The protocol for managing patients with dental caries was developed by the Moscow State University of Medicine and Dentistry (Kuzmina E.M., Maksimovsky Yu.M., Maly A.Yu., Zheludeva I.V., Smirnova T.A., Bychkova N.V. , Titkina N.A.), Dental Association of Russia (Leontiev V.K., Borovsky E.V., Vagner V.D.), Moscow Medical Academy. THEM. Sechenov of Roszdrav (Vorobiev P.A., Avksentieva M.V., Lukyantseva D.V.), dental clinic No. 2 of Moscow (Chepovskaya S.G., Kocherov A.M.., Bagdasaryan M.I., Kocherova M.A. .).

I. SCOPE

The dental caries management protocol is intended for use in the healthcare system Russian Federation.

II. NORMATIVE REFERENCES

- Decree of the Government of the Russian Federation dated 05.11.97 No. 1387 "On measures to stabilize and develop healthcare and medical science in the Russian Federation" (Sobraniye zakonodatelstva Rossiyskoy Federatsii, 1997, No. 46, item 5312).
- Decree of the Government of the Russian Federation of October 26, 1999 No. 1194 "On approval of the Program of state guarantees for providing citizens of the Russian Federation with free medical care" (Collected 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 on July 12, 2004 - M., 2004. - 211 p.

III. GENERAL PROVISIONS

The protocol for managing patients with dental caries has been developed to solve the following problems:

- establishment of uniform requirements for the procedure for diagnosing and treating patients with dental caries;
- unification of the development of basic programs of compulsory health insurance and optimization of medical care for patients with dental caries;
- ensuring optimal volumes, availability and quality of medical care provided to the patient in a medical institution.

The scope of this protocol is medical and preventive institutions of all levels and organizational and legal forms that provide medical dental care, including specialized departments and offices of any form of ownership.

This paper uses the data evidence strength scale:

A) The evidence is compelling: there is strong evidence for the proposed assertion.
B) Relative Strength of Evidence: there is sufficient evidence to recommend this proposal.
C) There is not enough evidence: The available evidence is insufficient to make a recommendation, but recommendations may be made in other circumstances.
D) Sufficient negative evidence: there is enough evidence to recommend that the use of this drug, material, method, technology be abandoned under certain conditions.
E) Strong negative evidence: there is sufficient evidence to rule out medicine, method, technique from the recommendations.

IV. RECORD KEEPING

Maintaining the Protocol "Dental caries" is carried out by the Moscow State Medical and Dental University of Roszdrav. The reference system provides for the interaction of the Moscow State University of Medicine and Dentistry with all interested organizations.

V. GENERAL QUESTIONS

Dental caries(K02 according to ICD-10) is an infectious pathological process that manifests itself after teething, in which demineralization and softening of the hard tissues of the tooth occur, followed by the formation of a defect in the form of a cavity.

Currently, dental caries is the most common disease of the dentoalveolar system. The prevalence of caries in our country in the adult population aged 35 years and older is 98-99%. In the general structure of providing medical care to patients in medical and preventive dental institutions, this disease occurs in all age groups of patients. Dental caries with untimely or improper treatment can cause the development of inflammatory diseases of the pulp and periodontium, loss of teeth, the development of purulent-inflammatory diseases of the maxillofacial region. Dental caries are potential foci of intoxication and infectious sensitization of the body.

The development rates of complications of dental caries are significant: in the age group of 35-44 years, the need for filling and prosthetics is 48% and tooth extraction - 24%.

Untimely treatment of dental caries, as well as the extraction of teeth as a result of its complications, in turn, lead to the appearance of secondary deformation of the dentition and the occurrence of pathology of the temporomandibular joint. Dental caries directly affects the health and quality of life of the patient, causing violations of the chewing process up to the final loss of this function of the body, which affects the digestion process.

In addition, dental caries is often the cause of the development of diseases. gastrointestinal tract.

ETIOLOGY AND PATHOGENESIS

The direct cause of enamel demineralization and the formation of a carious focus are organic acids (mainly lactic), which are formed during the fermentation of carbohydrates by plaque microorganisms. Caries is a multifactorial process. Microorganisms in the oral cavity, the nature and diet, enamel resistance, the quantity 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 an enamel demineralization focus, the course of the process and the possibility of its stabilization. Initially, a carious lesion occurs due to the frequent use of carbohydrates and insufficient oral care. As a result, adhesion and reproduction of cariogenic microorganisms occur on the surface of the tooth and dental plaque is formed. Further intake of carbohydrates leads to a local change in pH to the acid side, demineralization and the formation of microdefects in the subsurface layers of enamel. However, if the organic matrix of enamel is preserved, then the carious process at the stage of its demineralization can be reversible. Long-term existence of the focus of demineralization leads to the dissolution of the surface, more stable layer of enamel. Stabilization this process clinically it can be manifested by the formation of a pigmented spot that exists for years.

CLINICAL PICTURE OF DENTAL CARIES

Clinical picture characterized by diversity and depends on the depth and topography of the carious cavity. A sign of initial caries is a change in the color of the tooth enamel in a limited area and the appearance of a spot, subsequently a defect develops in the form of a cavity, and the main manifestation of the developed caries is the destruction of the hard tissues of the tooth.

With an increase in the depth of the carious cavity, patients feel increased sensitivity to chemical, thermal and mechanical stimuli. Pain from irritants is short-lived, after elimination of the irritant quickly passes. There may be no pain response. Carious damage to the chewing teeth causes chewing dysfunction, patients complain of pain when eating and aesthetic disorders.

CLASSIFICATION OF DENTAL CARIES

In the International Statistical Classification of Diseases and Related Health Problems of the World Health Organization of the Tenth Revision (ICD-10), caries is singled out as a separate heading.

K02.0 Enamel caries. "White (chalky) spot" stage [initial caries]
K02.I Dentinal caries
K02.2 Cement caries
K02.3 Suspended dental caries
K02.4 Odontoclasia
K02.8 Other dental caries
K02.9 Dental caries, unspecified

Modified classification of carious lesions by localization (according to Black)

Class I - cavities located in the area of ​​fissures and natural recesses of incisors, canines, 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 canines without disturbing the cutting edge.
Class IV - cavities located on the contact surface of the incisors and canines with a violation of the angle of the crown part of the tooth and its cutting edge.
Class V - cavities located in the cervical region of all groups of teeth.
Class VI - cavities located on the tubercles of molars and premolars and the cutting edges of incisors and canines.

The stain stage corresponds to the ICD-C code K02.0 - "Enamel caries. The stage of the "white (matte) spot" [initial caries]". Caries in the stain stage is characterized by changes in the color (matte surface) resulting from demineralization, and then the texture (roughness) of the enamel in the absence of a carious cavity, which did not spread beyond the enamel-dentin border.

The stage of dentine caries corresponds to the ICD-C code K02.1 and is characterized by destructive changes in enamel and dentin with the transition of the enamel-dentin border, however, the pulp is covered with a larger or smaller layer of preserved dentin and without signs of hyperemia.

The cement caries stage corresponds to the ICD-C code K02.2 and is characterized by damage to the exposed surface of the tooth root in the cervical region.

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

1 ICD-S - International classification dental diseases based on ICD-10.

GENERAL APPROACHES TO THE DIAGNOSIS OF DENTAL CARIES

Diagnosis of dental caries is made by taking anamnesis, clinical examination and additional methods examinations. 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. When diagnosing, the localization of caries and the degree of destruction of the crown part of the tooth are established. Depending on the diagnosis, the method of treatment is chosen.

Diagnosis is carried out for each tooth and is aimed at identifying factors that prevent the immediate start of treatment. These factors can be:

- the presence of intolerance medicines and materials used at this stage of treatment;
- comorbidities that aggravate treatment;
- inadequate psycho-emotional state of the patient before treatment;
- acute lesions of the oral mucosa and the red border of the lips;
- acute inflammatory diseases of the organs and tissues of the oral cavity;
- life-threatening acute condition/disease or exacerbation chronic disease(including myocardial infarction, acute cerebral circulation) that developed less than 6 months before applying for this dental care;
- diseases of periodontal tissues in the acute stage;
- unsatisfactory hygienic condition of the oral cavity;
- refusal of treatment.

GENERAL APPROACHES TO THE TREATMENT OF DENTAL CARIES

The principles of treatment of patients with dental caries provide for the simultaneous solution of several problems:

- elimination of factors causing the process of demineralization;
- prevention of further development of the pathological carious process;
- preservation and restoration of the anatomical shape of the tooth affected by caries and the functional ability of the entire dentoalveolar system;
- prevention of development 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 stage of "white (chalky) spot";
- fluoridation of hard tissues of teeth with suspended caries;
- preservation, as far as possible, of healthy hard tissues of the tooth, if necessary, excision of pathologically altered tissues, followed by restoration of the tooth crown;
- Issuance of recommendations on the timing of re-applying.

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

In the treatment of dental caries, only those dental materials and medicines are used that are approved for use on the territory of the Russian Federation in the prescribed manner.

ORGANIZATION OF MEDICAL CARE FOR PATIENTS WITH DENTAL CARIES

Treatment of patients with dental caries is carried out in medical and preventive institutions of the dental profile, as well as in departments and offices of therapeutic dentistry of multidisciplinary medical and preventive institutions. As a rule, treatment is carried out on an outpatient basis.

The list of dental materials and tools necessary for the work of a doctor is presented in Appendix 1.

Assistance to patients with dental caries is carried out mainly by dentists, general dentists, orthopedic dentists, and dentists. Nursing staff and dental hygienists are involved in the process of providing assistance.

VI. CHARACTERISTICS OF REQUIREMENTS

6.1. Patient Model

Nosological form: enamel caries
Stage: "white (chalky) spot" stage (initial caries)
Phase: process stabilization
Complication: no complications
ICD-10 code: K02.0

6.1.1 Criteria and features that define the patient model

- Tooth without visible damage and carious cavities.

- Focal demineralization of the enamel without the formation of a cavity, there are foci of demineralization - white matte spots. When probing, a smooth or rough surface of the tooth is determined without violating the enamel-dentin junction.
- Healthy periodontal and oral mucosa.

