Qualifying work of a dentist for the highest category. Certification work of a dentist-therapist of the highest category - abstract

A doctor who treats teeth has not only a specialization (therapist, surgeon, orthodontist, etc.), but also a category. How are they different from each other categories of dentists, What category does a dentist's career start with, and how can it be improved?

Categories of dentists and requirements for obtaining them

For all doctors, including dentists, upgrading is a natural part of professional growth. However, first of all, you need to become a dentist, and getting this profession is not so easy. First, yesterday's student must enter a medical school, and then master the educational program for several years in order to successfully complete it. Medical education is rightfully considered one of the most difficult: to obtain a medical diploma, you will need to work long and hard. Meanwhile, the profession of a dentist is quite popular. This is not only a very interesting specialty, but also one of the highest paid.

So, a career as a dentist begins with an appropriate education. During their studies at the university, students choose a specialization within which they will be able to upgrade their category in the future: therapist, orthodontist, periodontist, etc.

Graduation is followed by a new stage - internship. Only after completing it, the dentist can start working. During the practice, the doctor will gain professional experience and improve his skills. And in order to determine the level of qualification of a doctor and designate it, categories of dentists are assigned.

Like other doctors, dentists can upgrade their skills. The list of requirements corresponding to each category of dentists, as well as the procedure for their assignment, is established by law.

Each profession has its own categories, the number of which can reach six. As for the profession of a dentist, there are only three categories: first, second and highest. The rules for obtaining them are enshrined in Federal laws and orders of the Ministry of Health of the Russian Federation.

To get a higher qualification category, a doctor or pharmacist must pass certification. The procedure and terms for medical workers and pharmaceutical workers to pass certification to obtain qualification category approved

Clause 5 of the Procedure states that the category of doctor is valid for five years after it has been assigned. Paragraph 6 also clarifies that a doctor can try to pass certification for a higher category only three years after receiving the current category.

Clause 11 states that if a specialist received a category before 08/04/2013, it will be valid for the period for which it was assigned.

According to the first paragraph of the Procedure, the basis for obtaining a doctor of each category is the certification.

Initially, the doctor has a basic - the second category. Then, under certain conditions, he can receive the first, and after it - the highest category.

So, the main factor in assigning a new category of dentists is experience. But one diploma and several years of work as a dentist will not be enough.

In order to successfully pass certification, a doctor must constantly increase the base of theoretical knowledge and practical skills, improve his qualifications in various ways.

Although even this does not give any guarantee, since the decision on the compliance of the doctor with professional requirements is taken in person by the attestation commission.

• Dental clinic personnel management: selection, adaptation, motivation

Preparation for the assignment of the category of dentists

Stage 1. Creation of a commission that decides on assigning a qualification category to a doctor.

In order for a dentist to confirm his knowledge in order to obtain a new category of dentist, he must pass an attestation. The doctor is evaluated by an attestation commission, the procedure for creating which is indicated in clause 12 of the Procedure approved by Order of the Ministry of Health of Russia dated April 23, 2013 N 240n. Within the commission, a coordinating committee and groups of experts are distinguished.

For each specialty for which candidates will be assessed, a separate expert group is assembled.

According to clause 14 of the Procedure, the attestation commission should include:

• chief specialists of medical and pharmaceutical organizations;
• specialists from non-profit professional medical organizations;
• representatives of the state body or organization that collects the commission;
• representatives of the organization in which the candidate works;
• other persons.

Clause 14 of the Procedure also notes that a specific list of commission members must be approved by order of the state body or organization that forms this commission.

Stage 2. Transfer of a package of documents for consideration by the commission.

Documents should be submitted to the organization or state body that convenes the commission, no later than four months before the expiration of the category available to the dentist. It is possible to submit papers both in person and by mail. Clauses 20, 21 of the Procedure list the list of required documents:

1. An application addressed to the chairman of the commission signed by the doctor himself. It must contain the following data:

• Name of the applicant;
• what category he would like to receive;
• information about the existing category of dentist, including the date of its receipt;
• consent to receive and process personal data of a doctor;
• date of issue of the document.

2. Attestation sheet of a dentist, the form of which can be seen in the first appendix to the Order. The printed sheet must be certified by a personnel specialist.

3. Information about the work done for a certain period. For doctors with higher education, it is three years, with secondary education - one year. The report consists of two main parts:

• description of the work performed by the dentist;
• summing up the results of professional activity and developing options for its improvement.

The document must be signed by the dentist himself, as well as his employer; the seal of the organization is also required.

If for some reason the manager does not agree on the report for assigning the category of dentist, the specialist may require an explanation of the reasons in writing. He includes the received paper in his package of documents.

5. A certified copy of a work book and a diploma of higher or secondary specialized education, as well as other documents (certificates, certificates, etc.).

7. If the doctor changed his last name, first name or patronymic, a document confirming this fact is required.

Clause 21 of the Procedure clarifies that if the dentist submitted a package of documents late, an interview for assigning a new category can be held after the expiration of the current one.

Stage 3. Acceptance of documents by the commission.

The procedure for receiving documents from doctors is also regulated by the Procedure:

• when the documents are submitted by the dentist to the commission, they are entered into the registration log on the same day;
• then they check the correctness of filling out the application, compliance with the requirements for issuing an attestation sheet, as well as the availability of all necessary documents.

If any errors in the execution or incompleteness of the package of documents are found, the commission will refuse to accept the application for the doctor. A denial letter stating the reasons must be sent within a week. Having received it, the dentist will be able to correct the mistakes made and again submit his documents for consideration by the commission.

• Dental office nurse: basic requirements and functional responsibilities

What is the procedure for certification of dentists for the category

Stage 1. Checking professional skills.

A dentist can get a higher category only if he successfully passes an exam consisting of three parts (clause 7 of the Order):

• assessment by specialists of the report on the work done, prepared by the doctor;
• passing the test;
• face-to-face interview.

The purpose of these tests is to check the level of knowledge and skills of the dentist and to make sure that they really correspond to a higher category. It is precisely those skills that are directly related to the work in the specialty of this doctor that are evaluated. Also remember what a real specialist should know all about dental office cleaning and disinfectants .

