medical and pharmaceutical specialties is legislatively enshrined in the Federal Law of July 19, 1996 11 I;!5-FZ “On Higher and Postgraduate Professional Education”. And Article I, Article 6 “Levels of higher professional education, terms and forms of obtaining it” states: “for persons who have completed educational programs of higher medical, higher pharmaceutical education, the basis for their occupation of these positions is an initial one-year postgraduate internship (internship), confirmed certificate of the established form."< :,1мп же интерны (клинические ординаторы) в соответствии со статьей 18 того же
Закона становятся слушателями учреждений системы высшего и послевузовского
профессионального образования. Их статус в части получения образовательных
услуг приравнен к статусу студентов вуза соответствующей формы обучения.
Установлен порядок допуска к медицинской и фармацевтической деятельности
I 1"Ф лиц, получивших медицинскую и фармацевтическую подготовку в иностранных государствах (Постановление Правительства РФ от 07.02.1995 № 119
О i юрядке допуска к медицинской и фармацевтической деятельности в Российской
Федерации лиц, получивших медицинскую и фармацевтическую подготовку в нно
Странных государствах»). Организационно-распорядительными документами М.Ч
РФ с 1995 г. запрещён приём на врачебные должности и должности среднего меди
пинского персонала лиц с немедицинским образованием.
Приказом МЗ РФ от 27.08.1999 № 337 «О номенклатуре специальностей в учреждениях здравоохранения» определён перечень врачебных и провизорских специальностей и установлены требования к подготовке специалистов здравоохранения.
II соответствии с указанным Приказом оспонную врачебную специальность МОЖНО
получить, пройдя обучение П пнтержиуие {iK"|U^fflBNffiff#| подипоккл), диух
ц. х х п. интернатура была < воего рода исспериментом в отдельных регионах
|И1 (страны. Ответственность за субординатуру возложили HI нули, в интернатуре на
органы управления здравоохранением, а практическую реализацию - на заведую-
щих отделениями стационаров и поликлиник.
После внедрения государственного образовательного стандарта в высшей медицинской школе в 1995 г. субординатура была упразднена и интернатура стала первым этапом непрерывной послевузовской подготовки врачей. С начала 90-х годов
к подготовке в интернатуре были подключены и учреждения последипломного
образования в соответствии с Указанием МЗ РФ от 02.08.1993 № 234-У «О расширении специализации врачей-интернов на базе факультетов усовершенствования
врачей». Подготовка в интернатуре стала одним из необходимых видов послевузовского обучения. Без нее выпускники с дипломом о высшем медицинском
образовании не могли быть допущены к занятию профессиональной медицинской
деятельностью.
В Письме МЗ РФ от 21.01.2000 № 2510/584-32 руководителям органов управления здравоохранением и ректорам высших медицинских образовательных
учреждений- медицинских академий последипломного образования, институтов
усовершенствования врачей дано разъяснение относительно специальностей, по
которым возможно проведение подготовки в интернатуре. Из всех стоматологических специальностей интернатуру рекомендовано проводить по специальности
«стоматология».
Поступление в интернатуру обязательно для выпускников всех факультетов
медицинских вузов, если они не продолжили обучение в ординатуре или аспирантуре.
Таким образом, в нашей стране идёт формирование системы подготовки врачебных кадров, основанной на обязательном прохождении после окончания вуза
интернатуры. Именно продолженное обучение выпускников медицинских вузов
в интернатуре и клинической ординатуре должно стать основным направлением
подготовки врачей-стоматологов.
В типовых учебных планах, разработанных в 1999 г. во Всероссийском учебнометодическом центре по непрерывному медицинскому и фармацевтическому
образованию, указана основная цель обучения в интернатуре - подготовка
выпускников медицинских вузов к самостоятельному осуществлению первичной
квалифицированной неспециализированной врачебной помощи, преимущественно в амбулаторно-поликлинических условиях. Врачей, закончивших интернатуру,
допускают к работе в практическом здравоохранении или рекомендуют для поступления в клиническую ординатуру.
Большую часть времени интерны должны посвятить практической деятельности под контролем преподавателя либо старшего коллеги, изучая основы диагностики наиболее распространённых заболеваний, получая необходимые практические навыки.
Обучение в интернатуре должно подготовить выпускника вуза к самостоятельной практической деятельности в рамках квалификационных требований к основной специальности. Продолжительность обучения в интернатуре - 1 год. Основа
для оценки готовности выпускника интернатуры к самостоятельной деятельности - экзамен, учитывающий квалификационную характеристику специальности
в соответствии с Приказом МЗ РФ от 21.07.1988 № 579 «Об утверждении квалификационных характеристик врачей специалистов*. При условии сдачи экзамена
врач-интерн получает удостоверение об окончании интернатуры и сертификат с
указанием соответствующей специальности.
Клиническая ординатура. Б пункте 3 Приказа МЗ РФ от 17.02.1993 № 23
«Об утверждении Положения о клинической ординатуре» отмечена основная
задача обучения врачей в клинической ординатуре: подготовка высококвалифи-
И ЛГИЮЛНИГГ-ЛЬНОГ nPOOFCCMflJIAHbimr ИМ"АЗОВАНИЬ
21
цироианныл специалистоя для самостоятельной работы is органах и учреждениях
щравоохранения. Продолжительность обучения в ординатуре - от 2 до 5 лет по
решению учёного совета вуза с учётом специальности, по которой поводят обучение (Письмо М"Л РФ ректорам медицинских вузов от 28.07.1993 № 16-8/386).
Интернатура и ординатура ставят общую цель, но решают разные задачи. Если
прохождение интернатуры обеспечивает допуск к осуществлению врачебной деяггльности it рамках квалифицированной медицинской помощи, то после окончании ординатуры врач должен обладать необходимым уровнем знаний, умений и
навыков, позволяющих оказывать специализированную медицинскую помощь.
Подготовку в клинической ординатуре проводят в соответствии с учебными
и ||,ними, разработанными кафедральными коллективами вузов с учётом типовых
программ обучения в ординатуре, подготовленных во Всероссийском учебноMI годическом центре по непрерывному медицинскому и фармацевтическому
оПрнжжанию и стандарта специалиста. В процессе обучения интерны и клиниШские ординаторы должны получить своеобразный допуск к выполнению стомитплогических манипуляций на больных. В противном случае образовательное) чреждение не может гарантировать обеспечения у будущего специалиста необхоПимшо для практической деятельности уровня компетенции. Для преподавателей
i |ф| "i|i iit VI;Iготическую нагрузку при работе с интернами и клиническими ордина1И рассчитывают в соотношении 1:5. Подготовка в интернатуре и ординатуре
ирги стоматолога должна обеспечить овладение выбранной медицинской специIIOI I"l.io в полной мере.
Кжегпдно в РФ в интернатуре проходят обучение до 15 тыс. выпускников медиi
еких ну:иж, в клинической ординатуре - более 4 тыс. специалистов, васпирангург (юлее 3,5 тыс.
Потребность в специализации и усовершенствовании врачей в России возникМ примерно в середине XIX в. В 1841 г. начало систематическому проведению
i («циальных курсов повышения квалификации врачей в нашей стране положил
II 11 Пирогов в Медико-хирургической академии. Там начали проводить курсы
vi овершенствования знаний врачей как специальное мероприятие для поддержании необходимого уровня подготовки специалистов здравоохранения. В 1858 г.
выл создан «врачебный институт для усовершенствования в науках» (по существу,
институт усовершенствования врачей). Первый самостоятельный институт для
утнерии"иствования врачей в нашей стране и единственный в то время в мире -
I "iг 111111< ми! институт (сейчас Санкт-Петербургская медицинская академия после1
омного образования) создан более 100 лет назад. В последующие годы был
щ крыт целый ряд институтов и факультетов этого профиля.
()днако государственная система усовершенствования врачей в России возникла
\\ в.
Н настоящее время уже создана и действует государственная система повышения
квалификации, включающая сеть академий, институтов, факультетов и училищ.
< 1истема последипломного образования состоит из послевузовского (интернатура,
ординатура, аспирантура) и дополнительного (профессиональная переподготовка
и повышение квалификации: специализация, усовершенствование) профессионвльного образования.
I l.i протяжении более чем вековой истории старейшая в мире российская школа
последипломного образования накопила большой опыт проведения занятий и
контроля знаний специалистов. Зарубежные коллеги всегда отмечали преимущество отечественной системы повышения квалификации специалистов. Это преимущество определяла, в частности, выработанная годами государственная программа
подготовки и повышения квалификации врачей, в то время как в других странах
последипломное усовершенствование специалистов носило, как правило, инициа
тивный, индивидуальный характер,
22
nOMFBVSOBCKOE И ДОПОПНИТЕЛЬНОГ ПРОФЕССИОНАЛЬНОЬ ОБРАЗОВАНИЕ,
Система повышения квалификации врачей-стоматологов (дополнительное
медицинское образование) в РФ представлена семью учреждениями послевузовского образования, факультетами усовершенствования врачей при медицинских
пузах, а также курсами информации и стажировки на базе научно-исследовательских
институтов и крупных учреждений практического здравоохранения.
Работу по повышению квалификации и профессиональной переподготовке врачей регулируют Минздравсоцразвития РФ и Федеральное агентство по здравоохранению (Росздрав). Головное учреждение - Российская медицинская академия
последипломного образования.
В нашей стране установлены единые требования к организации всех видов
последипломного образования, единые сроки периодичности и продолжительности обучения. Используют единые (типовые) образовательные программы,
утверждён единый порядок проверки знаний и единый образец документов о присвоении квалификации и об усовершенствовании врачей.
Этапы последипломной подготовки врачей (организованных форм обучения).
Специализация - прохождение интернатуры или ординатуры (послевузовское образование) по специальности широкого профиля (первичная специализация), а затем по более узкой специальности (вторичная специализация,
дополнительное образование).
Повышение квалификации - дальнейшее совершенствование профессиональных знаний и навыков:
общее усовершенствование - повышение квалификации по всем разделам
специальности (согласно существующей законодательной базе повышение
квалификации специалистов должно проходить не реже одного раза в 5 лет)
длительностью от 144 учебных часов; при успешной сдаче экзамена врачстоматолог получает свидетельство государственного образца;
тематическое усовершенствование - по отдельным избранным разделам
специальности или актуальным вопросам (от 72 до 100 учебных часов);
слушатели, выполнившие все требования учебного плана, получают соответствующий документ государственного образца - удостоверение о прохождении краткосрочного повышения квалификации или свидетельство
о повышении квалификации для лиц, прошедших обучение по программе
в объёме свыше 100 ч (Постановление Правительства РФ от 26.06.1995
№ 610);
курсы информации или стажировки на базе научно-исследовательских
институтов и крупных учреждений практического здравоохранения.