6.1.2 How to include a patient in the Protocol

6.1.3. Requirements for the diagnosis of outpatient

The code	Name	Multiplicity of execution
A01.07.001		1
А01.07.002		1
А01.07.005		1
А02.07.001		1
А02.07.005	Thermal diagnostics of the tooth	1
А02.07.007	Percussion of the teeth	1
A02.07.008	Definition of bite	According to the algorithm
А03.07.001	Fluorescent stomatoscopy	On demand
А03.07.003		On demand
A06.07.003		On demand
А12.07.001		According to the algorithm
A12.07.003		According to the algorithm
А12.07.004		On demand

6.1.4. Characteristics of algorithms and features of the implementation of diagnostic measures

For this purpose, all patients must take an anamnesis, examine the oral cavity and teeth, as well as other necessary studies, the results of which are entered in the medical record of the dental patient (form 043 / y).

Collection of anamnesis

All teeth are subject to examination, starting with the right upper molars and ending with the lower right molars. All surfaces of each tooth are examined in detail, paying attention to the color, enamel relief, the presence of plaque, the presence of stains and their condition after drying the surface of the teeth, defects.

Pay attention to the presence of white matte spots on the visible surfaces of the teeth, the area, shape of the edges, surface texture, density, symmetry and multiplicity of lesions 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 non-carious lesions. Fluorescent stomatoscopy can be used to confirm the diagnosis.

Thermodiagnostics It is used to identify pain reactions and clarify the diagnosis.

Percussion used to exclude complications of caries.

Vital staining of dental hard tissues. In cases difficult for differential diagnosis with non-carious lesions, the lesion is stained with a 2% solution of methylene blue. If a negative result is obtained, appropriate treatment is carried out (another model of the patient).

Indices of oral hygiene determined before treatment and after training in oral hygiene, in order to control.

6.1.5. Requirements for outpatient treatment

The code	Name	Multiplicity of execution
A13.31.007	Oral hygiene training	1
A14.07.004	Controlled brushing	1
A16.07.089		1
А16.07.055		1
A11.07.013		According to the algorithm
A16.07.061		On demand
А25.07.001		According to the algorithm
А25.07.002		According to the algorithm

6.1.6 Characteristics of the algorithms and features of the implementation of non-drug care

Non-pharmacological care is aimed at ensuring proper oral hygiene in order to prevent the development of caries and includes three main components: oral hygiene education, supervised brushing and professional oral and dental hygiene.

In order to develop the patient's oral care skills (brushing the teeth) and the most effective removal of soft plaque from the surfaces of the teeth, the patient is taught oral hygiene techniques. Teeth brushing techniques are demonstrated on models.

Individually selected oral hygiene products. Oral hygiene education contributes to the prevention of dental caries (Level of Evidence B).

Controlled brushing of teeth means brushing, which the patient performs independently in the presence of a specialist (dentist, dental hygienist) in the dental office or oral hygiene room, with the necessary hygiene products and visual aids. The purpose of this event is to control the effectiveness of brushing teeth by the patient, correcting the shortcomings of brushing technique. Supervised brushing is effective in maintaining oral hygiene (Level of Evidence B).

Professional oral hygiene includes the removal of supragingival and subgingival plaque from the tooth surface and helps prevent the development of dental caries and inflammatory periodontal disease (Level of Evidence A).

First visit

Complete cleaning with circular movements of the toothbrush with closed jaws, massaging the gums, from right to left.

Individual selection of oral hygiene products is carried out taking into account dental status patient (state of hard tissues of teeth and periodontal tissues, the presence of dentoalveolar anomalies, removable and non-removable orthodontic and orthopedic structures) ().

Second visit

First visit

Next visit

The patient is instructed to attend a preventive examination to the doctor at least once every six months.

- carry out antiseptic treatment of the oral cavity with an antiseptic solution (0.06% chlorhexide solution, 0.05% potassium permanganate solution);

Grinding hard tissues of teeth

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

Sealing the fissure of a tooth with a sealant

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

6.1.7. Requirements for outpatient drug care

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

The main treatments for enamel caries in the stain stage are remineralizing therapy and fluoridation (Level of Evidence B).

Remineralizing therapy

The course of remineralizing therapy consists of 10-15 applications (daily or every other day). Before starting treatment, in the presence of rough surfaces, they are ground off. Start a course of remineralizing therapy. Before each application, the affected tooth surface is mechanically cleaned of plaque and dried with a stream of air.

Applications with remineralizing agents on the treated tooth surface for 15-20 minutes with a change of tampon every 4-5 minutes. Applications of 1-2% sodium fluoride solution are carried out in every 3rd visit, after application of a remineralizing solution on a cleaned and dried tooth surface for 2-3 minutes.

Application of fluoride varnish on the teeth, as an analogue of 1-2% sodium fluoride solution, is carried out in every 3rd visit after application with a remineralizing solution, on the dried surface of the tooth. After the application, the patient is not recommended to eat for 2 hours and brush his teeth for 12 hours.

The criterion for the effectiveness of a course of remineralizing therapy and fluoridation is a decrease in the size of the demineralization focus until it disappears, restoration of enamel gloss or less intense staining of the demineralization focus (according to a 10-point enamel staining scale) with a 2% methylene blue dye solution.

6.1.9. Requirements for the regime of work, rest, treatment and rehabilitation

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

6.1.10. Requirements for patient care and ancillary procedures

6.1.11. Dietary requirements and restrictions

After completion of each medical procedure it is recommended not to eat or rinse your mouth for 2 hours. Limiting the consumption of foods and drinks with low pH values ​​​​(juices, tonic drinks, yogurts) and thoroughly rinsing the mouth after taking them.

Limiting the stay of carbohydrates in the oral cavity (sucking, chewing sweets).

6.1.12. The form of informed voluntary consent of the patient during the implementation of the Protocol

6.1.13. Additional information for the patient and his family members

6.1.14. Rules for changing requirements when implementing the Protocol and terminating the requirements of the Protocol

6.1.15. Possible outcomes and their characteristics

Selection name	Development frequency, %	Criteria and Signs
Function compensation	30		2 months
Stabilization	60		2 months	Dynamic observation 2 times a year
	5		At any stage	Provision of medical care according to the protocol of the corresponding disease
	5

6.1.16. Cost characteristics of the Protocol

6.2. PATIENT MODEL

Nosological form: dentine caries
Stage: any
Phase: process stabilization
Complications: no complications
ICD-10 code: K02.1

6.2.1. Criteria and features that define the patient model

- Patients with permanent teeth.
- The presence of a cavity with the transition of the enamel-dentin border.
- Tooth with healthy pulp and periodontium.

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

6.2.2. Procedure for including a patient in the Protocol

The patient's condition that satisfies the criteria and features of the diagnosis of this patient model.

6.2.3. Requirements for the diagnosis of outpatient

The code	Name	Multiplicity of execution
A01.07.001	Collection of anamnesis and complaints in the pathology of the oral cavity	1
А01.07.002	Visual examination in the pathology of the oral cavity	1
А01.07.005	External examination of the maxillofacial region	1
А02.07.001	Examination of the oral cavity with additional instruments	1
А02.07.002		1
А02.07.005	Thermal diagnostics of the tooth	1
А02.07.007	Percussion of the teeth	1
A12.07.003	Determination of oral hygiene indices	1
А02.07.006	Definition of bite	According to the algorithm
А03.07.003	Diagnosis of the state of the dentoalveolar system using methods and means of radiation imaging	On demand
А05.07.001	Electroodontometry	On demand
А06.07.003	Targeted intraoral contact radiography	On demand
А06.07.010		On demand
А12.07.001	Vital staining of dental hard tissues	On demand
А12.07.004	Determination of periodontal indices	On demand

6.2.4. Characteristics of algorithms and features of the implementation of diagnostic measures

Collection of anamnesis

When collecting an anamnesis, they find out the presence of complaints of pain from irritants, an allergic history, the presence of somatic diseases. Purposefully identify complaints of pain and discomfort in the area of ​​a particular tooth, food jamming, how long ago they appeared, when the patient paid attention to them. Particular attention is paid to clarifying the nature of complaints, whether they are always, in the patient's opinion, associated with a specific stimulus. Find out the profession of the patient, whether the patient provides proper hygienic care for the oral cavity, the time of the last visit to the dentist.

When examining the oral cavity, the state of the dentition is assessed, paying attention to the presence of fillings, the degree of their fit, the presence of defects in the hard tissues of the teeth, the number of teeth removed. The intensity of caries is determined (CPU index - caries, filling, removed), hygiene index. Pay attention to the condition of the oral mucosa, its color, moisture content, the presence of pathological changes. All teeth are subject to examination, starting with the right upper molars and ending with the lower right molars.

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

Pay attention to the fact that probing is carried out without strong pressure. Pay attention to the presence of spots on the visible surfaces of the teeth, the presence of spots and their condition after drying the surface of the teeth, the area, shape of the edges, surface texture, density, symmetry and multiplicity of lesions 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 non-carious lesions. When probing the identified carious cavity, attention is paid to its shape, localization, size, depth, the presence of softened dentin, a change in its color, soreness, or vice versa, the absence of pain sensitivity. Particularly carefully examine the proximal surfaces of the tooth. Thermodiagnostics are being carried out. To confirm the diagnosis, in the presence of a cavity on the contact surface and in the absence of pulp sensitivity, radiography is performed.

When conducting electroodontometry, the sensitivity of the pulp with dentin caries is recorded in the range from 2 to 10 μA.

6.2.5. Requirements for outpatient treatment

The code	Name	Multiplicity of execution
A13.31.007	Oral hygiene training	1
A14.07.004	Controlled brushing	1
A16.07.002.	Restoration of a tooth with a filling	1
А16.07.055	Professional oral and dental hygiene	1
A16.07.003	Tooth restoration with inlays, veneers, semi-crowns	On demand
A16.07.004	Restoration of a tooth with a crown	On demand
А25.07.001	Prescribing drug therapy for diseases of the oral cavity and teeth	According to the algorithm
А25.07.002	Prescribing dietary therapy for diseases of the oral cavity and teeth	According to the algorithm

6.2.6. Characteristics of the algorithms and features of the implementation of non-drug care

Non-drug care is aimed at preventing the development of a carious process and includes three main components: ensuring proper oral hygiene, filling a carious defect, and, if necessary, prosthetics.

