Codes for the Dentistry of the ICD 10. The Protocol for Maintaining Patients Complete Lack of Teeth (complete secondary adenatia). If without a delicate of a constant tooth, then

All over the world, it is customary to unify medical diagnoses to use a unified classification: an international classification of diseases (hereinafter referred to as ICB). At the moment, the world has the tenth edition of the ICD-10. The classification of diagnoses is developing and approved by the World Health Organization (WHO). A new revision (ICD-11) is planned to be planned in 2022.

In Russia, the International Classification of Diseases of the 10th Review (ICD-10) adopted as a single regulatory document for accounting for incidence, reasons for people's appeals to medical institutions of all departments, causes of death.

The ICD-10 has been introduced into the practice of health throughout the territory of the Russian Federation in 1999 by order of the Ministry of Health of Russia from 27.05.97. №170. Those. This is a full-fledged regulatory act, mandatory for execution.

So, now we know that in the Russian Federation, the use of ICD-10 is mandatory. And this means only one thing: if the diagnosis of the ICD is not diagnosed, then it is legally considered not at all. And it is very serious.

Our big headache is that the so-called "old school" is used to using Soviet classifications that differ from the ICD. The country has not previously been part of the WHO system, and therefore used his own classifications. They are not bad and not good - they are just others. But you, colleagues, should clearly know - no classification, except ICB-10, has no legal significance.

We will specify that the law is allowed to supplement (and not substitut!) Diagnoses on the ICD-10 additional diagnosis for any domestic classification.

For example: Diagnosis from MKB-10 K08.1 The loss of teeth due to an accident, removal or local periodontal disease can be supplemented (clarify) by the diagnosis of Kennedy classification (1 class, etc.). Those. It is permissible, and sometimes correctly, write two or more diagnosis.

But we once again pay attention - the main diagnosis must be on the ICD-10. If you have written only a diagnosis from the "old Soviet" classification, even if it is faithful, you did not put a legally diagnosis.

Unfortunately, the legal side of the issue of diagnostics at the institute and even in postgraduate education is not paid completely to any attention. And this directly affects the risks of the physician insecurity under conditions of ever-increasing pressure on the part of patients and state orders. And they know the laws very well and apply them literally. I am confident that many colleagues, reading this material, are aware of the need to get acquainted in more detail with the ICD-10 and the possibilities of its proper use in their practice.

Let's wonder on several examples typical errors and delusions of dentists. Cases take not the most standard.

Example 1:

The starting situation - the patient comes to the dentist - an orthopedic with the already installed implants, for them the formists, no crown. It does not matter whether he has no teeth or completely. No pathology in the oral cavity, implants are integrated, the gums are healthy, only prosthetics are required. Question - What is the diagnosis of orthopedist in this case? The overwhelming majority of orthopedic doctors respond to this question like this: K08.1 Loss of teeth due to an accident, removal or local periodontal disease. And that's it. But the answer is not correct or not complete (depends on the number of missing teeth and substituted by implants).
The fact is that for such a situation in the ICD-10 there is its own separate diagnosis. And he sounds like this: Z96.5 The presence of teeth implants and jaws. Next, we simply carry out clarification - in the area of \u200b\u200bwhat teeth implants are installed. And if the jaws left toothless areas - then we absolutely complement this diagnosis by another, familiar and familiar "K08.1 loss of teeth due to an accident, removal or local periodontal disease." If all remote teeth are substituted with implants, then we leave only the diagnosis of Z96.5. Diagnosis K08.1 Relevant for the surgeon, when he only plans to put implants. For orthopedic with already installed implants, the diagnosis is already different.

Example 2:

The patient comes to receive with previously installed orthopedic structures. No pathology, orthopedics, teeth, implants, gums, roots - in perfect order. He appealed for professional view or hygiene. What are the diagnosis?

Almost all doctors answer that since there are no complaints and pathologies, since nothing needs to be done - it is not necessary to diagnose any diagnosis. And for some reason, they do not take into account the fact that the presence of witty teeth, implants, artificial orthopedic structures - this cannot be considered a healthy state without a diagnosis. For such cases in the ICD-10 there is a ready diagnosis: Z97.2 The presence of a dental device. If prostheses on implants - add already known to us Z96.5. We specify in the description of the teeth number, where orthopedics, where implants, etc. If removable prosthetics are used, add everyone a favorite adventure: k08.1, you can do the same class by Kennedy or Gavrilov. Remember that if you found some pathology or the patient came with complaints that were confirmed in the form of a diagnosis, it is the diagnosis and will be the main one, and then all auxiliary in the form of prostheses or implants.

Example 3:

Visit for fitting and correction of orthopedic design. Take an example of a single crown on the tooth when all other C \u003d teeth are saved and intact in the oral cavity. What will be diagnosed with orthopedic? For some reason, all doctors crave to repeat the previously therapeutic diagnosis - caries, pulpitis, periodontitis, injury (chip). But it's not right! At the time of prosthetics, no caries, nor the pulpitis, n no longer, the therapist cured them. Moreover, prosthet teeth with such diagnoses before their elimination is prohibited. So write in the map? And we write another special diagnosis of ICD-10, specially created for such cases: Z46.3 Fitting and fitting of the denture device. Those. Cured tooth requiring prosthetics. Everything is simple and understandable, and most importantly is legally correct. We write the same diagnosis when we try any orthopedic design.

There is another diagnosis of ICB-10 for orthopedists, used for fitting: z46.7 Fitting and fitting of the orthopedic device (brackets, removable prosthesis). It can also be used in cases, in it described (removable prosthetics).

Example 4:

Orthodontist sucks repeatedly, activates, modifies its orthodontic apparatus. What diagnosis will write? It seems to be asking for the one from which treatment began. And in some cases it will be correct. But often, the devices are applied in terms when, after prolonged treatment, recurrence, population, dystopia, three and bite have already been eliminated, and there is already a completely different kind (and therefore the diagnosis), which does not match this at the time of treatment. So, in order to invent anything and do not bother, use a special diagnosis for such cases from the ICD-10: Z46.4 Fitting and fitting an orthodontic device.

Example 5:

Not so often, but there is a situation in our practice when the patient is asking for non-medical, but cosmetic work. Those. When he does not have any medical problems at all.
Typical two cases are whitening teeth and veneers. The patient is either asking to make the color lighter, or use veneers solely with a cosmetic target (form, Bleach color). The reasons for these desires can be different, but in any case the patient has the right to want to look like that, and the doctor has the full right to give him this help if there is no contraindications.

Now the main question is - once the patient is not sick with anything, the teeth are intact, and we do something to him - what do we write in the map as a diagnosis? The situation is very similar to plastic surgery, when without any diseases and pathologies, purely cosmetic correction of the shape of the ears, nose, eyebrows, lips, chest, etc. is made. And of course, such situations in the ICD provide its code and diagnosis: Z41.8 Other procedures that do not have therapeutic purposes. We write it and further specify the type of procedure.

Example 6:

Surgeons are now rejected. In practice, it is necessary to extract non-corrosive membranes and pins after bone plast. At the same time, the starting diagnosis in the form of atrophy of the alveolar process no longer write - it is already restored just by this same bone plastic. The diagnosis of adventure does not correlate with the planned intervention, because Adenity is not treated with the extraction of the titanium membrane or Pina. Z47.0 Removal of the plate after the fighting of the fracture, as well as another internal locking device (Removal: nails, plates, rods, screws). Let anyone confuse the word "fracture", this is part of the diagnosis, which is important for us what is written after "... and also." Those. If we simply remove the titanium membrane, the pin \u003d you or pins and do not carry anything else in this visit, we write like this: Z47.0 Delete __________ (the name of what was deleted).

Example 7:

Now about complications after implantation, early and remote.

T84.9 Complications associated with an internal orthopedic prosthetic device, implant and graft, unspecified.

The most "favorite" diagnosis of implantologists - perimplantite - oddly enough, is absent in the ICD-10. So what to do? In the ICD for perimplantite there is a replacement.

To diagnose complications after implantation in the ICD there are diagnoses divided by a feature - mechanical or infectious.

In case of problems with implants, blocks or membranes, depending on the infection or mechanical cause of the problem, we write like this:

T84.7 Infection and inflammatory reaction due to other internal orthopedic prosthetic devices, implants and grafts

T84.3 Complication of mechanical origin associated with other bone devices, implants and grafts (mechanical breakdown, offset, perforation, incorrect position, protrusion (protrusion), leakage).

T85.6 Complications of mechanical origin associated with other refined internal prosthetic devices, implants and grafts

The same diagnosis of T84.3 we write when breakdown implant.

And if the Schnayderov membrane broke into sinus lifting?

Then here:

T81.2 Random puncture or gap when performing a procedure not classified in other categories

If you could not complete the operation according to the plan due to bleeding, then the diagnosis is:

T81.0 Bleeding and hematoma complicating the procedure

Example 8:

On unpleasant - namely, about complications after anesthesia or other drugs. On simple, type of fainting or collapse, we will not stop there, everything is clear there. What do we write about shock if he suddenly happen?

Here are three correctly formulated diagnoses, remember them - your freedom may depend on it.

T88.2 Shock caused by anesthesia at which the necessary drug was correctly entered

T88.6. Anaphylactic shockdue to a pathological response to adequately designated and properly used drug

T88.7 Pathological reaction to the drug or drug uncomfortable

Example 9:

An ambiguous situation when the patient makes complaints that are not confirmed by anything. Simply - lying. He presses, tert, interferes, uncomfortable - but in reality it is not. The ICD has a separate diagnosis for such situations:

Z76.5 Simulation of the disease [conscious simulation].

If you are 100% sure that you are drilled your head - boldly put such a diagnosis and deny it on the basis of any honey. interventions. The keyword here is 100% sure.

Example 10:

We often conduct various kinds of surveys as prevention. For certificate to school or to work, etc.

Do not confonses them with consultations, these are different things. If in the process of inspection, any suspicion of pathology is revealed - then the consultation of the profile specialist is appointed.

In the ICD for such actions there are your finished codes:

Z00.8 Medical examination in the course of mass surveys of the population

Z02.0 Examination in connection with admission to educational institutions. Inspection in connection with admission to the preschool institution (educational)

Z02.1 Examination before entering work

Z02.5 survey in connection with sports

Z02.6 Insurance Examination

Z02.8 Other surveys for administrative purposes

Example 11: Cosmetic manipulations performed in the absence of diseases at the request of the patient.

If the patient wants beautiful smooth teeth - we immediately think about the venira in the smile line.
But what to do if the patient is intact, there is no caries, no washes, nor bite pathology - when the patient is not sick, but wants beauty?
In this case, in the column "Diagnosis" we write z41. 8 procedures that do not have therapeutic purposes.
Yes exactly. Our veneers are not treated in this case, but only perform a cosmetic function. The same applies to cosmetology procedures - fillers, threads and other, plastic surgery - breast augmentation, a change in the shape of the nose, ears, eye cut, etc.

In conclusion: the ability to correctly diagnose is a gift, experience, work and a little luck for a doctor. Do not cope alone - collect a concept or medical commission. But do not treat the patient without a diagnosis. He thanks for you for it will not say.

The ability to correctly diagnose is to formulate - this is legal need. Adhere to those tips that are given in the article. Nothing criminal is that you will write the correct diagnosis, but in the old classification, of course, will not - the competent expert will understand and take it in any case. But this difference is to prostate the central cutter with a stamping or refractor. Learn to be competent and modern.

Remember that today it is not enough to treat patients well - you need to be able to well and fully write about the treatment on the map.

The protocol of maintaining patients "Caries Zubkov" was developed by the Moscow State Medical and Dental University (Kuzmina E.M., Maksimovsky Yu.M., Small A.Yu., Zholeva I.V., Smirnova T.A., Bychkov N.V. , Titikina N.A.), Dental Association of Russia (Leontyev V.K., Borovsky E.V., Wagner V.D.), Moscow Medical Academy. THEM. Sechenova Roszdrava (Vorobiev P.A., Avksenteva M.V., Lukyantseva D.V.), Dental clinic No. 2 of Moscow (Chepovskaya S.G., Kochers Am., Bagdasaryan M.I., Kocherova M.A. .).

I. Scope

The protocol of maintaining patients "Caries teeth" is intended for use in the health care system of the Russian Federation.

II. NORMATIVE REFERENCES

- Resolution of the Government of the Russian Federation of 05.11.97 No. 1387 "On measures to stabilize and develop health and medical science in the Russian Federation" (Meeting of the legislation of the Russian Federation, 1997, No. 46, Art. 5312).
- Decree of the Government of the Russian Federation of 10/26/1999 No. 1194 "On approval of the program of state guarantees to ensure citizens of the Russian Federation free medical help" (Meeting of the legislation of the Russian Federation, 1997, No. 46, Art. 5322).
- Nomenclature of works and services in health care. Approved by the Ministry of Health and Social Development of Russia 12.07.2004 - M., 2004. - 211 p.

III. General provisions

The Maintenance Protocol for Patients "Caries Teeth" is designed to solve the following tasks:

- establishing uniform requirements for the procedure for the diagnosis and treatment of patients with the caries of the teeth;
- Unification of the development of basic compulsory health insurance programs and optimization of medical care patients with teeth caries;
- ensuring optimal volumes, availability and quality of medical care provided to the patient in a medical institution.

The area of \u200b\u200bdissemination of this Protocol is therapeutic and preventive institutions of all levels and legal forms that provide medical dental assistance, including specialized branches and cabinets of any form of ownership.

This document uses a data evidence permitting scale:

A) evidence convincing: There are good evidence to the proposed statement.
B) relative persuasiveness of evidence: There is enough evidence in favor of recommending this proposal.
C) there is no sufficient evidence: The existing evidence is not enough to make recommendations, but recommendations may be given with other circumstances.
D) enough negative evidence: There is enough evidence to recommend to refuse to use under certain conditions of this medicinal product, material, method, technology.
E) good negative evidence: There are enough convincing evidence to eliminate the drug, method, methodology from recommendations.

IV. Maintaining Protocol

Maintaining the protocol "Caries Zubov" is carried out by the Moscow State Medical and Dental University of Roszdrava. The management system provides for the interaction of the Moscow State Medical and Dental University with all interested organizations.

V. General questions

Caries teeth (K02 according to the ICD-10) is an infectious pathological process, manifested after teething, which occurs demineralization and softening of solid tooth tissues, followed by the formation of a defect in the form of cavity.

Currently, the caries of the teeth is the most common disease of the teubo-jaw system. The prevalence of caries in our country in an adult population aged from 35 years and older is 98-99%. In the overall structure of the provision of medical care in the medical and preventive institutions of the dental profile, this disease is found in all age groups of patients. Caries teeth with late or improper treatment may cause development inflammatory diseases Pulp and periodonta, teeth loss, the development of purulent-inflammatory diseases of the maxillofacial region. Caries teeth are potential foci of intoxication and infectious sensitization of the body.

Indicators of the development of complications of caries of teeth are significant: in the age group of 35-44 years, the need for filling and prosthetics is 48% and dental removal - 24%.

The late treatment of caries of teeth, as well as the removal of teeth as a result of its complications, in turn, lead to the emergence of secondary deformation of dental rows and the occurrence of the pathology of the temporomandibular joint. Caries teeth directly affect the health and quality of the patient's life, causing violations of the chewing process up to the final loss of this function of the body, which affects the digestive process.

In addition, caries teeth are often the cause of the development of diseases of the gastrointestinal tract.

Etiology and pathogenesis

The direct cause of the demineralization of the enamel and the formation of the carious focus is organic acids (mostly dairy), which are formed in the process of fermentation of carbohydrate microorganisms of the dental. Caries is a multifactor process. The mouth microorganisms, the character and power regime, enamel resistance, the number and quality of mixed saliva, the general condition of the body, exogenous effects on the body, the fluorine content in drinking water affect the occurrence of the focus demineralization of the enamel, the course of the process and the possibility of its stabilization. Initially, carious defeat arises due to frequent use of carbohydrates and insufficient oral care. As a result, adhesion and reproduction of cariesogenic microorganisms occurs on the surface of the tooth and a toothflower is formed. Further flow of carbohydrates leads to a local change in pH in the acidic side, demineralization and formation of microdefects of the subsurface layers of enamel. However, if the organic enamel matrix is \u200b\u200bpreserved, the carious process at the stage of its demineralization can be reversible. The long existence of the focus of demineralization leads to a dissolution of the surface, more stable, enamel layer. Stabilization of this process clinically can manifest itself to the formation of a pigmented spot, existing years.

Clinical picture of caries teeth

The clinical picture is characterized by manifold and depends on the depth and topography of the carious cavity. The sign of the initial caries is to change the color of the enamel of the tooth on a limited area and the appearance of the spots, subsequently develops a defect in the form of a cavity, and the main manifestation of the developed caries is the destruction of solid tooth tissues.

With an increase in the depth of the carious cavity, patients feel increased sensitivity to chemical, temperature and mechanical stimuli. The pain from stimuli is short, after elimination of the stimulus quickly passes. Maybe the absence of pain reaction. The carious lesion of chewing teeth deteriorates disorders of the chewing function, patients complain of pain when receiving food and aesthetics disorders.

Classification of caries teeth

In the international statistical classification of diseases and problems associated with the health of the World Health Organization of the Ten-Style Revision (ICD-10), the caries is highlighted in a separate rubrication.

K02.0 Caries Enamel. Stage "White (Cretaceous) Spot" [initial caries]
K02.I Caries Dentina
K02.2 Caries Cement
K02.3 suspended caries teeth
K02.4 odonotoklasia
K02.8 another caries teeth
K02.9 caries teeth uncomfortable

Modified classification of carious lesions on localization (for black)

Class I - cavity localized in the field of fissures and natural deepends of incisors, fangs, molars and premolars.
Class II - cavities located on the contact surface of molars and premolars.
Class III - cavities located on the contact surface of the incisors and fangs without disturbing the cutting edge.
Class IV - cavities located on the contact surface of the incisors and fangs with a violation of the corner of the coronal part of the tooth and its cutting edge.
Class V - cavity, located in the subsidence of all groups of teeth.
Class VI - cavities located on the walls of molars and premolars and cutting edges of the cutters and fangs.

