Ministry of Health and Social Development Russian Federation

Northern State Medical University Department of Therapeutic Dentistry

Department of Public Health, Healthcare and Social Work

Department of Forensic Medicine and Law

Organization dental care to the population

Arkhangelsk

Reviewers:

Doctor of Medical Sciences, Professor, Head of the Department of Therapeutic Dentistry, Volgograd State Medical University V.F. Mikhalchenko; Doctor of Medical Sciences, Professor, Vice-Rector for educational work(international

activities) State Educational Institution of Higher Professional Education "Pomeranian state university them. V.M. Lomonosov" Federal Agency for Education A.G. Kalinin; Organization of dental care for the population:

textbook for dentists / ed. A.S. Opravina, A.M. Vyazmina.- Arkhangelsk:

Publishing house of the Northern State Medical University. – 2011. 519 p.

The purpose of publishing the textbook is to present one of the most important sections of the discipline “Organization of dental care to the population.” It covers the issues of organizing dental care for the urban and rural population, the types and structures of dental medical organizations, the standard of their equipment, sanitary-hygienic and sanitary-anti-epidemiological requirements, staffing of medical personnel and the procedure for admission to medical activities. Issues of the state and development of alternative dental care are reflected. The main legal provisions of medical activities are presented in accordance with the requirements of the State Educational Standard Russian Federation. The textbook is intended for doctors - dentists, teachers and students of medical universities.

Opravin A.S. Doctor of Medical Sciences, Head of the Department of Therapeutic Dentistry of SSMU; Vyazmin A. M. Doctor of Medical Sciences, Professor, Head of the Department of Public Health

health, healthcare and social work of SSMU; Svetlichnaya T.G. Doctor of Medical Sciences, Professor of the Department of Public Health,

health and social work SSMU, director of the Institute of Nursing Education SSMU; Sannikov A.L. Doctor of Medical Sciences, Professor of the Department of Public Health,

health and social work SSMU; Tokueva L.I. Candidate of Medical Sciences, Associate Professor of the Department of Therapeutic Dentistry of SSMU;

Kuzmina L.N. Candidate of Medical Sciences, Associate Professor of the Department of Therapeutic Dentistry of SSMU; Tsyganova O.A. Candidate of Medical Sciences, Associate Professor of the Department of Public Health,

health and social work SSMU; Varakina Zh.L. Candidate of Medical Sciences, Associate Professor of the Department of Public Health, Healthcare and Social Work of SSMU;

Ivshin I.V. Candidate of Medical Sciences, Associate Professor, Head of the Department of Forensic Medicine and Law of SSMU; Spirina M.V. Senior Lecturer at the Department of Public Health, Healthcare and Social Work of SSMU.

1.1. Organization, functions and work of a dental clinic, department,

office……………..…………………………………………………………………………………..…10

1.1.1. Types and structure of dental clinics………………………….….12

1.1.2. Departments and functional rooms of dental clinics.......47

1.1.2.1. Dental office. Equipment standard…………………….....47

1.1.2.2.Therapeutic department…………………………………………………………......50

1.1.2.3. Surgical department…………………………………………………...71

1.1.2.4. Orthopedic department with dental laboratory…………...81

1.1.2.5. Department of Pediatric Dentistry……………………………………………………105

1.1.2.6. Physiotherapeutic department (office)………………………….....142

1.1.2.7. X-ray room……………………………………………153

1.1.2.8. Prevention room…………………………………………………….168

1.1.3. Sanitary and hygienic and sanitary and anti-epidemiological requirements for dental medical organizations………………176

1.1.3.1. Sanitary and hygienic requirements for dental medical organizations…………………………………………….177

1.1.3.2. Sanitary and anti-epidemiological requirements for dental medical organizations…………………...................................... .......182

1.1.4. Staffing standards for medical personnel of dental organizations……………………………………………………………………………….…189

1.1.5. The procedure for admission to professional (medical) activities. Specialist certificate…………………………………..….....192

1.1.6. Dental Association of Russia……………………………………………………......204

2.1. Dental care at the level of a first-aid post, a medical outpatient clinic or a local hospital…………………………………………………………………………………......234

2.2. Dental care at the department level, central offices district hospital(CRH)……………………………………………………………......237

2.3. Dental care at the level of regional (territorial, republican) dental clinic………………………………………………………..………………....238

2.4. Staffing standards for medical personnel for providing dental care to residents of rural areas……………………………………………………………………...240

3.1. Features of the dental services market in the Russian Federation………………………………...246

3.2. Dental medical service as an economic category…………...255

3.3. Dental organization as a service-producing enterprise………….256

3.4. Pricing of dental services………………………………………....260

4.1. Dental accounting and reporting documentation………………………………...268

4.2. Performance indicators dentist……………………………………………….293

4.2.1. Main epidemiological indicators…………………………………….293

4.2.2. Indicators of dental morbidity……………………………..293

4.2.3. Analysis and planning of dental work medical and preventive institutions…………………………………………………………................................. ...................294

4.2.4. Quantitative and qualitative indicators at a therapeutic appointment......295

4.2.5. Indicators of work at a dental surgical appointment……….…..299

4.2.6. Indicators of work at an orthopedic appointment…………………………….…..299

4.2.7. Indicators of work at an orthodontic appointment……………………………....300

4.2.8. The procedure for calculating the main qualitative indicators of a doctor’s work is

dentist………………………………………………………………………………… 301

4.2.8.1. Therapeutic technique…………………………………………………….301

4.2.8.2. Orthopedic appointment……………………………………………………..302

4.2.8.3. Surgical procedure………………………………………………………303

4.2.8.4. Children's reception………………………………………………………………………………303

4.2.8.5. Indicators for assessing the work of the head of the department (therapeutic and surgical)………………………………………………………………..304

4.2.8.6. Indicators for assessing the work of the head of the orthopedic department...304

4.2.8.7. Indicators for assessing the work of the production manager of a dental laboratory…………………………………………………………………………………305

4.2.8.8. Analysis of the activities of dental institutions…………………..305

4.2.8.9. Assessment of the activities of a dental institution (in dynamics over the past 3-5 years) ………………………………………………………306

4.3. International approaches to the study of dental epidemiology

diseases………………………………………………………………………………………..308

4.4 Dental morbidity in the population of Russia……………………………310

4.5. Clinical examination………………………………………………………………………………………..315

5.1. Concept of disability. Types of disability………………………...336

5.2. The procedure for issuing a certificate of incapacity for work in case of illnesses and injuries………..337

5.3. The procedure for issuing a certificate of incapacity for caring for a sick family member..339

5.4. The procedure for sending citizens to medical and social examination (MSE)………...340

5.5. Examination of temporary disability in practice dentist……….341

5.6. The procedure for recording and storing documents certifying temporary disability……………………………………………………………………………………….343

6.1. Concept, goals, types of health insurance. Mechanism of insurance medicine.347

6.2. Objectives and principles of compulsory health insurance. Subjects and participants of the compulsory medical insurance system………………………………………………………………………………….359

Test tasks
Sample answers
List of basic literature
Chapter 7. Rights of citizens in the field of health protection. – O.A. Tsyganova
Questions for Review and Discussion
Test tasks
Sample answers
List of basic literature
Chapter 8. Quality medical care: problems and solutions. – T.G. Svetlichnaya

8.1. Modern concept of quality of medical care……………………………413

8.1.1 Methodological approaches to studying the quality of medical care......414

8.1.2 Organizational and methodological approaches to assessing the quality of medical care abroad………………………………………………………419

8.1.3 Alternative approaches to managing the quality of medical care....423

8.2. Quality management of medical care in healthcare of the Russian Federation……………...431

8.2.1. Organization of quality control of medical care in healthcare institutions……………………………………………………………….433

8.2.2. Organization of the procedure for non-departmental examination of the quality of medical care…………………………………………………………………………………435

8.2.2.1.Organization and procedure for conducting non-departmental quality control of medical care in the compulsory medical insurance system……………………………………………………......439