Caries treatment, regardless of the location of the carious cavity, includes: premedication (if necessary), anesthesia, opening of the carious cavity, removal of softened and pigmented dentin, formation, finishing, washing and filling of the cavity (if indicated) or prosthetics with inlays, crowns or veneers.

Indications for prosthetics are:

Damage to the hard tissues of the crown part of the tooth after preparation: for the group of chewing teeth, the index of destruction of the occlusal surface of the tooth (IROPZ) > 0.4 indicates the manufacture of inlays, IROPZ > 0.6 - the manufacture of artificial crowns is indicated, IROPZ > 0.8 - the use of pin structures is indicated followed by the manufacture of crowns;
- prevention of the development of deformities of the dentoalveolar system in the presence of neighboring teeth with fillings that replenish more? chewing surface.

The main goals of treatment:

Stopping the pathological process;
- restoration of the anatomical shape and function of the tooth;
- prevention of the development of complications, including the prevention of the development of the Popov-Godon phenomenon in the area of ​​the teeth of antagonists;
- restoration of the aesthetics of the dentition.

Treatment of dentinal caries with filling and, if necessary, prosthetics, allows for compensation of function and stabilization of the process (Level of Evidence A).

Algorithm for teaching oral hygiene

First visit

The doctor or dental hygienist determines the hygiene index, then demonstrates to the patient the technique of brushing and flossing the teeth, using dental arch models, or other demonstration tools.

Toothbrushing begins with a site in the region of the upper right chewing teeth, sequentially moving from segment to segment. In the same order, teeth are cleaned in the lower jaw.

Pay attention to the fact that the working part of the toothbrush should be placed at an angle of 45 ° to the tooth, make cleaning movements from gum to tooth, while removing plaque from the teeth and gums. Clean the chewing surfaces of the teeth with horizontal (reciprocating) movements so that the brush fibers penetrate deep into the fissures and interdental spaces. The vestibular surface of the frontal group of teeth of the upper and lower jaws should be cleaned with the same movements as molars and premolars. When cleaning the oral surface, the brush handle should be perpendicular to the occlusal plane of the teeth, while the fibers should be at an acute angle to the teeth and capture not only the teeth, but also the gums.

Complete cleaning with circular movements of the toothbrush with closed jaws, massaging the gums from right to left.

The cleaning time is 3 minutes.

For high-quality cleaning of the contact surfaces of the teeth, it is necessary to use dental floss.

Second visit

In order to consolidate the acquired skills, controlled brushing of the teeth is carried out.

Controlled brushing algorithm

First visit

Treatment of the patient's teeth with a staining agent, determination of the hygienic index, demonstration to the patient with the help of a mirror of the places of the greatest accumulation of plaque.
- Brushing the patient's teeth in his usual manner.
- Re-determination of the hygiene index, assessment of the effectiveness of brushing teeth (comparison of the hygiene index before and after brushing), showing the patient with a mirror of stained areas where plaque was not removed during brushing.
- Demonstration of the correct technique of brushing teeth on models, recommendations to the patient on correcting deficiencies in hygienic oral care, using dental floss and additional hygiene products (special toothbrushes, toothbrushes, single-beam brushes, irrigators - according to indications).

Next visit

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

Stages of professional hygiene:

Patient education in individual oral hygiene;
- removal of supra- and subgingival dental deposits;
- polishing of surfaces of teeth, including surfaces of roots;
- elimination of factors contributing to the accumulation of plaque;
- applications of remineralizing and fluoride-containing products (with the exception of areas with a high fluoride content in drinking water);
- motivation of the patient to prevent and treat dental diseases. The procedure is carried out in one visit.
- When removing supra- and subgingival dental deposits (tartar, dense and soft plaque), a number of conditions should be observed:
- removal of tartar with application anesthesia;

- isolate treated teeth from saliva;
- pay attention that the hand holding the instrument must be fixed on the patient's chin or adjacent teeth, the terminal shaft of the instrument is parallel to the axis of the tooth, the main movements - lever-like and scraping - must be smooth, not traumatic.

In the field of ceramic-metal, ceramic, composite restorations, implants (plastic instruments are used in the processing of the latter), a manual method is used to remove dental deposits.

Ultrasound devices should not be used in patients with respiratory, infectious diseases and in patients with pacemakers.

To remove plaque and polish smooth surfaces of teeth, it is recommended to use rubber caps, chewing surfaces - rotating brushes, contact surfaces - flosses and abrasive strips. Polishing paste should be used from coarse to fine. Fluoride-containing polishing pastes are not recommended before certain procedures (fissure sealing, teeth whitening). Fine polishing pastes and rubber caps should be used when processing implant surfaces.

It is necessary to eliminate the factors contributing to the accumulation of plaque: remove the overhanging edges of the fillings, re-polish the fillings.

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

With caries of dentin, filling is carried out in one visit. After diagnostic studies and a decision on treatment at the same appointment, treatment is started.

It is possible to place a temporary filling (bandage) if it is not possible to put a permanent filling on the first visit or to confirm the diagnosis.

Anesthesia;
- "disclosure" of the carious cavity;


- excision of enamel, devoid of underlying dentin (according to indications);
- cavity formation;
- cavity finishing.

It is necessary to pay attention to the processing of the edges of the cavity to create a high-quality marginal fit of the seal and prevent chipping of the enamel and filling material.

When filling with composite materials, sparing preparation of cavities is allowed (level of evidence B).

Features of preparation and filling of cavities

Class I cavities

You should strive to keep the tubercles on the occlusal surface as much as possible; for this, before preparation, with the help of articulating paper, enamel areas that carry an occlusal load are identified. The tubercles are removed partially or completely if the slope of the tubercle is damaged by 1/2 of its length. The preparation, if possible, is carried out in the contours of natural fissures. If necessary, use the technique of "prophylactic expansion" according to Black. The use of this method helps to prevent the recurrence of caries. This type of preparation is recommended primarily for materials that do not have good adhesion to the tooth tissues (amalgam) and are retained in the cavity due to mechanical retention. When expanding the cavity to prevent secondary caries, attention must be paid to maintaining the maximum possible thickness of dentin at the bottom of the cavity.

Class II cavities

Before starting the preparation, the types of access are determined. Spend the formation of the cavity. The quality of the removal of affected tissues is checked using a probe and a caries detector.

When filling, it is necessary to use matrix systems, matrices, interdental wedges. With extensive destruction of the crown part of the tooth, it is necessary to use a matrix holder. It is necessary to perform anesthesia, since the imposition of a matrix holder or the introduction of a wedge is painful for the patient.

A properly formed contact surface of the tooth can never be flat - it must have a shape close to spherical. The contact zone between the teeth should be located in the equatorial region and slightly higher - as in intact teeth. The contact point should not be modeled at the level of the marginal ridges of the teeth: in this case, in addition to food getting stuck in the interdental space, chipping of the material from which the filling is made is possible. As a rule, this error is associated with the use of a flat matrix that does not have a convex contour in the equator region.

The formation of the contact slope of the marginal ridge is carried out using abrasive strips (strips) or disks. The presence of the slope of the edge ridge prevents material from chipping in this area and food getting stuck.

Attention should be paid to the formation of a tight contact between the filling and the adjacent tooth, the prevention of excessive introduction of the material into the region of the gingival wall of the cavity (creating an "overhanging edge"), ensuring the optimal fit of the material to the gingival wall.

Class III cavities

When preparing, it is important to determine the optimal approach. Direct access is possible in the absence of an adjacent tooth or in the presence of a prepared cavity on the adjacent contact surface of an adjacent tooth. Lingual and palatal accesses are preferred, as this allows preserving the vestibular surface of the enamel and providing a higher functional aesthetic level of tooth restoration. During preparation, the contact wall of the cavity is excised with an enamel knife or bur, having previously protected the intact neighboring tooth with a metal matrix. A cavity is formed by removing enamel devoid of underlying dentin, and the edges are treated with finishing burs. It is allowed to preserve the vestibular enamel, devoid of underlying dentin, if it does not have cracks and signs of mineralization.

Class IV cavities

Class IV cavity preparation features are a wide fold, the formation in some cases of an additional platform on the lingual or palatal surface, gentle preparation of tooth tissues during the formation of the gingival wall of the cavity in the event of a carious process spreading below the gum level. When preparing, it is preferable to create a retention form, since the adhesion of composite materials is often insufficient.

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

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

Formation of lingual and palatal fragments of the cutting edge. The first reflection is carried out through the enamel or previously applied composite from the vestibular side;
- formation of the vestibular fragment of the cutting edge; flashing is carried out through the cured lingual or palatal fragment.

Class V cavities

Before starting the preparation, it is imperative to determine the depth of the spread of the process under the gum, if necessary, the patient is sent for correction (excision) of the mucous membrane of the gingival margin to open the surgical field and remove the area of ​​hypertrophied gum. In this case, the treatment is carried out in 2 or more visits, because after the intervention, the cavity is closed with a temporary filling, cement or oil dentin is used as a temporary filling material until the tissues of the gingival margin heal. Then the filling is done.

The shape of the cavity should be round. If the cavity is very small, gentle preparation with ball burs is acceptable without creating retention zones.

For filling defects that are visible when smiling, you should choose a material with sufficient aesthetic characteristics. In patients with poor oral hygiene, it is recommended to use glass ionomer (polyalkenate) cements, which provide long-term fluoridation of tooth tissues after filling and have acceptable aesthetic characteristics. In elderly and elderly patients, especially with symptoms of xerostomia, amalgam or glass ionomers should be used. It is also possible to use compomers with the advantages of glass ionomers and high aesthetics. Composite materials are indicated for filling defects in cases where the aesthetics of a smile is very important.

Class VI cavities

Features of these cavities require gentle removal of affected tissues. Burs should be used, the size of which is only slightly larger than the diameter of the carious cavity. Let us refuse anesthesia, especially with an insignificant depth of the cavity. It is possible to preserve enamel devoid of underlying dentin, which is associated with a rather large thickness of the enamel layer, especially in the region of the molars ().