Stage of the spot corresponds to the code on the ICD-C K02.0 - "Caries Enamel. Stage" White (matte) spot "[initial caries]". The caries in the stain stage is characterized by arising due to demineralization with color changes (matte surface), and then textures (roughness) of enamel in the absence of a carious cavity that did not spread beyond the enamel-density border.

The Karies Dentin stage corresponds to the code according to the ICD C K02.1 and is characterized by destructive changes in enamel and dentin with the transition of the enamel-dentine border, but the pulp is closed with a large or smaller layer of preserved dentin and without signs of hyperemia.

The stage of caries cement corresponds to the code according to the ICB-C K02.2 and is characterized by the lesion of the naked surface of the tooth root in the subsidence.

The stage of suspended caries corresponds to the code according to the ICD C K02.3 and is characterized by the presence of a dark pigmented spot within the enamel (focal demineralization of enamel).

1 MKB-C is the international classification of dental diseases based on the ICD-10.

General approaches to the diagnosis of caries of teeth

Diagnosis of caries of teeth is produced by collecting anamnesis, clinical inspection and additional methods Surveys. The main task in the diagnosis is to determine the stage of development of the carious process and the choice of the appropriate method of treatment. Diagnostics establishes the location of the caries and the degree of destruction of the coronal part of the tooth. Depending on the diagnosis, the treatment method is chosen.

Diagnostics are carried out for each tooth and is aimed at identifying factors that impede the immediate start of treatment. Such factors can be:

- the presence of intolerance to drugs and materials used at this stage of treatment;
- accompanying diseases, aggravating treatment;
- inadequate psycho-emotional patient's condition before treatment;
- acute lesions of the mucous membrane of the mouth and the red border of the lips;
- acute inflammatory diseases of the organs and tissues of the oral cavity;
- threatening life acute condition / disease or exacerbation of chronic disease (including myocardial infarction, acute violation of cerebral circulation), developed in less than 6 months before the treatment of this dental care;
- diseases of the tissues of periodontal under the aggravation stage;
- unsatisfactory hygienic state of the oral cavity;
- Refusal of treatment.

General approaches to the treatment of caries of teeth

The principles of treatment of patients with caries of teeth provide simultaneous solution of several tasks:

- elimination of factors resulting from the demineralization process;
- prevention of further development of the pathological carious process;
- preservation and restoration of the anatomical shape affected by caries tooth and the functional ability of the entire dental system;
- Preventing the development of pathological processes and complications;
- improving the quality of life of patients.

Caries treatment may include:

- elimination of microorganisms from the surface of the teeth;
- remineralizing therapy at the "white (chalk) stain" stage;
- fluorination of solid teeth tissues when suspended caries;
- preservation as far as possible healthy solid tooth tissues, if necessary, excision of pathologically modified tissues, followed by the restoration of the tooth crown;
- issuance of recommendations for the timing of re-circulation.

The treatment is carried out for each tooth affected by caries, regardless of the degree of defeat and the treatment of other teeth.

In the treatment of caries of teeth, only those dental materials and drugs are used, which are allowed for use in the territory of the Russian Federation in the prescribed manner.

Organization of medical care to patients with caries teeth

Treatment of patients with caries of teeth is carried out in therapeutic and preventive institutions of the dental profile, as well as in departments and cabinets of therapeutic dentistry of multidisciplinary medical and prophylactic institutions. As a rule, treatment is carried out in outpatient polyclinic conditions.

The list of dental materials and tools necessary for the work of the doctor, we present in Appendix 1.

The provision of assistance to patients with caries of the teeth is carried out mainly by dental doctors, dental physicians, dental physicians, dentists, dentists. In the process of assistance, the average medical personnel and hygienists are dental.

Vi. Characteristics of requirements

6.1. Patient model

Nonological form: Caries Enamel
Stage: Stage "White (Cretaceous) Spot" (initial caries)
Phase: Stabilization of the process
Complication: without complications
Code of the ICD-10: K02.0.

6.1.1 Criteria and signs that define the patient's model

- Tooth without visible destruction and carious cavities.

- focal demineralization of enamel without cavity formation, there are foci of demineralization - white matte spots. During sounding, a smooth or rough surface of the tooth is determined without a disruption of the enhable-dentine compound.
- Healthy periodontal and mucous membrane of the mouth.