8.3. Technologies for quality control of medical care…………………………….…442

8.3.1. Standards and standardization in healthcare……………………………...442 8.3.1.1. Definition of the concept “standard”, types of standards. Development procedure and

use of standards in healthcare……………………………..442 8.3.1.2. Definition of the concept of “standardization”. System organization

standardization in healthcare………………………………………………………448

8.3.2. The importance of medical (clinical) audit in provision and control

quality of medical care…………………………………………………………….451 8.3.2.1. Dangerous places in the diagnostic and treatment process and paths

reducing the risk of medical errors…………………….....452

8.3.3. Indicators of health care system performance and their importance in assessing the quality of medical care…………………………………………………………….458

8.4. Control and permitting mechanisms in healthcare……………………….466

8.4.1. The importance of licensing and accreditation in quality assurance

medical care………………………………………………………………………………468 8.4.1.1. Definition of the concept of “licensing”. Procedure

licensing of healthcare institutions………………………….....468 8.4.1.2. Definition of the concept “accreditation”. Accreditation procedure

healthcare institutions…………………………………………………………….471 8.4.1.3.Use of licensing and accreditation procedures in systems

ILC management abroad………………………………………………..475

8.4.2. The importance of certification and attestation of medical workers in ensuring the quality of medical care………………………………………………………………477

8.5. Dental care quality management……………………………………………………480

9.1. Fundamentals of medical psychology……………………………………………………..500

9.1.1. The role of medical psychology in the practical work of a doctor -

dentist….................................................. ........................................................ .......506

9.2. Issues of medical ethics and deontology……………………………………………………………..511

9.2.1. The concept of medical ethics and deontology………………………………………………………511

9.2.2. Doctor and patient…………………………………………………………………………………...513

INTRODUCTION

The demand for dental care in the Russian Federation has always been high. Specific gravity dental diseases among general morbidity The incidence of the population reaches 20-25%, per 1000 inhabitants there are 345-550 cases. The prevalence of caries ranges from 95% to 100% in different regions of the Russian Federation. In persons over 35 years of age, the prevalence severe forms periodontitis reaches 100%, and by the age of 65, every resident of Russia on average has 5-6 teeth out of 28-32. In 99% of cases, dental patients are served in outpatient clinics. The healthcare system of the Russian Federation currently employs 47 thousand dentists and more than 18 thousand dentists with average special education. Of all dentists, 43.8% are general dentists, 8.6% are pediatric dentists, 9.6% are dental surgeons, 17.7% are orthopedic dentists, 16.7% are dentists. Availability of specialists (dentists and

dentists) per 10,000 population reaches 4.5.
	In the nomenclature of positions in dentistry by order of the Ministry
Healthcare of the Russian Federation			“On the introduction of a specialty
“Preventive dentistry” from 6			February 2001 No. 33
position of “dental hygienist”.
	The socio-economic transformations taking place in Russia are
	main	prerequisites	reforming

healthcare. The goals of healthcare reform are set out in the Concept for the Development of Healthcare and Medical Science in the Russian Federation (1997). They significantly affected the dental service. Its main task is adaptation to the conditions of market relations.

Over the last decade, the dental service of the Russian Federation has been characterized by:

wide and diverse network of institutions various forms property;

large number of personnel; high resource intensity;

the emergence of new regulatory documents regulating professional activities, guaranteeing that staff perform their duties at the proper level, and provide effective and high-quality assistance.

Currently, the constituent entities of the Russian Federation have been given broad powers, and therefore the activities of similar health care institutions can vary significantly.

Based on the regulatory legal acts of the Russian Federation in the field of public health and the practice of organizing medical care and, in particular, dental care, we present the most typical, optimal forms, methods and content of the work of the main structural elements of the health care system.

CHAPTER 1. ORGANIZATION OF DENTAL CARE FOR THE URBAN POPULATION

1.1. Organization, functions and work of a dental clinic, department, office

In the Russian Federation, the activities of medical and preventive institutions, including dental ones, regardless of their organizational and legal basis and form of ownership, are regulated by the Fundamentals of the Legislation of the Russian Federation on the protection of public health dated July 22, 1993. No. 5487-1 (as amended by Decree of the President of the Russian Federation dated December 24, 1993 No. 2288, Federal laws dated 03/02/1998 No. 30-FZ, dated 12/20/1999 No. 214-FZ and dated 12/02/2000 No. 139-FZ).

The dental service is planned and controlled by the Ministry of Health and Social Development of the Russian Federation, in the constituent entities of the Federation - by their administrations, which include health care committees (administrations, departments, ministries).

At all administrative levels of healthcare management there is a position of chief specialist, including dentistry. Chief specialists are appointed from among the most qualified dentists, professors, associate professors, and researchers working in the field of dentistry and knowledgeable about the organization of dental care for the population. Most often, these positions are occupied by the chief physicians of regional (republican, regional) or large city dental clinics; in a district, the chief physician of a district dental clinic.

Forms and methods of work of the chief dentist

The chief dentist carries out:

scientific, organizational and methodological management of the work of dental clinics, departments and offices;

carrying out activities to organize and provide dental care to the population;

introduction into the practice of dental clinics (departments, offices) of new methods of prevention and treatment of diseases of the teeth, jaws, and oral mucosa;

provision of medical and advisory assistance by the regional dental clinic to city and district clinics (departments, offices); city ​​dental departments, offices of district clinics;

organization of quality control of treatment and preventive work of clinics, departments, offices;

analysis of dental morbidity of the population; control over the implementation of dental development plans

assistance in the region, city, district;

control of the implementation of the oral sanitation plan for organized populations;

monitoring the implementation of the action plan to improve medical and secondary medical care. personnel;

providing information on the state of dental care to the population to departments, departments and ministries of health.

To fully meet the needs of the population for dental care, a network of institutions and dental personnel is required, taking into account the existing levels and structure of the pathology of the maxillofacial area.

Health care reforms carried out in Russia in recent decades could not but affect dental care. Reforming the organization of dental care is carried out by denationalization and privatization of public medical institutions, the introduction of a market economy, the development of the private sector and entrepreneurship.

In modern conditions, dental care is provided to the population by a network of public and commercial dental institutions. The change in forms of ownership led to the formation of new structures: private dental clinics, prevention centers, highly specialized clinics. To date, 3 forms of ownership have formed in the Russian Federation: state, private and mixed.

However, in the current market conditions, a significant part of dental care is provided by state dental institutions (clinics, departments, offices).

In order to further improve and develop healthcare in the Russian Federation, it was published Order of the Ministry of Health and

social development of the Russian Federation “On the organization of medical care” dated October 13, 2005. No. 633. Appendix No. 1 to this order approved the “Regulations on the organization of medical care.” According to him, the following stand out:

1. Primary health care(PHC)

Dental care within the framework of primary health care is organized in the municipal district (in an outpatient clinic, local hospital, clinic, including a children's clinic, district hospital, central district hospital).

In the urban district, dental care is organized in the city clinic, including a children's clinic, center, medical unit, and city hospital.

Primary health care is a guaranteed (available and free) type of assistance provided to citizens in the area of ​​their first contact with the health care system. It includes prevention, diagnosis, treatment and rehabilitation of the most common diseases, as well as injuries, poisoning, sanitary and hygienic education (N. Naygovzina, 2005).

2. Dental specialized medical care

Oral health is an important condition for the normal general physical condition of the human body. It is known that there is close connection almost all non-communicable diseases affecting the teeth and oral cavity. Occurrence in humans various types pathologies of the cardiovascular system, rheumatism, nephropathy, many infectious and allergic conditions, diseases of the gastrointestinal tract and liver are considered by clinicians in connection with dental diseases.

In the presence of foci chronic infection in the oral cavity, the frequency of somatic diseases increases by 2-4 times, and if an unsatisfactory oral hygiene index is also detected - by more than 5 times. Therefore, the task of protecting public health cannot be solved without eliminating dental pathology.