В процессе профессиональной деятельности любой врач-стоматолог может
получить новую специальность, предусмотренную номенклатурой специальностей, утверждённой Минздравсоцразвития России. Для этого необходимо пройти
профессиональную переподготовку в объёме свыше 500 учебных часов в in the prescribed manner . According to Order of the Ministry of General and Professional Education dated June 18, 1997 No. 1221, professional retraining is carried out as long-term training in the curriculum necessary for a specialist to perform a new type of professional activity. The form and timing of training are established in accordance with the learning objectives. The level of education of specialists undergoing professional retraining must not be lower than the level of education required for a new type of professional activity. Mastering professional retraining programs for specialists is completed by mandatory final certification (final qualifying work, final exam, interdisciplinary examination, etc.). Students who have fulfilled the requirements of the curriculum, by decision of the certification commission, receive a diploma of professional retraining in the relevant specialty. POST-GRADUATE INCREASE AND ADDITIONAL PROFESSIONAL EDUCATION. 23 qualifications are designated by current regulatory and legal documents as a right for specialists and as an obligation - to send workers for training as necessary, but at least once every 5 years - for managers/1 and ir/ini In addition to PIO, advanced training of workers every 5 years - one and i requirements for issuing a license to conduct medical activities. To obtain a qualification category during preliminary certification, advanced training is not necessary if the specialist has not passed the third stage of the document on additional education. h Article 54 of the Fundamentals of the Legislation of the Russian Federation on the Protection of Health of Citizens dated July 22, 1993 No. 5487-1 states that the right to engage in medical and pharmaceutical activities in the Russian Federation has persons with higher or secondary medical and pharmaceutical education in the Russian Federation who have received a diploma and a special title, as well as a specialist certificate and a license to carry out medical or pharmaceutical activities. “a specialist certificate is issued on the basis of postgraduate professional education (graduate school, residency), or additional education (advanced training, specialization), or a verification test conducted by commissions of professional medical and pharmaceutical and i society, in theory and practice chosen specialty, issues of legislation in the field of protecting the health of citizens. Doctors during the period of training in institutions of the state or municipal health care system have the right to work in these institutions under the supervision of medical personnel responsible for their professional knowledge. (students of higher and secondary medical educational institutions may be allowed to participate in the provision of medical care to citizens in accordance with i training programs and under the supervision of medical personnel in the manner prescribed by the Ministry of Health of the Russian Federation. Persons who do not have a completed higher medical or pharmaceutical<><> |); positions may be allowed to engage in medical or pharmaceutical activities in the positions of workers with secondary medical education in the manner established by the Ministry of Health of the Russian Federation. Doctors or pharmacists who have not worked in their specialty for more than 5 years can be admitted to practical medical or pharmaceutical activities after undergoing retraining in the relevant educational institutions! based on a verification test carried out by commissions of professional medical and pharmaceutical associations. Workers with secondary medical or pharmaceutical education, not r.| Those who have worked in their specialty for more than 5 years can be admitted to practical medical or pharmaceutical activities after confirming their mini qualifications in the relevant institution of the state or municipal health care system or on the basis of a screening test carried out by professional medical and pharmaceutical commissions \\\\\.and (occupations. Persons who have received medical and pharmaceutical training in foreign countries may be admitted to medical or pharmaceutical activities after an exam in the relevant educational institutions of the Russian Federation (in accordance with the procedure established by the Government of the Russian Federation). And also after receiving a license for medical or pharmaceutical activities, unless otherwise provided by international treaties of the Russian Federation. Persons illegally engaged in medical and pharmaceutical activities bear criminal liability in accordance with the legislation of the Russian Federation. 24 AFTERBV30BCK0I AND Lchpiinim III iidi PROFESSIONAL! pm-l Nrilmsh Current provisions on the system of new qualifications for healthcare workers of the Russian Federation provided;) but upon completion of training and passing the qualification exam, students are issued a specialist certificate or a certificate of the established form. The issuance of other state documents in the system for improving the qualifications of healthcare specialists is not provided. The Law of the Russian Federation “On Education” determines that the right to educational activities is granted to educational institutions of various organizational and legal forms and subordination, registered by local governments in an application form, having an appropriate license issued by the state education management body, and a certificate of state accreditation. The majority of teaching commercial medical institutions and public associations currently do not have these licenses or certificates of state accreditation and therefore are not entitled to engage in educational activities. All kinds of certificates, certificates, diplomas and other documents issued by them do not have legal force and cannot become the basis for issuing licenses for certain types of medical and pharmaceutical activities to healthcare professionals, and especially to persons without medical education (Letter of the Ministry of Health of the Russian Federation dated January 21, 1997 No. 2510/ 456-97-27). CONTINUOUS MEDICAL EDUCATION ABROAD Postgraduate medical education in developed countries takes place within the framework of continuing medical education programs [Eng. continuous medical education (OWE)] and continuous professional training [eng. continuous professional development (CPD)]. A special feature of CME/CPD is that the training is carried out independently, rather than under the supervision of a teacher. After completing a physician's residency or residency training, a lifelong process of postgraduate education begins. Doctors regularly study modern medical literature, take medical education courses, and attend medical conferences. Many professional journals and specialized medical websites publish specially designated sections (CME) with educational materials. After mastering the topics and answering the test questions, you can receive a “credit” and a corresponding certificate. Hospitals, licensing boards, and professional medical societies require physicians to provide reports on their participation in various types of postgraduate education. For many years, universities have struggled to increase hours in their degree programs. Currently, society is interested not only in the hours spent on training, but also in the acquired professional knowledge and skills. In June 1999, a declaration was signed in Bologna (Italy), later called the Bologna Declaration. It provides for the creation by 2010 of a harmonized pan-European higher education space. To date, more than 40 European countries are involved in the Bologna process. At the mini-throne conference of higher education in European countries, held in September 2002 in Berlin, it was decided that Russia should join the Bologna Declaration. In 2003, Russia officially entered the Bologna process. The Bologna process provides for the solution of several main tasks: o the formation of a system of credit units; o - creation of a unified system that controls the quality of education (international system of accreditation of universities), educational standards; introduction of a single pan-European diploma supplement; P0SL1 VU IUBI M"l P DiniLPPP iiMiui iii \ uwnunn creation of conditions for the free movement of students and specialists from three European countries; POSSIBILITY of transition of individual faculties to a two-stage model of education - bachelor's degree - master's degree. By signing the Bologna Declaration, Russia assumed certain obligations. In the coming years, Russian universities, while preserving the best traditions of domestic education, must adapt their personnel training system to the European one: develop continuity of education, ensure connections with science and improve quality. Thus, Russia will enter the single European educational space and domestic diplomas will be recognized in European countries. ONE OF the most important tasks on this path is the introduction of a system of credit units. The volume of all types of educational work will be calculated in credits. Credits are points accumulated by a student during the education process. Credits can be considered a kind of international equivalent of educational assessment. Credits reflect not only the time spent on training, but also the result of training - the development of knowledge and skills. Credits can be used for all types of learning (both organized and self-paced). Taking credits allows the student to continue receiving education at any time in another country participating in the Bologna Process. The introduction of a credit system will make it possible to accumulate credits not only in universities, but also in the postgraduate education system with their subsequent crediting (for example, during re-certification). Thus, in the Russian Federation, a system of continuous professional education has been created and is constantly being modernized, preserving and developing I) it, which was embedded in domestic medicine and higher medical education. Continuing professional education accompanies the professional activity of every doctor and dentist in the world m number. Chapter 2 Organization of therapeutic dental care GENERAL PRINCIPLES OF ORGANIZING DENTAL CARE AND ACTIVITIES OF DENTAL INSTITUTIONS IN MARKET RELATIONS CONDITIONS According to official medical statistics and still existing ideas regarding the number of requests from the population, dental care is in second place after general therapeutic care. In the structure of dental interventions, the leading place belongs to therapeutic care, since dental caries affects, according to WHO data (Geneva, 1995), from 70 to 100% of the population (depending on the region of residence and the age of those examined). In addition, one should take into account the low durability of filling materials, which often leads to loss of fillings and relapses of carious lesions and sometimes requires repeated re-treatment and restoration of previously applied fillings. Another serious problem that largely does not depend on dentists is the low level of population seeking timely dental care. As a result, patients often come with advanced cases of dental diseases or with their complications, requiring longer treatment periods and the labor costs of medical personnel to eliminate them. Until recently, the existing, unfortunately, mentality of the population in our country, which does not contribute to the prevention of dental morbidity and the timeliness of the population seeking therapeutic dental care, was not completely overcome. Due to the population's untimely seeking of dental care, the proportion of requests for pulpitis and periodontitis is still high. Moreover, due to acute pain, treatment is sometimes carried out during working hours, which causes significant damage to the country’s economy. The organizers of the dental service certainly take into account all the above factors. Moreover, they are constantly making attempts to ensure maximum access to dental care for the population. With the entry into force of Order No. 50 of January 25, 1988 “On the transition to a new labor accounting system for dental doctors and forms of organizing dental appointments" the issues of rationing have undergone significant changes for the better. Now, according to the Order of the Fundamental Rule1, the poor is not the number of visits made to doctors, but the amount of work they performed, expressed in UET. If before (Circular Letter dated 02/07/1949 No. 5 /14) the work plan of each doctor per day was 19 visits and up to 21 work units, then currently the number of visits is limited to 10 12. At the same time, the main factor of the regulatory plan is the need for the doctor to perform at least 25 UET per day at 5- day work week. It is necessary to monitor the long-term results of the treatment and the state of the dental status of the population, depending on the carried out emergency and prophylactic measures. Only this approach can bring domestic therapeutic dentistry to a qualitatively new level. [Only when a doctor is interested in the specific results of his work throughout the entire time of work with the part of the population entrusted to him, will he be interested in improving its quality. Under such conditions, he will have an incentive to switch to preventive methods of treatment, the introduction of measures to prevent dental diseases among the population, and the criterion for quality iii.i of his work will be a reduction in the population’s use of dental care and medical procedures performed by increasing the number of preventive ones. Data from epidemiological studies are extremely necessary when organizing those types of outpatient dental care, including therapeutic care. Only with their help can it be determined and calculated the upcoming volume of remediation work and labor costs for its implementation. They are extremely necessary for assessing all intermediate stages of implementation of preventioniii"ii"i MIX programs, as well as for summing up the results of this work. Of course, in order to comply with the above principle of organizing the work of general practitioners, it is necessary to ensure the creation of optimal conditions for them. We concern primarily the arrangement of the workplace and the creation of the necessary physical conditions, including the provision of necessary equipment and materials in accordance with existing standards (Order of the USSR Ministry of Health of 1984 No. 670). Issues of staffing regulation are leading in the activities of medical institutions, INCLUDING dental institutions. Current staffing standards< Приказ МЗ СССР от 10.10.1976 № 950) предусмотрено суммарно по 4,0 долж|нч in нрнчей терапевтического и хирургического стоматологического профиля
рмо-поликлинических учреждений и 1,0 должности врачей-ортопедов.
Ммшп теретвом здравоохранения СССР в своё время была предусмотрена возможi установления индивидуальных штатных нормативов, что зафиксировано
it I [риказах от 1975 № 370, от 1977 № 1166 и от 1984 № 670. Однако указанной
возможностью воспользовались лишь республики Прибалтики и ряд других территорий.