6.1.2 Patient Inclusion Procedure in Protocol

6.1.3. Requirements for the diagnosis of outpatient polyclinic

The caries classification system is designed to streamline the degree of defeat. It helps to choose a technique for further treatment. Caries is one of the most famous and common diseases of the teeth all over the world. When detecting tissue damage, mandatory dental treatment is required to prevent further destruction of the elements of the dentition. General Doctors more than once made attempts to create a single, universal system of human disease classifications. As a result, in the XX century, "International Classification - ICD" was developed. Since the creation of a single system (in 1948), it was constantly revised and complemented by new information. The final, 10 in the account revision was conducted in 1989 (hence the name - MKB-10). Already in 1994, the international classification began to be used in countries in the World Health Organization. In the system, all diseases are distributed over sections and marked with a special code. Oral diseases, salivary glands and jaws K00-K14 belong to the section digestive system K00-K93. It describes all pathology of the teeth, not only caries. The K00-K14 includes the following list of pathologies related to teeth lesions: Point k00. Problems with development and teething. Adenctia, existence of extra teeth, anomalies external view teeth, wrapping (fluorosis and other darkening of enamel), disorders of the formation of teeth, hereditary underdevelopment of teeth, problems with teething. Paragraph K01. Retented (immersed) teeth, i.e. The changed position during the rubberization, in the presence or absence of an obstacle. Paragraph K02. All types of caries. Enamel, Dentin, cement. Suspended caries. Pulp exposure. Odonotoklasia. Other types. Point k03.Various lesions of solid teeth tissues. Erasing, enamel, erosion, granuloma, cement hyperplasia. Paragraph K04. Defeat pulp and periapical fabrics. Pulpitis, degeneration and gangrene pulp, secondary dentine, periodontitis (acute and chronic apical), periapical abscess with cavity and without it, various cysts. Paragraph K06. The pathologies of the gums and the edges of the alveolar crest. Recession and hypertrophy, injuries of alveolar edge and gum, epulis, atrophic comb, various granulomas. Paragraph K07. Changes in bite and various jaw abnormalities. Hyperplasia and hypopalsia, macroganatia and micrognising of the upper and lower jaws, asymmetry, proactation, retrognacy, all types of bite disorders, twisted, diasthem, three, offset and rotation of teeth, transposition. Improper closure of jaws and acquired bite disorders. Diseases of the temporomandibular joint: breakfast, click on the opening of the mouth, pain dysfunction. Paragraph K08. Functional problems S. supported apparatus and changing the number of teeth due to the effects of external factors. Loss of teeth due to injury, removal or illness. Atrophy of the alveolar crest due to a long lack of tooth. Pathology of alveolar crest. Consider in detail the section K02 caries teeth. If the patient wants to know that the record made a dentist in the map after the treatment of the tooth, it is necessary to find the code among subsections and explore the description. K02.0 enamel Primary caries or chalk spot - primary form of the disease. At this stage there is still no damage to solid tissues, but demineralization and high enamel susceptibility to irritation are already diagnosed. In dentistry, 2 forms of initial caries are determined: Active(White spot); Stable (Brown stain). Caries in active form in the treatment can go or in stable, or completely disappear. Brown spot is irreversible, it is possible to get rid of the problem only by the preparation with sealing. Symptoms: Pain- for the initial stage is not characteristic of the dental pain. However, due to the fact that the demineralization of the enamel occurs (its protective function is reduced), in the affected area, strong susceptibility can be felt. External violations - visible at the location of the caries on one of the teeth of the outer row. Looks like an imperceptible spot of white or brown shade. Treatment depends on a specific stage of the disease. When the stain is Cretaceous, it is assigned a remineralizing treatment and fluorination. When the caries is pigmented, preparation and sealing are performed. With timely treatment and observance of Hygiene of the mouth, a positive forecast is expected. K02.1 Dentina A huge number of bacteria live in the mouth. As a result of their vital activity, organic acids occurs. They are guilty of the destruction of basic mineral components, of which the crystal enamel grille consists. Caries Dentin is the second stage of the disease. It is accompanied by a violation of the structure of the tooth with the advent of the depression. However, the hole is not always noticeable. Often, the violations can be disturbed only at the reception at the dentist when the probe is entitled to diagnose. Sometimes it is possible to independently notice the caries. Symptoms: the patient is inconvenient to chew; painfulness from temperatures (cold or hot food, sweet foods); external disorders that are particularly visible on the front teeth. Pain sensations can be provoked by one or immediately with several foci of the disease, but quickly pass after eliminating the problem. There are only a few types of dentin diagnostics - instrumental, subjective, objective. Sometimes it is difficult to detect the disease, exclusively according to the symptoms described by the patient. At this stage no longer do without born. The doctor drills patients with teeth and installs a seal. In the process of treatment, the specialist not only tries to preserve the tissue, but also the nerve. K02.2 cement In comparison with damage to the enamel (initial stage) and dentin, caries cement (root) is diagnosed greatly less often, but is considered aggressive and malicious to teeth. The root is characterized by relatively thin walls, it means that there are no diseases for the complete destruction of the fabrics. All this can turn into a pulpit or periodontitis, which sometimes leads to the removal of the tooth. Clinical symptoms depend on the focus concentration location. For example, when placing the cause in a sedentine region, when the swollen gums protects the root from other influences, we can talk about the closed form. With this outcome, bright symptoms are not observed. Usually, with a closed location of the caries of cement, there are no pain or they are not expressed. Stock Foto Remote tooth with cement caries With an open form, in addition to the root, the destruction may also be a trick. Patient may accompany: External disorders (especially expressed in front); Inconvenience during food intake; Pain sensations from stimuli (sweet, temperature, when feeding under the scenes). Modern medicine allows you to get rid of caries for several, and sometimes in one reception of the dentist. Everything will depend on the form of the disease. If the gum closes the hearth, bleeding or greatly interferes with sealing, then the gums are performed primarily. After getting rid of soft tissues, the affected area (after or without impact) is temporarily selected by cement and oil dentin. After healing of tissues, the patient comes again to repeated sealing. K02.3 suspended The suspended caries is a stable shape of the initial stage of the disease. It is manifested in the form of a dense pigment stain. Usually, such caries passes asymptomaticly, patients do not complain about anything. Detect stain it is possible at a dental inspection. Caries has a dark brown, sometimes black. The surface of the tissue is studied by testing. Most often, the focus of the suspended caries is located in the subsidence and natural depuses (pits, etc.). The treatment method depends on various factors: Spots size - too large formations are prepared and seal; From the wishes of the patient - If the stain is on external teeth, then damage is eliminated by photopolymer fillings so that the color coincides with the enamel. Small dense foci of demineralization are usually located during a time segment with periodicity of several months. If the teeth are correctly cleaned, and the number of carbohydrate patient consumed will decrease, the future progressive development of the disease may be observed. When the stain grows and becomes soft, it is prepared and seal. K02.4 odonotoklasia Odonotoklasia is a heavy form of dental damage. The disease affects enamel, thinning it and leading to the formation of caries. No one is insured against odonotoklasia. The appearance and development of damage affects a huge number of factors. There are even poor heredity, regularity of hygiene of the mouth, chronic disease, the rate of metabolism, harmful habits. The main visible symptom of odonotoklasia is toothache. In some cases, due to a non-standard clinical form or an increased pain threshold, the patient does not feel. Then only the dentist will be able to put the correct diagnosis during inspection. The main visual sign, talking about enamel problems - teeth damage. This form of the disease, like other forms of caries, is treatable. The doctor first cleans the affected area, then seals the painful area. Avoiding the development of odonotoklasia will help only the quality prevention of the oral cavity and regular inspections from the dentist. K02.5 with pullups All tooth fabrics are destroyed, including a pulp chamber - a partition separating dentin from pulp (nerve). If the pulp chamber wall rotched, the infection penetrates into soft fabrics Tooth and cause inflammation. The patient feels severe pain when food and water in the carious cavity. After her cleansing, pain retreats. In addition, in advanced cases there is a specific smell of mouth. This condition is considered to be deep caries and requires a long expensive treatment: mandatory removal of "nerve", cleaning of channels, sealing with guttaperch. Several visits of the dentist are required. Details of the treatment of all types of deep caries are described in the article. Paragraph added in January 2013. K02.8 Other View Another caries is a medium or deep form of a disease that develops in a previously treated tooth (relapse or re-development next to the seal). The average caries is the destruction of elements of the enamel on the teeth, accompanied by the attack or permanent pain in the field of the hearth. They are explained by the fact that the disease has already moved to the upper layers of Dentin. The form requires mandatory dental care, in which the doctor removes the affected areas with their subsequent recovery and sealing. Deep caries - a form that is characterized by extensive damage to the internal tooth tissues. It amazes a significant area of \u200b\u200bDentin. It is impossible to ignore the disease at this stage, and the refusal of treatment may damage the nerve (pulp).In the future, if not to take advantage of medical help, the pulpit or periodontitis develops. The plot that was affected is fully removed with subsequent reducing filling. K02.9 Uncomfortable Uncomfortable caries - a disease that develops not alive, but on depulted teeth (those who have been removed by the nerve). The reasons for the formation of such a form do not differ from standard factors. Usually unspecified caries occurs at the junction of a seal and an infected tooth. His appearance in other areas of the oral cavity is observed much less often. The fact that the tooth is dead does not protect him from the development of caries. Teeth depend on the presence of sugar penetrating into purph cavity Together with food and bacteria. After saturation, the glucose bacteria begins the formation of an acid leading to the formation of a dental plaque. Caries depugded tooth is treated according to the standard scheme. However, in this case, there is no need to use anesthesia. Nerva, who is responsible for pain, no longer in the tooth. Prevention The diet of a person is strongly affected on the condition of the tissue. To prevent caries, you need to follow some recommendations: consume less sweet, flour; balance the diet; monitor vitamins; fierce food well; rinse mouth after meals; regularly and properly brushing your teeth; avoid simultaneous intake of cold and hot food; periodically carry out inspection and rehabilitation of the oral cavity. The video provides additional information on the topic of the article. Timely treatment will help to quickly and painlessly get rid of caries. Preventive measures Prevent damage to enamel. Always better not to bring to illness than to treat it. If you have found a mistake, please select the text fragment and click Ctrl + Enter.. Such a diagnosis with Code K07.3 on the ICD-10 (International Classification of Diseases of the 10th Review) The dentist-orthodontist puts if the tooth cut down with a slope or displacement, or appeared at all outside the dental arc. Mostly it happens with the bottom eighties, cutters and fangs. The satellite of dystopias may be other anomalies of the teeth position - a crowding, displaced or open bite, as well as retention. Causes of appearance Heredity. If the child inherited, for example, the dad is a large teeth, and from mom a small jaw, no diSTopias. In addition, she can inherit itself. Ultipical formation of adventure adventures in the embryo. Injuries and bad habits: long-term use of a dummy, habit of biting a pencil, etc. Early removal of dairy teeth. Features of the time of teething. For example, if the fangs appear late, that is, after 9 years, there may be no place for them in the arc. Often dystopia cause polymodacy ("extra teeth"), Macrodente (abnormally large), partial lack of teeth or a sharp discrepancy between the magnitude of dairy and constant. Types of dystopia Depending on how and where the crown is shifted, several types of pathology distinguish: The slope to the opposition of the mouth - it means it is a vestibular position of a dystoped tooth, and if on the contrary, in the depth of the oral cavity - about oral. When the body of the tooth is fully located outside the arc and shifts forward or backward, the dentist will mark the presence of a mesial or distal position in the map, respectively. Newbie is cut above the rest? - Such anomaly will be called supravnia. If below, infrall. Rare anomalies - the total and transposition. In the first case, the tooth turns around its axis, in the second - changes in places with a neighbor, for example, the Klys takes the place of Premolant. Depending on what kind of tooth occupies an improper position, distinguishes the dystopia of the cutters, canines, molars and premolars or "eight". The eighth molars appear the most recently, and that is why they are associated with them the greatest risk of dystopia. Bone tissue has already been formed, and often a novice has no place in the dental arc. In addition, any indigenous precedes a milk pioneer who "breaks" the path. The "wise" mlaro does not have such an assistant, as there are no teeth-neighbors who determine the correct position on the arc. Possible complications The dystopic tooth may injure the mouth mucosa, language and cheeks, resulting in decabital ulcers. Anomalies of the position of the crowns and the wrong bite - a frequent cause of caries: the oral hygiene is complicated, completely remove the flare and residues of food from interdental gaps is difficult. Another complication is problems with diction and feeding of food. Also over the crown not yet, inflammation often arises - pericoronitis. And in the most difficult cases, the "problematic" tooth cuts out outside the alveolar arc, which, of course, entails not only serious discomfort, but also diseases of other organs. The therapy method depends on the state of the dystoped tooth and its payload. Sometimes it is enough to polish sharp edges and give a shape that will not be injured the mucous membrane. More often than in the improper position of the tooth are resorted to orthodontic methods of treatment. Bracket systems allow you to cope with serious bite disorders. If there is no place for the tooth, and this, for example, an important, in terms of functionality and aesthetics, cans, then you will have to remove its neighbors and only then start orthodontic treatment. Treatment of dystopia brackets When you need to remove a dystoped tooth Removal - the procedure is not pleasant, and therefore always extreme measure. It is resorted to such cases: in the presence of pulpitis, periodontitis or cysts; if it is a tooth of wisdom, complicating the treatment of the caries of seventh molars; when an anomaly is accompanied by osteomyelitis or periostitis; if the surrounding tissues are seriously injured. If there is no such testimony, the dentist will do everything possible to keep the dystoped tooth. Note that treatment is optimal to go through the end of the growth of the facial skeleton, that is, up to 14-16 years. In this case, the results you will see faster, and they will be noticeably better than with a later appeal to a specialist. Protocol for maintaining patients Full absence of teeth (Complete secondary adenatia) The protocol of maintaining patients "The complete lack of teeth (complete secondary adentei)" was developed by the Moscow State Medical and Dental University (Professor, D.N. A.Yu. Malny, M.N.S. N.A. Titkin, E.V. . Ershova), Moscow Medical Academy. THEM. Sechenov of the Ministry of Health and Social Development of the Russian Federation (Professor, Ph.D. P.A. Vorobiev, D.M.N. M.V. Avksentieva, Ph.D. D.V. Lukjantseva), Dental clinic No. 2 of Moscow (AM Kochers, S.G. Chepovskaya). I. Scope The protocol of maintaining patients "Complete lack of teeth (complete secondary adencti)" is intended for use in the health care system of the Russian Federation. II. NORMATIVE REFERENCES Resolution of the Government of the Russian Federation of 05.11.97 No. 1387 "On measures to stabilize and develop health and medical science in the Russian Federation" (Meeting of the legislation of the Russian Federation, 1997, No. 46, Art. 5312). Decree of the Government of the Russian Federation of October 26, 1999 No. 1194 "On Approval of the Program of State Guarantees to Provide Citizens of the Russian Federation of Free Medical Assistance" (Meeting of the legislation of the Russian Federation, 1997, No. 46, Art. 5322). III. Designations and abbreviations The following protocol uses the following designations and abbreviations: MKB-10 - International statistical classification of diseases and problems related to health, the World Health Organization, the tenth revision. ICB-S. - International classification of dental diseases based on the ICD-10. IV. General provisions The protocol of maintaining patients "Complete lack of teeth (complete secondary adenatia)" is designed to solve the following tasks: Establishing uniform requirements for the procedure for the diagnosis and treatment of patients with a complete absence of teeth (with complete secondary adventies); Unification of the development of basic compulsory health insurance programs and optimization of medical care patients with a complete absence of teeth (with full secondary adventies); Providing optimal volumes, available and quality of medical care, complained by the patient in a medical facility and in the territory within the framework of public hectares of ensuring citizens of free metrics. The distribution area of \u200b\u200bthis Protocol is therapeutic and preventive institutions of the dental profile of all levels, including specialized branches. This protocol uses the data of evidence of evidence of data: AND) Evidence convincing: There are good evidence to the proposed statement, B) Relative persuasive evidence: There is enough evidence in favor of recommending this proposal. C) There is no sufficient evidence: There are not sufficient evidence to take advantage, but recommendations may be given in view of other circumstances. D) Enough negative evidence: There is enough evidence to relate to refuse to apply a given drug in a certain situation. E) Good negative evidence: There are enough convincing evidence to eliminate the drug or methodology from the recommendations. V. Maintaining Protocol The protocol is carried out by the Moscow State Medical and Dental University of the Ministry of Health of Russia. The management system provides for the interaction of the Moscow State Medical and Dental University with all interested organizations. Vi. GENERAL ISSUES According to statistical data, the complete lack of teeth (complete secondary adenatia) as a result of the removal of teeth, loss due to an accident (injuries) or diseases of the Paro-donta in our country occurs quite often. Indicators of the incidence of the total absence of teeth (complete secondary adventies) increase in increasing (five times) in each subsequent age group: the population aged 40-49 years of occurrence of a complete secondary adventure is 1%, aged 50-59 years - 5.5% , and people over 60 years old - 25%. In the overall structure of the provision of medical care for patients in therapeutic and preventive institutions of the dental profile, 17.96% of patients are diagnosed with "complete lack of teeth (complete secondary adencti)" one or both jaws. The complete lack of teeth (complete secondary adenaty) directly affects the quality of the patient's life. The complete lack of teeth (complete secondary adenaty) determines the violation until the final loss of the vital function of the body - the feeding of food, which affects the process of digestion and admission to the body of the necessary nutrients, and is also often the cause of the development of diseases of the gastrointestinal tract of an inflammatory nature. No less serious are the consequences of the complete absence of teeth (full secondary adentia) for social status of patients: impaired articulation and diction affect the patient's communication abilities, these violations are associated with changes in appearance due to the loss of teeth and the developing atrophy of chewing muscles may determine changes in the psycho-emotional state right up to violations psyche. The complete lack of teeth (complete secondary adenaty) is also one of the reasons for the development of specific complications in the maxillofacial region, such as the dysfunctions of the temporomandibular joint and the corresponding pain syndrome. The concepts of "loss of teeth due to an accident, removal of teeth or localized periodontitis" (K08.1 on the ICD-C is the international classification of dental diseases based on the ICD-10) and such terms as "complete secondary adencti" and "complete lack of teeth" ( Unlike adventure - disorders of development and teething - to 00.0), in fact, are synonyms and are used both in relation to each of the jaws and both by both jaws. The complete lack of teeth (complete secondary adenaty) is a consequence of a number of diseases of the dental system - caries and its complications, periodontal diseases, as well as injuries. Caries in our country is one of the most common diseases. His prevalence in adults aged 35 years and older is 98-99%. The development rates of complications of caries are also significant: the percentage of deletions in the age group over 35-44 years is 5.5, and in the next age group - 17.29%. In the structure of dental assistance in the treatment of patients with pulpitis, which, as a rule, is a consequence of untreated caries, are 28-30%. Indicators of occurrence of periodontal diseases are also great: the prevalence of signs of lesion of periodontal in the age group 35-44 years is 86%, other authors call the frequency of the occurrence of pathological signs of periodontal diseases 98%. These diseases in untimely and poor-quality treatment can lead to a spontaneous loss of teeth due to pathological processes in inflammatory and / or dystrophic fabrics, to loss of teeth due to removal of non-treating teeth and their roots with deep caries, pulp and periodontitis. The late orthopedic treatment of the complete absence of teeth (complete secondary adentia) in turn causes the development of complications in the maxillofacial region and the pathology of the temporomandibular joint. The main sign of the complete absence of teeth (complete secondary adentia) is the complete absence of teeth on one or both jaws. The clinical picture is characterized by changes in the configuration of the person (lip wary), sharply pronounced nasolabial and chinful folds, omitting the angles of the mouth, decrease the size of the lower third of the face, in some patients - maceration and "hires" in the area of \u200b\u200bthe angles of the mouth, violation of the chewing function. Often the complete lack of teeth (complete secondary adenaty) is accompanied by the usual sublifting or dislocation of the temporomandibular joint. After the loss or removal of all teeth there is a gradual atrophy of alveolar processes of jaws, progressing over time. CLASSIFICATION Full absence of teeth (Full secondary adventure) In clinical practice, the complete lack of teeth (complete secondary adulthy) of the upper jaw (full of teeth (complete secondary adventure) of the lower jaw (complete secondary adventure) of the lower jaw (complete adventure) of both jaws is distinguished. Several classifications of toothless jaws were proposed. The largest distribution was obtained by the classification of the shredder for torsion of the upper jaw and the keller for toasting the lower jaw. In domestic practice, the classification of the toothless jaws of Kurlyandsky V.Yu is also quite widely applied. These classifications are based, first of all, on anato-topographic characteristics - the degree of atrophy of the alveolar process, as well as the level of attachment of the tendons of the chewing muscles (classification of Kur-Lyandsky). The classification of Oxman I.M. is also used, which suggested a single classification for the upper and lower toothless jaws, which takes into account the degree of atrophy of alveolar process. With the complete absence of teeth (complete secondary adentia) it is impossible to allocate the stages of the course of the disease. General approaches to diagnostics Complete lack of teeth (full secondary adventure) The diagnosis of the complete absence of teeth (complete secondary adventure) is made by clinical inspection and collection of history. The diagnosis is aimed at eliminating factors that impede immediate start of prosthetics. Such factors may have: Not remote roots under the mucous membrane; - exostosis; - tumor-like diseases; - inflammatory processes; - diseases and lesions of the mucous membrane of the oral cavity. General approaches to treatment Full absence of teeth (Full secondary adventure) The principles of treatment of patients with complete secondary adventies imply a simultaneous solution of several tasks: Restoration of sufficient functional ability of the dental system; - Preventing the development of pathological processes and complications; - improving the quality of life of patients; - elimination of negative psycho-emotional consequences associated with the complete absence of teeth. The manufacture of prostheses is not shown if the existing prosthesis is still functional or if its function can be restored (for example, repair, remap). The manufacture of a prosthesis includes: examination, planning, preparation for prosthetics and all measures for the manufacture and fixation of the prosthesis, including the elimination of deficiencies and control. This also includes the instruction and training of the patient to care for the prosthesis and the oral cavity. The orthopedist dentist must determine the characteristics of prosthetics depending on the anatomical, physiological, pathological and hygienic state of the patient's dental system. When choosing between the same effective types of prosthesis, it must be guided by the indicators of economy. In cases where it is impossible to immediately complete the treatment, the use of immediat-prostheses is shown, especially to prevent the development of the pathology of the temporo-night joint. You can apply only those materials and alloys that are approved for use, clinically tested, the safety of which is proven and confirmed by clinical experience. The basis of the complete removable prosthesis should be made, as a rule, from plastics. Reinforcement of the prosthesis basis with special metal meshes can be used. For the manufacture of metal base, careful justification is necessary. With a confirmed allergic response of the oral cavity tissue, tests should be conducted and select the material that showed itself as portable. When tavorobaby, the jaw shows the removal of the functional cast (ottiska), it is necessary to function the functional formation of the edge of the prosthesis, i.e. For removal of the cast (ottiska), it is necessary to manufacture an individual rigid layer (impressionable) spoon. The manufacture of a removable prosthesis on a toothless jaw using a plastic or metal base includes the following: anatomical, functional castors (retirement) of both jaws, determining the central relationship of the jaws, checking the design of the prosthesis, overlay, fitting, sucking, installation, remote control and proofreading. If necessary, use soft linings under the prosthesis. Organization medical Patient care With a complete lack of teeth (Full secondary adventure) Treatment of patients with complete secondary adventure is carried out in the medical and preventive institutions of the dental profile, as well as in the departments of orthopedic dentistry. As a rule, treatment is carried out in an ambulance-latur-polyclinic conditions. Assisting the patients with the complete absence of teeth (complete secondary adventies) is carried out by dentist doctors orthopeds. In the process of assistance, medium-sized medical personnel is involved, including dental techniques. VII. Characteristics of the requirements of the protocol 7.1. Patient model Nonological shape: loss of teeth due to accident, dental removal or localized periodoiditis Stage: Any Phase: process stabilization Complications: without complications Code on the ICD-C: K 08.1 7.1.1. Criteria and signs that define the patient's model Complete lack of teeth on one or both jaws. A healthy oral mucosa (moderately pink, moderately mobile, pale pink, moderately distinguishes the mucosa secret - I class in Supple). Changing the configuration of the face (lip stock). Sharply pronounced nasolabial and chinful folds, omission of angles of mouth. Reducing the size of the lower third of the face. No tests. The lack of expressed atrophy of the alveolar process (with the complete absence of teeth on one or both jaws - I class in Kurlyandsky, I class in Oxman, with the complete absence of teeth on Upper Jaw - I Type according to the classification of shredder, with the complete absence of teeth on the lower jaw - I type of keller). The absence of a pronounced pathology of the temporal lesser joint. Lack of diseases of the mucous membrane of the oral cavity. 7.1.2. The procedure for including the patient in the protocol The patient's condition satisfying the trees and signs of the diagnosis of this patient model. 7.1.3. Requirements for the diagnosis of outpatient polyclinic The code Name Multiplicity Execution 01.02.003 Palpation of muscles 1 01.04.001 Collecting anamnesis and complaints in the pathology of the joints 1 01.04.002 Visual examination of the joints 1 01.04.003 Palpation joints 1 01.04.004 Percussion Justov 1 01.07.001 Collecting anamnesis and complaints in the pathology of the oral cavity 1 01.07.002 Visual study in the pathology of the oral cavity 1 01.07.003 Palpation of the oral cavity 1 01.07.005 External inspection of the maxillofacial region 1 01.07.006 1 01.07.007 Determination of the degree of opening of the mouth and restriction of mobility of the lower jaw 1 02.04.003 1 02.04.004 Auscultation Sustava 1 02.07.001 1 02.07.004 1 06.07.001 Panoramic X-ray of the upper jaw 1 06.07.002 1 09.07.001 Investigation of mouthprints-imprint By need 09.07.002 Cytological study of the contents of the cyst (abscess) of the oral cavity or the contents of the sewage pocket By need 11.07.001 By need 7.1.4. Characteristics of algorithms and features of non-drug assistance The survey is aimed at establishing a diagnosis corresponding to the patient model, an exception possible complications, Determining the ability to proceed with prosthetics without additional diagnostic and medical and preventive measures. To this end, it is harvested by anamnesis, inspection and palpation of the oral cavity and the people of the Li-Tseva region, as well as others related research. Collect Anamneza When collecting anamnesis, the time and causes of the loss of teeth are found, whether the previously removable prosthetic has been used, an allergic history. It is purposefully revealed by complaints of pain and discomfort in the field of temporomyluorous joints. Find out the profession of the patient. Visual study In case, inspection draws attention to the pronounced and / or acquired asymmetry of the face and the severity of the nasolabial and chinful folds, the nature of the lip of closure, the presence of cracks and macerations in the angles of the mouth. Pay attention to the degree of opening of the mouth, the smoothness and direction of the movement of the lower jaw, the ratio of the jaws. Pay attention to the color, moisture, the integrity of the mucous membranes of the oral cavity in order to eliminate the concomitant pathology, including infectious diseases. In suspected of the presence of diseases of the mucous membrane of the oral cavity, a study of prints-prints. With a positive result, the patient is carried out according to the corresponding patient model. Palpation When examining the oral cavity, pay attention to the severity and location of bridles and peeling folds. Attach attention to the presence and degree of atrophy of alveolar processes. Reveal the presence of exostoses hidden under the mucous membrane of the roots of the teeth. In suspected of their presence - X-ray examination (aiming or panoramic jaw photography). With a positive result, the immediate prosthetics is postponed and surgical preparation for prosthetics (in accordance with the other patient's model). Pay attention to the presence of tumor-kind diseases. In suspected of their presence, a cytological study, biopsy. With a positive result, immediate prosthetics are postponed and appropriate treatment is carried out. Palpation is carried out to determine the torus, "chatting" ridge and degrees of the mucous membrane. Visual study and palpation of temporomandibular joints When inspection, pay attention to the color skin Pokrov In the joints of the joints. It is found out if there is no crunch (clicks) and pain in the field of temporomandibular joints when the lower jaw movements. When opening the mouth, pay attention to the synchronicity and symmetry of the movements of the joint heads. If the pathology of the temporomandibular joints is suspected, an x-ray study is carried out - the tomography of the joints with the closed and open mouth. With a positive result, prosthetics must be combined with additional therapy (another patient model - complete secondary adenatia with complications). Anthropometric studies These studies allow you to determine the height of the lower person, are mandatory and always carried out at the prosthetics stage. 7.1.5. Requirements for the treatment of outpatient polyclinic 7.1.6. Characteristics of algorithms and features of non-drug assistance The main method of treatment with the complete lack of teeth (complete secondary adentia) of one or both jaws is the prosthetics with complete removable lamines. This allows you to restore the basic functions of the dental system: biting and chewing food, diction, as well as aesthetic proportions of the face; prevents the pro-gressing of atrophy of alveolar processes jaw bone and muscle atrophy of the maxillofacial area (the level of persuasiveness of evidence A). With the complete lack of teeth (complete secondary adventure) of both jaws, complete dentures on the upper and lower jaws are made simultaneously. First visit. After diagnostic research and deciding on prosthetics on the same reception proceed to treatment. The first step is to remove an anatomical cast (print) for the manufacture of an individual rigid blind (writhing) spoon. Special interlocking (impressive) spoons for toothless jaws should be applied, alginate blind (implicit) masses. The feasibility of the use of special laying (impressive) spans is due to the need to prevent extended boundaries, both in the manufacture of individual spoons and in the manufacture of a prosthesis. As an alternative, in practice, standard stall (implicit) spoons are often used, which can lead to stretching the mucosa in transitional fold and the subsequent expansion of the boundaries of the prosthesis, which necessitates the poor fixation of the prosthesis. The cost of special and standard spoons is the same. After removing the cast (ottiska), its quality is monitored (mapping anatomical relief, no pore, etc.). Next visit. A compatory of an individual rigid plastic interleave (writhing) spoon is performed. It should be paid to the edges of the spoon made in the laboratory conditions, which must be volumetric (thickness of about 1 mm). If necessary, the doctor himself can make an individual rigid plastic clinic (impressive) spoon in the clinic. The sucking is carried out using functional samples on the coat of arms. Samples are made with a semi-closed mouth with a reduced amplitude of the movements of the lower jaw. During the retreat from the suction technique, the individual rigid plastic interleave (instead-line) spoon using functional samples in the coat of copper in a strict sequence cannot be provided with stabilization and fixation of future prostheses. After sucking the edge of the spoon, it is edged with wax and are drawn up active (using the functional movements of the muscles) and passive ways. At the rear edge of the spoon on the upper jaw, it is necessary to put an additionally strip of softened wax over the line A in order to provide a full-fledged valve zone in this area. The distal valve on a spoon on the lower jaw should be closed, creating an adhesive wax roller across the coat. This technique ensures the closure of the distal valve and prevents the fixation disruption when food bonus. Criterion for completing the suction - the formation of the valve zone and fixation of an individual spoon on the jaw. Obtaining a functional cast (ottiska): Removal (ottiska) The cast is to produce silicone blind (implicit) with the use of the appropriate adhesive material (glue for silicone mass). The edges of the cast are drawn up (ottiska) active (using functional movements) and passive methods. ZincEvgenolic climbing masses can also be used. After removal, the quality of the cast (output) is made (mapping anatomical relief, no pore, etc.). Next visit. Determination of the central relations of the jaws anatomy-physiological method for determining the correct position of the lower jaw relative to the top in three planes (vertical, sagittal and trans-versal). The determination of the central relations of the jaws is made using the wax bases made in the dental laboratory with occlusal rollers. Pay special attention to the formation of the correct protethic plane, determining the height of the lower person, definition of a smile line, a median line, a fang line. The choice of color, size and shape of artificial teeth is made in accordance with individual features (patient's age, size and face form). Next visit. Verification of the design of the prosthesis (decree of the teeth on the wax basis conducted in the conditions of the dental laboratory) on the wax basis to assess the correctness of all previous clinical and laboratory stages of the manufacture of the prosthesis and making the necessary corrections. Attention should be paid: when the teeth are formulated by the type of orthoganatic bite, the upper front teeth should block the lower maximum as possible by 1-2 mm. When the teeth are closed, between the upper and lower front teeth should be a horizontal slit at 0.25-0.50 mm. Next visit. The imposition and sucking of the finished prosthesis after the laboratory phase of replacing the wax basis on the plastic. Before applying to estimate the quality of the prosthesis basis (the absence of pores, sharp edges, protrusions, roughness, etc.). Color may indicate insufficient polymerization. The sky of the upper jaw prosthesis should not be thicker than 1 mm. Prostheses are introduced into the mouth, check the density of the closure of the dental rows and the fixation of dentures (it should be remembered that usually the fixation is improved by the 7th day of using the prosthesis). Next visit. The first correction is scheduled the day after the prosthesis, followed by testimony (no more than once every three days). The adaptation period can last up to 1.5 months. With the appearance of pain in the field of tissue of the prosthetic bed, associated with the injury of the mucous membrane, the patient is recommended to immediately stop using the prosthesis, to appear to the doctor, renewing the use of 3 hours before visiting the doctor. For mechanical damage The mucous membrane, the formation of ulcers, the sections of the prosthesis in these places are minimally separated. The prosthesis basis correction is carried out until the first subjective feeling of reducing pain syndrome. Medical therapy is prescribed by anti-inflammatory drugs and means accelerating the epithelization of the oral mucosa. Patients with severe torus In the manufacture of a working model to produce "insulation" in the region of Torus in order to prevent overpressure. Patients with allergic reactions to plastics When identifying allergic history, allergic skin samples should be carried out on the material of the prosthesis basis. With a positive reaction, prostheses made of colorless plastics, according to the testimony, silver the prosthesis basis is carried out. For patients with insufficiently favorable anatomy-topographic conditions of the prosthetic bed, the prosthesis basis can be made with a soft lining. Indications: The presence of acute bone protrusions on the prosthetic bed, an acute inner oblique line in the absence of absolute (clear) testimony for surgical intervention in order to eliminate them; - increased pain sensitivity of mouth, - The absence of a pronounced submembrance layer. The need for applying a soft lining is detected in the process of adapting to a new prosthesis. Soft linings are manufactured by the clinical and laboratory method according to the well-known technique. 7.1.7. Drug Requirements Ambulatory Polyclinic 7.1.8. Characteristics of algorithms and features of the use of medicines The use of local anti-inflammatory and epithelials in the occurrence of Namins and ulcers on the mucous membrane, especially during the adaptation period to the prosthesis, shows sufficient effectiveness in everyday dental practice. Analgesics, Nesteroids Anti-inflammatory drugs Funds for the treatment of rheumatic Diseases and gout We are usually prescribed rinsing and / or baths with oak bark brands, chamomile flowers, sage 3-4 times a day (level of persuasiveness of proof C). Appliques for the affected areas of sea buckthorn oil - 2-3 times a day to 10-15 minutes (level of persuasiveness of proof B). Vitamins Appliques for afflicted areas with oil solution of retinol (vitamin A) - 2-3 times a day for 10-15 minutes (level of persuasiveness of proof C). Blood Hemodialyzat deproteinated - adhesive paste for the oral cavity - 3-5 times a day on the affected areas (level of persuasiveness of proof C). 7.1.9. Requirements for labor, recreation, treatment or rehabilitation There are no special requirements. 7.1.10. Care requirements for patient and subsidiary procedures There are no special requirements. 7.1.11. Requirements for dietary appointments and restrictions Refusal to use very hard pectics, requiring chewing solid pieces, from biting pieces of solid products, vegetables and fruits (for example, from an entire apple). Refusal to use very hot food. 7.1.12. Form of voluntary informed consent of the patient execution of the Protocol Informed voluntary consent, the patient gives in writing. 7.1.13. Additional information for the patient and his family members Assessment of the cost of protocol and quality price Clinical and economic analysis is carried out according to the requirements of regulatory documents. Comparison of results When monitoring the protocol, the results of the fulfillment of its requirements, statistical data, indicators of the treatment of medical and preventive institutions (the number of patients, the number and types of manufactured structures, the manufacturer, the presence of complications) are carried out annually. The procedure for forming a report and its form The annual monitoring results report include quantitative results obtained in the development of medical records, and their qualitative analysis, conclusions, proposals for the update of the Protocol. The report is submitted to the developer group of this Protocol. The reporting materials are stored in the Standardization Department in Health of the Research Institute of Public Health and Health Management of the Moscow Medical Academy. THEM. Sechenov of the Ministry of Health of the Russian Federation and is stored in his archive. Removable dentures (Additional information for the patient) 1. Removable dentures need to pray with a toothbrush with paste or with toilet soap twice a day (in the morning and in the evening), as well as after eating as far as possible. 2. In order to avoid breakdown, the prosthesis, as well as injury to the oral mucosa, it is not recommended to take and chew very hard food (for example, crackers), bite off from large pieces (for example, from an entire apple). 3. At night, if the patient shoots about theses, they must be kept in a wet environment (after cleaning, wrap the prostheses into a wet napkin) or in a water vessel. In the prosthesis you can sleep. 4. In order to avoid breakage of prostheses, do not stop their falls on the tiled floor, in cancer wine and on other solid surfaces. 5. As the rigid dental damage form, they need to be cleaned by special means sold in pharmacies. 6. In disassembly, a removable prosthesis is disturbed, which can be associated with the weakening of the clum-based fixation, it is necessary to contact the clinic of orthopedic dentistry to activate the clamps. 7. In no case, in no case, under any circumstances, it is not to try to carry out a fix, repair or other effects on the prosthesis. 8. In the event of a breakdown or the occurrence of the third in the base of the removable prosthesis, the patient must urgently apply to the clinic of orthopedic dentistry for the replacement of the prosthesis. Patient map History History № _______________________ Name of the institution _______________________ Date: Observation Start _______________________ FULL NAME_______________________ End of observation _______________________ age_______________________ Diagnosis of the main _______________________ Accompanying illnesses:_______________________ Patient model: _______________________ The volume of irradiated medical care: The code Name Performance mark (multiplicity) Diagnostics 01.02.003 Palpation of muscles 01.04.001 Collecting anamnesis and complaints in the pathology of the joints 01.04.002 Visual examination of the joints 01.04.003 Palpation joints 01.04.004 Percussion Justov 01.07.001 Collecting anamnesis and complaints in the pathology of the oral cavity 01.07.002 Visual study in the pathology of the oral cavity 01.07.003 Palpation of the oral cavity 01.07.005 External inspection of the maxillofacial region 01.07.006 Palpation of the maxillofacial region 01.07.007 Determination of the degree of opening of the mouth and restriction of mobility of the lower jaw 02.04.003 Measurement of joint mobility (angler) 02.04.004 Auscultation Sustava 02.07.001 Inspection of the oral cavity with additional tools 02.07.004 Anthropometric studies 06.07.001 Panoramic X-ray of the upper jaw 06.07.002 Panoramic Radiography of the Lower Jaw 09.07.001 Investigation of mouthprints-imprint 09.07.002 Cytological study of the contents of the cyst (abscess) of the oral cavity or the contents of the sewage pocket 11.07.001 Biopsy of the mucous membranes of the oral cavity Treatment 16.07.026 Prosthetics with complete removable lamines D01.01.04.03 Removable Orthopedic Design Correction 25.07.001 Purpose of drug therapy for diseases of the oral cavity and teeth 25.07.002 Appointment of dietary therapy for diseases of the oral cavity and teeth Distribute assistance (specify the drug used): Drug complications (indicate manifestations): ________________________________________________ The name of the drug, which caused them: ________________________________________________ Exodus (according to the outcome classifier): ________________________________________________ Patient information is transferred to the institution, monitoring the Protocol: ________________________________________________ (institution name) (date) Signature of the person responsible for monitoring the OST in the medical facility: ________________________________________________ Conclusion when monitoring Completeness of the compulsory list of non-drugs well no NOTE Performance of the fulfillment of medical services well no Completeness of the compulsory list of the drug assortment well no Compliance with the requirements of the Duration / Duration Protocol well no