Dental care has long been one of the most popular types of medical care. Moreover, in 99% of cases, patients are served in outpatient clinics. In the structure of dental diseases requiring hospitalization (about 1% of patients), the leading place is occupied by odontogenic inflammatory diseases, neoplasms and injuries of the maxillofacial area.

Today, the Ministry of Health of Russia, health authorities of the country's regions and municipal councils, within their competence, plan activities for the development of dental care for the population and monitor the activities of subordinate dental services. A chief dental specialist is appointed at all administrative levels of health care management.

The training of dentists is carried out at the dental faculties of medical universities. Along with this, Russia still continues to produce dentists with secondary medical education. Today, the indicator of the population's provision with personnel of all doctors and dentists is on average 4.7 (in a number major cities- more than 5) specialist per 10 thousand inhabitants.

According to the current nomenclature in Russia, dentists with higher education can work in healthcare institutions both in the main specialty of dentistry and in specialties requiring in-depth training: orthodontics, pediatric dentistry, therapeutic dentistry, orthopedic dentistry, surgical dentistry.

Outpatient dental care is provided to the urban population in various types of specialized treatment and preventive institutions. These include:

1) state and municipal dental clinics (for adults and children);

2) dental units (departments and offices) as part of other state health care institutions (territorial clinics, medical units, hospitals, dispensaries, antenatal clinics etc.);

3) dental offices in non-medical organizations (schools and preschool institutions, higher and secondary specialized educational institutions);

4) private dental clinics.

There have been no major changes in the network of public dental institutions in the country over the past ten years. Total quantity The number of dental clinics during these years remained practically unchanged and today amounts to about 950 institutions. At the same time, the number of dental units (departments and offices) within other organizations has decreased slightly.

The transition to market relations in the healthcare sector, price liberalization, and the development of new civil legislation - all this contributed to rapid growth during the last decade of private dental clinics. Today private sector dental care is represented both by commercial structures of various organizational and legal forms (production cooperatives, business societies and partnerships), and by individual entrepreneurs carrying out their activities in providing dental services individually (without forming a legal entity).

The bulk of private dental services are small outpatient clinics (on average 2-3 chairs) and separate offices. Less common are larger clinics and even entire networks of clinics, which can be found almost only in large cities.

In a free market medical services the population has real opportunity choosing a dental institution and doctor. Moreover, today paid dental care has already become the most important factor the financial condition of not only private, but also public dental institutions. In these conditions, there is already competition between clinics to attract patients, which to a certain extent helps to improve the quality of dental care in general.

In accordance with the Decree of the Government of the Russian Federation dated November 26, 1999 No. 1194 “On the program of state guarantees for providing citizens of the Russian Federation with free medical care,” citizens are provided with assistance for diseases of the teeth and oral cavity at the expense of compulsory medical insurance funds. In addition, at the expense of budgets of all levels, preferential dental prosthetics are provided to certain categories of citizens, including children under 18 years of age, old-age pensioners, war invalids, disabled people since childhood, labor disabled people of groups I and II, heroes Soviet Union, heroes of the Russian Federation, full gentlemen Orders of Glory, residents of besieged Leningrad, veterans of military operations in other countries, etc.

When providing citizens with free care, it is necessary to combine the well-known principles of centralization and decentralization in the organization of dental services. In the centralized form, the population is received directly at the dental clinic or in the dental department (office) of another medical institution.

A decentralized form of service involves the creation of permanent dental offices in enterprises and organizations. The advantage of this form is that, firstly, service to the population occurs locally and constantly; secondly, there is the possibility of full medical care for workers or students; thirdly, the possibility of closer contact between the doctor and the patient increases. In providing dental care to children, a decentralized form of organization based on educational institutions is advisable.

Issues of organizing dental care have always been the focus of national healthcare.

The last decade has been characterized by technical progress, the introduction of modern equipment and new technologies into the practice of dentists.

The main structure, as before, remains state municipal medical institutions, which, despite the increasing outflow of specialists to the private dental sector, provide the largest volume of dental care.

In the system of state and municipal urban healthcare services, there are three levels of dental care.

First level. First-level institutions include: dental departments in multidisciplinary clinics, medical units, as part of the central district hospitals (central district hospitals) and other medical institutions, dental offices in enterprises, educational institutions, kindergartens, agricultural enterprises, antenatal clinics and other institutions. At the first level, the bulk of measures for individual prevention and treatment of the most common types of dental pathology are carried out, ending with sanitation of the oral cavity and, if necessary, simple dentures.

Second level is represented by state and municipal dental clinics in administrative districts of cities, where highly qualified specialized care is provided in the main profiles of the dental specialty: therapeutic dentistry with endodontics, surgical dentistry and dental prosthetics. As a rule, such dental clinics also perform the functions of unique methodological and practical centers for organizing dental care and implementing municipal dental programs in the service area.

On the third level highly qualified and specialized consultative, diagnostic and therapeutic assistance is provided in such narrow areas of dentistry as periodontics, endodontics, diseases of the oral mucosa, dental neurology, complex dental prosthetics, orthodontics, maxillofacial orthopedics, dental implantation, plastic surgery, oncostomatology, etc. d. Institutions at this level should primarily include dental clinics of the constituent entities of the Federation, scientific and educational medical institutes, and specialized centers. The main flow of patients at the third level should be formed as a result of referrals from specialists of the previous (first and second) levels. At this level, organizational and methodological management of the dental service of a constituent entity of the Federation is carried out.

DENTAL CLINIC

Dental clinics occupy a special place in the structure of the city dental service.

The regulations on the dental clinic were approved by order of the USSR Ministry of Health dated December 10, 1976? 1166.

Regulations on the dental clinic

1. Dental clinic is a medical and preventive institution whose activities are aimed at the prevention of dental diseases, timely identification and treatment of patients with diseases of the maxillofacial area.

2. A dental clinic is organized in the prescribed manner and operates among the population, at industrial enterprises, in higher and secondary educational institutions, construction and other organizations, including, in appropriate cases, in children's groups.

3. The boundaries of the area of ​​operation of the clinic, the list of organizations that it serves, are established by the health authority according to the subordination of the clinic.

4. The main objectives of the clinic are:

a) carrying out measures to prevent diseases of the maxillofacial area among the population and in organized groups;

b) organization and implementation of activities aimed at early detection of patients with diseases of the maxillofacial area and their timely treatment;

c) provision of qualified outpatient dental care to the population.

5. To carry out the main tasks, the clinic organizes and conducts:

Complete sanitation of the oral cavity for all persons visiting the clinic for dental care;

Complete sanitation of the oral cavity in pre-conscription and conscription contingents;

Emergency medical care for patients with acute diseases and injuries of the maxillofacial area;

Dispensary observation of certain groups of dental patients;

Qualified outpatient dental care with timely hospitalization of persons in need of inpatient treatment;

Examination of temporary disability of patients, issuance sick leave and recommendations for rational employment, referral to medical labor expert commissions of persons with signs of permanent disability;

The whole complex of rehabilitation treatment of pathologies of the maxillofacial area and, above all, dental prosthetics and orthodontic treatment;

Activities to improve the qualifications of doctors and nursing staff.

6. The dental clinic may include:

Departments of therapeutic and surgical dentistry (including, in appropriate cases, children’s);

Mobile dental units;

Dental prosthetics departments;

Organizational method room;

Auxiliary units (X-ray, physiotherapy rooms);

Registry;

Administrative and economic part;

Accounting.

The specific structure of the clinic is established by the health authority according to its subordination.

7. The staff of the dental clinic is established according to the current staffing standards and standard staffing levels.

Traditionally established structure of the dental clinic includes the following divisions (see diagram below):

1) registry;

2) dental departments: therapeutic, surgical, orthopedic with a dental laboratory, pediatric dentistry;

3) primary examination room;

4) emergency dental care office;

5) physiotherapy room;

6) X-ray diagnostic room.