According to clause 18 of the Procedure, the commission has the right to evaluate work for the category of a dentist only if at least half of all its members are present at the meeting.

Clause 19 regulates the keeping of the minutes of the meeting. The secretary is responsible for filling in the minutes, and after the meeting, the chairman and other members of the commission must also sign it. The form of this document is given in the second Appendix to the Order.

1. Consideration by the commission of the received package of documents. According to paragraph 17 and paragraph 24 of the Procedure, 30 days are allotted for this.
2. Also, within 30 days, a report on the work of the doctor must be considered. Based on the results of its study, the commission issues an official conclusion.
3. Within thirty days after the submission of documents, the date and place of the examination of the dentist must be determined. The specialist must learn about where and when the exam will take place at least 30 days before the appointed time. This information must be reported to the doctor personally, and can also be additionally posted on the Internet on the official website of the organization and on information stands. Clause 16 of the Procedure allows the remote conduct of the exam, as well as the format of the off-site meeting of the certification commission.
4. Interview and testing. Clause 24 of the Procedure establishes that the interview and testing must be carried out no later than 70 days after the dentist has submitted documents to the commission. As for testing, clause 25 of the Procedure establishes that the result is considered successful if the doctor correctly solved 70% of the test tasks.P. 26 of the Order states that the transition to an interview is possible only when the dentist has successfully completed the test part of the exam. Experts should find out whether the level of knowledge and training of the candidate corresponds to the category of dentist for which he is applying. To do this, members of the commission will ask questions related to the theoretical and practical aspects of work in the specialty being certified.
5. The decision to assign or refuse to assign a new category to a doctor, which is made based on the results of testing his knowledge (clauses 19, 27 of the Procedure).

All present members of the attestation commission take part in the voting. A simple majority vote is required to decide whether or not to assign a new category to a dentist. If the votes are equally divided, the decision is made by the chairman of the commission.

According to paragraph 19 of the Procedure, if the candidate is a member of the commission, then he cannot participate in the vote on assigning a category to himself.

Clause 27 of the Procedure contains a list of reasons that allow members of the commission to decide to refuse to assign a category:

• negative assessment of the progress report that the dentist submitted to the commission;
• unsuccessful passing by the candidate of the test part of the exam (less than 70% of correct answers);
• non-appearance of the doctor to the organization on the day of the test or interview.

According to paragraphs 28, 29 of the Procedure, the decision of the commission (if it was decided not to assign a category, the refusal must be justified) is recorded in the minutes of the meeting and in the certification sheet of the dentist.

Clause 19 of the Procedure provides that a member of the commission has the right to disagree with the final decision. In this case, he can express his opinion in writing and attach a paper to the protocol.

Stage 2. Issuance of an order to assign new categories to dentists and transfer of relevant documents to them.

Clause 32 of the Procedure provides that, based on the results of meetings of attestation commissions, an administrative act of a state body or organization is issued on the assignment of qualification categories to doctors.

Clauses 33, 34 regulate the procedure for informing the dentist about the decision. To do this, the secretary of the attestation commission must:

• make an extract from the relevant order, which reflects the results of certification and the assignment of categories of dentists to specialists;
• transfer the extract to each dentist personally, or arrange postal delivery. The deadline for delivery of the extract is also legally established - no later than 120 days after the doctor submitted the documents for registration;
• enter information about the delivery or mailing of the extract to the document registration log.

Stage 3. Appeal by the doctor of the decision made by the commission.

If a dentist believes that his attestation work for the category of a dentist is assessed unfairly, he can file a complaint with the state body or organization under which it was formed. Clauses 16, 35 of the Procedure establish that the doctor has the right to challenge the decision within a year after the decision is made.

• The clinic has implemented a system of continuous improvement: + 10 thousand per employee

What should a dentist's report per category look like?

Section 1. Introduction.

Information about the reporter. The volume of this part is about a page. The dentist should briefly describe his work and major achievements. It is worth noting the passage of advanced training courses, to mention the presence of professional awards.

Information about the place of work of the dentist. Here you need to provide basic data about the medical institution, such as the number of visits, types of procedures performed, etc. Particular attention should be paid to the distinctive features of the institution.

Information about the department in which the doctor works. It is necessary to briefly, but at the same time informatively describe the activities of the department, the established principles of labor organization, performance indicators for the reporting period. Provide information about the technical equipment (availability of equipment for conducting research, procedures, etc.), as well as about the workforce and the place the dentist occupies in it.

Section 2. The main part - information about the work of the dentist over the past three years.

All the given indicators should be compared with the annual analysis of the data of the last three years. A candidate for the category of a dentist may also compare similar indicators by place of work, city, region and country. If an infographic is used, it is mandatory to give an explanation to it, including:

Description of the contingent. Statistics relating to the age and sex characteristics of patients, the most common diseases, the characteristics of the course of the disease, etc. You can compare the characteristics of the contingent with previous years.

Diagnostic system. The doctor can highlight the most common diseases and describe the system for diagnosing them using tables, algorithms, etc. It will be a plus if the dentist demonstrates awareness of modern ways diagnostics, their possibilities, indications and contraindications.

Section 3. List of laws and official documents that the dentist is guided by in his work.

1. Type of document (order, resolution, letter, guidelines).

2. The state body that adopted the document (Ministry of Health, city or regional health department, government).

3.Date of acceptance.

4.Document number.

5. Full name.

Section 4. List of sources.

Author's articles, including those written with the participation of other doctors. It is necessary to provide a photocopy of the pages of the journal, if the article was published, a list of monographs, titles of reports and other materials written over the past five years.

List of specialty books read by the dentist over the past five years, as well as the literature that he used to prepare the report.

Surcharge for category dentists

Depending on the level of professionalism of the doctor and the set of skills that he owns, his salary also changes. After receiving the category of a dentist, a specialist can count on an increase.

Additional payments for the category can be received by both employees and heads of medical institutions.

The amount of the surcharge will depend on the underlying wages dentist.

Legislatively, the right to receive it is enshrined in the annex to the Decree of the Ministry of Labor of Russia No. 6.