The code	Name	Multiplicity of execution
A01.07.001.		1
A01.07.002.		1
A01.07.005		1
A02.07.001.		1
A02.07.005.	Thermodyniagnosis of the tooth	1
A02.07.007.	Percussion teeth	1
A02.07.008.	Definition of bite	According to the algorithm
A03.07.001	Luminescent stomatoscopy	By need
A03.07.003		By need
A06.07.003.		By need
A12.07.001.		According to the algorithm
A12.07.003.		According to the algorithm
A12.07.004.		By need

6.1.4. Characteristics of algorithms and features of diagnostic measures

To this end, all patients are required to collect anamnesis, inspection of the oral and teeth, as well as other necessary research, the results of which are in a medical record of a dental patient (form 043 / y).

Collect Anamneza

All teeth are subject to the survey, they begin to inspect the right upper molars and finish with the right lower molars. In detail examine all the surfaces of each tooth, pay attention to the color, relief of the enamel, the presence of plaque, the presence of spots and their condition after drying the surface of the teeth, defects.

Pay attention to the presence of white matte spots on visible surfaces of the teeth, the area, the form of the edges, the surface texture, density, symmetry and the plurality of lesions of the lesion in order to establish the severity of changes and the rate of development of the process, the dynamics of the disease, as well as differential diagnosis with noncaryomic lesions. Luminescent dentoscopy can be applied to confirm the diagnosis.

Thermodyniagnostic It is used to identify pain reaction and clarifying the diagnosis.

Percussion Used to eliminate caries complications.

Vital staining of solid tooth tissues. In difficult for differential diagnosis with noncaryotic lesions, cases of damage to 2% methylene blue solution are stained. When receiving a negative result, appropriate treatment (the other patient model) is carried out.

Oral hygiene indices Determine before treatment and after training the oral hygiene, in order to control.

6.1.5. Requirements for the treatment of outpatient polyclinic

The code	Name	Multiplicity of execution
A13.31.007.	Hygiene training oral hygiene	1
A14.07.004.	Controlled cleaning of teeth	1
A16.07.089		1
A16.07.055		1
A11.07.013		According to the algorithm
A16.07.061		By need
A25.07.001.		According to the algorithm
A25.07.002.		According to the algorithm

6.1.6 Characteristics of algorithms and features of non-drug assistance

Non-drugs are aimed at ensuring proper oral hygiene in order to prevent the development of the carious process and includes three main components: teaching oral hygiene, controlled teeth cleaning and professional oral hygiene and teeth.

In order to develop in a patient, the skills of the oral cavity (teeth cleaning) and the maximum efficient removal of a soft dental plaque from the surfaces of the teeth teach the patient to techniques of oral hygiene. Teeth cleaning techniques are demonstrated on models.

Individually select the means of oral hygiene. Training Oral hygiene skills contributes to the prevention of the development of the caries of the teeth (the level of persuasiveness of evidence B).

Under controlled cleaning of the teeth, the patient is implied, which the patient performs independently in the presence of a specialist (dentist doctor, hygienist dental) in the dental office or the oral hygiene room, in the presence of necessary hygiene and visual benefits. The purpose of this event is to control the effectiveness of teeth cleaning by the patient, correction of disadvantages of teeth cleaning techniques. Controlled teeth cleaning allows to achieve efficient maintenance of oral hygiene (level of persuasiveness of evidence B).

Professional oral hygiene includes removal from the surface of the tooth over-and fit dental sediments and prevents the development of the caries of teeth and inflammatory diseases of the periodontal (the level of persuasiveness of evidence A).

First visit

Complete cleaning with circular motions of a toothbrush with closed jaws, carrying out the gum massage, right to left.

The individual selection of hygiene facilities of the oral cavity is carried out taking into account the dental status of the patient (the state of solid tissues of teeth and periodontal tissues, the presence of dental anomalies, removable and fixed orthodontic and orthopedic structures) ().

Second visit

First visit

Next visit

The patient instructs about the need to be a prophylactic examination for the doctor at least 1 time in six months

- to conduct antiseptic treatment of the oral cavity with a solution of antiseptics (0.06% chlorhexide slices, 0.05% solution of potassium permanganate);

Stopping solid teeth tissues

Stopping is carried out before the course of remineralizing therapy in the presence of rough surfaces.

Sealing Tooth Tooth Sealant

To prevent the development of the carious process, sealing the teeth of teeth with a sealant in the presence of deep, narrow (pronounced) fissures.

6.1.7. Drug Requirements Ambulatory Polyclinic

6.1.8. Characteristics of algorithms and features of the use of medicines

The main methods of treating caries enamel in the stain stage is remineralizing therapy and fluorination (level of persuasiveness of evidence B).

Remineralizing therapy

The course of remineralizing therapy consists of 10-15 applications (daily or every other day). Before the beginning of treatment, in the presence of rough surfaces, they are carried out their stove. Embed to the course of remineralizing therapy. Before each applique, the affected surface of the tooth is mechanically cleaned from the plaque and dried with a jet of air.

Applications with remineralizing agents on the treated surface of the tooth for 15-20 minutes with a shift of the tampon every 4-5 minutes. Appliques 1-2% sodium fluoride is carried out in each 3rd visit, after applining with a remineralizing solution on the purified and dried surface of the tooth for 2-3 minutes.

Application on the fluorulat teeth, as an analogue of a 1-2% sodium fluoride solution is carried out in each 3rd visit after appliqués with a remineralizing solution, on the dried surface of the tooth. After appliqués, the patient does not recommend eating for 2 hours and brushing the teeth for 12 hours.

The criterion for the effectiveness of the rate of remineralizing therapy and fluorination is to reduce the size of the focus of demineralization up to its disappearance, the reduction of the gloss of enamel or less intensive staining of the focus of demineralization (according to the 10-point film of the enamel dye) with a 2% methylene blue solution.

6.1.9. Requirements for labor regime, recreation, treatment and rehabilitation

Patients with caries enamel in the stain stage must attend a specialist once every six months for observation.

6.1.10. Care requirements for patient and subsidiary procedures

6.1.11. Requirements for dietary appointments and restrictions

After completing each healing procedure, it is recommended not to take food and do not rinse the mouth within 2 hours. Restriction of food consumption and beverages with low pH values \u200b\u200b(juices, tonic drinks, yogurts) and thorough rinsing of the mouth after their reception.

Restriction of the stay of carbohydrates in the oral cavity (sucking, chewing candies).

6.1.12. Form of informed voluntary consent of the patient when implementing the Protocol

6.1.13. Additional information for the patient and his family members

6.1.14. Rules for changing requirements when executing the protocol and termination of the requirements of the Protocol

6.1.15. Possible outcomes and their characteristics

Name of outcome	Frequency of development,%	Criteria and signs
Compensation function	30		2 months
Stabilization	60		2 months	Dynamic observation 2 times a year
	5		At any stage	Providing medical care but the protocol of the relevant disease
	5

6.1.16. Cost characteristics of the protocol

6.2. Patient model

Nonological form: Caries Dentina
Stage: Any
Phase: Stabilization of the process
Complications: without complications
Code of the ICD-10: K02.1.

6.2.1. Criteria and signs that define the patient's model

- Patients with constant teeth.
- The presence of cavity with the transition of the enamele-dentine border.
- Tooth with a healthy pulp and periodontal.

- When the carious cavity is probed, short-term pain is possible.

6.2.2. The procedure for including the patient in the protocol

The patient's condition satisfying the criteria and signs of the diagnosis of the patient's model.

6.2.3. Requirements for the diagnosis of outpatient polyclinic

The code	Name	Multiplicity of execution
A01.07.001.	Collecting anamnesis and complaints in the pathology of the oral cavity	1
A01.07.002.	Visual study in the pathology of the oral cavity	1
A01.07.005	External inspection of the maxillofacial region	1
A02.07.001.	Inspection of the oral cavity with additional tools	1
A02.07.002.		1
A02.07.005.	Thermodyniagnosis of the tooth	1
A02.07.007.	Percussion teeth	1
A12.07.003.	Determination of oral hygiene indexes	1
A02.07.006.	Definition of bite	According to the algorithm
A03.07.003	Diagnostics of the state of the dental system using methods and means of radiation visualization	By need
A05.07.001.	Electropotometry	By need
A06.07.003.	Aiming Intraverse Contact Radiography	By need
A06.07.010		By need
A12.07.001.	Vital staining of solid tooth tissues	By need
A12.07.004.	Defining periodontal indexes	By need

6.2.4. Characteristics of algorithms and features of diagnostic measures

Collect Anamneza

When collecting anamnesis, find out the presence of complaints of pain from stimuli, allergic history, the presence of somatic diseases. It is purposefully detected by complaints of pain and discomfort in the field of a particular tooth, to jammed food, how long ago they appeared when the patient drew attention to them. Special attention is paid to finding out the nature of complaints, whether they always, in the opinion of the patient, are associated with a specific irritant. Find out the profession of the patient, whether the patient has proper hygienic care for the oral cavity, the last visit to the dentist's doctor.

When examining the oral cavity, the state of dental rows is estimated, paying attention to the presence of a seal, the degree of their adjacent, the presence of defects of solid teeth tissues, the number of remote teeth. The caries intensity is determined (the CPU index - caries, seal, removed), hygiene index. Pay attention to the state of the mucous membrane of the mouth, its color, moisture, the presence of pathological changes. All teeth are subject to the survey, they begin to inspect the right upper molars and finish with the right lower molars.

Survey all the surfaces of each tooth, pay attention to the color, relief of the enamel, the presence of plaque, the presence of spots and their condition after drying the surface of the teeth, defects.