Algorithm and features of manufacturing tabs

Indications for the manufacture of inlays for dentine caries are cavities of classes I and II according to Black. Inlays can be made from metals, as well as from ceramics and composite materials. Inlays allow you to restore the anatomical shape and function of the tooth, prevent the development of the pathological process, and ensure the aesthetics of the dentition.

Contraindications to the use of inlays for dentin caries are tooth surfaces that are inaccessible for the formation of cavities for inlays and teeth with defective, fragile enamel.

The question of the method of treatment with an inlay or crown for dentin caries can only be decided after the removal of all necrotic tissues.

Tabs are made in several visits.

First visit

During the first visit, a cavity is formed. The cavity under the tab is formed after the removal of necrotic and pigmented tissues affected by caries. It must meet the following requirements:

be box-shaped;
- the bottom and walls of the cavity must withstand chewing pressure;
- the shape of the cavity should ensure that the inlay is kept from displacement in any direction;
- for an accurate marginal fit that ensures tightness, a bevel (fold) should be formed within the enamel at an angle of 45 ° (when making solid inlays).

The preparation of the cavity is carried out under local anesthesia.

After the formation of the cavity, the insert is modeled in the oral cavity or an impression is obtained.

When modeling a wax model, inlays pay attention to the accuracy of the wax model fit to the bite, taking into account not only the central occlusion, but also all movements of the lower jaw, to exclude the possibility of formation of retention areas, to give the outer surfaces of the wax model the correct anatomical shape. When modeling an inlay in class II cavities, matrices are used to prevent damage to the interdental gingival papilla.

In the manufacture of inlays by the indirect method, impressions are taken. Obtaining an impression after odontopreparation at the same appointment is possible in the absence of damage to the marginal periodontium. Two-layer silicone and alginate impression masses, standard impression trays are used. It is recommended that the edges of the trays be edged with a narrow strip of adhesive plaster before taking impressions for better retention of the impression material. It is advisable to use special glue to fix the silicone impressions on the spoon. After the spoons are removed from the oral cavity, the quality of the impressions is checked.

In the manufacture of ceramic or composite inlays, color determination is carried out.

After modeling the inlay or obtaining impressions for its manufacture, the prepared tooth cavity is closed with a temporary filling.

Next visit

After the inlay is made, the inlay is fitted in the dental laboratory. Pay attention to the accuracy of the marginal fit, the absence of gaps, occlusal contacts with antagonist teeth, proximal contacts, the color of the inlay. If necessary, carry out a correction.

In the manufacture of an all-cast inlay, after polishing it, and in the manufacture of ceramic or composite inlays, after glazing, the inlay is fixed with permanent cement.

The patient is instructed about the rules for using the tab and indicates the need for regular visits to the doctor once every six months.

Algorithm and features of manufacturing micro prostheses (veneers)

For the purposes of this protocol, veneers should be understood as faceted veneers made on anterior teeth. upper jaw. Features of the manufacture of veneers:

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

First visit

When deciding on the manufacture of a veneer, treatment is started at the same appointment.

Preparation for preparation

Tooth preparation for veneer is performed under local anesthesia.

When preparing, special attention should be paid to the depth: 0.3-0.7 mm of hard tissues are ground off. Before starting the main preparation, it is advisable to retract the gums and mark the preparation depth using a special marking bur (disk) 0.3-0.5 mm in size. It is necessary to pay attention to the preservation of proximal contacts, to avoid preparations in the cervical region.

Obtaining an impression from the prepared tooth is carried out at the same reception. Two-layer silicone and alginate impression masses, standard impression trays are used. It is recommended that the edges of the trays be edged with a narrow strip of adhesive plaster before taking impressions for better retention of the impression material. It is advisable to use special glue to fix the silicone impressions on the spoon. After removing the spoons from the oral cavity, the quality of the impressions is checked (accuracy of displaying the anatomical relief, the absence of holes, etc.).

Plaster or silicone blocks are used to fix the correct ratio of the dentition in the position of central occlusion. The color of the veneer is determined.

The prepared teeth are covered with temporary veneers made of composite material or plastic, which are fixed on a temporary calcium-containing cement.

Next visit

Placement and fitting of veneers

Particular attention must be paid to the accuracy of the fit of the edges of the veneer to hard tissues tooth, check the absence of gaps between the veneer and the tooth. Pay attention to approximal contacts, to occlusal contacts with antagonist teeth. Contacts are especially carefully verified during sagittal and transversal movements of the lower jaw. If necessary, a correction is made.

The veneer is cemented to a permanent cement or a dual-cure cementation composite. Pay attention to matching the color of the cement to the color of the veneer. The patient is instructed about the rules for using the veneer and indicates the need for regular visits to the doctor once every six months.

Algorithm and features of manufacturing a solid crown

An indication for the manufacture of crowns is a significant damage to the occlusal or cutting surface of the teeth with preserved vital pulp. Crowns are made on the teeth after the treatment of dentine caries by filling. Solid crowns for dentin caries are made on any teeth to restore the anatomical shape and function, as well as to prevent further tooth decay. Crowns are made in several visits.

Features of the manufacture of solid crowns:

When prosthetics of molars, it is recommended to use a one-piece cast crown or a crown with a metal occlusal surface;
- in the manufacture of a solid-cast metal-ceramic crown, an oral garland is modeled (a metal edging along the edge of the crown);
- plastic (on request - ceramic) cladding is made in the area of ​​the anterior teeth on the upper jaw only up to 5 teeth inclusive and on the lower jaw up to 4 teeth inclusive, then - on demand;
- when making crowns for antagonist teeth, it is necessary to follow a certain sequence:

• the first stage is the simultaneous manufacture of temporary mouth guards for the teeth of both jaws to be prosthetics with the maximum restoration of occlusal relationships and the obligatory determination of the height lower section faces, these mouth guards should reproduce the design of future crowns as accurately as possible;
• first, permanent crowns are made on the teeth of the upper jaw;
• after fixing the crowns on the teeth of the upper jaw, permanent crowns are made on the teeth of the lower jaw.

First visit

Preparation for preparation

To determine the viability of the pulp of prosthetic teeth, electroodontometry is performed before the start of therapeutic measures. Before the start of the preparation, impressions are obtained for the manufacture of temporary plastic crowns (caps).

Preparation of teeth for crowns

The type of preparation is selected depending on the type of future crowns and the group affiliation of the prosthetic teeth. When preparing several teeth, special attention should be paid to the parallelism of the clinical axes of the tooth stumps after preparation.

In the case of the gingival retraction method, when taking an impression, attention is paid to the somatic status of the patient. If you have a history of cardiovascular disease ( coronary disease heart, angina pectoris, arterial hypertension, cardiac arrhythmias) should not be used for gingival retraction aids containing catecholamines (including threads impregnated with such compounds).

To prevent the development of inflammatory processes in the tissues of the marginal periodontium, after preparation, anti-inflammatory regenerative therapy is prescribed (rinsing the oral cavity with oak bark tincture, as well as infusions of chamomile, sage, etc., if necessary, application with an oil solution of vitamin A or other means that stimulate epithelialization).

Next visit

Taking impressions

In the manufacture of solid crowns, it is recommended to appoint a patient for an appointment the next day or the day after the preparation to take a working two-layer impression from the prepared teeth and an impression of the antagonist teeth, if they were not taken on the first visit.

Two-layer silicone and alginate impression masses, standard impression trays are used. It is recommended that the edges of the trays be edged with a narrow strip of adhesive plaster before taking impressions for better retention of the impression material. It is advisable to use special glue to fix the silicone impressions on the spoon. After removing the spoons from the oral cavity, the quality of the impressions is monitored (display of the anatomical relief, absence of pores).

In the case of using the gingival retraction method, when taking impressions, attention is paid to the somatic status of the patient. If there is a history of cardiovascular diseases (ischemic heart disease, angina pectoris, arterial hypertension, cardiac arrhythmias), adjuvants containing catecholamines (including threads impregnated with such compounds) should not be used for gum retraction.

Next visit

Overlay and fitting of the frame of a solid crown. Not earlier than 3 days after the preparation, in order to exclude traumatic (thermal) damage to the pulp, a repeated electroodontometry is performed (it is possible to perform it at the next visit).

Particular attention should be paid to the accuracy of the fit of the framework in the cervical area (marginal fit). Check the absence of a gap between the wall of the crown and the stump of the tooth. Pay attention to the correspondence of the contour of the edge of the supporting crown to the contours of the gingival margin, to the degree of immersion of the edge of the crown into the gingival gap, proximal contacts, occlusal contacts with antagonist teeth. If necessary, a correction is made. If the lining is not provided, the cast crown is polished and fixed with temporary or permanent cement. To fix the crowns, temporary and permanent calcium-containing cements should be used. Before fixing the crown with permanent cement, an electroodontometry is performed to exclude inflammatory processes in the dental pulp. With signs of pulp damage, the issue of depulpation is resolved.

If a ceramic or plastic cladding is provided, the color of the cladding is selected.

Crowns with lining on the upper jaw are made up to the 5th tooth inclusive, on the lower jaw - up to the 4th inclusive. The veneers of the chewing surfaces of the posterior teeth are not shown.

Next visit

Placement and fitting of the finished cast crown with veneer

Particular attention should be paid to the accuracy of the fit of the crown in the cervical area (marginal fit). Check the absence of a gap between the wall of the crown and the stump of the tooth. Pay attention to the correspondence of the contour of the edge of the crown to the contours of the gingival margin, on

the degree of immersion of the crown edge into the gingival gap, proximal contacts, occlusal contacts with antagonist teeth.

If necessary, a correction is made. 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) or for permanent cement. To fix the crowns, temporary and permanent calcium-containing cements should be used. When fixing with temporary cement, special attention should be paid to the removal of cement residues from the interdental spaces.

Next visit

Fixation with permanent cement

When fixing with permanent cement, special attention should be paid to the removal of cement residues from the interdental spaces. The patient is instructed about the rules for using the crown and indicates the need for regular visits to the doctor once every six months.

Algorithm and features of manufacturing a stamped crown

A stamped crown, when properly made, fully restores the anatomical shape of the tooth and prevents the development of complications.