In addition, the clinic can organize departments and rooms to provide highly specialized dental care to patients. These include a periodontal office, an office for receiving patients with pathological changes in the oral mucosa, anesthesiology, orthodontics, prevention, acupuncture, hirudotherapy, and functional diagnostics rooms. Large dental clinics (regional, city) have departments (offices) of implantology, anesthesiology and resuscitation, restorative therapy, endodontics, clinical diagnostic laboratories, central sterilization rooms, pharmacies and others.

The structure of the dental clinic includes a general, children's, and orthopedic registry.

The registry's duties include: storage outpatient cards, regulating the flow of patients, informing visitors, reference work, storing and processing sick leave certificates, recording doctors' house calls.

The dental profession belongs to a group of increased risk of infectious diseases. During dental surgery, infection can be transmitted from patient to patient, dentist and vice versa.

Asepsis is a system for preventing infection from entering a wound during operations and preventing the development of nosocomial infections. Asepsis includes a set of measures to ensure sterilization of instruments and materials

SCHEME

and compliance with procedures during operations and invasive surgical procedures.

Medical and operating rooms, dressing rooms, treatment rooms must be subject to current, constant and spring cleaning using chemical disinfectants and physical factors: bactericidal, bacteriostatic and mechanical effects. Drills and other mechanical cutting instruments should be easy to process aseptically. After surgical interventions, separate collection of used materials in hard containers is provided: gauze wipes, balls and metal instruments - needles, blades, scalpels.

Doctors working in a surgical outpatient department and in a hospital must cut their nails short and ensure that there are no cracks or hangnails. Before the operation, the doctor, using a sterile brush and soap, washes the hands and forearms, rinses them and, after wiping them with a sterile napkin from the tips of the fingers to the elbows, treats them with a swab moistened with alcohol and an antiseptic solution. IN recent years hand treatment with a 20% chlorhexidine solution is common, as well as accelerated methods of treatment with drugs antibacterial action(Zerigel, 96% ethyl alcohol), solution ND-410.

Before the operation, the patient’s face is treated with alcohol and the oral cavity with a 0.12% solution of chlorhexidine or its derivatives, and the surgical field is isolated with sterile sheets.

The listed measures create a barrier to exogenous infection, and in 90% of cases it comes from external environment in case of violation of sterility during operations: from the air, by impostation, due to infection of suture material, instruments and devices.

Infection can occur endogenously - from the skin, from the oral cavity, and ENT organs. Factors of nonspecific protection of the patient and his immunity are of great importance in activating endogenous infection.

In both clinic and hospital settings, especially in inflammatory diseases, cross-hospital infection occurs, which often causes postoperative purulent complications.

Maintaining asepsis has great value to protect doctors and medical personnel, patients from infection with viral hepa-

titus C and group B, syphilis, tuberculosis, tetanus, anthrax, HIV infection.

An important part of asepsis is the sterilization of instruments. It consists of pre-sterilization cleaning, packaging, sterilization, monitoring its effectiveness and delivery of instruments to the surgical site.

Mechanical cleaning of instruments, syringes or carpule holders, and device systems is carried out using brushes and sterile detergents and antiseptics. Burs, cutters, circular saws, sharp curettage spoons, rasps, and osteotomy instruments should be processed especially carefully. Mechanical and antiseptic cleaning of instruments is complemented by ultrasonic treatment. After purulent interventions, instruments are especially carefully mechanically cleaned and additionally soaked in antiseptic solutions.

Instruments are sterilized using physical factors or chemicals. Physical methods of sterilization include steam, hot air (dry air), filtration, infrared and radiation methods. Currently, the most common sterilization is in dry steam sterilizers with packaging of each instrument. For air sterilization, craft bags are used, for steam sterilization, vegetable multilayer parchment is used. Multilayer packaging is the most reliable.

Individual devices (endoscopes, units of devices for hemosorption, lymphosorption) are cleaned and sterilized in a gas sterilizer.

The tips of dental drills are sterilized by boiling in petroleum jelly followed by centrifugation.

Chemical sterilization is most appropriate in the form of low-temperature exposure using formaldehyde and ethylene oxide gases. This method is very convenient as it only takes 20 minutes.

Dressing material - napkins, tampons, balls, bandages are packed in a towel or sheet and placed in containers, sterilized at a pressure of 2 atm and a temperature of 132.9 ° C for 20 minutes. Robes and sheets are also sterilized. The suture material is first treated in a triple solution, washed with running water, dried and sterilized by boiling in distilled water.

water for 20 minutes. The use of packaged disposable needles with suture material is also effective.

Impressions, protective plates, mouthguards, dental splints after rinsing in running water for 1 minute are disinfected in 0.5% chlorhexidine solution, MD-520 (50% glutaraldehyde and 50% alkylbenzyldimethylammonium chloride), 0.1% desoxon, 6 % hydrogen peroxide solution, and plasma disinfection is also used. After treatment with disinfectant, orthopedic medical splints, mouth guards, etc. are washed. in running water.

To control sterilization, ampoules with benzoic acid, resorcinol, antipyrine, ascorbic or succinic acid powder, pilocarpine hydrochloride, thiourea are placed between the material and the packaging tool. These drugs have high point melting (110-200 °C) and their melting indicates the optimal sterilization temperature.

The sterility of preoperative rooms, operating units, materials and instruments is checked bacteriological method- sowing under aerobic and anaerobic conditions, as well as placing test tubes with a spore-bearing non-pathogenic culture of microorganisms in jars. The absence of microorganism growth indicates the sterility of instruments and materials. Constant monitoring of the sterilization process can be carried out by placing biological indicators in the boxes. It should be borne in mind that tetanus endospores, anthrax, Mycobacterium tuberculosis, viruses, including the AIDS virus, fungi, Vibrio cholerae are poorly destroyed and high- and medium-level disinfectants are most effective in combating them.

In dental clinics, it is necessary to screen staff for dangerous and viral infections. Personnel must undergo an annual medical examination with a blood test for the presence of hepatitis A, B, C, D viruses, HIV infection, and be vaccinated against hepatitis B and diphtheria twice a year.

Considering the increase in the number of patients infected with HIV infection and AIDS patients, when operating on urgent patients, it is necessary to take increased precautions and work in double gloves and goggles, using only disposable instruments.

Infectious diseases transmitted during dental procedures

Basic requirements for operating a dental office

Before starting work and after the end of the work shift, the manipulation table, table for storing sterile instruments, dental chairs, sinks, sink taps are disinfected by wiping them twice with a rag moistened with a 1% chloramine solution, after which the bactericidal lamp is turned on. The sterile table is set for 6 hours. Sterile instruments can also be stored in sterile packaging or in a bactericidal chamber such as “MicrocidMed” to prevent secondary contamination of dental instruments.

Pre-sterilization treatment of dental instruments

Conducted by a nurse. Stages:

1. Soaking (detachable products are placed disassembled) in a 3% solution of chloramine, or a 6% solution of hydrogen peroxide, or a 5 - 8% solution of alaminol for 60 minutes.

2. Rinse for 15 seconds with running water.

3. Soaking (full immersion) in a biolot solution heated to 40 °C for 15 minutes.

4. Rinse each instrument in the same solution with brushes or cotton-gauze swabs for 15 s.

5. Rinsing sequentially: with tap and distilled water (at the rate of 200 ml of tap water for each product) for 1 and 0.5 minutes, respectively.

6. Drying in the open air.

Points 2, 3, 4 are intended for using solutions of chloramine and hydrogen peroxide.

Soaking of spent burs and endodontic instruments is carried out for 30 minutes in disinfectant. solution (3% hydrogen peroxide, 10% ammonia and 70% alcohol mixed in equal quantities), then in a biolot solution (at a temperature of 40 ° C) for 15 minutes.

Soaking used cotton-gauze swabs, gloves, masks, etc. produced in a 3% solution of chloramine or 5 - 8% solution of alaminol for 120 minutes.