Pay attention to ensuring that the probing was carried out without strong pressure. Draw attention to the presence of spots on visible surfaces of the teeth, the presence of spots and their condition after drying the surface of the teeth, the area, the form of the edges, the texture of the surface, density, symmetry and the plurality of lesions of the lesion in order to establish the severity of the disease and the rate of development of the process, the dynamics of the disease, and Also differential diagnosis with noncaryotic lesions. When sensing the detected carious cavity, pay attention to its shape, localization, magnitude, depth, the presence of a softened dentin, the change in its color, soreness, or on the contrary, the absence of pain sensitivity. Especially carefully examine the approximal surfaces of the tooth. Thermodyniagnosis is carried out. To confirm the diagnosis in the presence of a cavity on the contact surface and in the absence of sensitivity, the pulp is carried out x-ray.

When carrying out the electropotometry, the sensitivity indicators of the pulp during caries of dentin are recorded from 2 to 10 μA.

6.2.5. Requirements for the treatment of outpatient polyclinic

The code	Name	Multiplicity of execution
A13.31.007.	Hygiene training oral hygiene	1
A14.07.004.	Controlled cleaning of teeth	1
A16.07.002.	Tooth restoration of Ploma	1
A16.07.055	Professional oral hygiene and teeth	1
A16.07.003.	Tooth restoration by tabs, vinir, half-opera	By need
A16.07.004.	Tooth restoration crown	By need
A25.07.001.	Purpose of drug therapy for diseases of the oral cavity and teeth	According to the algorithm
A25.07.002.	Appointment of dietary therapy for diseases of the oral cavity and teeth	According to the algorithm

6.2.6. Characteristics of algorithms and features of non-drug assistance

Non-mediotic assistance is aimed at preventing the development of the carious process and includes three main components: ensuring proper hygiene of the oral cavity, sealing the carious defect and, if necessary, prosthetics.

Treatment of caries, regardless of the localization of the carious cavity, includes: Premedication (if necessary), anesthesia, disclosure of the carious cavity, removal of softened and pigmented dentin, formation, finishing, washing and sealing the cavity (by readings) or prosthetics by tabs, crowns or veneers.

Indications for prosthetics are:

Defeat of hard tissues of the coronal part of the tooth after the preparation: For a group of chewing teeth, index of destroying the occlusal surface of the tooth (frost)\u003e 0.4 shows the manufacture of tabs, fruits\u003e 0.6 - the manufacture of artificial crowns, frosts\u003e 0,8-shown followed by the manufacture of crowns;
- Preventing the development of deformities of the dental system in the presence of adjacent teeth with fillings, replenishing more? Chewing surface.

Main treaties:

Stop pathological process;
- restoration of the anatomical shape and the function of the tooth;
- Preventing the development of complications, including the warning of the development of Popova-Godon's phenomenon in the field of antagonist teeth;
- Restoration of the aesthetics of the dentition.

Treatment of caries dentin filling and, if necessary, prosthetics allows us to make compensation for the function and stabilization of the process (the level of persuasiveness of evidence A).

Algorithm Training Oral Hygiene

First visit

The physician or hygienist dental determines the hygienic index, then demonstrates the patient to the teeth cleaning technique with a toothbrush and dental threads using dental row models, or other demonstration agents.

Cleaning teeth starting from a plot in the region of the upper right chewing teeth, passing from the segment to the segment. In the same order, clean the teeth on the lower jaw.

To pay attention to the fact that the working part of the toothbrush should be located at an angle of 45 ° to the teeth, produce cleansing movements from the gums to the tooth, at the same time removing the flare from the teeth and the gums. Chewing surfaces of teeth cleaning horizontal (reciprocating) movements so that the fibers of the brushes penetrate deep into fissures and interdental intervals. The vestibular surface of the frontal group of teeth of the upper and lower jaws is cleaned by the same movements as molars and premolars. When cleaning the oral surface, the brush handle is perpendicular to the occlusal plane of the teeth, while the fibers must be under an acute angle to the teeth and capture not only the teeth, but also the gums.

Complete the cleaning of the circular motion of the toothbrush with closed jaws, carrying out the gum massage on the right left.

The duration of cleaning is 3 minutes.

For high-quality cleaning of contact surfaces of teeth, use dental threads.

Second visit

In order to secure the skill obtained, controlled teeth cleaning is carried out.

Algorithm of controlled teeth cleaning

First visit

Processing of the patient's teeth in the painting, determination of the hygienic index, a demonstration of the patient using the mirror of the places of the largest cluster of the plaque.
- Cleaning the teeth by the patient in its ordinary manner.
- Re-definition of the hygienic index, evaluation of the effectiveness of the teeth cleaning (comparison of the index index of hygiene before and after cleaning the teeth), demonstrating the patient using the mirror of the painted areas, where the dental flare was not removed when cleaning.
- Demonstration of proper teeth cleaning techniques on models, recommendations to the patient to correct the deficiencies of hygienic care for the oral cavity, the use of dental yarns and additional hygiene products (special toothbrushes, dental enshiks, monopropic brushes, irrigators - by testimony).

Next visit

Determination of the index hygienic, with a satisfactory level of oral hygiene - repetition of the procedure.

Stages of professional hygiene:

Training patient individual oral hygiene;
- removal of over- and fit dental deposits;
- polishing the surfaces of the teeth, including the surfaces of the roots;
- elimination of factors contributing to the cluster of the dental plaque;
- Applications of remineralizing and fluoride-containing funds (with the exception of areas with high fluorine in drinking water);
- Motivation of the patient to the prevention and treatment of dental diseases. The procedure is carried out in one visit.
- When removing over-and fit dental deposits (dental, a dense and soft dental flare), a number of conditions should be observed:
- removal of the dental stone to carry out with application anesthesia;

- Isolate processed teeth from saliva;
- Notice that the hand holding the tool must be fixed on the patient's chin or adjacent teeth, the terminal rod of the tool is located parallel to the axis of the tooth, the main movements - lever and scraping - must be smooth, not injured.

In the field of metal ceramic, ceramic, composite restorations, implants (when processing the latter, plastic tools are used) a manual method for removing dental sediments is used.

Ultrasonic devices should not be used in patients with respiratory, infectious diseases, as well as in patients with a pacemaker.

To remove the plaque and polishing smooth surfaces of the teeth, it is recommended to use rubber caps, chewing surfaces - rotating brushes, contact surfaces - floss and abrasive stations. Polishing paste should be used, starting with large-dispersed and finishing finely dispersed. Fluoride-containing polishing pastes are not recommended to use before carrying out some procedures (fissure sealing, teeth whitening). When processing implants surfaces, fine polishing pastes and rubber caps should be used.

It is necessary to eliminate the factors contributing to the cluster of the dental plaque: remove the hanging edges of the seal, repeated polishing the seal.

The frequency of professional hygiene of the oral cavity depends on the dental status of the patient (the hygienic state of the oral cavity, the intensity of the caries of the teeth, the state of the periodontal tissues, the presence of non-removable orthodontic equipment and dental implants). The minimum frequency of conducting professional hygiene - 2 times a year.

With caries, dentin seal is carried out in one visit. After diagnostic research and deciding on treatment on the same reception proceed to treatment.

It is possible to formulate a temporary seal (dressings), if it is impossible to put a permanent seal in the first visit or to confirm the diagnosis.

Anesthesia;
- "Disclosure" of the carious cavity;


- excision enamel deprived of dentin (according to indications);
- the formation of the cavity;
- Finishing the cavity.

It is necessary to pay attention to the processing of the edges of the cavity to create a high-quality edge adjustment of the seal and preventing the enamel chips and sealing material.

When filling with composite materials, gentle cavity is allowed (level of persuasiveness of evidence B).

Features of the preparation and sealing of cavities

Class I cavities

It should be striving to maximize the bumps on an occlusal surface, for this, before viewing using the articulation paper, the enamel sections are revealed, which carry an occlusal load. The bugs remove partially or completely if the boards are damaged by 1/2 of its length. The preparation is carried out in contours of natural fissures. If necessary, use the "prophylactic expansion" method for black. The use of this method contributes to the prevention of recurrence of caries. This type of preparation is recommended primarily for materials that do not have good adhesion to the tissues of the tooth (amalgam) and determine the cavity due to mechanical retention. Performing an expansion of the cavity to prevent secondary caries it is necessary to pay attention to the preservation of the maximum possible dentip thickness at the bottom of the cavity.

Class II cavities

Before the origin of the preparation determine the types of access. Conduct the formation of the cavity. Check the quality of the removal of affected fabrics using the probe and caries detector.

When sealing, it is necessary to use matrix systems, matrices, interdental wedges. With the extensive destruction of the coronal part of the tooth, it is necessary to use a matrixer. It is necessary to perform anesthesia, since the overlay of the matrixer or the introduction of the wedge is painful for the patient.

The correctly formed contact surface of the tooth in no case can be flat - it should have a form close to spherical. The contact zone between the teeth should be located in the equator area and slightly higher - as in intact teeth. You should not model the contact point at the level of edge ridges of the teeth: in this case, in addition to jammed food, the particles of the material from which the seal is made are possible in the interdental gap. As a rule, this error is associated with the use of a flat matrix that does not have a convex circuit in the equator area.

The formation of the contact slope of the edge ridge is carried out using abrasive strips (strokes) or disks. The presence of a edible ridge ridge prevents the material chips in this area and the jams of food.

It is necessary to pay attention to the formation of dense contact between the seal and the adjacent tooth, preventing the excessive injection of the material into the area of \u200b\u200bthe guessing wall of the cavity (creating a "hanging edge"), ensuring the optimal fit of the material to the gingny wall.

Class III cavities

When preparation, it is important to determine the best access. Direct access is possible in the absence of a number of worth the standing tooth or with the exhaust cavity on the adjacent contact surface of the adjacent tooth. Preferred pagan and sky access, as it allows you to preserve the vestibular surface of the enamel and provide a higher functional aesthetic level of tooth recovery. With the preparation, the contact wall of the cavity is excised by an enamel knife or boron, pre-defending the intact neighboring tooth with a metal matrix. Form the cavity, removing enamel deprived of dentin to be dentin, treated edges with finish boums. It is allowed to preserve vestibular enamel, deprived of dentin, if it does not have cracks and signs of mineralization.

Class IV cavities

The peculiarities of the preparation of the Class IV cavity are Wide Falts, the formation in some cases of an additional platform in a pagan or pagan surface, gentling the preparation of the tooth tissues in the formation of the gum cavity wall in the case of the distribution of the carious process below the gum level. During the preparation, it is preferable to create a reference form, since the adhesion of composite materials is often not enough.

When filling, pay attention to the proper formation of the contact point.

When filling with composite materials, the restoration of the cutting edge should be carried out in two stages:

The formation of the pagan and sky fragments of the cutting edge. The first removal is carried out through enamel or previously superimposed composite from the vestibular side;
- formation of a vestibular fragment of the cutting edge; Switching is carried out through a cured pagan or parallery.

Class V.

Before starting the preparation, it is necessary to determine the depth of the distribution of the process under the gum, if necessary, send a patient to correction (excision) of the gum-edge mucosa for disclosure of the operational field and removing the portion of the hypertrophied gum. In this case, the treatment is carried out in 2 or more visits, because after intervention, the cavity is closed with a temporary seal, cement or oil dentine is used as a material for a temporary seal before healing the tissues of the tissue edge. Then conduct sealing.

The form of the cavity should be rounded. If the cavity is very small, permissible sparing overlap by spherical boras without creating retention zones.

To seal defects, noticeable with a smile, you should choose a material with sufficient aesthetic characteristics. In patients with poor oral hygiene, it is recommended to use glass terminal (polyalcatenate) cements that provide long-term fluorility of the tooth tissues after sealing and having acceptable aesthetic characteristics. In patients of elderly and old age, especially with xerostomy phenomena, amalgam or glass meters should be applied. It is also possible to use compomers with the advantages of glass elements and high aesthetic. Composite materials are shown when filling defects in cases where the aesthetics of the smile is very important.

Class VI cavities

Features of these cavities require a gentle removal of affected tissues. Bills should be used, the size of which only slightly exceeds the diameter of the carious cavity. Suppose the abandonment of anesthesia, especially with a slight depth of the cavity. It is possible to preserve the enamel deprived of dentin to be dentin, which is associated with a sufficiently large thickness of the enamel layer, especially in the field of molars () bugrov.

Algorithm and features of the manufacture of tabs

Indications for the manufacture of tabs for caries dentin are cavities of classes I and II on Black. The tabs can be manufactured from both metal and ceramics and composite materials. The tabs allow you to restore an anatomical form, the function of the tooth, to prevent the development of the pathological process, to ensure the aesthetics of the dentition.

Contraindications to the application of tabs during caries dentin are the surfaces of the teeth, are not allowed to form cavities under the tabs and teeth with an infallible, fragile enamel.

The question of the treatment method by the tab or crown during caries dentin can be solved only after removing all necrotic tissues.

The tabs are manufactured in several visits.

First visit

During the first visit, the formation of the cavity is carried out. The cavity under the tab is formed after removing the accuracted caries of necrotic and pigmented tissues. It must meet the following requirements:

To be drawn;
- the bottom and walls of the cavity must withstand chewing pressure;
- the form of the cavity should ensure the hold of the tab from the displacement in any directions;
- For accurate edge adjustment, providing hermeticism, it is necessary to form an SCOS (fold) within the enamel at an angle of 45 ° (in the manufacture of solo-polished tabs).

The preparation of cavity is carried out under local anesthesia.

After the cavity is generated, the tab is simulated in the oral cavity or get an impression.

When simulating the wax model, the tabs pay attention to the accuracy of the fitting of the wax model according to not only the central occlusion, but also all the movements of the lower jaw, to eliminate the possibility of formation of the retention sites, to give the external surfaces of the wax model of the correct anatomical form. When modeling the tab in the class II cavity, matrices are used to prevent damage to the interdental gauge papilla.

In the manufacture of tabs, an indirect method is obtained to receive implications. Obtaining an impression after odontoprotation on the same reception is possible in the absence of damage to marginal periodontal. Silicone two-layer and alginate inspection masses, standard inspiration spoons are used. The edge of the spoons is recommended before receiving the impressions to edit the narrow band of the leukoplower for better retention of the output material. It is advisable to use special adhesive for fixing silicone prints on a spoon. After removing spoons from the oral cavity, the quality of writing is controlled.

In the manufacture of ceramic or composite tabs, the color is determined.

After modeling a tab or receipt of implications for its manufacture, the sweeping of the tooth is closed by a temporary seal.

Next visit

After the manufacture of tabs in the dental laboratory produce a suction tab. Pay attention to the accuracy of the edge adjustment, the absence of gaps, occlusal contacts with the teeth antagonists, the approximal contacts, the color of the tab. If necessary, conduct correction.

When making a solid tab after its polishing, and in the manufacture of ceramic or composite tabs - after glazing, the tabs on the constant cement are fixed.

The patient instructs the rules for using the tab and indicate the need to regularly visit the doctor once every six months.

Algorithm and features of the manufacture of microprotheses (veneers)

Under the veneers, for the purposes of this protocol, it is necessary to understand the facet of facing, manufactured on the front teeth of the upper jaw. Features of the manufacture of veneers:

The veneers are installed only on the front teeth in order to restore the aesthetics of the tooth row;
- veneers are made of dental ceramics or composite materials;
- in the manufacture of veneers, the preparation of tissues of the tooth is carried out only within the enamel, while pigmented sections are tossed;
- The veneers are made with overlapping the cutting edge of the tooth or without overlapping.

First visit

When making a decision on the manufacture of a veneer on the same reception proceed to treatment.

Preparation for preparation

The preparation of the tooth under the vinir is produced under local anesthesia.

During the preparation, pay special attention to the depth: 0.3-0.7 mm of solid tissues are tossed. Before starting the basic preparation, it is advisable to retracted the gums and the marking of the preparation depth using a special marking boron (disk) with a size of 0.3-0.5 mm. It is necessary to pay attention to the preservation of approximal contacts, avoid the preparation in the sera area.

Obtaining an impression from a sweeping tooth is carried out on the same reception. Silicone two-layer and alginate inspection masses, standard inspiration spoons are used. The edge of the spoons is recommended before receiving the impressions to edit the narrow band of the leukoplower for better retention of the output material. It is advisable to use special adhesive for fixing silicone prints on a spoon. After removal of spoons from the oral cavity, the quality of the prints (the accuracy of the display of anatomical relief, the absence of Nor, etc.) is performed.

To fix the correct ratio of dentitions in the position of central occlusion, gypsum or silicone blocks are used. The color of the vinir is determined.

Refireed teeth are coated with temporary veneers made of composite material or plastics, which are fixed to temporary calcium-containing cement.

Next visit

Vinir overlaying and suction

Particular attention must be paid to the accuracy of the adjacent of the edges of the vinir to the solid tissue tissues, check the absence of gaps between the vinir and the tooth. Pay attention to approximal contacts, on occlusive contacts with antagonist teeth. Especially carefully impose contacts during the sagittal and transversal movements of the lower jaw. If necessary, correction is carried out.

A veneer fixation is carried out on a permanent cement or composite material for double curing cementing. Pay attention to the color of the cement color of the vinir. The patient instructs the rules for use of vinir and indicate the need to regularly visit the doctor 1 time in six months.

Algorithm and features of the manufacture of a solid crown

The indication to the manufacture of the crown is a significant lesion of an occlusal or cutting surface of the teeth with a stored vital pulp. Crowns are made on the teeth after the treatment of caries dentin filling. Calcular crowns for caries dentin are made on any teeth to restore an anatomical form and function, as well as to prevent further destruction of the tooth. Crowns are manufactured in several visits.

Features of the manufacture of solid crowns:

Under the prosthetics of molars, the use of a solid crown or crown with a metal occlusal surface is recommended;
- In the manufacture of a solid metal ceramic crown, an oral garland is simulated (metal kart along the edge of the crown);
- plastic (according to the need - ceramic) cladding is made in the field of frontal teeth on the upper jaw only to 5 tooth inclusive and on the lower jaw up to 4 tooth inclusive, further - by the need;
- In the manufacture of crowns on the teeth-antagonists, it is necessary to observe a specific sequence:

• the first stage is the simultaneous manufacture of temporary CAPPs on the teeth to be prosthetized by both jaws with the maximum restoration of occlusal relations and the obligatory determination of the height of the lower part of the person, these kapps should reproduce the design of future crowns as accurately;
• first, constant crowns are made on the teeth of the upper jaw;
• after fixing the crowns on the teeth of the upper jaw make constant crowns on the teeth of the lower jaw.