The bonus is calculated as a percentage of salary.

The amount of the increase in the salary of a dentist depends on two factors:

• qualification category, which he possesses;
• position held by a doctor in a medical institution.

However, when determining the amount of the allowance, such a factor as the period of work of the doctor in his position is not taken into account.

Allowances are paid to the doctor on a monthly basis from the wage fund.

MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION

MUZ dental clinic №2

REPORT ON THE WORK OF A DENTIST

FOR 2008 - 2010

MATVEEVA VALENTINA IOSIFOVNA

Kaliningrad - 2011

Report plan

1. General information ………………………………………………. 3

2. Cabinet equipment and organization of work in

dental office…………………………….. 4

3. The work of a dentist at a therapeutic

reception. ………………………………………………………………5-19

4. Sanitary and educational work … ………………… 19-20

5. Sanitary and epidemiological mode of operation

Cabinet……………………………………………………….. 21-22

6. Conclusions ……………………………………………………… 23-28

1. General information

I have been working in the dental clinic No. 2 since August 1991. Polyclinic No. 2 provides therapeutic and preventive dental care to the adult population.

The clinic is located in a two-story adapted building at the address: st. Proletarskaya d.114. The polyclinic has a compressor room for supplying compressed air to dental units, a centralized washing and sterilizing room, a physiotherapy and X-ray room, and a reception desk. The polyclinic works in two shifts from 7.45 to 20.15 Saturday from 9.00 to 15.00. There are 2 medical departments and one denture department. In the medical departments there are 6 therapeutic rooms, 1 surgical room, 1 periodontal room, and an acute pain room. Treatment rooms are equipped with modern dental drills. Compressed air is centrally supplied to all turbine units.

2. Equipment of the office and organization of work in the dental office

The office in which I receive dental patients meets sanitary and hygienic standards. Equipped with a dental unit "Marus". There is cold and hot water, the necessary tools, a set of modern domestic and imported anesthetics and filling materials.

The load at the reception consists of primary coupons and repeated patients.

I work on the principle maximum number sanitation at the first visit.

The main tasks at the reception are:

1. Provision of qualified assistance to the population.

2. Carrying out sanitary and educational work, teaching oral hygiene.

3. Prevention of dental diseases.

3. The work of a dentist at a therapeutic appointment.

In recent years, the work of a dentist has undergone significant changes due to the use of:

1. Turbine installations, which makes it possible to use modern filling materials and makes the preparation of hard tooth tissues painless and fast.

2. More effective pain relief (alfacain, ultracain, orthocoin, ubestezin).

3. Modern filling materials (composites of light and chemical rejection).

4. Endodontic filling material: pastes for filling tooth canals with antiseptic, anti-inflammatory, restorative properties, gutta-percha pins and endodontic instruments.

I see patients with the following conditions:

1. Carious damage to the tissues of the tooth.

2. Complicated forms of caries.

3. Traumatic damage to the teeth.

4. Non-carious lesions of dental tissues.

5. Combined destruction of tooth tissues.

The office has a set of domestic and imported filling materials. Of the domestic ones, I most often use the following materials: unifas, phosphate cement, silidont, silicin, stomafil for fillings.

In case of deep caries, for medical pads I use drugs that have an anti-inflammatory effect and promote the formation of replacement dentin: calmecin, calradent, life, dykal.

In my work I prefer composite filling materials. Glass ionomer cements stabilize the process due to the fact that fluorine ions are released from them for a long time. I use cements such as stomafil, ketak molar, wind meter. These cements are used as cushioning, medical and restorative. Their advantages: ease of use, increased adhesion, biocompatibility with tooth tissues, high fluoride release, low solubility, strength.

Composite materials apply chemical and light curing.

From chemical available: alphadent, unifil, kompokur, charisma, etc.

From light-cured : herculite, filtek, valux, filtek-suprem, point, admira.

They have the following positive properties: color stability, good marginal fit, strength, good polishability.

Requirements for composite materials:

1. Good adaptation.

2. Water resistance.

3. Color stability.

4. Simple application technique.

5. Satisfactory mechanical strength.

6. Sufficiency of working hours.

7. Required depth of cure.

8. R-contrast.

9. Good polishability.

10. Biological tolerance.

Standard scheme for the use of composite materials:

1. Preparation of a carious cavity.

2. Color choice.

3. Applying a gasket.

4. Pickling.

5. Neutralization of acid.

6. Drying.

7. Adhesive application.

8. Restoration of the anatomical shape of the tooth.

9. Toning of the filling.

10. Strict adherence to instructions.

Composites classification

Curing method Purpose

Chemical Light Class A

Powder + curable for cavities I and II class.

Liquid one paste Class B

Paste-paste for cavities III and

The most common disease in dental practice is dental caries.

The most common classification is clinical and anatomical, which takes into account the depth of the spread of the carious process:

dental caries in the stain stage;

fissure caries;

superficial caries;

average caries;

deep caries.

Anatomical classification of cavities according to Black, taking into account the surface of localizations of the lesion:

1 class- localization of carious cavities in the area of ​​natural fissures of molars and premolars, in blind pits of incisors and molars.

Grade 2- on the lateral surfaces of molars and premolars.

3rd grade- on the lateral surfaces of incisors and canines without violating the integrity of the cutting edge.

4th grade- on the lateral surfaces of incisors and canines with violation of the integrity of the angle and cutting edge of the crown.

5th grade- in the cervical region.

Basic principles and sequence local treatment caries:

1. Anesthesia. The choice of anesthesia method is determined by the clinical and individual characteristics of the patient. The workplace has both domestic and imported anesthetics.

At present, we can firmly say that the problem of painless dental treatment has been solved. Used painkillers based on articaine relieve pain both in the treatment of caries of any localization and depth of the cavity, and all forms of pulpitis. Efficiency approaches 100%. On the upper jaw mainly infiltration anesthesia is used in the region of the root apex. On the lower jaw, the greatest effect is achieved by anesthesia near the condylar process of the lower jaw. Method: with the mouth as open as possible, the needle was injected 2 cm above the masticatory surface of the lower molars - up medially in the direction of the auditory canal. The duration of anesthesia is 2-4 hours.