Мосле многочисленных эпидемиологических исследований, проведённых в
I ">(>() 1980, it was proposed to follow the path of increasing the staffing level of dental institutions. In particular, it was proposed to increase the number of therapeutic and surgical dental doctors to 8 9, and orthopedic doctors - to 1.5-2. At the same time, the real capabilities of the country's educational institutions were not able to ensure the graduation of such a number of specialists, moreover, for several decades (1950-1980) 28 ORGANIZATION OF THE GRAPEUTIC DENTAL CARE the natural decline of dental specialists exceeded the graduation rates of educational institutions.This situation is due to the difficult demographic situation , which developed in our country after the Great Patriotic War. The aging process of the population, which was observed everywhere, also affected the dental workforce. As a result, the best indicator of the supply of dental personnel, achieved by 1985 (4.6 doctors per 10,000 population), still lagged behind current staffing standards. However, progress in this matter was planned, since by Order of the USSR Ministry of Health dated December 10, 1976 No. 1166, admissions to dental faculties were increased to 7.5 thousand people annually. Nevertheless, this process proceeded very slowly, and from 1975 to 1985, the supply of medical personnel increased by only 0.1 medical positions. Currently in the Russian Federation, the average supply of dental medical personnel is 4.5 doctors per 10,000 population, still significantly lagging behind the current staffing standards. According to the existing concept of organizing the dental service (Leontyev V.K., Shestakov V.T., 1991) and its social significance The state continues to bear the main burden of costs for providing dental care to the children's population. Certain social protection measures will also be taken for people of retirement age with low incomes. As a result, the bulk of budget funding will be directed to providing dental care to these categories of the population, as well as to a certain extent to rural workers. For other categories of the population, a mixed type of financing is provided: part of the dental care can be provided according to the budget (the so-called guaranteed volume of medical and surgical care - within 1-3 visits per year on average per 1 adult resident), the rest - at the expense of the population’s personal funds or enterprises. All orthopedic care remains paid, as before. The costs of the specified volume of budgetary guaranteed dental care are also covered to a large extent from the funds of the same population (working) by collecting 3.6% from the state's wage fund and deductions of trade union dues and income tax. The total amount of deductions exceeds 15%. According to the existing structure of dental institutions in the country in modern conditions The following model of organizing and providing dental care to the population should be considered optimal. The main link of the state dental service in cities is the city (district) dental clinic. Taking into account the capacity and throughput, clinics are divided into a number of types and categories with a certain number of medical positions. Children's dental clinics should remain on the budget and be financed mainly from funds state development, although in institutions of this type certain paid services may be provided (mainly introduced at the request of the parents of the children served). In addition, for such divisions it is possible to attract additional monetary or other material resources from various kinds of sponsorship organizations, foundations, etc. City (district) dental clinic Partially financed from the state budget. These funds are mainly allocated to provide the minimum guaranteed volume of dental care to the assigned population according to their requests (low-income groups and pensioners should have priority). ip lshmlshch"sh and i i\ For those categories of the working population, in addition, additional funds with enterprises and organizations for subscription services should be included (|> established limits. Additional sources of financing can also serve as personal funds of the population spent for paid services. These (in addition to prosthetics) include treatment and removal of teeth (including under anesthesia), placement of fillings using the latest filling materials, as well as reduction of treatment time (manufacturing dentures), etc. For this purpose, they create economic service of the clinic (for example, they are introducing the position of deputy chief physician for economics, etc.). The price list developed by it for paid services provided by this institution should be posted in a visible place. Prices may change and be indexed depending on the rate of inflation and other factors. In addition, the scope of paid services CAN be expanded, for which an appropriate fee is assigned.These include m.k sozh, physiotherapeutic treatment, cosmetology services, etc. At the discretion of the work collective, some doctors can serve patients i and I bk (jetu), the rest (as a rule, the most qualified specialists) are on self-support. With this form of organization of admission, all funds earned by i go to the general fund, after which they are distributed among all pi .by members of the team according to the volume and quality of work performed by them [shGni"Y. For this purpose, appropriate coefficients are introduced. In addition, penalties (reducing coefficients) may be provided, which \"in i i.iiiiiioT upon final summing up results. The advantage of such a system is that there is a desire for "RMOI improvement, since only the best specialists conduct self-supporting reception. 11< достатки:
пп истечении определённого времени это может привести к конфликтам в
коллективе;
од малоквалифицированных врачей на работу в другие учреждения на
должности с более высокой оплатой, а высококвалифицированных - в коммерческие структуры (кооперативы, частные dental offices). With the second option, it is possible to transfer all doctors simultaneously to the forms of budgetary and self-supporting appointments (for part of the working day or on certain days, the doctor conducts appointments on a budget basis, the rest of the time - on a self-supporting basis). Wherein .! M.I i (A certain proportion of these types of admissions must be observed in order to HI i pinch the morale of the poor population and limit the craving of doctors for the unbridled increase in the number of admitted self-supporting patients. The optimal ratio to treat is 50:50, and it must be maintained (especially in relation to budget admissions) and control by the administration. (“It is more legitimate to count the number of not only patients admitted, but also units of labor intensity performed (Order of the USSR Ministry of Health dated January 25, 1988 No. 50). 11The advantage of the second option is that doctors are on an equal footing \| 11disadvantages of the second option: the difficulty of equal distribution of budget admissions, since patients are given the right to choose a doctor; 0 the desire of doctors to preferentially see patients on a self-financing basis; premature wear and tear of equipment and equipment. The third option most preferred. Sub-options are possible. A certain part of doctors (mainly the most qualified and pre-retirement age) continue to provide appointments on a budget, providing dental care to predominantly socially vulnerable groups of the population. The remaining doctors are united in a rental team, which enters into an agreement with the administration providing for certain obligations to provide dental care to the population (guaranteed volume, quality, culture of service). Within this framework, both free service for pensioners and paid appointments are provided. required premises , equipment and equipment, ensures the livelihoods of both the rental team itself and all support services. The tenant also develops self-financing and contractual relations with the latter in the event of mutual need and interest (transition to the so-called on-farm accounting). Advantages. o- Differentiation of reception. Possibility of selecting the best doctors for the rental team. “Guarantee of free treatment for socially vulnerable segments of the population. Disadvantages o - Gradual stratification of the team. Lack of interest (including material) among budget group doctors in self-improvement. All doctors are being transferred to a rental contract. Part of the working time (certain days of the week) doctors are busy receiving budgetary patients. The rest of the time is spent on self-supporting reception. Advantages. All doctors are in the same starting position. All doctors have a material interest in increasing the volume and improving the quality of work (mainly in rental appointments). Elements of competition appear (fight for every paying patient). o- There is a gradual differentiation of doctors according to their level of qualifications. There is an incentive for other doctors to improve themselves. Market relations are being formed in the choice of doctors by patients, which accordingly affects the level of their payment. Flaws. o The desire of doctors to minimize the time of budgetary appointments in order to save effort on self-supporting appointments. The pursuit (especially at the first stage) of the number of paying patients, in connection with which conflicts in the team are possible. Premature wear and tear of equipment and equipment. Doctors lack the desire to improve the material and technical base of the unit, since the funds earned are spent mainly on salaries. Consumer attitude towards equipment and equipment as they are rented. In this regard, there is no desire for their safety (including rented premises and all fixed assets). As a rule, depreciation charges are so small that they do not cover the institution’s costs of replacing equipment and upgrading it. To eliminate the above-mentioned shortcomings, it is optimal to corporatize the ownership of dental clinics. Only under this condition will the equipment and equipment, as well as the premises, acquire a real owner and will be used more carefully. However, it should be taken into account that this is possible provided that the shareholders are members of the given team. In the event of the acquisition of the ORGANIZATION OF HERAPTICAL;KPIS!()ML1 (AND WITH THE HELP of taking over the control list of shares by third parties or organizations, it is quite possible not only to reduce the volume of dental care to the population, but even to completely stop it by repurposing the institution. In this case, not only the staff, but also population. And at present, other forms of ownership (for example, private) in dental clinics are hardly possible for the following reasons. Firstly, the state, despite all economic difficulties, is unlikely to sell off its property. Secondly, the initial accumulation of capital1. 1)1.1 i the country has not reached a form that would allow buying out entire institutions, although in the future this is quite possible, as well as attracting labor capital. And the benefit of corporatization is also evidenced by the fact that with this form of cofii government, in contrast to the state, the principles of managing such an institution significantly change, when the collective mind significantly reduces the possibility of making changes that are not always correct and even voluntaristic. The most important thing is that with this form of organization, the collective of shareholders will care not so much about the well-being of today, but about the prospects and opportunities for increasing the power of the division, increasing the level of dental care provided by r"iniMio, its volume and quality. In the structure of economic Institutional indicators are significant specific gravity acquire personal funds of shareholders. 1gm the possibility of purchasing new equipment and PS1KMTSPSHYA is significantly increased. In addition, there is a direct interest of staff in investing personal funds in their own institution, since this largely determines the level of their wages. Self-supporting dental clinic 1 and dental institutions are most ready for the transition to new economic relations. All types of treatment there, as you know, are paid. The goal is to make this service profitable, but at the same time accessible to the population. The advantages of institutions of this type include the fact that they can provide dental care to all groups of residents, regardless of place of residence. The main task of self-supporting institutions is to improve the quality of service and competitiveness with other (and >m.1T) "logical institutions, which at present is perhaps the only way of their self-preservation. "As for their forms of existence, they are determined at the discretion of the work collective. Possible both rental relations and corporatization. It is advisable that these institutions continue to remain state-owned, since a certain and very important part of the population has traditionally been oriented towards them. It is necessary to make the most of and expand these opportunities. It is optimal that in every city with the number of inhabitants i above 250 000 there was at least one self-supporting dental clinic. This, on the one hand, increases the population’s opportunity to receive qualified dental care, and on the other hand, is an incentive to improve the work of regional dental institutions. Having the opportunity to choose, people will prefer the best institution The loser in the competition will suffer, including economically. The organization of self-supporting dental institutions in modern locations is also justified for other, purely practical reasons. The fact is that often the most qualified doctors leave local dental institutions for an alternative network (cooperatives, etc.). If there had been an opportunity to move to work in a more prestigious and highly paid government agency, then perhaps they would have stayed. Thus, the state dental service would retain dental personnel, the reproduction of which would not require so much time, effort and money. Dental departments of general clinics The specific nature of the work of such departments, their direct dependence on the administration and the entire staff of the medical institutions on whose territory they are located, significantly reduces the possibility of making independent decisions. However, if we take into account that such institutions themselves are now not in the best financial situation, any possibility of obtaining additional income they will most likely be welcomed. The dental department team, having realistically weighed its capabilities, has the right to decide whether to switch to leasing. The possibilities for corporatization are more limited and depend on the opinion of the entire workforce of the clinic, although such a path is not excluded. This is more realistic if the institution is fully corporatized. In this type of dental institution, it is important to maintain the correct balance between budget and self-supporting appointments. Apparently, a greater emphasis should be placed on budgetary treatment, and self-supporting should not exceed 30-40% in the structure of dental care provided to the population. Dental offices located in cities Dental offices of higher and secondary educational institutions, industrial and other enterprises, as a rule, are organized by basic dental clinics. Some offices have an independent status, being, for example, part of medical units, sanatorium institutions, various departments, etc. Depending on the specifics of subordination, you need to choose tactics in relation to them. In this case, of course, a focus on the base unit is necessary. At the same time, it should be taken into account that, in functional terms, dental offices are still independent units, and sometimes have little control even from basic institutions. In this regard, it is advisable not only to rent them out or corporatize them, but also to sell them into private ownership. At the same time, they achieve a double effect: they increase the volume and quality of dental care provided and expand the possibilities of re-equipment. Part of the costs can be borne by the enterprise or institution on whose territory this or that office is located by concluding an agreement with the office staff for dental care for its employees. These funds may partially or fully cover the costs of free treatment. Those enterprises that have their own dental offices and maintain their medical staff have the right to decide their fate. Dental offices located in rural areas A similar approach can be applied to rural dental offices. Certain expenses can be borne by collective farms created joint stock companies or partnerships for joint cultivation of land. In the event that dental offices are completely taken over by the balance sheet and their own budget, they must take care not only of equipping the office with the necessary equipment, but also pay wages to the staff. At the same time, certain benefits may be provided (allocation of agricultural products, surcharges, etc.). In the absence of such an opportunity, perhaps the only way to preserve rural dental offices is to transfer them to self-supporting and self-financing. There is already positive experience in this regard, in particular. And Sverdlovsk region. All options related to the transfer of offices for rent, corporatization, or even selling them into private ownership are also possible. The decision on this should be made by the local dental association and territorial administration. Dental departments of central district hospitals Financing of such departments will need to be carried out to a significant extent from the state budget, but this does not mean a refusal to transfer them (partially or completely) to the conditions of self-financing or rental contracting. In each specific case, the issue must be resolved by the work collective, taking into account the current situation. I [when transitioning to rental relations, the conditions and order of organization as a whole (are similar to those in the city. At the same time, they may have certain specifics associated with the conditions of rural areas. Thus, in a number of cases, heads of collective farms may allocate additional funds to maintain activities of such units, subject to the effectiveness of their work on improving the health of workers Agriculture. Such initial relationships can be formalized in the form of partnership agreements outlining the obligations of both parties. Thus, dental units located in rural areas can be both on the budget and on a mixed form of financingii.iiiiH (budget + additional funds, voluntarily contributed by collective and farms, other institutions and individuals). It is also possible, but to a more limited extent than in cities, to search for a change in CODE to self-supporting relationships. However, it should be expected that the state (especially in the coming years) will be interested in maintaining budgetary dental services in rural areas. Mobile dental service As a rule, such a service is formed on the basis of regional dental clinics; it is mainly designed to provide dental care to the rural population. Such units travel to remote villages where there is no dental office or the assistance is provided in an insufficient volume.\\ currently , when a sharp rise in price of equipment, fuels and lubricants, etc. is observed, the mobile dental service becomes unprofitable and in some cases ceases to exist. In this regard, its transfer "n,| a self-supporting basis is the only measure ensuring its survival. l".< mi раньше штаты подобных подразделений набирали, как правило, из числа
сотрудников областной стоматологической поликлиники (или эти сотрудники
выезжали в район поочерёдно по графику), то сейчас они могут быть укомплек11 паны также из числа желающих, в том числе на конкурсной основе. Созданный
таким путём арендный коллектив (возможно, из числа лиц, ранее потерявших
работу) может взять в аренду автотранспорт, стоматологическое оборудование и
но договору приступить к работе.