First visit

Preparation for preparation

To determine the viability of the pulp of prosthetic teeth, the electrooptometry is carried out before the start of therapeutic measures. Before the origin of the preparation is obtained for the manufacture of temporary plastic crowns (KAPP).

Correne Dental Preparation

The type of preparation is selected depending on the type of future crowns and the group affiliation of prosthetic teeth. In the preparation of several teeth, pay special attention to the parallelism of the clinical axes of the teeth of teeth after the preparation.

In the case of the application of the retraction of the gums, upon receipt of the impression, attention is paid to the somatic status of the patient. If there is a history of cardiovascular diseases (ischemic heart disease, angina, arterial hypertension, violations heart Rhythm) It is impossible to apply for retraction of gums auxiliary agents containing catecholamines (including threads impregnated with such compositions).

To prevent the development of inflammatory processes in the tissues of the regional periodontal after the preparation, anti-inflammatory regenerating therapy is prescribed (rinse of the oral cavity of the oak cortex, as well as the influence of chamomile, sage, etc., if necessary, with an oil solution of vitamin A or other means that stimulate epithelization).

Next visit

Obtaining outlines

In the manufacture of solo-grained crowns, it is recommended to assign a patient for reception the next day or a day after the preparation for removing the working two-layer prints from the removal of teeth and the imposition of antagonist teeth, if they were not removed in the first visit.

Silicone two-layer and alginate inspection masses, standard inspiration spoons are used. The edge of the spoons is recommended before receiving the impressions to edit the narrow band of the leukoplower for better retention of the output material. It is advisable to use special adhesive for fixing silicone prints on a spoon. After removing spoons from the oral cavity, the quality of writing is made (mapping anatomical relief, no pores).

In the case of applying the retraction method, the somatic status of the patient is given. If there is a history of cardiovascular diseases (coronary heart disease, angina, arterial hypertension, heart rate disorders), the auxiliary agents containing catecholamines (including threads impregnated with such compositions) cannot be used for retraction of gums (including threads impregnated with such compositions).

Next visit

Overlay and suction frame of a solid crown. No earlier than 3 days after the preparation to eliminate traumatic (thermal) damage to the pulp, repeated electrooptometry is carried out (it is possible to hold on the next visit).

Particular attention should be paid to the accuracy of the frame adjacent in the subsidence (edible adjacent). Check the absence of a gap between the wall of the crown and the tooth cubes. Pay attention to the correspondence of the contour of the edge of the reference crown of the contours of the gums of the gum, to the degree of immersion of the crown edge into the gantry gap, approximal contacts, occlusal contacts with antagonist teeth. If necessary, correction is carried out. If the facing is not provided, polishing the solo-grained crown and its fixation of Pa temporary or permanent cement is carried out. For fixing crowns, temporary and constant calcium-containing cements should be applied. Before fixing the crown on the permanent cement, electrooptometry is carried out to eliminate inflammatory processes in the tooth pulp. In the signs of damage to the pulp, the question of depululation is solved.

If ceramic or plastic cladding is provided, the selection of cladding color is carried out.

Crowns with facing on the upper jaw make up the 5th tooth inclusive, on the bottom - until the 4th inclusive. Facing the chewing surfaces of the side teeth are not shown.

Next visit

Overlay and suction of the finished solid crown with facing

Special attention should be paid to the accuracy of the fit of the crown in the subsidence (edible adjacent). Check the absence of a gap between the wall of the crown and the tooth cubes. Pay attention to the correspondence of the contour of the crown of the contours of the gum edge, on

the degree of immersion of the crown edge into the gantry gap, approximal contacts, occlusal contacts with antagonist teeth.

If necessary, correction is carried out. When using a metal-plastic crown after polishing, and when using a metal-ceramic crown - after glazing, fixation is carried out for temporary (for 2-3 weeks) and whether on the constant cement. For fixing crowns, temporary and constant calcium-containing cements should be applied. Special attention when fixing on temporary cement, it is necessary to refer to the removal of cement residues from interdental intervals.

Next visit

Fixation on permanent cement

Special attention when fixing on permanent cement, it is necessary to refer to the removal of cement residues from interdental intervals. The patient instructs the rules for the use of the crown and indicate the need for a regular visit to the doctor 1 time in six months.

Algorithm and features of the manufacture of stamped crown

The stamped crown with proper manufacturing fully restores the anatomical shape of the tooth and prevents the development of complications.

First visit

After diagnostic research, the necessary preparatory medical measures and the decision to prosthetize on the same reception proceed to treatment. Crowns are made on the teeth after the treatment of caries dentin filling.

Preparation for preparation

To determine the viability of the pulp of the support teeth is carried out by electrooptometry prior to the start of all therapeutic measures.

Before the origin of the preparation, retains for the manufacture of temporary plastic crowns (Cannes). If it is impossible to make temporary kappa due to a slight preparation volume, fluorlates are used to protect the cleaned teeth.

Dental preparation

When preparation, pay attention to the parallel the walls of the sweeping tooth (cylinder shape). When the preparation of several teeth should be paid to the parallelism of the clinical axes of the teeth of the teeth after the preparation. The preparation of teeth is carried out under local anesthesia.

Obtaining an impression from repaired teeth on the same reception possible in the absence of damage to the marginal periodontal during the preparation. In the manufacture of stamped crowns, alginate inspection masses are used, standard peeling spoons. The edge of the spoons is recommended before receiving the impressions to edit the narrow band of the leukoplower for better retention of the output material. After removing spoons from the oral cavity, quality control is made.

To fix the correct ratio of dentitions in the position of central occlusion, gypsum or silicone blocks are used. If it is necessary to determine the central relations of the jaws, wax bases with occlusive rollers are manufactured. With the temporary Capps made, their suction is carried out, if necessary, relocate and fixation on temporary cement.

To prevent the development of inflammatory processes in the tissues of the regional periodontal, anti-inflammatory therapy (rinse of the oak cavity in the infusion of oak bark, chamomile, sage, if necessary, appliques of vitamin A, or other means that stimulate epithelials) is prescribed.

Next visit

Receipt is carried out if they were not received in the first visit.

Alginate print masses are used, standard inspisted spoons. The edge of the spoons is recommended before receiving the impressions to edit the narrow band of the leukoplower for better retention of the output material. After removing spoons from the oral cavity, the quality of writing is made (mapping anatomical relief, no pores).

Next visit

Next visit

Fitting and surgery stamped crowns

Particular attention should be paid to the accuracy of the adjacent of cortic in the subsidence (edge \u200b\u200badjacent). Check the absence of crown pressure on marginal periodontal fabric. Pay attention to the correspondence of the contour of the edge of the reference crown of the contours of the gums of the gum, the degree of immersion of the crown edge into the gantry slot (maximum of 0.3-0.5 mm), approximal contacts, occlusal contacts with antagonist teeth.

If necessary, correction is carried out. When using combined stamped crowns (protein) after sucking, the crowns are obtained to push the trees of the tooth using wax poured inside the crown. Determine the color of plastic cladding. Crowns with facing on the upper jaw make up the 5th tooth inclusive, on the bottom - until the 4th inclusive. Facing the chewing surfaces of the side teeth in principle are not shown. After polishing, fixation is made on constant cement.

Before fixing the crown on the permanent cement is carried out by electrooptometry to identify inflammatory processes in the pulp of the tooth. For fixing crowns, constant calcium-containing cements must be applied. In the signs of damage to the pulp, the question of depululation is solved.

The patient instructs the rules for the use of crowns and indicate the need to regularly visit the doctor once every six months.

Algorithm and features of the manufacture of a cell-operating crown

The indication for the manufacture of all-ceramic crowns is a significant lesion of an occlusal or cutting surface of the teeth with a stored vital pulp. Crowns are made on the teeth after the treatment of caries dentin filling.

All-ceramic crowns during caries dentin can produce on any teeth to restore an anatomical form and function, as well as to prevent further destruction of the tooth. Crowns are manufactured in several visits.

Features of the manufacture of all-tempered crowns:

The main feature is the need to prepare the tooth with a circular rectangular ledge at an angle of 90.
- In the manufacture of crowns on the teeth-antagonists, it is necessary to observe a specific sequence:

• the first stage is the simultaneous manufacture of temporary Capps on the teeth to be prosthetized with both jaws with the maximum restoration of occlusal relations and the mandatory determination of the height of the lower person. These kappa should reproduce the design of future crowns as accurately;
• alternately make constant crowns on the teeth of the upper jaw;
• after fixing the crowns on the teeth of the upper jaw make permanent crowns on the teeth of the lower jaw;
• when the ledge is located at the level of the gum edge or below, it is always necessary to use the retraction of the gums before receiving the impression.

First visit

After diagnostic research, the necessary preparatory medical measures and the decision to prosthetize on the same reception proceed to treatment.

Preparation for preparation

To determine the viability of the pulp of prosthetic teeth is carried out by zektoodontomometry prior to the beginning of the medical event. Before the origin of the preparation is obtained for the manufacture of temporary plastic crowns (KAPP).

Precarition of teeth for hypocheramic crowns

Always apparent with a rectangular circular ledge at an angle of 90 °. In the preparation of several teeth, pay special attention to the parallelism of the clinical axes of the teeth of teeth after the preparation.

The preparation of teeth with a vital pulp is carried out under local anesthesia. Obtaining an impression from repaired teeth on the same reception possible in the absence of damage to the marginal periodontal during the preparation. Silicone two-layer and alginate inspection masses, standard inspiration spoons are used. It is recommended that the edges of the spoon are recommended before receiving an outturope to be edged with a narrow band of the adhesive plate for better retention of the output material. It is advisable to use special adhesive for fixing silicone prints on a spoon. After removing spoons from the oral cavity, the quality of writing is controlled.

In the case of the application of the retraction of the gums, upon receipt of the impression, attention is paid to the somatic status of the patient. If there is a history of cardiovascular diseases (coronary heart disease, angina, arterial hypertension, heart rate violations) Cannot be used for retraction of gums auxiliary agents containing catecholamines (including threads impregnated with such compositions).

To fix the correct ratio of dentitions in the position of central occlusion, gypsum or silicone blocks are used. With the temporary caps made, their sucking is carried out, if necessary, removing and fixing on temporary calcium-containing cement.

The color of the future crown is carried out.

To prevent the development of inflammatory processes in the tissues of the regional periodontal after the preparation, anti-inflammatory regenerating therapy is prescribed (rinse the oak cavity of the oak, chamomile and sage, if necessary, appliques with vitamin A oil solution or other means that stimulate epithelialization).

Next visit

Obtaining outlines

In the manufacture of all-earramic crowns, it is recommended to assign a patient to the reception the next day or a day after the preparation for obtaining a working two-layer impression from removal of teeth and impulse from antagonist teeth, if they were not received in the first visit. Silicone two-layer and alginate inspection masses, standard inspiration spoons are used. The edge of the spoons is recommended before receiving the impressions to edit the narrow band of the leukoplower for better retention of the output material. It is advisable to use special adhesive for fixing silicone prints on a spoon. After removing spoons from the oral cavity, the quality of writing is made (mapping anatomical relief, no pores).

In the case of applying the retraction method, the somatic status of the patient is given. If there is a history of cardiovascular diseases (coronary heart disease, angina, arterial hypertension, heart rate disorders), the auxiliary agents containing catecholamines (including threads impregnated with such compositions) cannot be used for retraction of gums (including threads impregnated with such compositions).

Next visit

Overlay and suction of a all-tempered crown

Not earlier than 3 days after the preparation to eliminate the traumatic (thermal) damage to the pulp, repeated electrooptometry is carried out (it is possible to carry out the next visit).

Particular attention must be paid to the accuracy of the fit of the crown to the ledge in the subsidence (edible adjacent). Check the absence of a gap between the wall of the crown and the tooth cubes. Pay attention to the correspondence of the contour of the edge of the reference crown contours of the edge of the ledge, approximal contacts and occlusal contacts with antagonist teeth. If necessary, correction is carried out.

After the glaze, fixation is carried out for temporary (for 2-3 weeks) or per permanent cement. For fixing crowns, temporary and constant calcium-containing cements should be applied. Special attention when fixing on temporary cement, it is necessary to refer to the removal of cement residues from interdental intervals.

Next visit

Fixation on permanent cement

Before fixing the crown on the permanent cement, electrooptometry is carried out to eliminate inflammatory processes in the tooth pulp. In the signs of damage to the pulp, the question of depululation is solved. With vital teeth for fixing crowns, constant calcium-containing cements should be applied.

Special attention when fixing on a permanent cement to refer to the removal of cement residues from interdental intervals.

The patient instructs the rules for the use of the crown and indicate the need for a regular visit to the doctor 1 time in six months.

6.2.7. Drug Requirements Ambulatory-Noliklinic

6.2.8. Characteristics of algorithms and features of the use of medicines

The use of local anti-inflammatory and epithelial means is shown in mechanical injury of the mucous membrane.

Analgesics, nonsteroidal anti-inflammatory drugs, means for the treatment of rheumatic diseases and gout

Putting rinsing or baths with bravery of one of the drugs: bark oak, chamomile flowers, sage 3-4 times a day for 3-5 days (level of persuasive evidence C). Applications on the affected areas of sea buckthorn oil - 2-3 times a day to 10-15 minutes (the level of persuasiveness of evidence C).

Vitamins

Appliques on the affected areas of retinol affected areas are used - 2-3 times a day for 10-15 minutes. 3-5 days (the level of persuasiveness of evidence C).

Blood

Hemodializat deproteinized - adhesive paste for the oral cavity - 3-5 times a day on the affected areas 3-5 days (level of persuasiveness of evidence C).

Local anesthetics

6.2.9. Requirements for labor regime, recreation, treatment and rehabilitation

Patients must attend a specialist once every six months for observation.

6.2.10. Care requirements for patient and subsidiary procedures

6.2.11. Requirements for dietary appointments and restrictions

There are no special requirements.

6.2.12. Form of informed voluntary consent of the patient when implementing the Protocol

6.2.13. Additional information for the patient and his family members

6.2.14. Rules for changing requirements when executing the protocol and termination of the requirements of the Protocol

When identifying in the process of diagnosing features requiring preparatory measures to treatment, the patient is translated into a protocol for conducting patients corresponding to the detected diseases and complications.

When identifying signs of another disease that requires conducting diagnostic and medical measures, along with signs of Caries Enamel, the medical assistance to the patient is in accordance with the requirements:

A) section of this protocol of conducting patients corresponding to the maintenance of caries enamel;
{!LANG-d16a750699a451bdc5817c333da7fa40!}

{!LANG-06946e76d0876bdecded242c6e1d269d!}

Name of outcome	Frequency of development,%	{!LANG-fa2e3cf0a1aae1828fca4791de1b09a6!}	{!LANG-f92c43beb15fc4847c71961ba973567b!} {!LANG-80c559674176d99bcb9cbf4f8114f8c9!}	{!LANG-868736db15ec4f7bd22dcbf081f0e9ee!}
Compensation function	50			{!LANG-91b956d2e193e2fe75754733a4554fb7!} {!LANG-d3a45f4e464823a36094c4c94faf620c!}
Stabilization	30	{!LANG-419ce003d81963aa26d1dc2f824227a7!}	{!LANG-b263738ade9a1fc47ac5c7fb356acad3!}	Dynamic observation 2 times a year
{!LANG-85c421b659ee2b428c2f80243a7daf78!}	10	{!LANG-f427f943747547251f27c974dc01c1bb!}	At any stage	{!LANG-c04209391dc0af55a4761ef852afc076!}
{!LANG-831620cd5f2ed0e20094ec9594c20261!}	10	{!LANG-b42d0dd021306927b11555affb314fc2!}	{!LANG-65da15188228f04f480615dfe5bdf36f!}	{!LANG-c04209391dc0af55a4761ef852afc076!}

{!LANG-cfe1b2f03ed4f13e1a97873d00913bf3!}

{!LANG-d81d32278bd09028d7a95f97364fe6d5!}

{!LANG-b222e2802e8c8a236063d4861e90decb!}

Nonological form{!LANG-bd8a2facf4398e76163a416348bf24b6!}
Stage: Any
Phase: Stabilization of the process
Complications: without complications
Code of the ICD-10{!LANG-aa0119f80c82f9b9d87c43028fa5d1a0!}

{!LANG-4e720b11d786fe65bf3733258f049b59!}

- Patients with constant teeth.
{!LANG-117e00cc88aa2e91a5f7155de0cfd86e!}
{!LANG-0a78121cea97d7fb0bb1951b4dac7793!}
{!LANG-3d7cb3b2704e3e90452ce0a11db55f16!}
{!LANG-ae627c1b39ee4dcc57921af49b14a891!}
{!LANG-a2b0e539147f4d8fcae5780faed2ac1c!}
{!LANG-d037549efc2dd54af73df1a9627b9d90!}
{!LANG-7dac069aa2740d2c5c1004061c1e0f06!}
{!LANG-f3814fa08eafd7bd381f634f5b9ab2e4!}
{!LANG-c6f92c81d366a8e51ca0233ad64e5f61!}

{!LANG-6184b712d7036eaf60f8e655d45a5ff8!}

The patient's condition satisfying the criteria and signs of the diagnosis of the patient's model.