First visit

After diagnostic studies, the necessary preparatory therapeutic measures and a decision on prosthetics at the same appointment, treatment is started. Crowns are made on the teeth after the treatment of dentine caries by filling.

Preparation for preparation

To determine the viability of the pulp of the abutment teeth, electroodontometry is performed before the start of all therapeutic measures.

Before the start of the preparation, impressions are obtained for the manufacture of temporary plastic crowns (cannes). If it is impossible to make temporary mouthguards due to the small amount of preparation, fluoride varnishes are used to protect the prepared teeth.

Tooth preparation

During preparation, attention should be paid to the parallelism of the walls of the prepared tooth (cylinder shape). When preparing several teeth, attention should be paid to the parallelism of the clinical axes of the tooth stumps after preparation. Tooth preparation is performed under local anesthesia.

Obtaining an impression from the prepared teeth at the same appointment is possible in the absence of damage to the marginal periodontium during preparation. In the manufacture of stamped crowns, alginate impression masses and standard impression trays are used. It is recommended that the edges of the trays be edged with a narrow strip of adhesive plaster before taking impressions for better retention of the impression material. After removing the spoons from the oral cavity, quality control is carried out.

Plaster or silicone blocks are used to fix the correct ratio of the dentition in the position of central occlusion. If it is necessary to determine central ratio jaws, wax bases with occlusal rollers are made. When temporary mouth guards are made, they are fitted, if necessary, they are relocated and fixed with temporary cement.

To prevent the development of inflammatory processes in the tissues of the marginal periodontium associated with injury during preparation, anti-inflammatory regenerative therapy is prescribed (rinsing the oral cavity with infusion of oak bark, chamomile, sage, if necessary, applications with an oil solution of vitamin A or other means that stimulate epithelization).

Next visit

Impressions are taken if they were not taken on the first visit.

Alginate impression masses, standard impression trays are used. It is recommended that the edges of the trays be edged with a narrow strip of adhesive plaster before taking impressions for better retention of the impression material. After removing the spoons from the oral cavity, the quality of the impressions is monitored (display of the anatomical relief, absence of pores).

Next visit

Next visit

Trying and fitting stamped crowns

Particular attention should be paid to the accuracy of the fit of the dagger in the cervical area (marginal fit). Check the absence of crown pressure on the tissues of the marginal periodontium. Pay attention to the conformity of the contour of the edge of the supporting crown with the contours of the gingival margin, the degree of immersion of the edge of the crown into the gingival gap (maximum by 0.3-0.5 mm), proximal contacts, occlusal contacts with antagonist teeth.

If necessary, a correction is made. When using combined stamped crowns (according to Belkin), after fitting the crown, an impression of the tooth stump is obtained using wax poured into the crown. Determine the color of the plastic lining. Crowns with lining on the upper jaw are made up to the 5th tooth inclusive, on the lower jaw - up to the 4th inclusive. The veneers of the chewing surfaces of the posterior teeth are generally not shown. After polishing, it is fixed with permanent cement.

Before fixing the crown with permanent cement, an electroodontometry is performed to detect inflammatory processes in the dental pulp. To fix the crowns, permanent calcium-containing cements must be used. With signs of pulp damage, the issue of depulpation is resolved.

The patient is instructed about the rules for using crowns and indicates the need for regular visits to the doctor once every six months.

Algorithm and features of manufacturing an all-ceramic crown

An indication for the manufacture of all-ceramic crowns is a significant damage to the occlusal or cutting surface of the teeth with preserved vital pulp. Crowns are made on the teeth after the treatment of dentine caries by filling.

All-ceramic crowns for dentin caries can be made on any teeth to restore the anatomical shape and function, as well as to prevent further tooth decay. Crowns are made in several visits.

Features of the manufacture of all-ceramic crowns:

The main feature is the need to prepare a tooth with a circular rectangular ledge at an angle of 90°.
- When making crowns for antagonist teeth, it is necessary to follow a certain sequence:

• The first stage is the simultaneous production of temporary mouthguards for the teeth of both jaws to be prosthetics with the maximum restoration of occlusal relationships and the obligatory determination of the height of the lower face. These mouthguards should reproduce the design of future crowns as accurately as possible;
• alternately make permanent crowns on the teeth of the upper jaw;
• after fixing the crowns on the teeth of the upper jaw, permanent crowns are made on the teeth of the lower jaw;
• When the shoulder is at or below the gingival margin, gingival retraction must always be applied before taking the impression.

First visit

After diagnostic studies, the necessary preparatory therapeutic measures and a decision on prosthetics at the same appointment, treatment is started.

Preparation for preparation

To determine the viability of the pulp of the prosthetic teeth, electrodontometry is performed before the start of the treatment. Before the start of the preparation, impressions are obtained for the manufacture of temporary plastic crowns (caps).

Preparation of teeth for all-ceramic crowns

A 90° rectangular shoulder preparation is always used. When preparing several teeth, special attention should be paid to the parallelism of the clinical axes of the tooth stumps after preparation.

The preparation of teeth with vital pulp is performed under local anesthesia. Obtaining an impression from the prepared teeth at the same appointment is possible in the absence of damage to the marginal periodontium during preparation. Two-layer silicone and alginate impression masses, standard impression trays are used. It is recommended that the edges of the trays be edged with a narrow strip of adhesive plaster before taking the impression for better retention of the impression material. It is advisable to use special glue to fix the silicone impressions on the spoon. After the spoons are removed from the oral cavity, the quality of the impressions is checked.

In the case of the gingival retraction method, when taking an impression, attention is paid to the somatic status of the patient. If there is a history of cardiovascular diseases (ischemic heart disease, angina pectoris, arterial hypertension, cardiac arrhythmias), adjuvants containing catecholamines (including threads impregnated with such compounds) should not be used for gum retraction.

Plaster or silicone blocks are used to fix the correct ratio of the dentition in the position of central occlusion. When temporary mouth guards are made, they are fitted, if necessary, they are relined and fixed on a temporary calcium-containing cement.

The color of the future crown is being determined.

To prevent the development of inflammatory processes in the tissues of the marginal periodontal after preparation, anti-inflammatory regenerative therapy is prescribed (rinsing the oral cavity with tincture of oak bark, chamomile and sage, if necessary, applications with an oily solution of vitamin A or other means that stimulate epithelialization).

Next visit

Taking impressions

In the manufacture of all-ceramic crowns, it is recommended to appoint a patient for an appointment the next day or the day after the preparation to obtain a working two-layer impression from the prepared teeth and an impression from the antagonist teeth, if they were not obtained at the first visit. Two-layer silicone and alginate impression masses, standard impression trays are used. It is recommended that the edges of the trays be edged with a narrow strip of adhesive plaster before taking impressions for better retention of the impression material. It is advisable to use special glue to fix the silicone impressions on the spoon. After removing the spoons from the oral cavity, the quality of the impressions is monitored (display of the anatomical relief, absence of pores).

In the case of using the gingival retraction method, when taking impressions, attention is paid to the somatic status of the patient. If there is a history of cardiovascular diseases (ischemic heart disease, angina pectoris, arterial hypertension, cardiac arrhythmias), adjuvants containing catecholamines (including threads impregnated with such compounds) should not be used for gum retraction.

Next visit

Placement and fitting of an all-ceramic crown

Not earlier than 3 days after the preparation, to exclude traumatic (thermal) damage to the pulp, a repeated electroodontometry is performed (it is possible to perform it at the next visit).

Particular attention should be paid to the accuracy of the fit of the crown to the ledge in the cervical area (marginal fit). Check the absence of a gap between the wall of the crown and the stump of the tooth. Pay attention to the correspondence of the contour of the edge of the supporting crown to the contours of the edge of the ledge, proximal contacts and occlusal contacts with antagonist teeth. If necessary, a correction is made.

After glazing, fixation is carried out on temporary (for 2-3 weeks) or on permanent cement. To fix the crowns, temporary and permanent calcium-containing cements should be used. When fixing with temporary cement, special attention should be paid to the removal of cement residues from the interdental spaces.

Next visit

Fixation with permanent cement

Before fixing the crown with permanent cement, an electroodontometry is performed to exclude inflammatory processes in the dental pulp. With signs of pulp damage, the issue of depulpation is resolved. For vital teeth, permanent calcium-containing cements should be used to fix crowns.

When fixing with permanent cement, pay special attention to the removal of cement residues from the interdental spaces.

The patient is instructed about the rules for using the crown and indicates the need for regular visits to the doctor once every six months.

6.2.7. Requirements for outpatient drug care

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

The use of local anti-inflammatory and epithelizing agents is indicated for mechanical trauma to the mucous membrane.

Analgesics, non-steroidal anti-inflammatory drugs, drugs for the treatment of rheumatic diseases and gout

Assign rinses or baths with decoctions of one of the preparations: oak bark, chamomile flowers, sage 3-4 times a day for 3-5 days (level of evidence C). Applications on the affected areas with sea buckthorn oil - 2-3 times a day for 10-15 minutes (level of evidence C).

vitamins

Applications are applied to the affected areas with an oil solution of retinol - 2-3 times a day for 10-15 minutes. 3-5 days (level of evidence C).

Drugs affecting the blood

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

Local anesthetics

6.2.9. Requirements for the regime of work, rest, treatment and rehabilitation

Patients should visit a specialist once every six months for observation.

6.2.10. Requirements for patient care and ancillary procedures

6.2.11. Dietary requirements and restrictions

special requirements no.

6.2.12. The form of informed voluntary consent of the patient during the implementation of the Protocol

6.2.13. Additional information for the patient and his family members

6.2.14. Rules for changing requirements when implementing the Protocol and terminating the requirements of the Protocol

If signs are identified during the diagnostic process that require preparatory measures for treatment, the patient is transferred to the patient management protocol corresponding to the identified diseases and complications.

If signs of another disease are detected that require diagnostic and therapeutic measures, along with signs of enamel caries, medical care is provided to the patient in accordance with the requirements:

A) the section of this protocol for managing patients corresponding to the management of enamel caries;
b) a protocol for the management of patients with an identified disease or syndrome.