Решение всех вопросов, связанных с ремонтом техники, приобретением запасных частей, бензина, при таких условиях может быть возложено на арендный
коллектив. Последний в свою очередь заинтересован в увеличении объёма работ,
чтобы использовать заработанные средства на возмещение этих расходов. При
такой организации наблюдают общую заинтересованность: для областной стоматологической поликлиники - отсутствие заботы о приходящей в негодность
технике и необходимости организации стоматологической помощи в труднодоступных сельских районах, а для арендного коллектива - возможность заработать
путём получения автотранспорта для охвата большой части населения платной
стоматологической помощью. Тем самым ка селе также реализуют рыночные
принципы: каждый сельский житель вправе выбирать место получения стоматологической помощи, в том числе на бесплатной или платной основе.
С учётом материального положения большей части сельского населения передвижная стоматологическая служба также может находиться на смешанной форме
финансирования (бюджет + хозрасчёт). Кроме того, определённые средства на её
содержание могут выделять те хозяйства, на территории которых она работает.
Тогда социально незащищённые группы сельского населения могут получать,
как и прежде, бесплатную стоматологическую помощь (кроме ортопедической).
Необходимые для этого средства выделяют из фонда социального развития
либо из других источников финансирования. Указанные средства поступают на
счет арендного коллектива передвижной стоматологической установки согласно
объёму выполненной врачами работы в соответствии с действующими тарифами.
Подобные взаимоотношения оформляют соответствующим договором, имеющим
как юридическую, так и финансовую силу. В него вносят соответствующие коррективы по мере надобности или желания той или иной из сторон. Расторжение
договора также оформляют в установленном порядке при исключении взаимных
претензий. В случае наличия таковых дело передают в суд.
Передвижную стоматологическую службу можно использовать и в ином направлении. Например, в городах при обслуживании работников industrial enterprises, as well as for the rehabilitation of the child population. In this case, all the provisions stated above regarding city dental institutions apply to her. As a result, it can work both on a budgetary basis (when serving children) and on a self-supporting basis (when serving adults). Mixed forms of financing are also possible. In this regard, it is worth noting another important opportunity for the rational use of mobile dental services, namely the organization and implementation with its help of the prevention of dental diseases among various segments of the population. Thus, the principles of organizing and providing dental care to the urban and rural population in modern economic conditions only in general terms reflect the provisions of the proposed concept, the main sections of which are based on the real conditions of existence of most dental institutions, on the study and generalization of experience accumulated in this regard throughout the country . Of course, they need detail and more in-depth study for each of these sections. Apparently, in modern conditions it is necessary to unite all public and numerous private dental institutions into a single whole in order to eliminate their disunity. The Association of Dentists (All-Russian), as well as the Ministry of Health of the Russian Federation, should play an important role in this. This will make it possible to better use the network and personnel of the country’s dental institutions and increase their efficiency. The main task in modern conditions is to ensure the survival of public dental institutions in difficult economic conditions while maintaining their role in providing dental care to the population. The gradual transition from centralized management and financing to regional makes it possible for public dental institutions to receive additional sources financing, for example from the regional budget. Other possibilities cannot be excluded, in particular, through various kinds of sponsorship organizations, foundations, churches, etc. The main source of financing for public dental institutions may be the municipal budget, as well as financial contributions from the local dental association. It is necessary for nrgdogg.iigp, dental institutions have maximum but 1OPPORTUNITIES to choose the path of their own development. The estate's labor collective and NOBODY else should paid medical services. By Order of the Ministry of Health of the Russian Federation dated 08/06/1996 No. 312, dental institutions were allowed to switch to paid medical services in the case of NGDO< гатка бюджетного финансирования.
()сноаная задача государственных стоматологических учреждений по-прежнему
11 и тоит ii оказании максимального объёма бесплатной стоматологической помощи
м.к елению. Поэтому объёмы платных медицинских услуг не должны превышать и
ПК)бом стоматологическом учреждении 40-50% общего объёма оказываемой
м.и слению стоматологической помощи.
НОРМАТИВНЫЕ ДОКУМЕНТЫ, РЕГЛАМЕНТИРУЮЩИЕ ДЕЯТЕЛЬНОСТЬ
МЕДИЦИНСКИХ, В ТОМ ЧИСЛЕ СТОМАТОЛОГИЧЕСКИХ, УЧРЕЖДЕНИЙ
Согласно Постановлению Правительства РФ от 14.02.2003 № 101 врачСтоматолог-терапевт, а также зубной врач, работающий на этой должности, должHI.I иметь сокращённую 33-часовую рабочую неделю (Приложение 1, см. й>). Appendix 2 (see f) reflects the orders of the Ministry of Health of the Russian Federation and extracts from the orders regulating the activities of medical, including dental, institutions in conditions market economy. In excerpts from orders before< гавлены:
порядок допуска к осуществлению профессиональной (медицинской и фармацевтической) деятельности;
разряды оплаты труда Единой тарифной сетки по должностям работников
здравоохранения РФ;
гарантированный перечень видов стоматологической помощи (базовая программа), финансируемой из средств бюджетов, выделяемых на здравоохранение;
примерный перечень медицинских услуг, оказываемых за счёт государственных public organizations and other economic entities with any form of ownership, as well as personal funds of citizens. In addition, given full texts the following orders: f “On the organization of work of dental institutions in new economic conditions” (Order of the Ministry of Health and Medical Industry of Russia dated 06.08.1996 No. 312); * “On the introduction of the specialty “Preventive Dentistry” (Order of the Ministry of Health of the Russian Federation dated 02/06/2001 No. 33); 0 “On introducing amendments to the Order of the Ministry of Health of the Russian Federation dated August 27, 1999 No. 337 “On the nomenclature of specialties of healthcare institutions of the Russian Federation” (extract from the Order of the Ministry of Health and Social Development of the Russian Federation dated August 20, 2007 No. 553). MODERN ORGANIZATION OF DENTAL ATTENDANCE The organization of work and professional communications in dentistry is the conditions when the dental team (primarily the dentist) can, to one degree or another, realize their knowledge and skills at a medical appointment. Gone are the days of the medieval “charming of teeth”, when the measure of success in a dental practice was the removal of the psycho-emotional stress of the patient M.1 against the background of acute dental pain. Modern dentistry is a synthesis of science, art and craft, .i.e. therefore, the organization of the workspace, its equipment, the correct work schedule, algorithms i^smodical actions (including elements of the use of artificial intelligence - computerization, etc.) rise to the level of mandatory requirements. Issues of organizing dental care have always been the focus of national healthcare. They acquired particular relevance during the period of formation of market relations, since the problem of finding ways to increase the productivity of dentists clearly arises (Leontyev V.K., 1996,1997). If until the 90s this problem was solved by increasing the number of doctors, today this path looks unpromising. This is due to a reduction in real funding for dental care from government agencies. Currently, outpatient dental care in the country is provided by the following institutions: o - specialized dental clinics; dental departments in general medical institutions; 5- dental offices; o - non-state dental clinics, departments and offices. The main structure still remains polyclinics, which, despite the increasing outflow of specialists to the non-state dental sector, will still perform largest volume dental care for the population of the country. This is due to the following reasons: o - the general desire of the state for centralization; relief government controlled and control (including financial); relative cheapness due to centralized costs for diagnostic, sterilization, and physiotherapeutic equipment; the possibility of administrative control over the quality of treatment; opportunity for faster training of doctors (“mentor-learner” contact). At the same time, dental clinics as large organizations have significant disadvantages, which are, as a rule, universal in nature: the patient’s inability to choose the most experienced doctor (dependence on the registry); frequent lack of personal service for patients; 5- significant costs for maintaining buildings and structures; o- the state’s desire for equal funding of clinics (regardless of the level of technology used); remoteness from the places of residence of citizens (especially important for areas with cold climates); lack of highly qualified, and in recent years, even ordinary specialists. However, despite these shortcomings, it should be recognized that: clinics actually exist (there are more than 1000 of them throughout the country); the majority of the country's dental workforce is concentrated in clinics; a polyclinic is the most profitable organizational form of medical care for countries with weak economies; administrative control of the state over the dental service has been facilitated; o the collection of medical statistics data has been facilitated. n 1111MP1CI 37 The shortage of qualified)) medical personnel has become a problem both for i in vA "ipi gvenary institutions and for commercial structures - The fact is that, while working it government agency, the dentist, due to weak financial and technical support, is not able to fully follow new medical technologies, and he strives to work in a commercial structure that independently deals with supply issues, where he can fully realize himself as a specialist. Moreover, the opinion of a highly qualified iip.i"u in small teams is more significant in determining treatment doctrines, issues of choosing medical technologies, purchasing medical products, drugs, etc. Not least important are the issues of material remuneration based on labor results. Despite emerging breakthrough in the field of dental information! The most important field for information exchange is federal congresses and symposiums of regional dental associations. The state in information exchange is limited to honing the relationship between institutions, the Mandatory Fund health insurance(MHIF), Roszdravnadzor, Rospotrebnadzor, insurance companies, etc. To one degree or another, the regulations for relationships are prescribed by decisions of government bodies, but in the absence of regulatory documents, organizational issues are proclaimed in the form of recommendations by decisions of the Council of the Dental Sciences of Russia (StAR) (for example, StAR recommendations on endodontic liver). Members of the StAR Council, as professionals, being closer to the required specialty than government representatives, often speak out in favor of a cancer model, when the Dental Association puts forward new concepts of an organizational type, and government bodies, coordinating them with interested institutions (Ministry of Economy and Development, State Committee for Labor, Rospotrebndzor, Poi Shravnadzor, Rosstandarti, etc.) allow their implementation. And in some countries (USA, Germany, etc.) organizational decisions of Professional Associations government agencies taken into account more broadly. This is due to the fact that the system of providing dental care to the population in such countries is based on private ownership, i.e. The government is not responsible for the requirements for the equipment of clinics and offices that are being developed by the dental association. The highest public professional body for dentists in the world is FDI (World Federation I.IIOIKIIOH), and in Europe its regional organization ERO. Resolutions. I rice accepts the FDI at the meetings of its General Assemblies, the name of the professional standard for many countries. As a rule, all these [mi are published on the Internet at www.fdiworldental.org. Russia || II And represented by StAR with a casting vote since 1995, in ERO/FDI 1МЧ6 I Annually, delegations of Russian dentists are formed to participate in the World Congress of Dentists and the Plenary Meeting of ERO/FDI. MP Nits, 4) 1) 7, the 1st Pan-European Congress of Dentists was held in Moscow. (The largest contribution to international cooperation on the part of Russia in the past years was made by V.F. Rudko (honorary dentist of FDI), G.N. Pakhomon (head of the WHO dental department), V.K. Leontiev (President of StAR! """(> 2006), V.V. Sadovsky (Member of the Board of ERO/FDI), S.A. Rabiponich (Vice-Rector for International Affairs of the Moscow State Medical University (MGMSU)], etc. And in the Russian Federation, the centralized organization of dental care to the population consists of several stages of state regulation: “participation in the legislative process at the state level (laws, ukae); at the ministry level state committees, funds, agencies and departments; “participation in the regulation of educational standards and advanced training programs for specialists in dental and related professions; harmonization and coordination of various government agencies at the permitting stage (licensing, accreditation);< контроль над исполнением действующих норм и правил в зависимости от
формы собственности или ведомственной принадлежности конкретного обладателя лицензии.