{!LANG-d8eda923f75e5ada99db3acdbf4907ec!}

The code	Name	Multiplicity of execution
A01.07.001.	Collecting anamnesis and complaints in the pathology of the oral cavity	1
A01.07.002.	Visual study in the pathology of the oral cavity	1
A01.07.005	External inspection of the maxillofacial region	1
A02.07.001.	Inspection of the oral cavity with additional tools	1
A02.07.002.	{!LANG-d2d657e3752b71354d2ae9e0efb6ca96!}	1
A02.07.007.	Percussion teeth	1
A12.07.003.	Determination of oral hygiene indexes	1
A12.07.004.	Defining periodontal indexes	1
A02.07.006.	Definition of bite	According to the algorithm
A02.07.005.	Thermodyniagnosis of the tooth	By need
A03.07.003	Diagnostics of the state of the dental system using methods and means of radiation visualization	By need
A06.07.003.	Aiming Intraverse Contact Radiography	By need
A06.07.010	{!LANG-380046d4dc6aa2823d2f64b2888950f5!}	By need

{!LANG-8b18f69702272f6826e4f861a4cf5a66!}

{!LANG-a28c79b28b1a373e4abaccefaa3c9d27!}

{!LANG-effb5f1a3249290b5748d9ed5f566cca!}

Collect Anamneza

{!LANG-675124e3b2837cd52d4198fac3d1fe29!}

{!LANG-14d44ab4a27208c3ed0269ebfb3aaf39!}

{!LANG-eb6f9504e6d3a5d796b4b90e7aaf8676!}

{!LANG-fc9cddec650c3ef8943cf50ecc77d419!}

{!LANG-b7142cee1bf292716653cd3fd8fb501d!}

{!LANG-3c47a74084d717a95e91ddd6f04dd385!}

{!LANG-9ff5f883e15fe76716f7b4ba981704b5!}

{!LANG-9f8a23366264155d7a5aca86d0c915d3!}

{!LANG-5372209d2629fd898f3ca4c452b0920c!}

{!LANG-0f495b5c1294a8da11ec5c2623327158!}

{!LANG-036c18c115638123ab33f6de272131ec!}

Algorithm Training Oral Hygiene

First visit

The physician or hygienist dental determines the hygienic index, then demonstrates the patient to the teeth cleaning technique with a toothbrush and dental threads using dental row models, or other demonstration agents.

Cleaning teeth starting from a plot in the region of the upper right chewing teeth, passing from the segment to the segment. In the same order, clean the teeth on the lower jaw.

To pay attention to the fact that the working part of the toothbrush should be located at an angle of 45 ° to the teeth, produce cleansing movements from the gums to the tooth, at the same time removing the flare from the teeth and the gums. Chewing surfaces of teeth cleaning horizontal (reciprocating) movements so that the fibers of the brushes penetrate deep into fissures and interdental intervals. The vestibular surface of the frontal group of teeth of the upper and lower jaws is cleaned by the same movements as molars and premolars. When cleaning the oral surface, the brush handle is perpendicular to the occlusal plane of the teeth, while the fibers must be under an acute angle to the teeth and capture not only the teeth, but also the gums.

{!LANG-0b3de39a38d81b9da1e6aa640d787afd!}

For high-quality cleaning of contact surfaces of teeth, use dental threads.

{!LANG-1aac8bf7a584955cbb1e5f7321bbebc8!}

Second visit

{!LANG-1bc9ab41c46bf618659604036cf633d6!}

Algorithm of controlled teeth cleaning

First visit

{!LANG-c8f0c11918be3b59be86262cfc3b21ea!}
- Cleaning the teeth by the patient in its ordinary manner.
{!LANG-f33fc4b036acd7b929aca2fefe006f5e!}
- Demonstration of proper teeth cleaning techniques on models, recommendations to the patient to correct the deficiencies of hygienic care for the oral cavity, the use of dental yarns and additional hygiene products (special toothbrushes, dental enshiks, monopropic brushes, irrigators - by testimony).

{!LANG-340bc1a1c2aeccce56b16a64bbe7c7aa!}

{!LANG-45333c0620e2f304894b9c4de1529dcb!}

{!LANG-e8bbe623ef1f9d7db4a4b8b20bda775a!}

{!LANG-77bc5a6dd7e3ae4a6b101e7c07f94dae!}

Stages of professional hygiene:

Training patient individual oral hygiene;
- removal of over- and fit dental deposits;
- polishing the surfaces of the teeth, including the surfaces of the roots;
{!LANG-68dbd462415a58a0de7b30846429d092!}
- Applications of remineralizing and fluoride-containing funds (with the exception of areas with high fluorine in drinking water);
{!LANG-423c6f1a24d7b1f576d8624549a382ba!}

{!LANG-1d7028dca0834e2d1950cd1cf488d99b!}

{!LANG-7298a1bbea24049d54633027a6c4825d!}

{!LANG-1c6375e88fa5f5bc2bdb539049278bc9!}
{!LANG-d840b136576a02eae2c21cc870adcc22!}
- Isolate processed teeth from saliva;
- Notice that the hand holding the tool must be fixed on the patient's chin or adjacent teeth, the terminal rod of the tool is located parallel to the axis of the tooth, the main movements - lever and scraping - must be smooth, not injured.

In the field of metal ceramic, ceramic, composite restorations, implants (when processing the latter, plastic tools are used) a manual method for removing dental sediments is used.

Ultrasonic devices should not be used in patients with respiratory, infectious diseases, as well as in patients with a pacemaker.

{!LANG-34c696864e01bf7a53498e0468d513bf!}

It is necessary to eliminate the factors contributing to the cluster of the dental plaque: remove the hanging edges of the seal, repeated polishing the seal.

{!LANG-5ab67bc1df50dd78c9b57d244ba57a41!}

{!LANG-e92f1832095963578b112e01cb8cf7d9!}

{!LANG-74017333a2323d955033ebe68751d163!}

{!LANG-98c58967a4c85d136e2b0fab8d20e66c!}

{!LANG-1e650ab8f3b47b7b9ea34ab936138e8f!}

{!LANG-8e18fea6be3da6d0dd631c1fee502fc6!}

Anesthesia;
{!LANG-990e417da5e681804c9077c7b984436f!}
{!LANG-9f25a5521256522e83b3dcc968c50b4b!}
{!LANG-58dd9ddc0a75228fe22a7554991ef5e8!}

{!LANG-a8d8787831892669a9d6b0987bbec10b!}

{!LANG-8b52d8d16fb52df4ddc12a0a4c2070d7!}

{!LANG-bdf192b722a3da37f1cf459af6f911c3!}

{!LANG-c21f61a0b1583d4c12d77f6ab80a70d9!}

{!LANG-3e14623ab6db36875b84d6e21c601179!}

{!LANG-e7a725dea7ffcfee7aa215b3737d4a6f!}

{!LANG-3604e3cde07d508f64d1a1b20e164a83!}

Local anesthetics

{!LANG-d5d36771ecd45212443b5aca0db7f43b!}

{!LANG-879a4ece64ee1e869fdc91e85a07cbad!}

{!LANG-e3cb16676fe482ee5c960e2994ac5eea!}

{!LANG-98d67f37d565e5cb379bb9c5086d904b!}

{!LANG-c0d10eb0142b373d3deb3954d57d575f!}

{!LANG-ad494e7661550476a67137bca64c2a7e!}

There are no special requirements.

{!LANG-ba06362582cdcecbc537bd008a17c07a!}

{!LANG-06995d3414a4020d2e19c67dcbd0241a!}

{!LANG-855809d5888eedeaee59a8e1eff5db7a!}

When identifying in the process of diagnosing features requiring preparatory measures to treatment, the patient is translated into a protocol for conducting patients corresponding to the detected diseases and complications.

When identifying signs of another disease that requires conducting diagnostic and medical measures, along with signs of Caries Enamel, the medical assistance to the patient is in accordance with the requirements:

A) section of this protocol of conducting patients corresponding to the maintenance of caries enamel;
{!LANG-d16a750699a451bdc5817c333da7fa40!}

{!LANG-ea7ed572931779484923d8b102f03034!}

Name of outcome	Frequency of development,%	{!LANG-fa2e3cf0a1aae1828fca4791de1b09a6!}	{!LANG-a2534ccef36d5c40e4514a5b68a87ce9!}	{!LANG-ac95919009608105e85104213509be04!}
Compensation function	40	{!LANG-a6b817f1e91702646d9f7aa4eecc5eff!}	{!LANG-b263738ade9a1fc47ac5c7fb356acad3!}	Dynamic observation 2 times a year
Stabilization	15	{!LANG-b8f9d1a6792e440e38acc372c31a7e24!}	{!LANG-b263738ade9a1fc47ac5c7fb356acad3!}	Dynamic observation 2 times a year
	25	{!LANG-f427f943747547251f27c974dc01c1bb!}	At any stage	{!LANG-c04209391dc0af55a4761ef852afc076!}
{!LANG-e9d4e0e52b205cc96fc7e7104b2f3395!}	20	{!LANG-b42d0dd021306927b11555affb314fc2!}	{!LANG-65da15188228f04f480615dfe5bdf36f!}	{!LANG-c04209391dc0af55a4761ef852afc076!}

{!LANG-e083e9f58e712000c1629b69d7060208!}

{!LANG-d81d32278bd09028d7a95f97364fe6d5!}

{!LANG-1eba148bb4d39a1bc0242f3f3ea87fba!}

Nonological form{!LANG-4a9a76f69861fbebfbdece31c6370352!}
Stage: Any
Phase: Stabilization of the process
Complications: without complications
Code of the ICD-10{!LANG-deacd7c77adbaf555c82c3122d02e614!}

{!LANG-8d06366ed624dd97838afe787318b06c!}

- Patients with constant teeth.
{!LANG-d87ba7124514ff0fca385ae4a8a596a1!}
{!LANG-b9f9ea19033e093ae72c3e3d57e4c7db!}
{!LANG-b0d28230ceed218ea352b9d7bf0b4973!}
{!LANG-0697acfd74dc36467f129a02b788e6e7!}
{!LANG-1ede4458864180febf7ae04ec86547b5!}

{!LANG-a4435b4813329a53b16966e929ca6c6e!}

The patient's condition satisfying the criteria and signs of the diagnosis of the patient's model.

{!LANG-e22121fd924b4d3f3dda2600a181d0ee!}

The code	Name	Multiplicity of execution
A01.07.001.	Collecting anamnesis and complaints in the pathology of the oral cavity	1
{!LANG-878a8026e3f8814e05ae8c2f73786b76!}	Visual study in the pathology of the oral cavity	1
A01.07.005	External inspection of the maxillofacial region	1
A02.07.001.	Inspection of the oral cavity with additional tools	1
A02.07.002.	{!LANG-d2d657e3752b71354d2ae9e0efb6ca96!}	1
A02.07.007.	Percussion teeth	1
A02.07.005.	Thermodyniagnosis of the tooth	By need
A02.07.006.	Definition of bite	By need
{!LANG-c2d0c2711aca7cfcc98e6dd6ca0415ad!}	{!LANG-f1cce0c9afcbf2fe61dc6df9366e40fc!}	By need
A05.07.001.	Electropotometry	By need
A06.07.003.	Aiming Intraverse Contact Radiography	By need
{!LANG-eeec5611d80b8b5df4e51497c25e5551!}	{!LANG-380046d4dc6aa2823d2f64b2888950f5!}	By need
A12.07.003.	Determination of oral hygiene indexes	According to the algorithm
{!LANG-7156f003691b522d12752b38ac7ddc4a!}	Defining periodontal indexes	By need

{!LANG-cc97126f7fed074893fd75e784e87e9d!}

{!LANG-e5a6aefb9f3e1065aa74b37d3068f2aa!}

{!LANG-518e297886fa1a51be0bd53fbfddd057!}

{!LANG-515a3c2bdc103c1d69225686a8b21e2b!}

Collect Anamneza

{!LANG-a52426d9739f44b862dd8661c673d95a!}

{!LANG-1b02ae05a305a88eb633f860b391defb!}

{!LANG-1d20003b1bbeb7175c6a923e64a56fbf!}

{!LANG-7a9bb091acec4a1249ea0d74d124eff3!}

{!LANG-851402e1a8e63e1ed767661f81c5b0b0!}

{!LANG-0a9f85fb252f78608d9bc540c2dfd6ab!}

{!LANG-9ff5f883e15fe76716f7b4ba981704b5!}

{!LANG-e5bf51aad99ef7da0b658be7f730b391!}

{!LANG-641230fda69d3ba5522efbd682b6c421!}

The code	Name	Multiplicity of execution
A13.31.007.	Hygiene training oral hygiene	1
A14.07.004.	Controlled cleaning of teeth	1
A16.07.055	Professional oral hygiene and teeth	1
A11.07.013	{!LANG-da15e10164ad61484c023f7584e3d233!}	According to the algorithm
{!LANG-dd4f4d2c225a26d6c56857350588b96e!}	Tooth restoration of Ploma	By need
{!LANG-3559735f0797768e25e679bb1bcfc8fb!}	Sealing Tooth Tooth Sealant	By need
A25.07.001.	Purpose of drug therapy for diseases of the oral cavity and teeth	According to the algorithm
A25.07.002.	Appointment of dietary therapy for diseases of the oral cavity and teeth	According to the algorithm

{!LANG-40f244aa63d48b11f4a5c2e3e10886a2!}

{!LANG-b4d7cfa0e5567046d685ccb9e3474cde!}

{!LANG-32d7769254b97ff9340c8f72b67d305e!}
{!LANG-b0f725b318e71a1546095bb1094eece1!}

{!LANG-db4d21349e130dbc48d6f1acfc2c8606!}

{!LANG-df996169c38fae7271fa5dbaac274c99!}

Algorithm Training Oral Hygiene

First visit

{!LANG-25eabf9fe126103da176e4e6673f834b!}

Cleaning teeth starting from a plot in the region of the upper right chewing teeth, passing from the segment to the segment. In the same order, clean the teeth on the lower jaw.

To pay attention to the fact that the working part of the toothbrush should be located at an angle of 45 ° to the teeth, produce cleansing movements from the gums to the tooth, at the same time removing the flare from the teeth and the gums. Chewing surfaces of teeth cleaning horizontal (reciprocating) movements so that the fibers of the brushes penetrate deep into fissures and interdental intervals. The vestibular surface of the frontal group of teeth of the upper and lower jaws is cleaned by the same movements as molars and premolars. When cleaning the oral surface, the brush handle is perpendicular to the occlusal plane of the teeth, while the fibers must be under an acute angle to the teeth and capture not only the teeth, but also the gums.

{!LANG-087173dfead125cd5e86a4c93940be7b!}

The duration of cleaning is 3 minutes.

For high-quality cleaning of contact surfaces of teeth, use dental threads.

{!LANG-1aac8bf7a584955cbb1e5f7321bbebc8!}

Second visit

{!LANG-1bc9ab41c46bf618659604036cf633d6!}

Algorithm of controlled teeth cleaning

First visit

{!LANG-c8f0c11918be3b59be86262cfc3b21ea!}
- Cleaning the teeth by the patient in its ordinary manner.
- Re-definition of the hygienic index, evaluation of the effectiveness of the teeth cleaning (comparison of the index index of hygiene before and after cleaning the teeth), demonstrating the patient using the mirror of the painted areas, where the dental flare was not removed when cleaning.
- Demonstration of proper teeth cleaning techniques on models, recommendations to the patient to correct the deficiencies of hygienic care for the oral cavity, the use of dental yarns and additional hygiene products (special toothbrushes, dental enshiks, monopropic brushes, irrigators - by testimony).

{!LANG-340bc1a1c2aeccce56b16a64bbe7c7aa!}

{!LANG-45333c0620e2f304894b9c4de1529dcb!}

{!LANG-e8bbe623ef1f9d7db4a4b8b20bda775a!}

{!LANG-f97c887b5a85d5cfce0ffeedc1b9fcde!}

Stages of professional hygiene:

Training patient individual oral hygiene;
- removal of over- and fit dental deposits;
- polishing the surfaces of the teeth, including the surfaces of the roots;
- elimination of factors contributing to the cluster of the dental plaque;
- Applications of remineralizing and fluoride-containing funds (with the exception of areas with high fluorine in drinking water);
{!LANG-423c6f1a24d7b1f576d8624549a382ba!}

{!LANG-1d7028dca0834e2d1950cd1cf488d99b!}

{!LANG-0dcc1f3a7a13e201399ace2af220e45c!}

{!LANG-1c6375e88fa5f5bc2bdb539049278bc9!}
{!LANG-d840b136576a02eae2c21cc870adcc22!}
- Isolate processed teeth from saliva;
{!LANG-e28468b5f1adb4d28d950d71c5ea21e5!}

{!LANG-9829b46ea8aa8c10c0d0e1e6109b8196!}

{!LANG-b2c40c03d13b6a909d2f38f60d2f0f08!}

{!LANG-fdd6f772a197a9b757a95ef1229ea54f!}

{!LANG-4ffc33c2e8a3c7bef843d8476b91c3e9!}

Sealing Tooth Tooth Sealant

{!LANG-9a26ccaf221c7a0ba3b0400186922534!}

{!LANG-e92f1832095963578b112e01cb8cf7d9!}

First visit

{!LANG-1fc633ad7efb67084d99400d573060f7!}

{!LANG-4c7c055a7b06acddf277ae659a24a8bb!}

{!LANG-050a00e952b5f3e80dde63fa4e6bdea1!}

{!LANG-dc4573f53b2a4ec38b66b85186a96147!}

{!LANG-9cbc2d57d1bfbf07ad7d25ab0da7e792!}

{!LANG-6b826ed3c0bee705c140baffbf1508ba!}

{!LANG-384ed7ac223fa0107d7a9aa8ba96d546!}

{!LANG-c03403528810cc48da03ae32a6a498cd!}

{!LANG-7544262ff6b1cf6f2108b683c4a8a7a6!}

{!LANG-ba5819e8991e868327097428bd37ec0a!}

{!LANG-a01bec1eb4ca9fb8bc27c0da8d1bed93!}

{!LANG-90332083a94c9187023b827e97e4f34a!}

{!LANG-616c05850c207e147dc3b004d8e0c943!}

{!LANG-b222a47237b4ae2ba6a88db592c0b265!}

{!LANG-25b471f102f8ee41c67a12c673e9e4af!}

{!LANG-e6d773e8ee1fa9d37f3ada399faa222e!}

{!LANG-46aa24b9ab16f11d6e30657d62437453!}

When identifying in the process of diagnosing features requiring preparatory measures to treatment, the patient is translated into a protocol for conducting patients corresponding to the detected diseases and complications.