6.2.15. Possible outcomes and their characteristics

Selection name	Development frequency, %	Criteria and signs	indicative time of comprehension	Continuity and stages in the provision of medical care
Function compensation	50			Dynamic Surveillance 2 times per year
Stabilization	30	No recurrence and complications	Immediately after treatment	Dynamic observation 2 times a year
Development of iatrogenic complications	10	The appearance of new lesions or complications due to ongoing therapy (for example, allergic reactions)	At any stage	Provision of medical care according to the protocol of the corresponding disease
The development of a new disease associated with the underlying	10	Recurrence of caries, its progression	6 months after the end of treatment in the absence of follow-up	Provision of medical care according to the protocol of the corresponding disease

6.2.16. Cost characteristics of the Protocol

Cost characteristics are determined in accordance with the requirements of regulatory documents.

6.3. PATIENT MODEL

Nosological form: caries cement
Stage: any
Phase: process stabilization
Complications: no complications
ICD-10 code: K02.2

6.3.1. Criteria and features that define the patient model

- Patients with permanent teeth.
- Healthy pulp and periodontium of the tooth.
- The presence of a carious cavity located in the cervical region.
- The presence of softened dentin.
- When probing the carious cavity, short-term pain is noted.
- Pain from temperature, chemical and mechanical stimuli, disappearing after the cessation of irritation.
- Healthy periodontal and oral mucosa.
- The absence of spontaneous pain at the time of examination and in history.
- Absence of pain during percussion of the tooth.
- Absence of non-carious lesions of hard tissues of the tooth.

6.3.2. Procedure for including a patient in the Protocol

The patient's condition that satisfies the criteria and features of the diagnosis of this patient model.

6.3.3. Requirements for the diagnosis of outpatient

The code	Name	Multiplicity of execution
A01.07.001	Collection of anamnesis and complaints in the pathology of the oral cavity	1
А01.07.002	Visual examination in the pathology of the oral cavity	1
А01.07.005	External examination of the maxillofacial region	1
А02.07.001	Examination of the oral cavity with additional instruments	1
А02.07.002	Examination of carious cavities using a dental probe	1
А02.07.007	Percussion of the teeth	1
A12.07.003	Determination of oral hygiene indices	1
А12.07.004	Determination of periodontal indices	1
А02.07.006	Definition of bite	According to the algorithm
А02.07.005	Thermal diagnostics of the tooth	On demand
А03.07.003	Diagnosis of the state of the dentoalveolar system using methods and means of radiation imaging	On demand
А06.07.003	Targeted intraoral contact radiography	On demand
А06.07.010	Radiovisiography of the maxillofacial region	On demand

6.3.4. Characteristics of algorithms and features of the implementation of diagnostic measures

Diagnosis is aimed at establishing a diagnosis corresponding to the patient model, excluding complications, determining the possibility of starting treatment without additional diagnostic and therapeutic measures.

For this purpose, all patients must take an anamnesis, examine the oral cavity and teeth, as well as other necessary studies, the results of which are entered in the medical record of the dental patient (form 043 / y).

Collection of anamnesis

When collecting an anamnesis, they find out the presence of complaints about the nature of pain from irritants, an allergic history, and the presence of somatic diseases. Purposefully identify complaints of pain and discomfort in the area of ​​a particular tooth, complaints of food jamming, how long ago they appeared, when the patient paid attention to them. Find out the profession of the patient, whether the patient provides proper hygienic care for the oral cavity, the time of the last visit to the dentist.

Visual examination, examination of the oral cavity with additional instruments

When examining the oral cavity, the state of the dentition is assessed, paying attention to the presence of fillings, the degree of their fit, the presence of defects in the hard tissues of the teeth, the number of teeth removed. The intensity of caries is determined (CPU index - caries, filling, removed), hygiene index. Pay attention to the condition of the oral mucosa, its color, moisture content, the presence of pathological changes. All teeth are subject to examination, starting with the right upper molars and ending with the lower right molars. Examine all surfaces of each tooth, pay attention to the color, enamel relief, the presence of plaque, the presence of stains, the presence of stains and their condition after drying the surface of the teeth, defects.

The probe determines the density of hard tissues, evaluates the texture and degree of surface uniformity, as well as pain sensitivity.

Pay attention to the fact that the sounding was carried out without strong pressure. The presence of spots on the visible surfaces of the teeth, the area, shape of the edges, surface texture, density, symmetry and multiplicity of lesions are detected in order to establish the severity of the disease and the rate of development of the process, the dynamics of the disease, as well as differential diagnosis with non-carious lesions. When probing the identified carious cavity, attention is paid to its shape, localization, size, depth, the presence of softened tissues, a change in their color, soreness, or vice versa, the absence of pain sensitivity. Particularly carefully examine the proximal surfaces of the tooth.

Thermodiagnostics are being carried out.

Percussion is used to rule out caries complications.

X-rays are taken to confirm the diagnosis.

6.3.5. Requirements for outpatient treatment

6.3.6. Characteristics of the algorithms and features of the implementation of non-drug care

Non-drug care is aimed at preventing the development of a carious process and includes two main components: ensuring proper oral hygiene and filling a carious defect. Treatment of caries with cement fillings can achieve compensation of function and stabilization (Level of Evidence A).

Algorithm for teaching oral hygiene

First visit

The doctor or dental hygienist determines the hygiene index, then demonstrates to the patient the technique of brushing and flossing the teeth, using dental arch models, or other demonstration tools.

Toothbrushing begins with a site in the region of the upper right chewing teeth, sequentially moving from segment to segment. In the same order, teeth are cleaned in the lower jaw.

Pay attention to the fact that the working part of the toothbrush should be placed at an angle of 45 ° to the tooth, make cleaning movements from gum to tooth, while removing plaque from the teeth and gums. Clean the chewing surfaces of the teeth with horizontal (reciprocating) movements so that the brush fibers penetrate deep into the fissures and interdental spaces. The vestibular surface of the frontal group of teeth of the upper and lower jaws should be cleaned with the same movements as molars and premolars. When cleaning the oral surface, the brush handle should be perpendicular to the occlusal plane of the teeth, while the fibers should be at an acute angle to the teeth and capture not only the teeth, but also the gums.

Complete cleaning with circular movements of the toothbrush with closed jaws, massaging the gums from right to left. The cleaning time is 3 minutes.

For high-quality cleaning of the contact surfaces of the teeth, it is necessary to use dental floss.

Individual selection of oral hygiene products is carried out taking into account the patient's dental status (the state of hard tissues of teeth and periodontal tissues, the presence of dentoalveolar anomalies, removable and non-removable orthodontic and orthopedic structures) (see).

Second visit

In order to consolidate the acquired skills, controlled brushing of the teeth is carried out.

Controlled brushing algorithm

First visit

Treatment of the patient's teeth with a staining agent, determination of the hygienic index, demonstration to the patient with the help of a mirror of the places of the greatest accumulation of plaque.
- Brushing the patient's teeth in his usual manner.
- Re-determination of the hygiene index, assessment of the effectiveness of brushing teeth (comparison of the hygiene index before and after brushing teeth), showing the patient with a mirror the colored areas where the tooth was not successful when brushing.
- Demonstration of the correct technique of brushing teeth on models, recommendations to the patient on correcting deficiencies in hygienic oral care, using dental floss and additional hygiene products (special toothbrushes, toothbrushes, single-beam brushes, irrigators - according to indications).

Next visits

Determination of the hygienic index, with an unsatisfactory level of oral hygiene - repeat the procedure.

The patient is instructed to attend a preventive examination to the doctor at least once every six months.

Algorithm for professional oral and dental hygiene

Stages of professional hygiene:

Patient education in individual oral hygiene;
- removal of supra- and subgingival dental deposits;
- polishing of surfaces of teeth, including surfaces of roots;
- elimination of factors contributing to the accumulation of dentition;
- applications of remineralizing and fluoride-containing products (with the exception of areas with a high fluoride content in drinking water);
- motivation of the patient to prevent and treat dental diseases.

The procedure is carried out in one visit.

When removing supra- and subgingival dental deposits (tartar, dense and soft teeth), a number of conditions should be observed:

Removal of tartar is carried out with application anesthesia;
- carry out antiseptic treatment of the oral cavity with an antiseptic solution (0.06% chlorhexidine solution, 0.05% potassium permanganate solution);
- isolate treated teeth from saliva;
- pay attention that the hand holding the instrument must be fixed on the patient's chin or adjacent teeth, the terminal shaft of the instrument is parallel to the axis of the tooth, the main movements - lever-like and scraping - must be smooth, not traumatic.

In the field of ceramic-metal, ceramic, composite restorations, implants (plastic instruments are used in the processing of the latter), a manual method is used to remove dental deposits.

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

To remove plaque and polish smooth surfaces of teeth, it is recommended to use rubber caps, chewing surfaces - rotating brushes, contact surfaces - flosses and abrasive strips. Polishing infusion should be used, starting with coarse and ending with fine. Fluoride-containing polishing pastes are not recommended before certain procedures (fissure sealing, teeth whitening). Fine polishing pastes and rubber caps should be used when processing implant surfaces.

It is necessary to eliminate the factors contributing to the accumulation of plaque: remove the overhanging edges of the fillings, re-polish the fillings.

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

Algorithm and features of sealing

In case of cement caries (usually class V cavities), filling is carried out in one or several visits. After diagnostic studies and a decision on treatment at the same appointment, treatment is started.

Before starting the preparation, it is necessary to determine the depth of the spread of the process under the gum, if necessary, the patient is sent for correction (excision) of the mucous membrane of the gingival margin to open the surgical field and remove the area of ​​hypertrophied gum. In this case, the treatment is carried out in 2 or more visits, because after the intervention, the cavity is closed with a temporary filling, cement or oil dentin is used as a temporary filling material until the tissues of the gingival margin heal. Then the filling is done.

Before preparation, anesthesia is performed (application, infiltration, conduction). Before anesthesia, the injection site is treated with an anesthetic application.

General requirements for cavity preparation:

Anesthesia;
- maximum removal of pathologically altered tooth tissues;
- full preservation of intact tooth tissues is possible;
- cavity formation.

The shape of the cavity should be round. If the cavity is very small, gentle preparation with ball burs without creating retention zones is acceptable (Level of Evidence B).

Amalgams, glass ionomer cements and compomers are used for filling defects.