Следует знать, что претендент на получение лицензии на право занятия стоматологической помощью на территории РФ (но с привязкой к конкретному адресу)
должен:
>know the documents regulating the activities of the license holder; comply with standards related to the basics of medical knowledge and related specialties, specifically to dental specialties, norms of federal and municipal laws (“Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens”, Law “On the Protection of Consumer Rights”, etc.); -o- organize a classification of participants in the future treatment, preventive and business process; bear moral and civil liability for their actions (or inactions) to patients and society as a whole. Numerous collections and codes of laws and commentaries are devoted to this topic, so this chapter touches on the most important organizational technologies that are directly related to the organization of a dental appointment. Questions staffing specialties, issues of staff labor standards, accounting, reporting and organization of service as a whole also remain relevant. The authors' long-term research prompted them to write this chapter, which not only summarizes global experience, but also makes an attempt to adapt proven technologies to the conditions of domestic dentistry. USE OF SUPPORT PERSONNEL The task of increasing the productivity of dentists remains relevant in all countries of the world. It is solved in various directions, primarily by equipping the workplace with modern equipment, high-tech installations, high-quality tools, etc. The greatest importance is attached to the introduction of the latest techniques and technologies to minimize unjustified costs time. The latter is solved using the achievements of the science of ergonomics. Nevertheless, a significant reserve in increasing the productivity of dentists, which is still little used in our country, lies in improving the organization of the dental appointment itself, as well as in the use of support staff. And if in almost all dental institutions of the country, dental doctors are assisted by nurses, often specially trained, then dental assistants and hygienists are extremely rare, and the position of dental assistant is still not provided for in the nomenclature of medical specialties, so in fact, the functions of these specialists are forced to be performed by nurses or intern doctors. Practically, there are still no specialists such as managers in the structure of dental institutions. However, this position is extremely necessary! in modern conditions - during the period of adaptation to the dental services market, 3fl According to the World Health Organization (WHO) and the International Dental Federation (FDI), in the 70s, for every dentist there were auxiliary personnel (without dental technicians and nurses) in Germany - 1 .28, in England - 1.19, Norway - 1.02. In the United States of America (USA), each dentist is assisted in his work by an average of 1.3 assistants, including about 2% who use the services of three assistants and 10% who have two assistants. Even so, in the USA, the shortage of support personnel is determined at the level of M) -40%, assuming the optimal ratio of support personnel, i and<тматологовкакЗ:1 или, что предпочтительнее, как 4:1. В настоящее время
ракой уровень достигнут в Швеции.
I [редлагая различные варианты соотношения стоматологов и вспомогательного
персонала, большинство исследователей единодушны в том, что стоматологу в его
работе должен помогать как минимум один помощник, не считая зубных техникой и санитарок. Такого же мнения придерживалась и ВОЗ ещё в 60-х годах XX в.
(WHO, Techn, Rep. Sen, 1966, 298). В то же время простое количественное увеличгние нсмомогательного персонала само по себе не может существенно повысить
эффективность работы стоматологов. Существует прямая зависимость эффекипчни"ш работы врача от квалификации вспомогательного персонала, т.е. от
у||<ш1И1 его полготовки. Эксперты ВОЗ в одном из своих докладов рекомендовали
«... уделить внимание подготовке высококвалифицированного вспомогательного
|н"|к пилил, работа которого под непосредственным руководством и наблюдением
стоматолога позволит значительно увеличить объём помощи» (WHO, Techn. Rep.
Ill 1962, 244).
И настоящее время во всём мире существует около 30 типов стоматологической)
Персонала. Особенно широкое распространение они получили в скандинавских,
ипндноевропейских, латиноамериканских странах, а также в Канаде, Новой
Зеландии, Австралии, США, Таиланде и Японии. Несмотря на разнообразие типов
и особенно названий этих профессий, всех их по характеру деятельности можно
разделить на две группы:
щ.шачняющие лечебно-профилактические манипуляции в полости рта больНОГО (Operating Dental Auxiliaries);
Помогающие стоматологу осуществлять лечебно-профилактическую работу,
НО I к1 имеющие прямого доступа к полости рта больного (Non Operating Denial
Auxiliaries).
К нерпой относят стоматологических гигиенистов (DentalHygienisf) и школьных
I)
.1\ сестёр (School Dental Nurse). Эти специалисты есть примерно в 50 странах
мири
Ко второй группе относят ассистентов стоматолога (Dental Assistant), или, как
- называют, прикресельных ассистентов (Chairside Assistant). Представители
m.и профессии работают практически во всех странах мира. К этой группе можно
"I in и медицинских сестёр, работающих в амбулаторных стоматологических
учреждениях нашей страны. Однако их число крайне незначительно. Согласно
питррытурным данным подготовка вспомогательного стоматологического персо
нала i.i рубежом длится от одного года (и даже от трёх месяцев) до четырёх лет.
Различие в сроках подготовки объясняют разной квалификацией выпускаемых
специалистов, а также уровнем организации стоматологической помощи в коп
КрвТНоЙ стране.
И последние годы наметилась явная тенденция к расширению функций вспомоя
тельного персонала за счёт передачи им некоторых функций врачей-стоматолопш.
Тлк. но данным Т.Н. Held и J.H. Bair, которые провели опрос 37% стоматологов
американской армии, большинство специалистов высказались за передачу вело
мигательному персоналу 24 манипуляций из 53, предлагаемых анкетой и ВЫПОЛ
няемызс it настоящее время стоматологами. Анкетируемые оставили бы за сто-
ч
и
ппапцпл ii г лиг ши"ц 1.П1И i. HtM/uuiliil И"II |,М)И ПОМОЩИ
матологями печение каналов, проведение рентгеноскопии, удаление постоянных
зубов, наложение швов, я также диагностику заболевании и планирование лечения. При этом существует мнение, что необходимо четкое разграничение функций
помощников и стоматологов. Например, руководитель отдела ВОЗ по подготовке
и работе вспомогательного персонала доктор Sharon, давая определение понятия
«помощник стоматолога», указывала, что это «специалисты, имеющие специальную подготовку к выполнению ограниченного и строго определённого ряда процедур в полости рта больного». По мнению W.E. Brown, на помощника стоматолога
можно возложить наложение пломбы на подготовленную стоматологом полость,
снятие слепков.
Определяющее значение вспомогательного персонала состоит в том, что он
высвобождает время стоматолога на более сложные процедуры, требующие
высокой квалификации. Этого мнения придерживается большинство авторов.
Исследования показали, что стоматологи тратят на выполнение вспомогательных
манипуляций, которые можно передать медицинским сестрам, в среднем от 25 до
40% своего рабочего времени. Это в значительной мере отражается на показателях работы стоматологических учреждений. В то же время рациональная работа
вспомогательного персонала позволяет повысить производительность труда стоматологов на 40-60% по анализу большинства зарубежных публикаций. При этом
повышают качество работы как стоматолога, так и его помощника. Например,
Р.Е. Hammens, H.G. Jymison установили, что опытный вспомогательный персонал
подчас выполняет некоторые функции стоматологов гораздо лучше, чем студенты
стоматологических факультетов выпускного курса.
Экономия времени врача
Установлено, что есть ряд манипуляций, которые могут быть оценены одинаково. К ним относят переход врача для мытья рук к умывальнику (5 с), мытьё рук
(30 с) и переход от умывальника к креслу (5 с). По всем остальным манипуляциям,
отражённым в таблице, как показал хронометраж, врач тратит время только на
традиционном виде приёма. При этом суммарная потеря его рабочего времени
на непроизводительные затраты составляет на традиционном приёме в пределах
12,3 мин, а на приёме с ассистентом - 0,5 мин.
Таким образом, средняя экономия рабочего времени только на этих манипуляциях достигает 11,8 мин.
Таблица 2-1. Затраты рабочего времени стоматолога на некоторые манипуляции и движения во
время приёма пациентов
Движения врача, с
Традиционный приём
Приём с ассистентом
«в четыре руки»
Переход от кресла к умывальнику
5
5
Процедура мытья рук
30
30
Переход от умывальника к креслу
5
5
Манипуляции с креслом (подьём и т.д.)
11
0
Накрывание пациента салфеткой
4
0
Настройка светильника
5
0
Ожидание сплёвывания пациента в плевательницу (в
среднем за приём одного пациента]
180
0
Проведение аппликационной анестезии
60
0
300
(]
Ожидание эффекта инъекционной анестезии
ОРГАНИЗАЦИИ Г(РАП1ВТИЧ1 СКОЙ СТОМАТОЛОГИЧЕСКОЙ ПОМОЩИ
41
Окончание табл. 2-1
Замешивание прокладочного материала и высушивание кариозной полости
30
0
Замешивание и внесение пломбировочного MaTe-
45
0
im.lll.l
Рекомендации, повторное назначение
I"llOlf)
60
8
745
48
Как хорошо видно, это немалые потери. Для их исключения в современных
условиях врач старается восполнить их путём приёма другого больного, однако
ИГО Щ1 исегда получается, поэтому принцип работы «в четыре руки» выгоден и в
экономическом отношении, и прежде всего с позиции сокращения неоправданных
ИТрат премени квалифицированного врачебного персонала. При условии, что на
печении у врача в современных условиях в день в среднем находятся 10 пациентом, такая экономия рабочего времени в смену может достичь практически 2 ч, а
и месяц 43,1 ч.
3l lit г прем»! трудовой деятельности врач-стоматолог может сэкономить 18 972 ч,
I ill 1162 рабочих дня, или 13,1 года. Таким образом, суммарная экономия его
рабочего премени при работе с ассистентом может достигать 32,7%.
\и г ш.ппеизложенное доказывает несомненные преимущества (в том числе экономического плана) работы врача с помощником. Нетрудно представить, какие
экономические выгоды сулит внедрение данной системы в масштабах всей страны.
Это может высвободить врачей от неквалифицированной работы и направить их
и ИЛИЯ на выполнение основных лечебных манипуляций.
Кроме экономии времени, современный приём практически невозможно вести
без ассистента, так как требования к пульпощадящему препарированию (охлаждение водяным аэрозолем), работе слюноотсосом, пылесосом, требования к инфекционному контролю, соблюдение технологий пломбирования светоотверждаемыми материалами, работу гуттаперчей просто невозможно выполнить полноценно
(им помощника.
I hi основе более чем десятилетнего опыта обобщены должностные обязанности
ассистента с учётом российских условий. Должностные обязанности ассистента
i роматологического:
щ уготавливать рабочее место к приёму пациента;
п in (вить необходимый инструментарий и медикаменты для анестезии, аппликаций, подготавливать пломбировочный материал;
вызывать больного;
\< вживать и обеспечивать комфортное положение пациента в кресле как для
него самого, так и для врача;
приглашать врача-стоматолога к пациенту по мере его готовности;
и.и трыивать стоматологический светильник;
иоднвать инструментарий врачу;
проводить профилактику инфекционного заражения пациента и персонала;
работать со слюноотсосом и пылесосом;
I вмостоятельно проводить гигиенические мероприятия, определять индексы
и совместно с врачом осуществлять оценку эффективности проводимых профилактических мероприятий;
i овместно с менеджером (а при его отсутствии - по согласованию с врачом)
назначать пациенту дату повторных посещений;
мпплннть зубную формулу и помогать врачу в оформлении медицинской
документации;
42
iII 1 лии тция
< заполнять бланки, рецепты*, назначения по указанию врача-стоматолога;
проводин, санитарно-просветительную работу с пациентом во время приёма;
обеспечивать выбор и просмотр теле- и видеопрограмм пациентом в кресле.