2. Opening of the carious cavity: removal of the overhanging edges of the enamel, which allows you to expand the inlet into the carious cavity.

3. Expansion of the carious cavity . The enamel edges are aligned, the affected fissures are excised.

4. Necroectomy . Removal of all affected tissues from the cavity and the use of a caries detector to identify the affected dentin and leaving no traces in healthy areas.

5. Formation of a carious cavity. Creation of conditions for reliable fixation of the seal.

The task of operational technology- formation of a cavity, the bottom of which is perpendicular to the long axis of the tooth (it is necessary to determine the direction of inclination), and the walls are parallel to this axis and perpendicular to the bottom. If the inclination to the vestibular side - for the upper chewing teeth and to the oral - for the lower ones is more than 10-15 °, and the wall thickness is insignificant, then the rule for the formation of the bottom changes: it should have an inclination in the opposite direction. This requirement is due to the fact that occlusal forces directed to the filling at an angle and even vertically have a displacing effect and can contribute to the spallation of the tooth wall. This requires the creation of an additional cavity in the direction of the bottom to distribute the forces of masticatory pressure on thicker and, consequently, more mechanically strong tissue areas. In these situations, an additional cavity can be created on the opposite (vestibular, oral) wall along the transverse intertubercular groove with the transition to the side of the main cavity. It is necessary to determine the optimal shape of the additional cavity, in which it is possible to achieve the greatest effect of redistribution of all components of masticatory pressure with minimal surgical removal of enamel and dentin and the least pronounced reaction of the pulp.

The regularity of the action of forces of masticatory pressure on the tissues of the tooth and filling material.

a - the tooth is located vertically; b - the tooth has an inclination.

R, Q, P - direction of forces.

Often the pathological process goes beyond the carious cavity and the pulp and periodontium are involved in the process.

In recent years, the emotional perception of visiting the dentist's office has changed for the better thanks to the use of modern painkillers based on articaine. Low toxicity of the drug, rapid penetration into tissues, rapid removal from the body, high anesthetic effect allows the treatment of dental patients in a wider range: pregnant women, the elderly, children. Ultracaine does not contain a preservative that causes allergic reactions. The concentration of metabisulphate-antioxidant, a substance that prevents the oxidation of adrenaline, is minimal and is 0.5 mg per 1 ml of solution. Ultracaine is 6 times more effective than novocaine and 2-3 times more effective than lidocaine, the rapid onset of anesthesia is 0.3-3 minutes. allows you to maintain a favorable psycho-emotional background, the possibility of replacing conduction anesthesia with infiltration when working on the lower jaw. The properties of ultracaine listed above make it possible to use it in a wide range of dental diseases, in particular in the treatment of pulpitis.

Classification of pulpitis:

limited;

diffuse.

2. Chronic

fibrous;

· gangrenous;

hypertrophic.

3. Exacerbation of chronic pulpitis

Pulpitis treatment:

I. Without pulp removal.

1. Preservation of the entire pulp.

2. Vital amputation.

II. With the removal of the pulp.

1. Method of vital extirpation.

2. Method of devital extirpation.

3. Method of devital ammutation.

The canal is sealed, not reaching the top of 2 mm (data from MMSI named after Semashko), taking into account the state of the perapical tissues. Filling materials

1. Plastic:

non-hardening;

hardening.

2. Primary hard.

Plastic hardening materials called endo-sealers or sealers.

They are divided into several groups:

1. Zinc phosphate cements.

2. Preparations based on zinc oxide and eugenol.

3. Materials based on epoxy resins.

4. Polymeric materials containing calcium hydroxide.

5. Glass ionomer cements.

6. Preparations based on resorcinol-formalin resin.

7. Materials based on calcium phosphate.

Canal filling can be done using modern pastes and gutta-percha pins. In my practice, I most often use endomethasone, zinc-eugenol paste and paste based on resorcinol-formalin resin. I would especially like to note the work with endomethasone.

Endomethasone is a filling paste containing hormonal preparations, thymol, paraformaldehyde on a liquid basis of eugenol, anise drops. When filling the canals with this paste, a good therapeutic effect is achieved. The antibacterial properties of formaldehyde make it possible to use it in the treatment of chronic periodontitis with bone destruction at the root tips. Hormonal drugs reduce pain and inflammation, act plastically on the periodontium.

I perform root canal filling using the lateral condensation method, which is as follows.

1. Selection of the main gutta-percha pin (Master point).

A standard gutta-percha post of the same size as the last endodontic one, which was used to process the apical part of the canal (Masterfile), is taken and fitted in the canal. The pin does not reach the physiological tip by 1mm.

2. Selection of a spreader.

The spreader is selected the same size as the Master file, or one size larger so as not to go beyond the apical hole. The working length of the spreader should be 1-2mm. shorter than the working length of the canal.

3. Introduction to the channel of endosealant.

As an endosealant, I use AN +, endomethasone. The material is introduced into the canal to the level of the apical foramen and is evenly distributed along the walls of the canal.

4. Introduction of the main pin into the canal.

The pin is covered with filling material and slowly inserted into the canal to its working length.

5. Lateral condensation of gutta-percha.

A previously selected spreader is inserted into the root canal, while the gutta-percha is pressed against the canal wall.

6. Removing the spreader and inserting an additional pin.

7. Lateral condensation of gutta-percha, removal of the spreader and insertion of the second additional pin.

The operation is repeated until the canal is completely obturated, i.e. until the spreader stops penetrating the canal.

8. Removal of excess gutta-percha and paste.

9. X-ray quality control of filling.

10. Applying a bandage.

Classification of periodontitis:

I. Acute periodontitis

· serous;

purulent.

II. Chronic periodontitis

fibrous;

· granulating;

granulomatous.

III. Exacerbation of chronic periodontitis.

Acute periodontitis and exacerbation of chronic periodontitis of single-rooted teeth are treated under anesthesia in one visit using one of the listed pastes and gutta-percha pins, and sent to the surgical room for an incision in the area of ​​​​the projection of the root apex.