Quality control of pre-sterilization treatment assessed by using azopyram (azopyram, 3% hydrogen peroxide solution in a 1:1 ratio, applied with a pipette to the instrument or wiped with a swab) or amidopyrine (95 g of alcohol + 5 g of amidopyrine. 2 drops each: amidopyrine, 3% hydrogen peroxide, 30% acetic acid) samples. A blue-violet color indicates the presence of blood. 1% of simultaneously processed products of the same name (but not less than three products) are subject to control.

Disinfection of dental instruments

Before and after use, dental handpieces are wiped twice with 70% alcohol or 3% chloramine solution, then passed through a burner flame. Disinfection of tips can also be carried out in disinfection systems “Terminator”, “Assistina”, special “pockets”, etc.

Dental mirrors are immersed for 60 minutes in a closed container with a 3% chloramine solution or 6% hydrogen peroxide. Then they are rinsed with distilled water and wiped with a sterile cloth. Mirrors are stored in a sterile tray or in a closed sterile container.

Casts, attachments for guns for rinsing the tooth cavity, knives for cutting crowns, Kopa crown remover, etc. disinfected by wiping twice with a 1 - 3% chloramine solution (or special disinfection solutions) with an interval of 10 minutes.

During a therapeutic appointment, gloves are washed with running water and soap, wiped with alcohol or a special solution. During a surgical procedure, gloves should be disposable and sterile.

Sterilization

Sterilization is the complete destruction of microorganisms and their spores on (in) the sterilized object.

Requirements for sterilization

Sterilization must be carried out directly at the workplace, or the object to be sterilized must be placed in an impenetrable package (before or after sterilization).

After sterilization, the object must not contain living microorganisms. The object must not be modified during the sterilization process. After sterilization, the object must remain sterile for a long time.

Classification of sterilization methods

1. According to the obligate state of the sterilizing agent:

a) liquid methods;

b) using gaseous substances;

c) plasma sterilization;

d) using radiation.

2. According to the factor of influence on the object being sterilized:

a) penetrating or volumetric (destroy the protein of microorganisms);

b) having a superficial effect.

3. According to the method of influencing the sterilized object:

a) chemical;

b) physical;

c) combined.

Types of sterilization used in dentistry

Liquid

Chemical. This type of sterilization includes easy-to-use methods of soaking, treating instruments in solutions (for example, hydrogen peroxide 3%, 6%; hypochlorous acid salts; chloramine 1 - 3%, etc.). The solutions can also be used to process impressions during ultrasonic processing. The advantages of the method are the ability to process internal channels of small diameter and low processing temperature. The disadvantages of the method are: surface exposure, compliance with safety precautions, processing time (minimum 10 hours), mandatory several washes, harmful effects on personnel, the problem of waste disposal.

Thermal. Boiling. Sterilization of all-metal dental instruments (burs, needles, pluggers, hooks, reusable syringes, etc.), materials can be carried out by boiling in distilled water with the addition of 1 - 2% sodium bicarbonate solution for at least 30 minutes. The method is penetrating. Environmentally friendly. However, the duration of the procedure and the inability to boil sharp cutting instruments limit the use of this method.

Sterilization of dental handpieces can be carried out by boiling for 1 hour in petroleum jelly with the addition of a 2% solution of hydroxyquinol, followed by centrifugation. The method is reliable, penetrating, but time-consuming and requires special equipment.

Gas

Chemical. Gas sterilization with ethylene oxide. The object to be sterilized is kept in a gas environment for 1 hour, after which the room must be ventilated for 10 hours. The reliability of the method is very high (100% sterilization). The method is penetrating. It has high productivity, since it is carried out centrally, in large batches of the sterilized object. There are no restrictions on materials that can be subjected to this method. Sterilization can be carried out in packaging. All disposable instruments undergo this treatment. The disadvantages of the method are: the use of highly toxic gas, which can have a harmful effect on the environment, the possibility of current

significant precipitation on surfaces after treatment, duration of the procedure.

Ozone sterilization. The object is kept in an ozone atmosphere for 1.5 hours (for example, in the SS-5 apparatus). The method has no restrictions on the materials of the object being sterilized. However large number ozone is toxic, and the duration of the process does not add any advantages to this sterilization method.

Thermal. Dry heat method. It is the most common in dentistry because it is easy to use, environmentally friendly, and allows the processing of an object in packaging. However, not all instruments can be sterilized using this method. The object is kept at a temperature of 180 °C for 1 hour. The dry-heat oven cannot be filled (low reliability). High temperatures require compliance with safety precautions.

Steam (autoclaving) method. The sterilizing agent in this case is steam heated to 120 °C under a pressure of 1.1 atm. for 12 minutes, up to 134 °C - for 4 minutes. The method is penetrating, environmentally friendly, and the speed is high. However, high temperature and humidity limit its use for cutting tools and require compliance with safety precautions. Recently, the method has become widespread.

Glasperlene method. It is also penetrating, but is used only for sterilizing small instruments. The working part of the instruments is immersed in a medium heated to 240 - 270 °C for several seconds.

Plasma sterilization

Plasma is the fourth state of matter. For this type of sterilization, argon is used, passed through alternating current. The method is penetrating. The effect of ball lightning is used. Bombardment with atoms and molecules of the plasma substance of the sterilized object breaks the bond between the proteins of microorganisms, resulting in their death. Sterilization occurs at a temperature of 60 - 80 °C for 10 - 12 minutes. Device "Plasmodin-2".

Sterilization methods using radiation

Radiation sterilization. Using a penetrating ionizing radiation, the source of which is Co 60, is possible only in industrial conditions due to the risk of personnel exposure.

The method has the same positive characteristics, as the gas (ethylene oxide) method.

UV sterilization. Usage ultraviolet radiation possible only for open surfaces of the object being sterilized. The method is simple, but long work The device produces a large amount of ozone.

IR sterilization. Infrared radiation is also used to sterilize exposed surfaces (surface exposure) of the object being sterilized. But the method produces heating of surfaces.

Microwave sterilization. Ultra-high frequency currents (electromagnetic radiation) have a sterilizing effect. The method is ineffective and harmful to personnel, but the effect on the object being sterilized is short-lived.

Sterilization control

Sterilization control is carried out in one of the following ways:

Selective microbiological control (flush is sown on nutrient media);

The use of chemical indicators (indicator strips that change color at a certain temperature);

The use of biological indicators (strips with test microbial cultures, which after sterilization are placed in nutrient media; if there is growth, the entire batch is rejected).

Sterilization of instruments in case of threat of HIV infection

The virus dies at a temperature of 46 °C for 30 minutes.

Disinfectants (WHO, 1986): ethyl alcohol 70° - 10 min, 50° - 12 min; propyl alcohol 75° - 1 min, ethyl alcohol with acetone 1:1 - 10 min; chlorhexidine 4% - 5 min, 3% - 10 min; sodium hypochloride 0.5% - 1 min, 0.1% - 10 min; hydrogen peroxide 3% - 1 min, 0.3% - 10 min; formaldehyde 0.2% - 5 min, 2% - 1 min; phenol 5% - 1 min; Lysol 0.5% - 10 min; paraformaldehyde 0.6% - 25 min.; polyvinylpyralidone 10% - 1 min; chloramine 2%, formaldehyde 40% 1:1 - 10 hours for mirrors.

Organization of dental care for the urban population

Dental care for the urban population is provided in a variety of institutions or departments, from a dental office to an independent specialized dental clinic.

The beginning of this organizational hierarchy is the dental office - the most massive structural unit of the service. The pinnacle of organization and concentration of all its types is independent specialized dental clinic with departments of therapeutic, surgical and orthopedic dentistry, pediatric dentistry department or office, orthodontic, physiotherapy, x-ray offices and laboratory.

Such a highly specialized institution with a sufficient number of highly qualified specialists makes it possible to comprehensively resolve issues of diagnosis and treatment of patients, make maximum use of property, equipment, instruments and have the opportunity to consult patients with various specialists in one institution.