В случае универсального терапевтического и ортопедического приёма к указанным функциям ассистента стоматологического добавляют:
>ensuring retraction of the marginal gingival margin before taking an impression*; preparation and taking of impressions*; casting a plaster model if necessary; providing correction of temporary plastic crowns and fixed dentures*; polishing temporary denture structures after their correction; filling out a work order for a dental laboratory; carrying out a preliminary assessment of the quality of dental prosthetics when they are received from the laboratory*; when working in a team, the requirements for the assistant’s functions expand to the ability to carry out specific manipulations both in therapeutic and orthopedic appointments. Basics of “four-handed” dental technology Originating more than 40 years ago, this technology was firmly entrenched in capitalist countries in the late 60s. Then the whole concept boiled down to fulfilling two main tasks: » to increase labor productivity without compromising quality; Against this background, reduce stress and fatigue of the dentist during the working day (Chasteen E. Joseph, 1978). To solve the assigned problems, the principle of working “with four hands” was significantly expanded over time, although it retained its historical name. Currently, it already means five components of practice: sitting work; assistance from assistants; organization and regulation of each component of a dental appointment ( preliminary analysis, planning, management, evaluation); maximum simplification of working moments at the reception; > prevention of infectious diseases (infection control). In the USA, a number of serious studies have been made of the movement of the dentist's body during work. The sitting position of the doctor was recognized as the most advantageous from a mechanical point of view (Chasteen E. Joseph, 1978). Statistics have shown that the life expectancy of a dentist who works while sitting during his or her career is 17% longer than that of a dentist who works while standing. Working in a sitting position, a person spends 27% less energy than when doing the same work while standing. However, how the dentist and assistant sit is equally important. The essence of sedentary work is to be in a balanced posture. The domestic school, starting from the student's bench, teaches the dentist to work mainly with moving the center of gravity of the body to the right. Impaired coordination of the spinal column leads to changes not only in the intervertebral discs and paravertebral muscles, but also in nerve fibers and internal organs. Western schools recommend several positions of doctor, assistant and patient (Chasteen E. Joseph, 1978). There are also WHO recommendations (Alternative dental care systems, 1985). A general recommendation is to use a horizontal patient position. The dentist sits upright* Performance of official duties is possible only by specialists who have a dentist diploma! or | dental doctor, 1) PLMI.!SH[IN It SAS III I"II l.MIVI I.IIIMft lUJIiil I II I. M I H i IUIVIWM |i"i CHO (rarely behind the patient’s head in position 8 12 o’clock in the abstract dial (Fig. 2-1). The patient's LEGS are in the 6 o'clock position, an imaginary axis passes through the center of the patient's torso. The assistant is located in the position from 2 to 5 O'clock (Fig. 2-2). I ",i() 1) mil sp 1l assistant is usually located near him right hand. The next transfer zone is located between 5 and 8 o'clock. In this zone, the assistant transfers instruments to the doctor like an operating nurse (Fig. 2-3). One advantage is that the patient does not see the instrumentation. The transfer of the instrument in this zone occurs both from the doctor to the assistant and vice versa) using special gripping techniques. 12:00 1:00 11:00 10:00 9:00 3:00 4:00 Fig. 2-1. Doctor's position. 12:00 1:00 11:00 10:00 9:00 - 3:00 8:00 4:00 6:00 Fig. 2-2. Assistant position. 12:00 11:00 1:00 10:00 9:00 3:00 8:00 4:00 Fig. 2-3. Tool transfer area. The angle of the horizontal position of the chair should not exceed 20-25°. Moreover, in the mandibular position, the angle should approach 25°, and when treating teeth in the upper jaw - 5-10°. The doctor's feet are on the floor, knees bent at 90°, do not interfere with blood circulation in the lower extremities. Since for better visibility the assistant is located 10 cm above the doctor, and the bend angle in the knee joints is also desirable 90°, the industry produces special chairs with a circular stand (Fig. 2-4). The doctor's thigh is located just below the headrest of the chair, so the patient seems to be reclining on the doctor's lap. The static zone is located between the 12 and 2 o'clock positions on the abstract dial. It has little functionality. Usually no one sits here, with the exception of the “six-handed” technology, which is used when manipulating several lasers at the same time or with some restorative technologies. Correct positioning of personnel in isolation from other tenets of ergonomics is unacceptable. One of the main points of ergonomics is technological equipment. Domestic industry, as well as the industry of the countries of former members of the Council for Mutual Economic Assistance, has supplied and continues to supply dental institutions with dental equipment that has a number of characteristics that do not allow them to properly organize a “four-handed” appointment. Today, the main equipment for a dental appointment is considered to be: a dental unit with a chair; And the doctor's chair; > assistant's chair; functional dental furniture. To ensure all the necessary postures and movements of the doctor, assistant and patient, it is necessary to summarize the requirements for each piece of dental equipment. First of all, the chair must have a sufficiently heavy base, balanced in such a way as to support the patient’s body in both horizontal and vertical positions (Fig. 2-5). i and II 1DII IIUIVIUIHI"I K|kch should be unfolded and folded< я.мчим;! ГИЧвСКИ (в программируемом или Miiuy-
вльном режимах) от силовых приводов до соотношений сиденья и спинки от 90° до 180°, иметь
малошумный с минимумом вибрации привод,
подголовник с возможностью опоры не шеи, а
затылка пациента с широким основанием и углублением, предотвращающим случайные повороты головы (рис. 2-6). Дистальная ширина подгоповника не превышает 20 см. Желательно также
иметь складывающийся правый подлокотник для) цобства посадки и вставания пациента.
Установка стоматологическая должна иметь
i e мобильный рабочий столик с функциональными кушающимися и прочими инструментами,
позволяющими работать врачу как без ассистента
I положении 7-11 ч, так и с ассистентом в положеН I 2 ч.
I".Hiiniiii столик врача включает минимум три
функциональных места (рис. 2-7):
турбинный наконечник;
Низкооборотные (можно взаимозаменяемые)
угловой и прямой наконечники с микромотором;
шприц «вода-воздух» (пустер).
Все functional tools you can turn on "i.iii, and turn off with one foot pedal. All pj points for regulating the speed of rotation of instruments should not have recesses for potential< щсорения их инфицированными материалами.
Предпочтение следует отдавать ручкам управле-
Рис. 2-4. Расположение ассистента на специальном стуле.
Рис. 2-5. Modern installation dental for “four hands” reception> Fig. 2-6. A sample of a headrest that securely fixes the patient's head. Rice. 2-7. Corvid's work table. keys that are subject to replacement and sterilization, or touch keys with an easy-to-clean surface (see Fig. 2-7). The installation must include an assistant’s workplace equipped with at least two functional positions: O - water-air syringe (puster); $ evacuator drive for connecting an active saliva ejector or vacuum cleaner (it is advisable to equip them simultaneously, Fig. 2-8). In the case of a doctor working simultaneously in several chairs, when the greatest volume of patient placement is carried out by an assistant, it is advisable to have a foot- or manual control chair (the assistant’s workplace does not have to be built into the dental unit). Foreign industry produces mobile assistant workstations (on wheels or built into functional furniture). The installation lamp must emit shadow-free radiation with an intensity of more than 400 lux, even across the entire field. A luminous flux intensity regulator is desirable. The installation must include an autonomous water supply system (clean water system), which supplies dental handpieces and water-to-air syringes with water through tubings to prevent water from the public water supply system to which the installation is traditionally connected from entering the patient’s oral cavity (Fig. 2 -9). Installation tubes and hoses must be Fig. 2-8. Workplace assistant on a telescopic tripod. ny N ™ UY" be processed, have a smooth surface without folds and grooves, be made of chemically passive materials (Fig. 2-1 ()). I l,i surfaces installation, armchairs, chairs should not have cracks, folds, external damage, where dust from prepared slaughter, saliva and other aerosols can get and accumulate. stuck during lip preparation, fixed in places inaccessible for high-quality cleaning. The dental unit must be suitable for both a right-handed and a left-handed doctor. ("doctor's hum A dentist's chair, designed in an imaginary way to allow him I i.ii and nun, in the appropriate position, ||.k i mltrick as one of the important details of ergonomics. The ideal chair has 1 following characteristics: rectangular soft seat from Fig. 2-9. "Clean water" system. 301 ui degree of stability; before| a fairly wide long seat to support the buttocks and at least 2L of the length of the hips; Slightly rounded downward front edge of the seat so as not to put pressure on the vessels of the thighs; stable, convex and not changing its shape back to support the lower back; wide legs with five wheels, NS* >bn:1ately protruding from the projection of the base, which are both easy to move; and the seat height can be changed either manually. or with the help of a gas lift (pi(2 II). There are a lot of projects for a doctor that do not have these characteristics. The most common disadvantages: a round seat that does not provide sufficient support for the buttocks and hips; a flexible backrest that does not provide providing sufficient support for the lower back; "hard front edge of the seat without a downward curve, causing compression of blood vessels; heavy height adjustment system. Fig. 2-10. Tubings that do not comply with the modern concept of infection control. 48 1ANIZATION AND |.1()MLII11NICHI;K11I111 )MP1CI Some clinicians believe that the ideal chair has a seat that can be tilted as the dentist leans forward, based on the work of Mandal (1976), who observed that people performing this type of activity slouch rather than sit upright. It is believed that chairs with an inclined
- Authors: Dmitrieva L.A., Maksimovsky Yu.M. (ed.)
- Publisher: GEOTAR-Media
- Year of publication: 2009
- Annotation: National guidelines are the first series of practical guidelines in Russia on basic medical specialties, including all the basic information a doctor needs for continuous postgraduate education. Unlike most other guidelines, national guidelines give equal attention to prevention, diagnosis, pharmacotherapy and non-pharmacological treatments. This manual consists of a book and a CD, contains modern and relevant information on general and specific issues of therapeutic dentistry, a large number of illustrations, a pharmacological reference book and applications. The CD supplement to the manual includes additional illustrations not included in the printed part, an educational film about anesthesia methods in therapeutic dentistry, detailed information about filling materials, drugs used in endodontics and periodontics, various means individual and professional oral hygiene. Leading dental specialists took part in the preparation of this publication as authors, compilers and reviewers. All recommendations have undergone an independent peer review process. The manual is intended for dentists, senior students of medical universities, interns, residents, and graduate students.
- Keywords: Dental caries Endodontics Halitosis Oral hygiene Dental materials
- Printed version: No
- Full text: read a book
- Favorites: (readinglist)
Editors' Preface
Publication participants
Creation methodology and quality assurance program
List of abbreviations
Chapter 1. Postgraduate and additional professional education in the system of training dental personnel
Chapter 2. Organization of therapeutic dental care
General principles of organizing dental care and the activities of dental institutions in market conditions
Modern organization of dental appointments
Chapter 3. Equipment and equipment of the dental office
Chapter 4. Clinical examination of patients in therapeutic dentistry
Chapter 5. Dental materials for dental restoration in a therapeutic dentistry clinic
Chapter 6. Endodontics
Preventive endodontics
Conservative endodontics
Repeated endodontic dental treatment
Surgical endodontics
Chapter 7. Modern tooth-preserving biotechnologies
Chapter 8. Dental diseases of non-carious origin
Edentia
Supernumerary teeth
Anomalies in the size and shape of teeth
Endemic dental fluorosis
Tooth formation disorders
Hereditary disorders of dental development
Change in tooth color
Increased tooth wear
Grinding (abrasive wear) of teeth
Tooth erosion
Drug-induced and toxic disorders of the development of hard dental tissues
Odontogenic resorption
Deposits (growths) on teeth
Change in color of hard tissues of teeth after eruption
Dentin hyperesthesia
Necrosis of hard dental tissues
Traumatic dental injuries
Chapter 9. Modern methods of teeth color correction
Chapter 10. Oral hygiene
Individual oral hygiene
Professional oral hygiene
Chapter 11. Dental caries
Operative dental treatment technique
Chapter 12. Inflammation of the dental pulp
Chapter 13. Diseases of periapical tissues of teeth. Periodontitis
Chapter 14. Periodontal diseases
Anatomy and histology of periodontium
Classification of periodontal diseases
Catarrhal gingivitis
Ulcerative gingivitis
Hypertrophic gingivitis
Periodontitis
Osteoplastic materials in periodontology
Gum recession
Aggressive forms of periodontitis
Periodontal disease
Tumor-like lesions
Symptoms and syndromes manifested in periodontal tissues
Chapter 15. Halitosis
Chapter 16. Functional selective grinding
Chapter 17. Diseases of the oral mucosa
Traumatic lesions of the oral mucosa
Infectious diseases that appear on the oral mucosa
Allergic diseases
Drug allergy
Erythema multiforme exudative
Chronic recurrent aphthous stomatitis
Behçet's disease
Sjögren's syndrome
Changes in the oral mucosa in some systemic diseases and metabolic disorders
Digestive diseases
Endocrine system diseases, nutritional disorders and metabolic disorders
Hypovitaminosis
Diseases of the blood and blood-forming organs
Diseases of the circulatory system
Systemic connective tissue lesions
Lesions of the oral mucosa in dermatoses
Anomalies and independent diseases of the tongue
Cheilites
Precancerous diseases of the oral mucosa and red border of the lips
Changes in the oral mucosa during exogenous intoxication
Damage to the oral cavity due to HIV infection
Chapter 18. Local anesthesia in therapeutic dentistry
Chapter 19. Medicines used in therapeutic dentistry
Antiseptics and disinfectants
Chemotherapeutic agents
Synthetic chemotherapeutic agents
Antifungal agents
Antiviral agents
Anti-inflammatory drugs
Non-steroidal anti-inflammatory drugs and non-narcotic (non-opioid) analgesics
Steroidal anti-inflammatory drugs
Enzyme preparations
Astringents
Antiallergic drugs
Immunomodulators
Antihypoxants and antioxidants
Vitamins
Homeopathic remedies in dentistry
Chapter 20. Principles of interaction between doctors and society
Subject index
Pediatric therapeutic dentistry
National leadership
Ed. VC. Leontyeva, L.P. Kiselnikova
ISBN: 978-5-9704-4019-3
Publisher: GEOTAR-Media
Year: 2017
Number of pages: 952
The National Guide to Pediatric Therapeutic Dentistry is the second edition, supplemented and improved by its authors in accordance with the development of the specialty and suggestions from colleagues.