Treatment of destructive forms of periodontitis is carried out in several stages. For temporary canal filling, I use calcium-containing preparations: "Kollapan", "Kalasept", which allow you to successfully cope with the periapical infection and destruction of bone tissue. Repeat R-images after 6 months show either a decrease in bone destruction or restoration of the structure of bone trabeculae, which later form the bone, depending on the condition immune system this patient. If the conservative method did not lead to the desired effect, then the patient is sent to the surgical room to remove the cyst or cystogranuloma.

I check the long-term results in 3-6 months together with the surgeon. After the operation, the teeth become immobile, and after 3-6 months, bone tissue is visible in the place of the cyst in the R-image.

In the treatment of teeth with impassable root canals, I use copper-calcium hydroxide depophoresis. In addition, this method is used in case of severe infection of the contents of the canal, breakage of the instrument in the lumen of the canal (without going beyond the apex).

While working with the patient, I explain to him the chosen method of treatment and possible complications, the need to remove the roots and timely prosthetics. I explain the impact of bad habits on the state of the oral cavity.

The constant improvement of the equipment of the office and clinic with equipment and dental materials allows us to receive patients at the modern level.

Working with modern filling materials

Filling is the final stage in the treatment of caries and its complications, which aims to replace the lost tooth tissue with a filling.

The success of treatment largely depends on the ability to choose the right material and use it rationally.

Recently, light-cured composite materials have become widely used, which perfectly imitate tooth tissues in a number of indicators. Properties such as color gamut, transparency, abrasion resistance and polishability have greatly expanded the possibilities of restoring teeth without prosthetics. The process of restoring damaged teeth directly in the oral cavity in one visit is called restoration.

Filling is a purely medical procedure, while restoration combines elements of medical and artistic work.

Stages of restoration (filling):

1. Patient preparation.

2. Tooth preparation.

3. Restoration (filling).

It is necessary to teach the patient how to properly brush his teeth, remove dental deposits, if necessary, send him to a periodontal office. All surgical interventions should be carried out before treatment. The improvement of gum tissue is also important because the maximum effect is achieved with a combination of even healthy teeth and pale pink gums.

The main requirement for the restoration of teeth with light-curing materials is the exact and methodical observance of the instructions. Only when all the technological steps are completed, the necessary adhesion of the composite to the tooth tissues will be achieved and a good cosmetic result will be obtained. Despite some differences in the use of composites from different companies, there are general principles at work.

Preparation of a tooth for restoration includes the following manipulations:

1. Removal of altered tissues.

2. Formation of the edges of the enamel.

3. Removal of plaque from the surface of the tooth.

4. Opening of prisms.

5. Isolation from moisture and drying.

6. Applying a gasket.

7. Formation of the basis of the restoration.

8. Etching of tooth enamel.

9. Primer application.

10. Adhesive application.

It is necessary to stop at some stages of tooth preparation, namely, the opening of enamel prisms. This somewhat conventional expression implies the removal of the superficial thinnest structureless layer of enamel, which covers the prism beams. It is believed that the removal of the structureless layer and subsequent etching of the enamel with acid will create favorable conditions for fixing the composite. It is especially important to do this in cases where the composite is applied to a significant surface of the enamel (with hypoplasia, erosion, chipping of part of the crown).

Etching of tooth enamel produced in accordance with the instructions attached to the material. It should be remembered that excessive etching should not be allowed, since the changing structure of the enamel does not provide optimal adhesion conditions. Careful removal of the acid or gel is very important. In terms of time, the washing of the etching area should be at least 20 seconds. This is followed by thorough air drying.

Etching of dentine is carried out simultaneously with etching of enamel. This achieves the removal of the smeared layer and the formation of inter-collagen spaces, which are filled with a primer.

The primer is applied with a clean brush dentin, and after 30 sec. air from the gun removes excess volatile components of the preparation, the primer getting on the enamel does not affect the adhesion of the composite.

Application of adhesive is the final step in preparing the tooth for filling. The adhesive is introduced into the cavity with a brush and then with an air jet

evenly distributed along the walls. If the adhesive is chemically cured (two-component), then it does not need to be illuminated, but if it is light-cured (one-component), then it is reflected by the lamp. Usually it is 10 sec.

Restoration (filling) of the tooth

This stage includes:

1. Anchor introduction.

2. Application of the composite.

3. Curing of the composite.

4. Formation of the surface of the restoration.

5. Finishing reflection.

1. With a significant destruction of the tooth, I use anchor pins. Anchor pins are of various types, sizes - length and diameter of the section vary from 1 to 10 units. An important stage of restoration is the fitting of the anchor. The anchor must fit snugly into the channel to a certain depth. I think the most optimal is 2/3 of the root in the anterior group of teeth and up to ½ in the lateral ones. Anchor pins are screwed in until they stop, with a special tool, dissolving the petals. I always cover the anchors with light-cured material Opak to avoid its translucence through the layer of the main composite.

2. The introduction of the composite is carried out using trowels that do not have defects. With deep cavities, the composite is applied in layers (up to 3 ml). This is especially important with light curing materials. The “lunge” formed on the surface of the composite, called the “oxygen inhibited layer”, ensures the connection of the layers of the composite without adhesive. This layer cannot be damaged - washed, polluted. The curing of the material is associated with shrinkage that appears in the direction away from the light source.

3. The next step is grinding and polishing. First of all, it is necessary to remove excess materials with the help of burs. It is important to create the main details of the surface shape: the longitudinal stripes of the incisors, the cusps and the fissures of the molars. After correcting errors and re-finishing, the surface of the restoration is polished with plastic or rubber heads. Contact surfaces are polished using strips and flosses. The final processing of the restoration is carried out using sponges and polishing pastes. At the end of the work, a final reflection is carried out. The maximum effect is achieved with a perpendicular position of the light beam.

4. Sanitary and educational work

For any country, it is cheaper to prevent a disease than to treat it, so health education should be a state program.