When identifying signs of another disease that requires conducting diagnostic and medical measures, along with signs of Caries Enamel, the medical assistance to the patient is in accordance with the requirements:

A) section of this protocol of conducting patients corresponding to the maintenance of caries enamel;
{!LANG-d16a750699a451bdc5817c333da7fa40!}

{!LANG-4c15c9a1ed2457b697483ca47fea14c8!}

Name of outcome	Frequency of development,%	{!LANG-cd3aeda27283c2b2d972c29c7d9dcf5f!}	{!LANG-a2534ccef36d5c40e4514a5b68a87ce9!}	{!LANG-868736db15ec4f7bd22dcbf081f0e9ee!}
Compensation function	30	{!LANG-f6fb786b940961185beb20e71696220f!}		Dynamic observation 2 times a year
Stabilization	50	{!LANG-56d94d407911d12ce0ac56f2d288bc97!}	{!LANG-405af4bcbe045d16d0801a3904adca15!}	Dynamic observation 2 times a year
{!LANG-96070e1e6bdd633647852eaefa4a9438!}	10	{!LANG-f427f943747547251f27c974dc01c1bb!}	{!LANG-faacaacde78fef9dc870518a2469c1e7!}	{!LANG-c04209391dc0af55a4761ef852afc076!}
{!LANG-831620cd5f2ed0e20094ec9594c20261!}	10	{!LANG-b42d0dd021306927b11555affb314fc2!}	{!LANG-ba64b491f1181014f52ccea9186cf441!}	{!LANG-c04209391dc0af55a4761ef852afc076!}

{!LANG-29214e184151df434130f803d022b376!}

{!LANG-d81d32278bd09028d7a95f97364fe6d5!}

{!LANG-025cb3a340d40ee71f29133556be053a!}

{!LANG-dd98a06964114ed4e46daf1f2250ec27!}

{!LANG-a5689e0bae9c761dd698c95395430033!}

{!LANG-a69c718e1dfbaa6613b7f7b8c642146f!}

{!LANG-d32766380cf9e036185261b9ac21aadf!}

{!LANG-2ba7101659e102755fe31fb723fed3ed!}

{!LANG-a7abba22160f9203e8908b30d6e06023!}
{!LANG-2ff7f582fa143ec5e95150a71776844a!}
{!LANG-24ae5edfee7ab720e46c71a1950d26e5!}
{!LANG-c2ac01db460bbf9eca4c2120deabb1ed!}

{!LANG-b932fb23d9f90bfafd068b327c7e227d!}

{!LANG-d34640deb57018cf7a849fe16d6436d8!}
{!LANG-67f9284b954334532628d915b128b383!}
{!LANG-eb77f59d314d2e7057c118fe6a83f30c!}

{!LANG-15c4a4fd0e13b0ae504413cc29f31d8a!}

{!LANG-b5d3c9e9b9d478e67bdc8b724ad796db!}

{!LANG-ec56e7d928b8778048e311ddcea05257!}

{!LANG-3f1092d5391e0bb8df5b333b60f74e81!}

{!LANG-9e16a34819a1d0cc55f9796da61494eb!}

{!LANG-cc912ac5c868e818edc969743554a6aa!}

{!LANG-3465cf8d0367d7271a123689bacc6e9f!} {!LANG-23df3ca16676eb63f4dca2a77911b17c!}{!LANG-6deaa9e4ab35e2f1bcec0af11319534a!}

{!LANG-a439872e8dbb1257789cdb8261fca618!}

{!LANG-81d908ed1aeb44f90311a8f984a59ad9!}

{!LANG-296b2b75d651dc89d4af9f74aa7b423e!}

{!LANG-29558764646ea36bdd5ba4bda076cc89!}

{!LANG-4642f10743bd3a50d1bdfc0ccf794585!}

{!LANG-c94f61e6766d8de9b77055c840475b16!}
{!LANG-26bb0723185b91c062be28fd16c2f1b5!}

{!LANG-c1e7a412e81bcb8617dd056ff4e2efa2!}

{!LANG-ab45f89e2e1b11bcaef3de45374f6928!}

{!LANG-d69a6a6af2b7f9217d26c54a3bbfc129!}

{!LANG-94730ce1b55319d06c53cbb2016c5143!}

Clinical and economic analysis is carried out according to the requirements of regulatory documents.

{!LANG-c20d23a94140e1cb508da71d812910fa!}

{!LANG-87e52f5a5d8035fa6bcd60704106a1e5!}

{!LANG-21d81956621cdbe005d44e547a40c2f4!}

{!LANG-c382c492f52a2d45f6619d4ed8f52e7b!}

{!LANG-2133ccf496bc98cf5a08c896dda2c429!}

{!LANG-5863e796de93577112a9cfdb7de462a7!}

{!LANG-069bbe27f2906e227e1cbdc5bf2da248!}

{!LANG-2c7b332a014e6c339be4b82cd6ce3edf!}
{!LANG-29738d96369ffdaddaa3dbdbd66d91ef!}
{!LANG-593eaa841544380f305f51b0eac50772!}
{!LANG-70a9473dd9d3b0c6903ad7b71ed4ff5c!}
{!LANG-55265a33d9e91696c893b7f5a1556e8e!}
{!LANG-5f8640ded5e4fc1f30e7cbcb05628c5b!}
{!LANG-13c172619457fa0bf07d8dfc06c076b6!}
{!LANG-1b1e4ebed61bcf64a1e619c228c9408b!}
{!LANG-cc26048e229df041a4865b0fdc08d402!}
{!LANG-56c85b38f265cb13e494032fa534ec97!}
{!LANG-bea39fcab16c64f11ee2ffd6e5b2157a!}
{!LANG-b93163dfd7e0cf533c31952d94cfa11b!}
{!LANG-5ac6d1df549f82f722860738a944fc08!}
{!LANG-9725d0856be159b8d46f496141b5bf6a!}
{!LANG-33f81a16200472ac7ab7f14c2c84bf1b!}
{!LANG-53cc06fb42d4984d98594eb7a82a8909!}
{!LANG-3c772046803c3c33463d8053f3ae4fd0!}
{!LANG-bf9336928f4cd9110372643dd3768ca8!}
{!LANG-cd850bf6bc5a0506f85cb96ad2226be7!}
{!LANG-044fda5b4a2a6addb0d25a1836601dc8!}
{!LANG-0426ec7af5d0ed157865d0bab8ddaa2b!}
{!LANG-c60db1e195b5c064ef687d8fc15d4ebf!}
{!LANG-4e685d5bf57a062a85d305e1fbf1360b!}
{!LANG-8d8ca0bc084060c084b3b985f833cf5a!}
{!LANG-b2692e973cfae7414a36101a62b9e67a!}
{!LANG-f8d6c1517a9c3616b1895574320e3819!}
{!LANG-0505d610f0bd72da4bbddb1470b03188!}
{!LANG-9d891cfddec7f990b492d4b49eca12a4!}
{!LANG-44b268586899ec91a93057cae1f6f6ce!}
{!LANG-61c4987d7f3f98e3d7d71c77e7b78c80!}
{!LANG-5b2595965a8150f11fade18c38860b6e!}
{!LANG-9a138cc99bdff71ca88075c598617305!}
{!LANG-0d33eaa7f5e1ebb70b0c737b9fc9f07b!}
{!LANG-b7e37383daa75360f35ab1ea319feb1b!}
{!LANG-7c52a6ca76b73062415e5676314efaaa!}
{!LANG-dc3b4f60d3dfa7064517aad988a25c2f!}
{!LANG-b7b175c9c651a1bdea472dad1ad6960c!}
{!LANG-4beab11a215c8b63680bbe19fab5707e!}
{!LANG-28040020cb2b23cf827a8b62ba8aeb40!}
{!LANG-7627399ca7eec58f5628b3b970514dd8!}
{!LANG-230b3073471fc1e01b422d97b97c7723!}
{!LANG-8cdafdcd22ed1781a60b4e4fd62a2967!}
{!LANG-84d77b3c31c4abe9118332f0e817ead1!}
{!LANG-badb537e628e7093e5f061a05972f2dc!}
{!LANG-04de139b63fd7231cb33f69d3c25a919!}
{!LANG-5b4e3e1bd5421f84e0700b378ae1991f!}
{!LANG-27a8463345b6a92a153b0e56251e1e4a!}
{!LANG-a578c75c07cce1bcb9120ac49e68669a!}
{!LANG-936277556354789c30aafed6a5fb6e66!}
{!LANG-6f6e388e72a8b9eb96d85cded1c33af1!}
{!LANG-383c04ecaeb3f2eb3811c2f5d877c0fd!}
{!LANG-2a307541e1e7bd5e488945a5073134f7!}
{!LANG-d0ee6a1a494b0aa614d349bbe04db3b2!}
{!LANG-f3981f824c07278127a98293c7d96f09!}
{!LANG-d42bb4a1c51b01d11c3e0667a87223b3!}
{!LANG-04e15eed3207d34b6a12a0538cabb91c!}
{!LANG-c3f1dfa5ea342f65a0b13531cb7d9df0!}

{!LANG-12542623de25530598ebdcfdd15c0339!}

{!LANG-9f901874921926e8480669eab4a7b241!}
{!LANG-33a9651c8ad67c515ba5054d0726034d!}
{!LANG-2c14d49d720c484a3b750325c9a5d946!}
{!LANG-0d02d4c419e425ee961a54966ebabfbd!}
{!LANG-e4ab2fa632e264a2c95ea80797b10001!}
{!LANG-2ffd6bafc5d46468d7cf912b38786e22!}
{!LANG-0667f2f3e1e0d93af042ad6bd621b882!}
{!LANG-361d051b2f4e8ac053cc73f845d3d33a!}
{!LANG-46fb49eb4b6bdeaa6c3aaa783908754e!}
{!LANG-5b628034ea201fdca77f896e3a574e42!}
{!LANG-9e59561b3371ac5c385ddff3f5fc2026!}
{!LANG-c6d95502cbe929f1a52eabeebde96ff4!}
{!LANG-75d14775e1f46370b61efd5e5f3c2570!}
{!LANG-e47eebebaed03667bac1213af47caa5e!}
{!LANG-d1a6d07a1bfd127a50b55a99f845e0b8!}
{!LANG-50a62febda964ade2c05fdc19a9fb459!}
{!LANG-e69a91a757f35362eb5dfc4672b6eaf4!}
{!LANG-4cd524d36913a219796936a6f0e4c6b8!}
{!LANG-1ee9375c359dd8c884e0fc129008e1ef!}

{!LANG-c9439dfcb3905bd9453e34b08287e798!}

{!LANG-c7c82976f4eeb31e1194562bcd1be471!}

{!LANG-734714ca9137b95d537d465d397c0fef!}

{!LANG-abc931381ce5d13f30c9a35f25ab6f4d!}	{!LANG-ef9f638d3ed27ee5607324c4b777f5a7!}
{!LANG-ce97c95193c64090fefba5adc186fca6!}	{!LANG-7cbf711dfe61e76a88dc537249e6b786!}
{!LANG-ef9045598594e36e57ce17c9eb89c01b!} {!LANG-9e5b92eed64a57c760fed260d6bea550!}	{!LANG-e91dd50c7213b232eabfeb9b06be6868!}
{!LANG-e03f49c8621482a90774497f04524311!}	{!LANG-2efc3a3c64b98128bc90a2e05f1ee82d!} {!LANG-3fce46e6abb3d1359e0484387b8d1c45!}{!LANG-08f9a063c4e9be04ea4211b4826f39c7!}
{!LANG-69e069256e1a8ab342794a764697999f!}	{!LANG-aaae39736a57d5761bc4a594aa9a89c0!}
{!LANG-cf5fbba89233d96719d02525403284b7!}	{!LANG-61dc58e50b4844324c5595f31104d12a!}
{!LANG-89d4e5e3c8c66b457e438aacb1b69456!}	{!LANG-842f2313bff044e543473e438bf1bd6a!} {!LANG-356a9bbc5ee943c5fac0158605095b64!} {!LANG-3fce46e6abb3d1359e0484387b8d1c45!}{!LANG-89e7e1798e710dc18660aa4feb512c1f!}
{!LANG-c18af3a7bf82cd1a85cd535ec3ac61bb!}	{!LANG-54f8da8b9700a5b4b4d66b638c847cb9!}
{!LANG-ad27f1f67362173b88e035c2dbbfaf02!}	{!LANG-e6f2a590a3fac1bd9747df9d0d217e6a!}
{!LANG-dbd80e41fde58cafb708e899c975125e!}	{!LANG-bbe98104dcd8e26f9831746f770fa9fb!}

{!LANG-93081a9581bd5aa10a32ccf633bd4188!}

{!LANG-c7c82976f4eeb31e1194562bcd1be471!}

{!LANG-166246f1a3d5e49e2cf001184bca2a82!}

{!LANG-9c4bd131a5af286c1a6957f89e4ab35b!}

{!LANG-758d2fd2b32b7bea432e0d0dcb6960ea!}

{!LANG-66c5a74696289fa1ababf491b5cb2d26!}

{!LANG-b1104950f6561c5a14fdf84b55a2aaca!}

{!LANG-2c12c2a79431c0f779b0d586d724daac!}

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{!LANG-c4234d2f3b2690cbe195340a61cc2649!}

{!LANG-c170d4dbe3dc3ae7edf5d3d34682bf8d!}

{!LANG-538b0ed4418fdbccb7e381b78c0c57f9!}

{!LANG-bfffaabde319e69984a4bae87490bd6e!}

{!LANG-2b79739ebe9b08ef23cf853be9527888!}

{!LANG-2fe9d8d23f59fba5126f9c579068f55f!}

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{!LANG-d0dc3f8cae8e26eaf0466c63f5c8bc9e!}

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{!LANG-c8c7b43185718482b1f5ec8ff907eeab!}

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{!LANG-56f0a31b17d3ca3713bac2de7f9238fe!}

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Patient map

{!LANG-91e6250fb0ffd3ce00124c684681a1a8!}

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The code {!LANG-0f56c35a94ed1d2867703d16226eff12!}	{!LANG-b04bba030894553b7d3f26edac488092!}	Multiplicity of execution
{!LANG-d3d55ab6c96a65f23531ea81526913a7!}
A01.07.001.	Collecting anamnesis and complaints in the pathology of the oral cavity
A01.07.002.	Visual study in the pathology of the oral cavity
A01.07.005	External inspection of the maxillofacial region
A02.07.001.	Inspection of the oral cavity with additional tools
A02.07.005.	Thermodyniagnosis of the tooth
A02.07.006.	Definition of bite
A02.07.007.	Percussion teeth
A03.07.001	Luminescent stomatoscopy
{!LANG-c2d0c2711aca7cfcc98e6dd6ca0415ad!}	Diagnostics of the state of the dental system using methods and means of radiation visualization
A06.07.003.	Aiming Intraverse Contact Radiography
A12.07.001.	Vital staining of solid tooth tissues
A12.07.003.	Determination of oral hygiene indexes
A12.07.004.	Defining periodontal indexes
A02.07.002.	{!LANG-d2d657e3752b71354d2ae9e0efb6ca96!}
A05.07.001.	Electropotometry
{!LANG-33c31a668071ec4e2e1fea16b6765f36!}	{!LANG-380046d4dc6aa2823d2f64b2888950f5!}
{!LANG-9b2ccc7e985da7edd10df3b22b42166e!}	{!LANG-da15e10164ad61484c023f7584e3d233!}
A13.31.007.	Hygiene training oral hygiene
A14.07.004.	Controlled cleaning of teeth
{!LANG-7dad1e5b9ff917dbe7d16f394a7d5438!}	Tooth restoration of Ploma
A16.07.003.	{!LANG-f2f9c58f05a6dee4630eec2865ace59c!}
A16.07.004.	Tooth restoration crown
A16.07.055	Professional oral hygiene and teeth
{!LANG-3559735f0797768e25e679bb1bcfc8fb!}	{!LANG-10181fb62a059bebdd6ac27a60812595!}
A16.07.089	{!LANG-50381305bad9b6f0a7974f0d23cdeaed!}
{!LANG-2bac3471d642a6aceae0c9debb748b9c!}	Purpose of drug therapy for diseases of the oral cavity and teeth
{!LANG-6de89a3edeeb80788e54a0422147dc0e!}	Appointment of dietary therapy for diseases of the oral cavity and teeth

Distribute assistance (specify the drug used):

{!LANG-019a1c74d132963803257b6d165dcc74!}

{!LANG-863875229d511a18d419c30c0993cfe0!}

{!LANG-6e18a377ab021195d9bc01f958e244ef!}

{!LANG-9edd4f37163e3198932c53f74b2fe38d!}

{!LANG-300ee5fbb9bc199eee245ac40638cbd8!}

Conclusion when monitoring	Completeness of the compulsory list of non-drugs	{!LANG-045ee0c3ea31d5c71e0a730a3091b8f2!}	{!LANG-ec45ca0b7151e8290491d5d4e69b10e5!}	NOTE
	Performance of the fulfillment of medical services	{!LANG-045ee0c3ea31d5c71e0a730a3091b8f2!}	{!LANG-ec45ca0b7151e8290491d5d4e69b10e5!}
	Completeness of the compulsory list of the drug assortment	{!LANG-045ee0c3ea31d5c71e0a730a3091b8f2!}	{!LANG-ec45ca0b7151e8290491d5d4e69b10e5!}
	{!LANG-dbc1608e127a9019911ee5a2b20f7702!}	{!LANG-045ee0c3ea31d5c71e0a730a3091b8f2!}	{!LANG-ec45ca0b7151e8290491d5d4e69b10e5!}

 

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{!LANG-6a7209d6e8ca063c7c89cb3dd4f3d658!}
{!LANG-98264441bb5e6f87d887e60f6e912328!} {!LANG-2774a44f438017573192a1e74e4d357d!} {!LANG-906cf0a21cd255ebd0b4e91b20c4d526!} {!LANG-a60001ee1af8822b9bbb5853569ac8cf!} What means lives Queen of Great Britain: the main income of the royal family