The capacity of dental clinics varies and is determined by the number of full-time medical positions.

Table No. 3. Categories of independent dental clinics and staffing standards for medical personnel (approximate distribution by departments and offices)

Name of departments and offices	Categories of clinics and number of medical positions
I	II	III	IV	V
30-40	25-30	20-25	15-20	10-15
1. Chief physician
2. Deputy Chief Physician		-	-	-	-
3. Heads of departments			2-3	1-2
4. Branches:
Therapeutic	9-14	8-10	7-8	6-7	4-6
Surgical	2-3			1-2	1-2
Orthopedic	5-7	4-5		3-4	1-2
Children's	6-8	5-6	3-5	2-3	1-2
5. Offices:
Orthodontic			1-2
Physiotherapeutic	0,5	0,5	-	-	-
X-ray	0,5	0,5	-	-	-
Total	30-40	25-30	20-25	15-20	10-15

The vast majority of patients is treated in the therapeutic department, so from 30 to 15% of the entire medical staff of the clinic are directly involved in the treatment of diseases of the oral cavity and teeth. The share of dental surgeons is 7-8%, and orthopedic dentists are 16-18%.

Emergency dental care During the opening hours of the clinic, he is the dentist on duty, and at night, he is the doctor at special emergency dental care points, organized in several clinics in the city.

In addition to the budgetary network of dental clinics, self-supporting clinics are opening in cities, which provide highly qualified dental care to all residents, regardless of age, place of work and residence.

Chief physician of the dental clinic carries out management of all treatment-and-prophylactic, organizational-methodological, economic and financial activities, monitors the implementation of activities aimed at improving the quality and culture of medical care for the population, analyzes the performance indicators of the institution and individual specialists, appoints and dismisses medical and administrative personnel, imposes disciplinary sanctions on employees for violations labor discipline.

As a loan manager, he controls the correct use of the budget, is responsible for sanitary conditions and the implementation of fire safety measures, etc.

Deputy for medical and preventive work bears responsibility for the quality of examination and treatment of patients, medical examination, rational use of medications, equipment, and advanced training of medical staff. He resolves issues of hospitalization of patients together with the organizational and methodological office, studies the experience of other dental clinics, and holds production meetings.

Each department is headed manager, which ensures the organization of the correct and timely diagnosis, quality treatment and disease prevention, appropriate maintenance of medical records, advanced training of doctors and nursing staff, preservation and use of equipment, instruments and medicines.

Staffing standards for medical personnel in dental clinics are determined by Decree of the Ministry of Health of Ukraine No. 33 dated February 23, 2000. According to him, in urban dental clinics for adults located in cities with a population of more than 25 thousand people, they are as follows:

· 1-4 positions of dentists and dental surgeons in total per 10 thousand adult population of the city where the clinic is located;

· 2.5 positions in total per 10 thousand adult rural population;

· 2.7 positions in total per 10 thousand adult rural population;

· 2 positions of dentists and orthopedists, who are supported by self-supporting or special means, are established based on:

· 1 position per 10 thousand adult population of the city where the clinic is located;

· 0.7 positions per 10 thousand adult rural population;

· 0.8 positions per 10 thousand adult rural population.

The positions of heads of departments are established by:

· dental department – ​​1 position for every 12 positions of dentists and dental surgeons, but no more than 3 positions per clinic;

· denture department (maintained on self-support or at the expense of special funds) – 1 position per clinic, in which, according to current staffing standards, at least 4 positions of dentists and orthopedists are established.

The position of deputy chief physician for medical affairs is provided for in the staff of the clinic, where there are at least 40 medical positions, including the position of the chief physician.

Positions of dental surgeons in departments maxillofacial surgery are installed at the rate of 1 per 25 beds. In accordance with the standards for providing the population with hospital beds for certain profiles, beds for dentistry are not provided. They are deployed in large cities in one of the city hospitals in agreement with local health authorities. The position of the head of the surgical dental department is established instead of 0.5 of the position of a doctor if there are less than 60 beds in the department.

To serve patients in hospitals of regional, central city, city hospitals, medical units organize dental offices at the rate of 1 position for 600 beds, in tuberculosis hospitals - 0.5 for every 250 beds, but not less than 0.5 positions in hospitals.

The positions of nurses in medical offices are established on the basis of one position per:

· 1 position of a dental surgeon;

· 2 positions of dentists and orthodontists;

· 3 positions of dentists and orthopedists.

In dental offices, where the staff provides for 1 position of a dentist, at least 1 position of a nurse is introduced.

In dental laboratories that are self-supporting, the number of dental technicians is established depending on the amount of work on prosthetics at the rate of 2-3 positions per orthopedic dentist. The position of a senior dental technician in a dental laboratory is provided for every 10 positions of dental technicians, but not less than 1 position for 3 dental technicians instead of one of them.

The positions of junior nurses are established at the rate of 1 position for 1 position of a dental surgeon, or for 3 positions of dentists of other specialties.

A mandatory structural department of any dental clinic is the registration office (with a medical archive), which regulates the flow of patients and carries out accounting, statistical and reference information activities.

The reception desk works in two shifts. Its work should begin in 20-25 minutes. before admitting patients. Depending on the capacity of the clinic, several registrars may work at the reception desk in one shift. The registrar fills out the passport part of the dental patient’s medical record, issues a coupon for an appointment with a doctor, which indicates the date and time of the appointment, the doctor’s name, office number, and floor. Medical records are transferred to the offices. Registrars control self-registration of patients for appointments, provide certificates of work of others medical institutions cities.

Calculations of registrar positions are made according to the principle of 1 registrar for every 5 positions of doctors who conduct receptions, but not less than 1 position per shift.

To save time, an examination room is organized in the clinic, the dentist of which ensures reasonable referral of patients to other rooms, and, if necessary, provides emergency assistance.

The therapeutic department has rooms for the treatment of diseases of the teeth, periodontium and oral mucosa. Large clinics may have 2 therapeutic departments.

When one chair is installed in a therapeutic dentistry office, the room must have an area of ​​at least 14 square meters. m. For each additional chair you need to allocate at least 7 square meters. m. Doctors of the department of therapeutic dentistry work in 2 shifts according to the schedule. The most effective was the provision of therapeutic dental care on a local-territorial basis.

In view of the patient’s right to choose a doctor, outpatient appointments are carried out on the principle of free appointment, and according to the local-territorial principle, only dispensary work is carried out.

The dentist is appointed as the chief physician of the clinic. In his daily work he reports to the manager. department, deputy chief physician for medical treatment and chief physician. Doctor's orders are mandatory for secondary and junior staff departments within the limits of their functional responsibilities.

The dentist is obliged:

· ensure effective and high-quality provision of dental care to patients;

· provide emergency assistance in cases of anaphylactic shock, collapse, loss of consciousness, etc. emergency conditions;

· take part in medical examinations of the population;

· carry out examination of temporary disability;

· carry out dispensary observation of certain contingents;

· systematically improve your professional level by applying modern methods of diagnosis, treatment and prevention of dental diseases;

· constantly take care of improving the professional theoretical skills of middle and junior staff;

· carry out sanitary educational work among the population;

· adhere to workplace safety rules.

The dentist is responsible for:

· failure to fulfill the production plan and poor quality treatment of patients;

· the occurrence of complications after treatment due to his fault;

· poor quality and untimely maintenance of necessary medical documentation;

· irrational use of available diagnostic and treatment equipment, instruments and other medical equipment.

Results medical examinations, data from monitoring patients during outpatient visits allows us to select dispensary groups for further recording, observation and treatment.

D1– healthy and practically healthy individuals who do not have dental diseases, periodontal disease or malocclusions. This also includes patients who have a compensated form of caries, diseases of the mucous membrane associated with unhygienic maintenance of the oral cavity and patients after traumatic damage to the dental system. Their sanitation is carried out once a year.