The dentist is obliged to conduct sanitary and educational work with the population. 70% of the condition of the oral cavity depends on the patient himself. First of all, how and with what he brushes his teeth. In domestic pastes, highly alkaline chalk with low whiteness and a high content of highly abrasive oxides of aluminum and iron is used. Therefore, our pastes do not foam well and have a grayish color. If they are used constantly, they can lead to thinning of the enamel. The chalk used by Western firms is devoid of these shortcomings. Antimicrobial components, plant extracts, mineral resins, fluorine are introduced into the pastes.

Russian, Bulgarian, Indian pastes are 90% hygienic.

I recommend Colgate, Blend and Honey, Signal, Pepsodent pastes to my patients. These pastes contain chlorhesedin - which helps fight bacterial plaque, cleaning agents, fluorine. The effectiveness of fluorinated pastes in the fight against caries is 30%.

I have conversations with patients. List of conversations:

1. Oral hygiene.

2. How to choose the right toothbrush and paste.

3. Prevention of dental diseases.

I conduct explanatory work about bad habits.

For three reporting periods, I prepared and heard at medical conferences abstracts on the topic:

1. HIV infection in the oral cavity.

2. Root canal treatment technique.

3. Mistakes and complications during canal instrumentation.

5. Sanitary and epidemiological regime in the office

The dental office where I work complies with sanitary standards (24 sq.m.). Availability of cold and hot water. The cabinet is equipped with a bactericidal lamp, which is turned on 3 times a day for 30 minutes. There are centralized air sterilizers. They keep a log of their work. I use disposable masks, gloves, goggles.

Daily three times wet cleaning using 5% lysitol or alominal 5% or septodor-forte.

General cleaning once a month.

The rules of personal hygiene and measures for the prevention of self-infection of AIDS and VG "B" are observed. If blood gets on the intact skin of the hands, the blood should be removed with a dry swab, then wiped with a 70 ° alcohol solution or 0.5% alcohol solution of chlorhexidine 2 times, wash hands with soap and treat with alcohol.

If blood has got on damaged skin, it is necessary to squeeze out blood from the wound, lubricate with 5% iodine solution, wash hands with soap and treat with 70% alcohol solution.

All manipulations with patients are carried out in rubber gloves, mask, glasses.

If saliva gets on the mucous membranes of the eyes, they must be washed with a stream of water or a 1% solution of boric acid and a few drops of silver nitrate should be introduced. It is recommended to treat the nasal mucosa with a 1% solution of protargol, the mouth and throat additionally (after rinsing with water) with a 70% alcohol solution or a 1% solution of boric acid.

After removing gloves, hands are treated with 70% alcohol and soap.

Tips for drills, emptyers, ultrasonic instruments, needleless syringes after each patient are wiped with a sterile swab moistened with 70% alcohol (twice). At the end of the shift in 6% hydrogen peroxide for 1 hour.

Sighting mirrors are collected in a storage glass with a 6% hydrogen peroxide solution, then washed with water, a detergent-disinfectant solution for 15 minutes, rinsed, dried with a swab and immersed in a 0.5% alcohol solution of chlorhexidine or 70% alcohol for 30 minutes. After that, "clean mirrors" are transferred to the container.

Modern aseptic solutions, such as septador-forte, lysitol (5%) do not require pre-treatment washing solution.

Burs - after use, they are immersed in a container with a solution of septador-forte for 1 hour. After rinse with a brush with a swab for 3-5 minutes. After that, the burs are subjected to pre-sterilization treatment and exposure for 15 minutes. The burs are then washed with a brush. Irrigation for 10 minutes with distilled water, air sterilization method at a temperature of 180 ° and 1 hour in a Petri dish. Used burs are placed in the "Bar Disinfection" container.

All other instruments used in the treatment are subject to a full cycle of processing for the prevention of viral hepatitis and AIDS. Immediately after use, the instruments are rinsed in a disinfectant solution marked "Rinse in disinfectant solution" and immersed in the "Instrument Disinfection" container with lysitol or alominal for 1 hour. Then they are washed under running water for 3-5 minutes.

All instruments, including pulp extractors and canal fillers (newly obtained) are subject to disinfection with alcohol, washing with water, pre-sterilization treatment and sterilization.

There should not be anything superfluous on the doctor's table. The table should be wiped with a 6% hydrogen peroxide solution or disinfectant.

Cotton swabs must be sterile (steam sterilization at a temperature of 120 degrees for 20 minutes, change after 6 hours).

conclusions

The reforms carried out in our country since the 90s have also affected the dental service – market factors began to work, competition appeared, the opportunity for patients to choose a clinic and an attending physician.

At present, we can firmly say that the problem of painless dental treatment has been solved. Pain medications used

"Ultracain" relieve pain both in the treatment of caries of any localization and depth of the cavity, and all forms of pulpitis. Efficiency approaches 100%.

In the competitive struggle for patients, attention should be paid to the provision of highly qualified dental care in the shortest possible time, as a result of which the number of visits to the dentist is reduced to a minimum due to the effective use of modern technology and materials; such as carpool anesthesia, which allows you to completely remove the patient's sensitivity to the doctor's instrumental manipulations and the restoration of teeth with composite materials, whose advantage is that the work is carried out in one visit and the patient does not experience discomfort associated with the presence of turned teeth. Once every six months, the patient visits the dentist to polish the surface.

When carrying out restoration work, high-class materials and equipment are used that allow opening the tooth cavity without vibrations.

Among the patients of dental clinics and offices, interest in the aesthetic side of dental treatment has recently increased, the desire to have fillings that do not differ in color from natural teeth.

In this regard, training in methods of working with composite materials remains a serious problem. At present, the creation of the image of a highly qualified specialist is impossible without the introduction of light-cured composite materials of new generations into practice.

Participation in all-Russian dental forums, seminars for dentists, medical conferences in the clinic allows us to become more familiar with the achievements in dentistry, and also gives us the opportunity to master modern methods treatment of dental diseases.

For three reporting years 2002 - 2004 at a therapeutic appointment.

QUALITATIVE INDICATORS

CONCLUSIONS

1. There is a decrease in the number of working days in 2003, as the polyclinic was undergoing a major overhaul. This was also affected by the increase in the number of vacation days in connection with the provision of 12 additional days for working with hazardous materials.