In patients who neglect oral hygiene, it is recommended to use glass ionomer (polyalkenate) cements, which provide long-term fluoridation of tooth tissues after filling and have acceptable aesthetic characteristics.

In elderly and elderly patients, especially with symptoms of xerostomia (reduced salivation), amalgam or glass ionomers should be used. It is also possible to use compomers with the advantages of glass ionomers and high aesthetics. Composite materials are indicated for filling defects in cases where the aesthetics of a smile is very important (see).

Patients are scheduled to see a doctor at least once every six months for preventive examinations.

Requirements for outpatient drug care

Characteristics of algorithms and features of the use of medicines

Local anesthetics

Before preparation, anesthesia is performed (application, infiltration, conduction) according to indications. Before anesthesia, the injection site is treated with local anesthetics (lidocaine, articaine, mepivacaine, etc.).

6.3.9. Requirements for the regime of work, rest, treatment and rehabilitation

Patients should visit a specialist once every six months for preventive examinations and, necessarily, for polishing composite fillings.

6.3.10. Requirements for patient care and ancillary procedures

No special requirements

6.3.11. Dietary requirements and restrictions

There are no special requirements.

6.3.12. The form of voluntary informed consent of the patient during the implementation of the Protocol

6.3.13. Additional information for the patient and his family members

6.3.14. Rules for changing requirements when implementing the Protocol and terminating the requirements of the Protocol

If signs are identified during the diagnostic process that require preparatory measures for treatment, the patient is transferred to the patient management protocol corresponding to the identified diseases and complications.

If signs of another disease are detected that require diagnostic and therapeutic measures, along with signs of enamel caries, medical care is provided to the patient in accordance with the requirements:

A) the section of this protocol for managing patients corresponding to the management of enamel caries;
b) a protocol for the management of patients with an identified disease or syndrome.

6.3.15. Possible outcomes and their characteristics

Selection name	Development frequency, %	Criteria and signs	Estimated time to reach outcome	Continuity and staging of medical care
Function compensation	40	Restoration of the anatomical shape and function of the tooth	Immediately after treatment	Dynamic observation 2 times a year
Stabilization	15	No recurrence or complications	Immediately after treatment	Dynamic observation 2 times a year
	25	The appearance of new lesions or complications due to ongoing therapy (for example, allergic reactions)	At any stage	Provision of medical care according to the protocol of the corresponding disease
The development of a new disease associated with the underlying	20	Recurrence of caries, its progression	6 months after the end of treatment in the absence of follow-up	Provision of medical care according to the protocol of the corresponding disease

6.3.16. Cost characteristics of the Protocol

Cost characteristics are determined in accordance with the requirements of regulatory documents.

6.4. PATIENT MODEL

Nosological form: suspended dental caries
Stage: any
Phase: process stabilization
Complications: no complications
ICD-10 code: K02.3

6.4.1. Criteria and features that define the patient model

- Patients with permanent teeth.
- The presence of a dark pigmented spot.
- Absence of non-carious diseases of hard tissues of teeth.
- Focal demineralization of the enamel, when probing, a smooth or rough surface of the tooth enamel is determined.
- Tooth with healthy pulp and periodontium.
- Healthy periodontal and oral mucosa.

6.4.2. Procedure for including a patient in the Protocol

The patient's condition that satisfies the criteria and features of the diagnosis of this patient model.

6.4.3. Requirements for the diagnosis of outpatient

The code	Name	Multiplicity of execution
A01.07.001	Collection of anamnesis and complaints in the pathology of the oral cavity	1
A0 1.07.002	Visual examination in the pathology of the oral cavity	1
А01.07.005	External examination of the maxillofacial region	1
А02.07.001	Examination of the oral cavity with additional instruments	1
А02.07.002	Examination of carious cavities using a dental probe	1
А02.07.007	Percussion of the teeth	1
А02.07.005	Thermal diagnostics of the tooth	On demand
А02.07.006	Definition of bite	On demand
А0З.07.003	Diagnostics of the state of the dentoalveolar system using methods and means of radiation imaging	On demand
А05.07.001	Electroodontometry	On demand
А06.07.003	Targeted intraoral contact radiography	On demand
A06.07.010	Radiovisiography of the maxillofacial region	On demand
A12.07.003	Determination of oral hygiene indices	According to the algorithm
A12.07.004	Determination of periodontal indices	On demand

6.4.4. Characteristics of algorithms and features of the implementation of diagnostic measures

The examination is aimed at establishing a diagnosis corresponding to the patient's model, excluding complications, determining the possibility of starting treatment without additional diagnostic and therapeutic measures.

For this purpose, all patients must take an anamnesis, examine the oral cavity and teeth, as well as other necessary studies, the results of which are entered in the medical record of the dental patient (form 043 / y).

The main differential diagnostic feature is the color of the spot: pigmented and does not stain with methylene blue, in contrast to the "white (chalky) spot", which is stained.

Collection of anamnesis

When collecting an anamnesis, they find out the presence of complaints of pain from chemical and temperature irritants, an allergic history, the presence of somatic diseases. Purposefully identify complaints of pain and discomfort in the area of ​​a particular tooth, complaints of food jamming, patient satisfaction with the appearance of the tooth, the timing of the appearance of complaints, when the patient noticed the appearance of discomfort. Find out whether the patient is carrying out proper hygienic care for the oral cavity, the profession of the patient, the regions of his birth and residence (endemic areas of fluorosis).

Visual examination, external examination of the maxillofacial region, examination of the oral cavity with additional instruments

When examining the oral cavity, the condition of the dentition is assessed, paying attention to the intensity of caries (the presence of fillings, the degree of their fit, the presence of defects in the hard tissues of the teeth, the number of extracted teeth). The state of the oral mucosa, its color, moisture content, and the presence of pathological changes are determined.

All teeth are subject to examination, starting with the right upper molars and ending with the lower right molars. All surfaces of each tooth are examined in detail, paying attention to the color, enamel relief, the presence of plaque, the presence of stains and their condition after drying the surface of the teeth, defects.

Pay attention to the presence of a dull and / or pigmented spot on the visible surfaces of the tooth, the area, shape of the edges, surface texture, density, symmetry and multiplicity of lesions in order to establish the severity of the disease and the rate of development of the process, the dynamics of the disease, as well as differential diagnosis with non-carious defeats. Fluorescent stomatoscopy can be used to confirm the diagnosis.

Thermodiagnostics is used to identify pain reactions and clarify the diagnosis.

Percussion is used to rule out caries complications.

Oral hygiene indices are determined before treatment and after oral hygiene training, in order to control.

6.4.5. Requirements for outpatient treatment

The code	Name	Multiplicity of execution
A13.31.007	Oral hygiene training	1
A14.07.004	Controlled brushing	1
А16.07.055	Professional oral and dental hygiene	1
A11.07.013	Deep fluoridation of hard dental tissues	According to the algorithm
A16.07.002	Restoration of a tooth with a filling	On demand
A16.07.061	Sealing the fissure of a tooth with a sealant	On demand
А25.07.001	Prescribing drug therapy for diseases of the oral cavity and teeth	According to the algorithm
А25.07.002	Prescribing dietary therapy for diseases of the oral cavity and teeth	According to the algorithm

6.4.6. Characteristics of the algorithms and features of the implementation of non-drug care

Treatment of suspended caries, regardless of the location of the carious cavity, includes:

If the spread of the spot is less than 4 mm2 along the occlusal surface or one third of the contact surface, the application of fluorine-containing preparations and dynamic observation;
- if it is impossible to dynamically monitor the development of the process or if the prevalence of the lesion is more than 4 mm - the creation of a cavity and filling.

Non-drug care is aimed at preventing the development of a carious process and includes two main components: ensuring proper oral hygiene and, if necessary, filling a carious defect.

Remineralization therapy and, if necessary, filling treatment can provide stabilization (Level of Evidence B).

Algorithm for teaching oral hygiene

First visit

The doctor or dental hygienist determines the hygiene index, then demonstrates to the patient the technique of brushing the teeth with a toothbrush and dental floss, using models of dental rads, and other demonstration tools.

Toothbrushing begins with a site in the region of the upper right chewing teeth, sequentially moving from segment to segment. In the same order, teeth are cleaned in the lower jaw.

Pay attention to the fact that the working part of the toothbrush should be placed at an angle of 45 ° to the tooth, make cleaning movements from gum to tooth, while removing plaque from the teeth and gums. Clean the chewing surfaces of the teeth with horizontal (reciprocating) movements so that the brush fibers penetrate deep into the fissures and interdental spaces. The vestibular surface of the frontal group of teeth of the upper and lower jaws should be cleaned with the same movements as molars and premolars. When cleaning the oral surface, the brush handle should be perpendicular to the occlusal plane of the teeth, while the fibers should be at an acute angle to the teeth and capture not only the teeth, but also the gums.

Complete cleaning with circular movements of the toothbrush with closed jaws, massaging the gums from right to left.

The cleaning time is 3 minutes.

For high-quality cleaning of the contact surfaces of the teeth, it is necessary to use dental floss.

Individual selection of oral hygiene products is carried out taking into account the patient's dental status (the state of hard tissues of teeth and periodontal tissues, the presence of dentoalveolar anomalies, removable and non-removable orthodontic and orthopedic structures) (see).

Second visit

In order to consolidate the acquired skills, controlled brushing of the teeth is carried out.

Controlled brushing algorithm

First visit

Treatment of the patient's teeth with a staining agent, determination of the hygienic index, demonstration to the patient with the help of a mirror of the places of the greatest accumulation of plaque.
- Brushing the patient's teeth in his usual manner.
- Re-determination of the hygiene index, assessment of the effectiveness of brushing teeth (comparison of the hygiene index before and after brushing), showing the patient with a mirror of stained areas where plaque was not removed during brushing.
- Demonstration of the correct technique of brushing teeth on models, recommendations to the patient on correcting deficiencies in hygienic oral care, using dental floss and additional hygiene products (special toothbrushes, toothbrushes, single-beam brushes, irrigators - according to indications).

Next visits

Determination of the hygienic index, with an unsatisfactory level of oral hygiene - repeat the procedure.