D2– persons who have subcompensated numerous caries, dental fluorosis, increased fragility, gingivitis, periodontitis, leukoplakia, neuralgia trigeminal nerve, after surgical interventions and dental injuries, those with inflammatory processes (osteomyelitis, odontogenic lymphadenitis, etc.) are undergoing orthodontic treatment, etc. They are inspected and sanitized at least 2 times a year.

D3– persons with sub- and decompensated forms of caries, generalized periodontal disease and periodontitis, diseases of the marginal periodontium caused by diseases internal organs(periodontal syndrome), as well as those that require complex dental treatment with a severe course of the disease, with chronic relapsing aphthous stomatitis etc. This group is examined and sanitized 3 times a year or more.

Dental surgery department provided only in large dental clinics if the clinic has 6 or more dental surgeons on staff.

The structure of such a department includes: an operating room, a preoperative room, a sterilization room, and rooms for the temporary stay of patients after surgery. The area of ​​the surgical department with one dental chair is 23 sq.m. for each subsequent chair - +7 sq.m.

Dental clinics of categories II-V have only a surgical room.

In recent years, the structure of surgical departments of dental clinics has included offices rehabilitation treatment and rehabilitation. This makes it possible to ensure continuity in outpatient and inpatient treatment of patients, increase its efficiency and reduce the duration of temporary disability.

The main responsibilities of a dental surgeon at a polyclinic are:

· reception of primary and secondary patients, diagnosis of diseases, provision of emergency and planned surgical care;

· advisory assistance to patients;

· referral of patients for consultation to specialized institutions and for inpatient treatment;

· carrying out medical examinations in the oral cavity;

· medical examination of patients according to profiles;

· examination of temporary disability;

· carrying out medical rehabilitation at the stage of follow-up treatment of patients with injuries, inflammatory processes tissues of the maxillofacial region.

Dental orthopedic care is one of the foundations of tertiary prevention. Without orthopedic intervention, it is impossible to consider dental patients cured, because almost all of them have damage to the dentofacial apparatus.

The relevance of orthopedic dental care for child's body is confirmed by scientific observations that show that among children preschool age 20-25% has various disorders in the development of the jaw system, and 5-7% of them require emergency orthopedic care.

Orthopedic care is provided in departments or offices of dental clinics. Doctors orthopedic department provide medical care to adults and children in cases where there are no children's dental facilities.

For orthopedic treatment, patient populations are formed by independently seeking help, as well as by patients referred by dentists of other specialties.

The activities of the orthopedic department are supported by self-supporting or special funds. Free or preferential treatment is provided to participants in the liquidation of the Chernobyl accident, disabled people of war, labor and persons equivalent to them, pensioners, and children.

The orthopedic department includes patient reception rooms, a dental laboratory and a foundry.

The doctor on duty examines the patient and selects the design of the necessary prosthesis. If the patient needs sanitation of the oral cavity, he is referred to a therapist or surgeon who provides treatment and preparation for prosthetics.

After processing teeth for dentures, the orthopedic doctor takes an impression and, through a nurse, passes it on to the production manager. The manager determines the deadline for the intermediate stage of prosthesis manufacturing and appoints the patient for the next visit. Depending on the organization of work of dental technicians, orthopedic care can be provided in three forms:

· individual – when the dental technician completely makes the denture himself;

· brigade – when there is a distribution according to the type of prosthesis;

· step-by-step – when there is a distribution of operations on one prosthesis.

Every regional, city and district dental clinic (department) organizes an appointment with an orthodontist for the treatment and prevention of malocclusions and jaw deformities in children. The positions of orthodontists are distinguished from the positions of pediatric dentists. With a standard of 5.0 doctors per 10 thousand children, 0.5 positions are allocated to orthodontics.

The positions of dental technicians to serve the work of orthodontists are established on a 1:1 basis.

Surgical dental inpatient departments are organized in regional and large city hospitals. The number of beds in them depends on the population that lives there and on the use of the hospital as a clinical base for universities.

An independent department is created if it has from 40 to 60 beds. For inpatient treatment For patients with pathology of the maxillofacial region in small settlements, specialized beds are deployed in one of the surgical departments of a city or district hospital, with the consent of local health authorities. According to staffing standards, there are 25 beds per dental surgeon in the hospital.

OBJECTIVE OF THE LESSON: to know the current state of dental care, the structure, tasks and organization of work of a city dental clinic, to master the methodology for calculating and assessing general and special indicators of the clinic’s performance, to use the information obtained to analyze and plan the activities of the institution.

METHODS OF CONDUCTING THE CLASS: Students independently prepare for practical lesson according to the recommended literature and do individual homework. The teacher checks the correctness of homework for 10 minutes and points out mistakes made, checks the level of preparation using testing and oral questioning. Then students independently calculate the main performance indicators of the clinic based on the annual report of the medical institution. Analyze the data obtained and formulate a conclusion. At the end of the lesson, the teacher checks independent work students.

TEST QUESTIONS:

1. What types of treatment and prevention institutions provide outpatient dental care to the population?

2. Name the main tasks of the dental clinic.

3. What is the structure and organization of work of the city dental clinic?

4. How is the work of the clinic’s reception desk organized?

5. What are functional responsibilities dentist?

6. How is dispensary observation of patients at the city dental clinic organized?

7. What is anti-epidemic work in a dental clinic?

8. What main types of documentation do dentists use?

9. Name the general and special performance indicators of the dental clinic. What is the methodology for calculating and evaluating them?

Dental care is a type of specialized medical care provided for diseases and injuries of teeth, jaws and other organs of the oral cavity and maxillofacial area. Dental care includes therapeutic, orthopedic and surgical dentistry and is one of the most widespread types of specialized medical care. The bulk of dental care (more than 90%) is provided in outpatient settings. Outpatient dental care is provided by:

In specialized state and municipal dental clinics (adults and children);

In dental departments (offices) that are part of other government health care institutions: territorial clinics, medical units, dispensaries, antenatal clinics;

In dental offices deployed in non-medical organizations: preschool and school institutions, higher and secondary specialized educational institutions;

In private dental organizations, institutions, offices.

The dental clinic is the main treatment and preventive institution in the system of outpatient dental care, whose activities are aimed at the prevention of dental diseases, timely identification and treatment of patients with diseases of the maxillofacial area. The work here is based mainly on the local principle, and the dispensary method should be the leading method.

Depending on the number of medical positions, clinics are divided into categories.

As a part of the dental clinic in the department of orthopedic and orthodontic dentistry, as a rule, a dental laboratory is deployed, in which significantly different complex technological processes associated with the manufacture of dentures are carried out: casting, stamping, soldering, grinding, polishing, polymerization and artistic modeling. In addition, mobile dental offices equipped with special vehicles can be created in the regional (regional) dental clinic.

The main tasks of the city dental clinic:

Providing highly qualified and specialized dental care in the clinic and at home.

Organization and implementation of measures for the prevention of diseases of the maxillofacial area - medical examination of the population, sanitary education, promotion of a healthy lifestyle, anti-epidemic measures.

Carrying out rehabilitation treatment of pathologies of the maxillofacial area and, above all, dental prosthetics and orthodontic treatment.

High-quality clinical expert work - examination of temporary disability and timely identification of signs of permanent disability.

Timely hospitalization of persons in need of inpatient treatment.

Maintaining continuity of connections with other health care facilities.

The main tasks of a dentist are to provide outpatient setting qualified medical and diagnostic assistance to patients with diseases of the teeth and oral cavity, living in the area where the clinic operates, as well as workers and employees of attached enterprises. In his work, a dentist reports directly to the deputy chief physician for medical affairs, and in his absence, to the chief physician of the clinic.

Functional responsibilities of a dentist:

1. Conduct outpatient appointments according to a schedule approved by the administration of the clinic, regulating the flow of visitors by rationally distributing repeat patients.