2. In 2003, there was a decrease in the number of admitted patients per day due to the reconstruction of the polyclinic, the re-equipment of offices with modern dental units. In their work, they

more modern light-polymer materials are used, which require more time for this work.

3. The number of fillings delivered per day has decreased due to preventive and restoration work using modern light-polymer materials, which require more time to work with.

4. The treatment for caries decreased by 14.6%, as the treatment of teeth with complicated forms of caries on previously treated teeth by amputation methods and overtreated root canals increased by 15.8%.

5. The rate of treatment of teeth with complicated forms of caries has increased due to the use of modern endodontic instruments, filling materials for root canals.

6. The use of modern anesthetics and endodontic instruments made it possible to use the method of one-session treatment of complicated forms of caries more widely compared to 2003 by 10.5% in 2004. More than 64% of complicated forms of caries are treated in 1 visit.

7. Patients are admitted mainly by appointment. This may explain the decline in the number of sanitized patients.

8. To increase the amount of UET per day in 2004. the transition of work by order No. 277 and the treatment of complicated forms of caries in 1 visit affected.

9. Due to the use of modern filling materials, endodontic instruments, depophoresis, which require repeated visits to the dentist, the SU has increased by 1 sanitation. This was also affected by work on order No. 277.

In 2004 the number of teeth cured with a conservative method for chronic granulomatous periodontitis has increased due to the use of modern filling materials for root canals, which contain calcium-containing preparations in their composition.

If in 2002 11 teeth with DS were successfully treated by a conservative method: chronic granulomatous periodontitis, then already in 2004. 19 teeth. In the treatment of these teeth, the depophoresis method was also used. The use of the depophoresis method and calcium-containing preparations makes it possible to successfully cope with periapical infection and bone tissue destruction. Repeated R-shots after 6 months show a decrease in bone tissue destruction. Of the 19 teeth, after 12 months, 14 have a restoration of the structure of the bone trabeculae, and after 24 months, a complete restoration of the bone structure in all treated teeth with DS: chronic granulomatous periodontitis.

St. Petersburg, 2004

• Introduction
  • About the author
  • Characteristics of the place of work
• Certification material for the last 3 years
  • caries
  • complicated caries
  • preparation for prosthetics
  • non-carious lesions of the teeth
  • aesthetic restoration of teeth
• Training
• Conclusion

I Introduction

About the author

I, Full Name, 19 .. year of birth, in 19 .. she graduated from the 1st Leningrad Medical Institute. Academician I.P. Pavlov, Faculty of Dentistry, majoring in dentistry.

From 19.. to the present, I have been working as a dentist of the 1st therapeutic department in the dental clinic No. ... of the administrative district of St. Petersburg.

Characteristics of the place of work

In the treatment room there are 6 medical chairs with stationary dental units "Hiradent 654" and "Hiradent 691". The office is equipped with the necessary tools and equipment for the diagnosis and treatment of diseases (devices DSK-2, EOM-3, etc.)

Sterilization of instruments is carried out centrally in the sterilization room. The Terminator apparatus is used to process the tips. Boras and instruments are processed and sterilized by a nurse. For endodontic instruments, there is a glassperlenic sterilizer. Small tools are stored in the Ultraviol shelf.

There is a bactericidal chamber UF-KB-I-FP for storage of sterile medical instruments. To work with light-curing composites, I use lamps - dental polymerizer "ESTUS-Profi", "Cromalux", etc.

II. Certification material for the last 3 years

My main tasks are the treatment and prevention of dental diseases among the adult population of the region. I usually accept patients on CHI. The working shift lasts from 5.5 to 6.5 hours. During a shift, I provide assistance to an average of 11-12 patients, of which 4-5 are primary. During a working day, I fill an average of 13 teeth, 2-3 of them with complicated forms of caries. There are 1-2 sanitation per day. From time to time I work in the duty room of the polyclinic, where I provide emergency dental care to the population.

During the reporting period (2001-2003), I examined a total of 7638 patients, of which 2702 were primary, 849 patients were sanitized, which is an average of 33.1% of the number of primary patients. During the reporting period, 8704 teeth were cured, including 6861 caries, 1843 complicated forms.

I start working with the patient by taking an anamnesis, then I conduct an external examination and examination of the oral cavity, in which I determine the hygiene index, identify bite pathologies, assess the condition of the oral mucosa, and be sure to palpate the submandibular lymph nodes. Based on the data obtained, I make a diagnosis and draw up a treatment plan.

REPORT ON THE WORK OF A DENTIST
FOR 2008 - 2010
MATVEEVA VALENTINA IOSIFOVNA

Kaliningrad - 2011

Report plan

2. Cabinet equipment and organization of work in

dental office…………………………….. 4

2. Equipment of the office and organization of work in the dental office

3. The work of a dentist at a therapeutic appointment.

In recent years, the work of a dentist has undergone significant changes due to the use of:

Turbine installations, which makes it possible to use modern filling materials and makes the preparation of hard tooth tissues painless and fast.
More effective pain relief (alfacain, ultracain, orthocoin, ubestezin).

1. Good adaptation.

2. Water resistance.

3. Color stability.

4. Simple application technique.

5. Satisfactory mechanical strength.

6. Sufficiency of working hours.

7. Required depth of cure.

8. R-contrast.

9. Good polishability.

biological tolerance.

Standard scheme for the use of composite materials:

1. Preparation of a carious cavity.

2. Color choice.

3. Applying a gasket.

4. Pickling.

5. Neutralization of acid.

6. Drying.

7. Adhesive application.

8. Restoration of the anatomical shape of the tooth.

9. Toning of the filling.

10. Strict adherence to instructions.

Curing method Purpose

Powder + curable for cavities I and II class.
Liquid one paste Class B
Paste-paste for cavities III and

IV-V class.

dental caries in the stain stage;
fissure caries;
superficial caries;
medium caries;
deep caries.

1 class- localization of carious cavities in the area of ​​natural fissures of molars and premolars, in blind pits of incisors and molars.

Grade 2- on the lateral surfaces of molars and premolars.