This guide consists of a book and an electronic application, containing modern and relevant information on general and specific issues of pediatric therapeutic dentistry and the prevention of dental diseases in childhood, presented from the perspective of evidence-based medicine. The publication contains a large number of illustrations, a description of technologies, a pharmacological reference book and applications.
The electronic application includes the main regulations regulating the activities of pediatric dentists and children's dental services in the Russian Federation, samples of accounting and reporting documentation and a description of the procedure for filling out medical documentation. In addition, it presents computer programs for creating plans for individual prevention of caries and periodontal diseases for children and adolescents.
The manual is intended for dentists, clinical residents, interns, and senior students of dental faculties.
Preface
Publication participants
Creation methodology and quality assurance program
Conventions and abbreviations
SECTION I. ORGANIZATION OF CHILDREN'S DENTAL CARE
Chapter 1. History of the development and organization of dental care for children in Russia
Chapter 2. Medical examination of children at the dentist
Chapter 3. Organization of dental care in children's medical and preschool educational institutions, antenatal clinics
Chapter 4. Prevention of dental anomalies
Chapter 5. Organization of school dentistry
Chapter 6. Changes in the oral cavity in children with general somatic diseases
Chapter 7. Dental care for children with disabilities
Chapter 8. Principles of evidence-based medicine as the basis for the introduction of new means, methods and technologies for providing dental care to children
SECTION II. DEVELOPMENT AND AGE CHARACTERISTICS OF A CHILD
Chapter 9. Development of the face, oral cavity, internal organs and child systems
Chapter 10. Laying and formation of temporary and permanent teeth
Chapter 11. Teething (clinical and histological characteristics)
SECTION III. DIAGNOSTIC METHODS
Chapter 12. Clinical methods
Chapter 13. Instrumental methods
Chapter 14. Clinical and laboratory methods
Chapter 15. Radiation methods
SECTION IV. PAIN RELIEF IN CHILDREN'S THERAPEUTIC DENTISTRY
Chapter 16. Correction of children's behavior at a dental appointment
Chapter 17. Local anesthesia
Chapter 18. Providing dental care under general anesthesia
SECTION V. DISEASES
Chapter 19. Dental caries. Etiology, pathogenesis, classification
Chapter 20. Caries of primary teeth
Chapter 21. Caries of permanent teeth
Chapter 22. Methods of prevention and treatment of fissure caries
Chapter 23. Hereditary malformations of hard dental tissues
Chapter 24. Acquired malformations of hard dental tissues. Enamel hypoplasia
Chapter 25. Acquired malformations of hard dental tissues. Dental fluorosis
Chapter 26. Dental erosion in children
Chapter 27. Pulpitis of temporary teeth
Chapter 28. Pulpitis of permanent teeth
Chapter 29. Periodontitis
Chapter 30. Dental trauma
Chapter 31. Periodontal diseases
Chapter 32. Diseases of the oral mucosa
Chapter 33. Diseases of the lips and tongue
SECTION VI. TECHNOLOGIES AND MATERIALS IN CHILDREN'S THERAPEUTIC DENTISTRY
Chapter 34. Prophylactic materials
Chapter 35. Adhesive systems
Chapter 36. Filling materials
Chapter 37. Restorative technologies used in the treatment of diseases of hard dental tissues
Chapter 38. Dental restoration using standard protective crowns
Chapter 39. Restoration of permanent teeth in children using CEREC technology
Chapter 40. Materials and technologies used in endodontic treatment
SECTION VII. FORMULARY
Chapter 41. Local anesthetics
Chapter 42. Antiseptics
Chapter 43. Chemotherapy drugs
Chapter 44. Antifungal drugs
Chapter 45. Antiviral drugs
Chapter 46. Anti-inflammatory drugs
Chapter 47. Antiallergic drugs
Chapter 48. Immunomodulators
Subject index
Electronic application
Basic regulatory documents regulating the activities of pediatric dentists and pediatric dental services
Principles of maintaining medical records in a pediatric dentistry clinic
Computer programs for individual prevention of caries and periodontal diseases for children and adolescents
Name: Therapeutic dentistry. National leadership
Dmitrieva L.A., Maksimovsky Yu.M.
The year of publishing: 2009
Size: 126.94 MB
Format: pdf
Language: Russian
The book covers basic practical and theoretical basis therapeutic dentistry, outlining general and specific issues. Each chapter of the manual contains illustrative aids that are guaranteed to improve the process of learning the material. The issues of anesthetic management during manipulations, various side effects of therapy, methods of their correction and prevention are described in detail, the main groups of filling material are outlined with their detailed characteristics, and pharmacological drugs used in dental practice. Data on oral hygiene and its types are presented in detail. The book "Therapeutic Dentistry. National Guide" edited by Dmitrieva L.A., et al., is intended for dental students, interns, and therapeutic dentists.
This book has been removed at the request of the copyright holder
Name: Problems of endodontics. Prevention, detection and elimination.
Hülsmann M., Schäfer E.
The year of publishing: 2009
Size: 77.8 MB
Format: pdf
Language: Russian
Description: The book "Problems of Endodontics" describes in detail diagnostic issues, practical problems of preserving vital pulp in endodontics, describes the criteria for choosing a treatment method, issues of anesthesia and... Download the book for free
Name: Therapeutic dentistry
Borovskoy E.V.
The year of publishing: 2003
Size: 295.81 MB
Format: pdf
Language: Russian
Description: The educational manual "Therapeutic Dentistry", edited by E.V. Borovsky, examines modern principles therapy of diseases of the oral cavity and teeth. Epidemiology is presented. pathogenesis, etiology... Download the book for free
Name: Clinic, diagnosis and treatment of diseases of the oral mucosa and lips
Anisimova I.V., Nedoseko V.B., Lomiashvili L.M.
The year of publishing: 2008
Size: 17.75 MB
Format: djvu
Language: Russian
Description: The book “Clinic, diagnosis and treatment of diseases of the oral mucosa and lips”, edited by I.V. Anisimova, et al., examines the anatomical and physiological features of the oral mucosa and lips, ... Download the book for free
Name: Modern endodontics of a practical doctor
Nikolishin A.K.
The year of publishing: 1998
Size: 2.12 MB
Format: doc
Language: Russian
Description: Practical guide “Modern endodontics for a practitioner”, edited by Nikolishin A.K., examines issues of practical therapeutic dentistry. The clinical features of root... Download the book for free
Name: Composite filling and facing materials in dentistry
Borisenko A.V., Nespryadko V.P.
The year of publishing: 2004
Size: 1.75 MB
Format: djvu
Language: Russian
Description: Practical guide “Composite filling and veneering materials in dentistry”, edited by Borisenko A.V., et al., examines the use of filling materials in therapeutic... Download the book for free
Name: Cosmetic restoration of dental crowns
Stepanov A.E.
The year of publishing: 1999
Size: 1.99 MB
Format: djvu
Language: Russian
Description: The practical guide “Cosmetic restoration of dental crowns”, edited by Stepanova A.E., examines the method of fixing various filling materials to teeth. The method of using... Download the book for free
Name: Therapeutic dentistry
Helwig E., Klimek I., Attin T.
The year of publishing: 1999
Size: 31.26 MB
Format: pdf
Language: Russian
Description: The educational manual "Therapeutic Dentistry", edited by Helwig E., et al., examines the basic issues of therapeutic dentistry. Data on epidemiology, etiopathogenesis, clinical... Download the book for free
Name: Practical therapeutic dentistry
Nikolaev A.I., Tsepov L.M.
The year of publishing: 2001
Size: 4.32 MB
Format: djvu
Language: Russian
Description: The educational manual "Practical therapeutic dentistry", edited by Nikolaev A.I., et al., examines the basic issues of therapeutic dentistry. Data on epidemiology, etiopath...
UDC 616.31 (083.13) BBK 56.6 T35 The National Guide to Therapeutic Dentistry was developed and recommended by the Moscow Dental Association and the Association of Medical Societies by Kagestvo. T35 Therapeutic dentistry: national guide / ed. L.A. Dmitrieva, Yu.M. Makashovsky. - M.: GEOTAR-Media, 2009. - 912 p. - (Series “National Guidelines”). ISBN 978-5-9704-1084-4 National Guides - the first series of practical guides in Russia for m major medical specialties, including all the basic information a doctor needs for continuous postgraduate education. Unlike other manuals, the national manuals give equal attention to prevention, diagnosis, pharmacotherapy and non-drug methods. . iioni, I" number of illustrations, pharmacological reference and<
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N 1 1 4
Принижение1 к руководству на компакт-диске включает дополнительные иллюии, in1 пошедшие и состав печатной части, учебный фильм о методах анестезии в
(ширинкой гтмитшюгии, подробные сведения о пломбировочных материалах.
|||.и,|\, которые применяются в эндодонтии и пародонтологии, о различных
Ш.1Ч индииидуалыюй и профессиональной гигиены полости рта.
II ипдготпнкс настоящего издания в качестве авторов-составителей и рецензентов
Принимали участие ведущие специалисты-стоматологи. Все рекомендации прошли
г i.mm имого рецензирования.
Рукшшдстио предназначено врачам-стоматологам, студентам старших курсов
медицинских вузов, интернам, ординаторам, аспирантам.
УДК 616.31(083.13)
ББК 56.6
Авторы, редакторы и издатели руководства предприняли максимум усилий, чтобы
обеспечить точность представленной информации, в том числе дозировок лекарственных средств. Осознавая высокую ответственность, связанную с подготовкой
руководства, и учитывая постоянные изменения, происходящие в медицинской
науке, мы рекомендуем уточнять дозы лекарственных средств по соответствующим
инструкциям. Пациенты не могут использовать эту информацию для диагностики и
самолечения.