2. Provide qualified and timely examination and treatment of patients with diseases of the teeth and oral cavity.

3. Conduct preventive examinations and sanitation of the oral cavity among patients undergoing dispensary observation in the clinic.

4. Provide out of turn emergency assistance patients with acute toothache, as well as war and labor veterans.

5. Provide correct execution examination of temporary disability.

6. Refer patients, if indicated, to additional types studies (laboratory, radiological, functional, etc.).

7. Timely submit patients with unidentified forms of diseases or those who have been ill for a long time for consultation with other medical specialists at the clinic and CEC.

8. Consult patients on the referral of other specialists of the institution, including at home.

9. Carry out timely hospitalization of patients, in accordance with indications.

10. Observe the principles of deontology in your work.

11. Monitor and manage the work of nursing staff in the dental office.

12. Systematically improve your professional qualifications by studying relevant literature, participating in conferences and seminars.

13. Participate in promoting sanitary and hygienic knowledge among the population on the prevention of dental and oral diseases.

14. News medical records dental patients, a diary for recording the work of a dentist, a sheet of daily recording of the work of a dentist, a log for recording preventive examinations of the oral cavity, etc.

A dentist has the right:

Make proposals to the administration of the clinic on improving the organization of treatment and preventive dental care for the population, the organization and conditions of their work and the work of nursing staff of the dental office;

Participate in meetings on the organization of dental care;

Prescribe and cancel any treatment preventive measures, based on the patient’s condition;

Obtain information necessary to perform job duties;

Improve your qualifications through advanced training courses in the prescribed manner.

The dentist is responsible for both poor quality work and erroneous actions, as well as for inaction and failure to make decisions that fall within the scope of his duties and competence, in accordance with current legislation.

An important part of a dentist’s work is preventive work. Disease prevention is a system of medical and non-medical measures aimed at preventing deviations in health status, slowing down the progression of diseases and reducing them adverse consequences. In dentistry, it is customary to divide preventive measures into primary, secondary and tertiary prevention.

Primary prevention: a set of general measures to improve human health in combination with special ones aimed at preventing dental caries, periodontal diseases, and dental anomalies (sanitary education, balanced nutrition, water fluoridation, elimination of occupational hazards).

Secondary prevention is a set of measures to timely treatment caries and its complications, periodontal diseases and dental anomalies. Main organizational method secondary prevention is the planned provision of dental care (planned sanitation).

Tertiary prevention is the restoration of lost function of the dental system as a result of tooth loss.

In order to actively prevent dental caries and other common dental diseases, clinics conduct routine sanitation of teeth and oral cavity for designated groups of the population (children and adolescents in organized groups, students, workers of industrial enterprises, pregnant women, etc.)

Methods for carrying out planned sanitation:

Centralized – provides for examination, diagnosis of diseases and provision of all types of treatment in a dental clinic. This method allows for high-quality treatment and preventive work, since the clinic has modern special equipment, materials and medications, and the best diagnostic capabilities.

Decentralized - planned rehabilitation is carried out in existing dental offices in enterprises, organizations and educational institutions with a workforce of at least 2,000 people and a number of students of at least 1,500 people.

Brigade (travelling) - in a dental clinic, a team of 3 - 4 doctors, 1 nurse and 1 orderly is formed to provide dental care to rural residents, children in preschool institutions, and elderly citizens. This method uses specially equipped transport.

An assessment of the work of a dentist is carried out by the deputy chief physician of the clinic for the medical department based on the results of work for the quarter (year) based on taking into account quality and quantitative indicators his work, his compliance with the requirements of fundamental official documents, labor discipline rules, moral and ethical standards, and social activity. To record the work of dental doctors, a system is used that is based on measuring the volume of work in conventional units of labor intensity (CLU). Labor accounting according to UET is aimed at increasing the interest of doctors in the final results own labor, stimulate their productivity growth and develop a preventive focus in their work. The amount of work required by a doctor to apply a filling for moderate caries is taken as 1 UET. Labor costs when performing more than complex types works are increasing. So, when applying a filling with deep caries the doctor performs 1.5 UET, when treating pulpitis of a single-rooted tooth in one visit 4.0 UET (for a two-root tooth - 5.0 UET, for a three-root tooth - 6.0). Treatment of periodontitis in a single-rooted tooth in one visit is estimated at 3.5 UET, for a two-root tooth at 4.5 UET, and for a three-root tooth at 5.5 UET.

A doctor with a six-day working week must perform 21 conventional unit labor intensity per working day, for a five-day - 25 UET. The annual workload per doctor is 5,500 UET.

The use of the principle of conventional units of labor intensity (UCL) provides for the following possibilities for intensifying the activities of dental institutions, taking into account budget financing and financing under compulsory health insurance programs:

1. reducing the number of visits to the patient to provide him with dental care, which, in turn, provides each patient with savings in his personal and working time spent on receiving this care, in the amount of 30% to 60% due to the reduction in travel and registration time , waiting for an appointment; providing a larger volume of assistance in one visit: treatment of 2-3 teeth for caries in one visit, treatment of pulpitis - in one visit, etc.;

2. saving the doctor’s working time by reducing the time spent on non-productive elements of the labor process (calling a patient, preparing the workplace, preparing surgical field, work with documentation, etc.);

3. reducing the number of such auxiliary elements of the labor process as the selection of instruments necessary to perform work, their sterilization (reducing the number of referrals for instruments for sterilization from 2-5 times, corresponding to the number of visits, to 1);

4. increasing the number of fillings applied per shift from 6 (according to standards focused on assessment by visits) to 10-12 due to the rational use of real working time of dental doctors.

5. increasing the overall labor productivity of dental doctors by 15-20%, and in some regions by 25%.

Performance indicators of the dental clinic

1. Provision of population with dental outpatient care:

Number of occupied dental positions in the clinic? 10000

Population in the area where the clinic operates

The standard is 5.0 per 10,000 adults and 5.0 per 10,000 children.

2. Staffing levels of dentists

Number of dentist positions filled? 100

Number of full-time dental positions

Norm – 100%

3. Average number of visits to dentists per resident per year:

Number of all visits to dentists by area residents

Population in the area where the clinic operates

The average number of visits per adult to dentists is 1.9; per 1 child – 1.4; total – 1.79.

4. Average number of UET produced by one doctor per day:

The total number of conventional units of labor intensity generated during the reporting period

Number of working days in the period? number of occupied medical positions

A doctor with a six-day working week must perform 21 conventional units of labor intensity per working day, with a five-day week - 25 UT.

5. Share of initial visits

Number of initial visits to the dental clinic? 100

Number of all visits made to the dental clinic

The average number of initial visits is about 45%

6. The ratio of treated and extracted teeth

Total teeth filled

Permanent dentition teeth removed

Under conditions of use modern technologies amounts to

7. Proportion of sanitized persons from among those who applied to the clinic

Number of people sanitized by turnover? 100

Total number of admitted primary patients

Must be at least 55-60%

8. Proportion of those in need of sanitation, among those inspected as planned

The number of those in need of sanitation out of those examined? 100

Total number of persons inspected as planned

On average reaches 70%

9. The share of sanitation in preventive work

The number of those sanitized out of those identified during planned sanitization? 100

Number of people in need of sanitation out of those examined

This figure should be close to 100%

TASK FOR INDEPENDENT WORK:

Task No. 1.

Based on the annual report of the medical institution, calculate the performance indicators of the dental clinic. Analyze the data obtained and draw a conclusion about the features of organizing the work of the dental clinic.

Lisitsyn Yu.P. Public health and healthcare. M, 2002.

Lisitsyn Yu.P. Social hygiene (medicine) and healthcare organization. Kazan, 1999. – p. 321- 339

Yuryev V.K., Kutsenko G.I. Public health and healthcare. S-P, 2000. – p. 399-415.

Public health and healthcare. Ed. V.A. Minyaeva, N.I. Vishnyakova M. “MEDpress-inform”., 2002. – p. 296-312.