3rd grade- on the lateral surfaces of incisors and canines without violating the integrity of the cutting edge.

4th grade- on the lateral surfaces of incisors and canines with violation of the integrity of the angle and cutting edge of the crown.

5th grade- in the cervical region.

Anesthesia. The choice of anesthesia method is determined by the clinical and individual characteristics of the patient. The workplace has both domestic and imported anesthetics.

The regularity of the action of forces of masticatory pressure on the tissues of the tooth and filling material.

1 and 2 - correct; 3 - incorrect design of the cavity.

R, Q, P - direction of forces.

a - the tooth is located vertically; b - the tooth has an inclination.
R, Q, P - direction of forces.

Often the pathological process goes beyond the carious cavity and the pulp and periodontium are involved in the process.
In recent years, the emotional perception of visiting the dentist's office has changed for the better thanks to the use of modern painkillers based on articaine. Low toxicity of the drug, rapid penetration into tissues, rapid removal from the body, high anesthetic effect allows the treatment of dental patients in a wider range: pregnant women, the elderly, children. Ultracaine does not contain a preservative that causes allergic reactions. The concentration of metabisulphate-antioxidant, a substance that prevents the oxidation of adrenaline, is minimal and is 0.5 mg per 1 ml of solution. Ultracaine is 6 times more effective than novocaine and 2-3 times more effective than lidocaine, the rapid onset of anesthesia is 0.3-3 minutes. allows you to maintain a favorable psycho-emotional background, the possibility of replacing conduction anesthesia with infiltration when working on the lower jaw. The properties of ultracaine listed above make it possible to use it in a wide range of dental diseases, in particular in the treatment of pulpitis.
Classification of pulpitis:

1. Sharp

limited;
diffuse.

fibrous;
gangrenous;
hypertrophic.

Classification of periodontitis:
I. Acute periodontitis

serous;
purulent.

fibrous;
granulating;

granulomatous.

MBUZ State Polyclinic No. 2

Chief Physician

"____" _____________ 2011

WORK ANALYSIS

for 2008-2010

surgeon dentist

Novosibirsk city

1. Description of the workplace.

2. Methods of examination.

3. Anesthesia technique.

4. Method of treatment.

5. Analysis of complications and their causes.

6. Clinical examination.

7. Analysis of medical activity.

8. Sanitary and educational work.

9. Clinical cases.

10. Conclusion.

11. Literature.

1. DESCRIPTION OF THE WORKPLACE:

The dental clinic, of which I am an employee, is located in a 2-storey building and is multidisciplinary. The clinic has a reception, physiotherapy, X-ray rooms.

The clinic is open from 07:30 to 20:00 on weekdays and from 09:00 to 15:00 on Saturdays. Reception by doctors is carried out in two shifts. Primary patients receive coupons at the reception, there are logs of preliminary appointments for appointments with doctors of any profile. Repeated patients are appointed by a doctor.

The work of the X-ray room is organized in two shifts, the equipment of the room allows you to receive both intra- and extra-oral images.

The work of the physiotherapy room is organized in two shifts. The cabinet is equipped with devices for galvanization and electrophoresis, amplipulsephoresis, Darsonvalization, UHF, fluctuorization, ultrasound and ultraphonophoresis and for phototherapy (quartz).

The dental clinic is equipped with a treatment and prevention room, a surgical room, an orthopedic room, a children's department and a dental laboratory. The surgical room in which I conduct an appointment consists of three rooms: the first, with an area of ​​12 sq. m., for the processing and disinfection of instruments, the second - the actual surgical room for two workplaces, with an area of ​​34.8 sq. m., the walls are tiled to the ceiling, the ceiling is painted with oil paint, the floor is tiled, there is one window. There are two chairs of the KSEM-03 type in the office, two tables of a dentist, two shadow-free lamps SM-28, a BEPB-06 drill, a ShSS-80 dry-heat cabinet, two UV-bactericidal chambers for storing sterile instruments ("Ultra-Light" ), laser apparatus MITs-Photon-03. In addition, there are 2 cabinets for storing medicines, 2 tables for the work of a nurse, 2 desks with bedside tables for storing documentation. The sink is equipped with two dispensers for treating the surgeon's hands (the first one with bactericidal liquid soap, the second one with Lizanin skin antiseptic). The office is designed for daily admission of patients, performing current surgical procedures.

All three rooms are equipped with 4 UV germicidal ceiling lamps.

Autoclaving of material and linen is carried out in an autoclave located separately from the cabinets.

The operational activity of surgeons develops as patients are selected, doctors themselves form their own operating plans. Each of the operating surgeons performs 6-8 planned operations per week.

The staff of the clinic provides home care. Calls are served 3 times a week from 9-00 to 14-00 hours by car. Doctors of surgical reception provide assistance at home according to the established order, coupons are removed for the duration of the call. Me in 2008-2010. 248 calls were serviced.

2. EXAMINATION METHODS:

Examination of the patient begins with an assessment of the patient's complaints, clarification of the anamnesis, then an examination is performed.

It should be noted the importance of careful collection of anamnesis and complaints of the patient. This allows you to find out the etiology of the underlying disease, concomitant diseases, the presence or absence of allergies to medications.

Examination of the patient includes the exclusion of pathological asymmetry of the face, the assessment of the color of the skin and mucous membranes, their moisture content, the opening of the mouth and the possibility of lateral movements of the lower jaw, the mobility of the tongue, and the assessment of the bite. Mandatory palpation assessment of the state of regional lymph nodes- chin, submandibular, cervical, retromaxillary; large salivary glands with control over discharge from the excretory ducts, as well as lesions. During the examination, the condition of the patient's teeth, their mobility, the presence or absence of gum pathology is necessarily recorded. Of great importance in the diagnosis is radiography, if necessary, contrast sialography is performed; for diagnostic purposes, a cytological examination of scrapings from lesions is performed; puncture of lymph nodes with an assessment of the discharge; biopsy followed by histopathological examination. The material taken with the help of a biopsy is preserved and sent to the pathohistological laboratory of the ICD No. 12, where the examination of materials obtained during operations is also carried out.