Права на данное издание принадлежат издательской группе «ГЭОТАР Медиа*,
Воспроизведение и распространение в каком бы то ни было виде гасти или целом издания
не могут быть осуществлены без письменного разрешения издатспыкоп щруппы> ISBN 978-5-9704-1084-4 © Avtorosh Team, 2008 c Publishing Group I UTAR M e d i a - . ,"i)t)") CONTENTS Preface by the editors Participants of the publication Creation methodology and quality assurance program List of abbreviations Chapter 1. Postgraduate and additional professional education in the dental personnel training system (S.G. Sokhov) Chapter 2. Organization of therapeutic dental care General principles organization of dental care and activities of dental institutions in market conditions (A.V. Alimsky) Modern organization of dental appointments (V.V. Sadovsky) Chapter 3. Equipment and equipment of the dental office (L.A. Dmitrieva, O.A. Georgieva) Chapter 4. Clinical examination of patients in therapeutic dentistry (Z.E. Revazova, T.A. Rizhinashvili) Chapter 5. Dental materials for tooth restoration in a therapeutic dentistry clinic (P.V. Dobrovolsky) Chapter 6. Endodontics (L.A. Dmitrieva, A.E. Romanov, T.V. Zyuzina, I.V. Butenko., G.S. Pashkova) Preventive endodontics Conservative endodontics Repeated endodontic treatment of teeth Surgical endodontics Chapter 7. Modern tooth-preserving biotechnologies (S.D. Arutyunov) Chapter 8. Diseases of teeth of non-carious origin (Yu.M. Maksimovsky).. Adentia Supernumerary teeth Anomalies in the size and shape of teeth Endemic dental fluorosis Disturbances in the formation of teeth Hereditary disorders in the development of teeth Changes in the color of teeth Increased abrasion of teeth Grinding (abrasive wear) of teeth Erosion of teeth Drug-induced and toxic disorders of the development of hard dental tissues Odontogenic resorption Deposits (growths) on teeth Change in color of hard dental tissues after eruption Dentin hyperesthesia Necrosis of hard dental tissues Traumatic damage to teeth 6 7 10 13 15 26 26 35 66 121 142 175 179 181 218 230 232 248 251 251 251 252 257 261 267 267 270 273 276 277 277 280 281 283 288 4 CONTENTS Chapter 9. Modern methods of teeth color correction (L.A. Dmitrieva, M.A. Sultanova) Chapter 10. Oral hygiene (L.A. Dmitrieva, T.V. Zyuzina, O.A. Kruzhalova) Individual oral hygiene Professional oral hygiene Chapter 11. Dental caries (E.M. Kuzmina, KS. Beaver) Operative technique of dental treatment (L.A. Dmitrieva, V.I. Baisheva, K.S. Bobr) Chapter 12. Inflammation of the dental pulp (E.V. Ivanova) Chapter 13. Diseases of the periapical tissues of the teeth. Periodontitis (A.V. Mitronin) Chapter 14. Periodontal diseases Anatomy and histology of periodontium (A. I. Grudyanov, L.Yu. Orekhova) Classification of periodontal diseases (A.K. Grudyanov, L.Yu. Orekhova) Catarrhal gingivitis (A.I. Grudyanov) Ulcerative gingivitis (A.K. Grudyanov) Hypertrophic gingivitis (A.I. Grudyanov) Periodontitis (A.I. Grudyanov) ) Osteoplastic materials in periodontology (Z.E. Revazova) Gum recession (D.A. Kostryukov) Aggressive forms of periodontitis (A.I. Grudyanov) Periodontal disease (A.I. Grudyanov) Tumor-like lesions (A.I. Grudyanov) Symptoms and syndromes manifested in periodontal tissues (T.D. Chirkova) Chapter 15. Halitosis (O.O. Yanushevig, A.V. Mitronin, KG. Dmitrieva) Chapter 16. Functional selective grinding (33. Revazova, A.V. Voinov , E. Prosvirova) Chapter 17. Diseases of the oral mucosa Traumatic lesions of the oral mucosa (L.A. Aksamit) Infectious diseases manifesting on the oral mucosa (L.A. Aksamit) Allergic diseases (V.I. Spitsyna) Drug allergy Exudative erythema multiforme Chronic recurrent aphthous stomatitis Behcet's disease Sjögren's syndrome Changes in the oral mucosa in certain systemic diseases and metabolic disorders (L.A. Aksamit) Diseases of the digestive system Diseases of the endocrine system, nutritional disorders and metabolic disorders Hypovitaminosis Diseases of the blood and hematopoietic organs 292 304 304 311 322 359 392 415 463 463 466 467 472 474 476 487 497 506 510 512 5 15 526 540 553 555 575 616 616 633 638 644 645 648 649 652 655 66] 0CHAPTER1 5 Diseases of the circulatory system 666 (ui dark lesions of connective tissue 668 1 [lesions of the oral mucosa with dermatoses (V.I. Spitsyna) 670 Anomalies and independent diseases of the tongue (V.I. Spitsyna ) 693 Chsylitis (LL. Aksamit) 715 11|and cancerous diseases of the oral mucosa and red lips (LL. Aksamit) 728 Changes in the oral mucosa due to exogenous intoxication (DA. Aksamit) 741 Damage to the oral cavity due to HIV infection (V.I. Spitsyna) 746 Chapter 18. Local anesthesia in therapeutic dentistry (S.A. Rabinvig, E.V. Zorian, S.T. Sokhov, V.I. Stosh, O.N. Moskovets) 760 Chapter 19. Medicinal means used in therapeutic i HOM1TOLOGY (E.V. Zoryan) 808 Antiseptics and disinfectants 808 Chemotherapeutic agents 816 Synthetic chemotherapeutic agents 833 Antifungal agents 839 Antiviral agents 843 Anti-inflammatory drugs 847 Non-steroidal anti-inflammatory drugs and non-narcotic (non-opioid) analgesics 847 Steroidal anti-inflammatory drugs 851 Enzyme preparations 854 B astringents 855 Antiallergic agents 857 Immunomodulators 861 Antihypoxants and antioxidants 873 Vitamins 876 Homeopathic remedies in dentistry 883 Chapter 20. Principles of interaction between doctors and society (GL. Komarov) Subject index 892 898 LIST OF ABBREVIATIONS c - designation of materials presented on the CD * - designation of trade names of medicines p - designation of medicines not registered in the Russian Federation m - designation of canceled medicines AFP - aggressive forms of periodontitis Bis-GMA - bisphenol-A-glycidyl methacrylate BPP - rapidly progressive periodontitis HIV - human immunodeficiency virus WHO - World Health Organization HSV - herpes simplex virus GAG - glycosaminoglycans BBB - blood-brain barrier DNA - deoxyribonucleic acid GIT - gastrointestinal tract LLP - lichen planus lichen planus LP - the sum of all teeth affected by caries (K), filled (P) and removed (U) due to complications of caries LDF - laser Doppler flowmetry LSS - sulfur-containing compounds ICD - International Classification of Diseases ICD-C - International Classification dental diseases MEE - exudative erythema multiforme NSAIDs - non-steroidal anti-inflammatory drugs PABA - para-aminobenzoic acid GSHAL - polymorphonuclear leukocytes PCR - polymer zno-chain reaction RIF - immunofluorescence reaction RNA - ribonucleic acid SGPR - burning mouth syndrome GIC - glass ionomer cement ESR - speed erythrocyte sedimentation SPAC - glass polyalkenate cement AIDS - human acquired immunodeficiency syndrome FIP - functional selective grinding CNS - central nervous system COX - cyclooxygenase EDTA - ethylenedimethyltetraacetic acid EEE - endodontic-endosseous implants Tu - half-life C^x - maximum concentration FDI - World Dental Federation PG - prostaglandin PDGF - platelet-derived growth factor Chapter 1 Postgraduate and additional professional education in the dental personnel training system The beginning of the implementation of the priority national project “Health” imposes on educational medical institutions a special responsibility for training personnel for the outpatient department, including for the network of dental institutions . The most important component of resource provision for healthcare is human resources. The availability of personnel, their qualifications and distribution, operating conditions, social well-being, logistics and technological support for the labor process determine the proper level of medical care to the population. The last decade of the 20th century. left Russia with many unresolved problems, including an extremely unfavorable demographic situation: life expectancy in Russia is on average 14 years less than in Western Europe. The mortality rate exceeds European indicators by 1.6 times; since 1985, the rate of decline in the birth rate is 2 times higher than in European countries; Children's health indicators are 2-3 times lower than in Europe. According to L.A. Boqueria (2007), the number of doctors of all specialties in the Russian Federation (RF) reaches 688 thousand, the provision of doctors per 10 thousand population is 42.7, while in Italy this figure is 27, France - 25, USA - 23 , Germany - 21, Great Britain - 16, Japan - 14. In the Russian Federation there are 60.8 thousand dentists, i.e. 8.8% of the total number of doctors with the total number of budgetary and self-supporting dental clinics - 899. In 2006, in the annual address of the President of the Russian Federation to the Federal Assembly V.V. Putin identified the current demographic situation in Russia as a key problem that poses a threat to the progressive socio-economic development and national security of the country. The mortality rate of the population has increased, including from preventable factors (diseases of the circulatory system, neoplasms, other chronic non-infectious diseases, injuries and poisonings). Life expectancy in patients with aggravated chronic pathology, in the European Union countries is 18-20 years, in Russia does not reach 7 years. The observed deviations in the health of the population are mainly due to the difficult economic state of the Russian state. However, the prospects for positive change depend to a large extent on the contribution that effective health care and social development systems can make to public health. The national project “Health”, aimed at achieving effective performance of the industry, provides for targeted improvement of the resource provision of medical institutions in general and, first of all, its personnel infrastructure as the main factor in deciding the accessibility, effectiveness and quality of medical care provided. The main problem of personnel policy is the insufficient level of funding, leading to low efficiency of medical care provided and unsatisfactory quality of training of medical and nursing personnel. At the same time, increasing the educational knowledge and practical skills of modern medical personnel and the rational use of their potential systemically affects other significant volumetric parameters of healthcare: financial and production resources. Doctors, including dentists, are trained in 47 medical universities, the total graduation rate of doctors of all specialties and pharmacists is on average 25 thousand per year, of which more than 3 thousand are dentists. The nomenclature list of activity profiles includes 125 specialties, 7 of them - dental profile (in European countries - up to 57). Every year, in the system of the Ministry of Health and Social Development of the Russian Federation, more than 180 thousand doctors can improve their qualifications free of charge in the established network of postgraduate education institutions, in advanced training faculties for doctors at medical universities, as well as on the basis of research institutes and large practical healthcare institutions. In the course of professional activity, a doctor can acquire a new specialty through professional retraining provided for by the nomenclature of specialties approved by the Ministry of Health and Social Development of Russia. In 1970, the USSR Ministry of Health created a nomenclature of medical specialties and a nomenclature of medical positions, which included 51 specialties and 75 medical positions (Order of the USSR Ministry of Health dated May 4, 1970 No. 280). The professional activities of medical personnel in the healthcare system are based in accordance with developed legal, regulatory and policy documents that provide for the provision of medical and nursing personnel to the population of the Russian Federation from the perspective of the multifaceted functions they perform. The formation of the new nomenclature is based on a three-stage training of specialists with the preservation of continuity in the acquisition of specialties, the presence of objective and significant features that establish, on the one hand, connections between individual specialties, and, on the other, differences. Obtaining a specialty is possible if you have a higher diploma medical or pharmaceutical education and subsequent training in internship, clinical residency, graduate school, as well as in institutions of additional education. The first stage: studying at a university, obtaining a basic specialty and qualifications with a diploma. P1.1 "LIEING..- 17 Second stage: training in internship, residency, graduate school (postgraduate education), obtaining a BASIC specialty. Third stage: training in residency, graduate school or in institutions of additional education (professional retraining), receiving additional This is the basic specialty - the totality of knowledge, ideas, abilities and skills of a university graduate in the main professional MMM educational programs that provide the opportunity for professional activity and compliance with the assigned qualifications. The basic specialty 1 HI and i.i fibiTb is based on educational standards. i >(new specialty is part of the basic specialty, within which it i o 1/|.t.|. (>it involves obtaining more in-depth professional knowledge and field of activity in the profile of this specialty. Additional specialty is part of the main specialty, representing further deepening knowledge and skills in a selected narrow area of professional activity. OCHI IBI [th document regulating vocational training - Constitution |(I 1>. 11| and n i December 12, 1993 Article 43 guarantees the general availability and free of charge of secondary vocational education, free receipt of higher education n|||1.1 iniunini in state or municipal institutions on a competitive Hi pin 1"f establishes federal state educational systems, supports various forms of education and self-education.