The patient is instructed to attend a preventive examination to the doctor at least once every six months.

Algorithm for professional oral and dental hygiene

Stages of professional hygiene:

Patient education in individual oral hygiene;
- removal of supra- and subgingival dental deposits;
- polishing of surfaces of teeth, including surfaces of roots;
- elimination of factors contributing to the accumulation of plaque;
- applications of remineralizing and fluoride-containing products (with the exception of areas with a high fluoride content in drinking water);
- motivation of the patient to prevent and treat dental diseases.

The procedure is carried out in one visit.

When removing supra- and subgingival dental deposits (tartar, dense and soft plaque), a number of conditions should be observed:

Removal of tartar is carried out with application anesthesia;
- carry out antiseptic treatment of the oral cavity with an antiseptic solution (0.06% chlorhexidine solution, 0.05% potassium permanganate solution);
- isolate treated teeth from saliva;
- pay attention that the hand holding the instrument must be fixed on the patient's chin or adjacent teeth, the terminal shaft of the instrument is parallel to the axis of the tooth, the main movements - lever-like and scraping - must be smooth, not traumatic. In the field of ceramic-metal, ceramic, composite restorations, implants (plastic instruments are used in the processing of the latter), a manual method is used to remove dental deposits.

Ultrasound devices should not be used in patients with respiratory, infectious diseases and those on a medication regimen to control electrolyte balance, as well as in patients with a pacemaker.

To remove plaque and polish smooth surfaces of teeth, it is recommended to use rubber caps, chewing surfaces - rotating brushes, contact surfaces - flosses and abrasive strips. Polishing paste should be used from coarse to fine. Fluoride-containing polishing infusions are not recommended before certain procedures (fissure sealing, teeth whitening). Fine polishing pastes and rubber caps should be used when processing implant surfaces.

Attention is drawn to the need to eliminate the factors that contribute to the accumulation of plaque: the overhanging edges of the fillings are removed, the fillings are re-polished.

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

Sealing the fissure of a tooth with a sealant

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

Algorithm and features of sealing

First visit

Treatment is carried out in one visit.

Create a cavity by removing pigmented demineralized tissue. Pay attention to the fact that the cavity was formed within the enamel. If a preventive expansion of the cavity is necessary to fix the filling, the transition of the enamel-dentin border is allowed. In the treatment of chewing teeth, the formation of a cavity is carried out in the contours of natural fissures. The cavity edges are finished, washed and dried before filling. Then the filling is done. Pay attention to the mandatory restoration of the anatomical shape of the tooth, align the occlusal and proximal contacts (see).

6.4.7. Requirements for outpatient drug care

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

The main method of treatment of suspended caries in the presence of a pigmented spot is fluoridation of the hard tissues of the tooth.

Fluoridation of dental hard tissues

Applications of 1-2% sodium fluoride solution are carried out in every 3rd visit. after application with a remineralizing solution on a cleaned and dried tooth surface for 2-3 minutes.

Coating of teeth with fluorine varnish, as an analogue of 1-2% sodium fluoride solution, is carried out in every 3rd visit after application of a remineralizing solution on a dried tooth surface. After the application, the patient is not recommended to eat for 2 hours and brush his teeth for 12 hours. The criterion for the effectiveness of fluorination is the stable state of the spot size.

6.4.9. Requirements for the regime of work, rest, treatment and rehabilitation

Patients with enamel caries should visit a specialist once every six months for observation.

6.4.10. Requirements for patient care and ancillary procedures

6.4.11. Dietary requirements and restrictions

After completion of each treatment procedure, it is recommended not to take a niche and not rinse your mouth for 2 hours.

Limiting the consumption of foods and drinks with low pH values ​​​​(juices, tonic drinks, yogurts) and thoroughly rinsing the mouth after taking them. Limiting the stay of carbohydrates in the oral cavity (sucking, chewing sweets).

6.4.12. The form of informed voluntary consent of the patient during the implementation of the Protocol

6.4.13. Additional information for the patient and his family members

6.4.14. Rules for changing requirements when implementing the Protocol and terminating the requirements of the Protocol

If signs are identified during the diagnostic process that require preparatory measures for treatment, the patient is transferred to the patient management protocol corresponding to the identified diseases and complications.

If signs of another disease are detected that require diagnostic and therapeutic measures, along with signs of enamel caries, medical care is provided to the patient in accordance with the requirements:

A) the section of this protocol for managing patients corresponding to the management of enamel caries;
b) a protocol for the management of patients with an identified disease or syndrome.

6.4.15. Possible outcomes and their characteristics

Selection name	Development frequency, %	Criteria and signs	Estimated time to reach outcome	Continuity and stages in the provision of medical care
Function compensation	30	Recovery appearance tooth		Dynamic observation 2 times a year
Stabilization	50	Lack of both positive and negative dynamics	2 months with remineralization, with filling immediately after treatment	Dynamic observation 2 times a year
Development of iatrogenic complications	10	The appearance of new lesions or complications due to ongoing therapy (for example, allergic reactions)	At the stage of dental treatment	Provision of medical care according to the protocol of the corresponding disease
The development of a new disease associated with the underlying	10	Recurrence of caries, its progression	6 months after the end of treatment and in the absence of follow-up	Provision of medical care according to the protocol of the corresponding disease

6.4.16. Cost characteristics of the Protocol

Cost characteristics are determined in accordance with the requirements of regulatory documents.

VII. GRAPHIC, SCHEMATICAL AND TABLE REPRESENTATION OF THE PROTOCOL

Not required.

VIII. MONITORING

CRITERIA AND METHODOLOGY FOR MONITORING AND EVALUATION OF THE EFFICIENCY OF THE IMPLEMENTATION OF THE PROTOCOL

Monitoring is carried out throughout the territory of the Russian Federation.

The list of medical institutions in which monitoring of this document is carried out is determined annually by the institution responsible for monitoring. Medical organization is informed about inclusion in the protocol monitoring list in writing. Monitoring includes:

Collection of information: on the management of patients with dental caries in medical institutions at all levels;
- analysis of the obtained data;
- drawing up a report on the results of the analysis;
- submission of a report to the Protocol development team to the Department of Standardization in Healthcare of the Institute of Public Health and Health Administration of the Moscow Medical Academy. I. M. Sechenov.

The initial data for monitoring are:

Medical documentation - a medical card of a dental patient (form 043/y);
- tariffs for medical services;
- tariffs for dental materials and medicines.

If necessary, when monitoring the Protocol, other documents can be used.

In health care facilities identified by the monitoring list, once every six months on the basis of medical records a patient chart is compiled () on the treatment of patients with dental caries corresponding to the patient models in this protocol.

The indicators analyzed during the monitoring process include: inclusion and exclusion criteria from the Protocol, lists of mandatory and additional range of medical services, lists of mandatory and additional range of medicines, disease outcomes, cost of medical care under the Protocol, etc.

PRINCIPLES OF RANDOMIZATION

Randomization (of hospitals, patients, etc.) is not provided for in this Protocol.

PROCEDURE FOR EVALUATION AND DOCUMENTATION OF SIDE EFFECTS AND DEVELOPMENT OF COMPLICATIONS

Information about side effects and complications that have arisen in the process of diagnosing and treating patients are recorded in the patient's record (see).

PROCEDURE FOR EXCLUDING A PATIENT FROM MONITORING

A patient is considered included in the monitoring when the Patient Card is completed for him. An exception from monitoring is carried out if it is impossible to continue filling out the Card (for example, failure to appear for a medical appointment) (see). In this case, the Card is sent to the institution responsible for monitoring, with a note on the reason for exclusion of the patient from the protocol.

INTERIM EVALUATION AND PROTOCOL AMENDMENTS

The evaluation of the implementation of the Protocol is carried out once a year based on the results of the analysis of information obtained during monitoring.

Amendments to the Protocol are carried out in case of receipt of information:

A) on the presence in the Protocol of requirements that are detrimental to the health of patients,
b) upon receipt of convincing evidence of the need to change the requirements of the Mandatory Level Protocol.

The decision on changes is made by the development team. The introduction of amendments to the requirements of the Protocol is carried out by the Ministry of Health and Social Development of the Russian Federation in the prescribed manner.

PARAMETERS FOR ASSESSING THE QUALITY OF LIFE WHEN IMPLEMENTING THE PROTOCOL

To assess the quality of life of a patient with dental caries, corresponding to the Protocol models, an analog scale (P) is used.

EVALUATION OF PROTOCOL IMPLEMENTATION COST AND QUALITY PRICE

Clinical and economic analysis is carried out in accordance with the requirements of regulatory documents.

COMPARISON OF RESULTS

When monitoring the Protocol, an annual comparison is made of the results of fulfilling its requirements, statistical data, and performance indicators of medical institutions.

PROCEDURE FOR FORMING THE REPORT

The annual monitoring results report includes quantitative results obtained during the development of medical records and their qualitative analysis, conclusions, proposals for updating the Protocol.

The report is submitted to the Ministry of Health and Social Development of the Russian Federation by the institution responsible for monitoring this Protocol. The results of the report may be published in the open press.

Attachment 1

LIST OF DENTAL MATERIALS AND INSTRUMENTS REQUIRED FOR THE DOCTOR'S WORK MANDATORY ASSORTMENT

1. A set of dental tools (tray, mirror, spatula, dental tweezers, dental probe, excavators, trowels, pluggers)
2. Dental mixing glasses
3. Tool kit for working with amalgams
4. A set of tools for working with KOMI books
5. Articulation paper
6. Turbine tip
7. Handpiece
8. Contra angle
9. Steel contra-angle burs
10. Diamond burs for turbine handpiece for preparation of hard dental tissues
11. Diamond burs for contra-angle for preparation of hard tissues of teeth
12. Carbide burs for turbine handpiece
13. Carbide burs for contra-angle
14. Disk holders for contra-angle handpiece for polishing discs
15. Rubber polishing heads
16. Polishing brushes
17. Polishing discs
18. Metal strips of different grain sizes
19. Plastic strips
20. Retraction threads
21. Disposable gloves
22. Disposable masks
23. Disposable saliva ejectors
24. Disposable cups
25. Glasses for working with a solar lamp
26. Disposable syringes
27. Carpool syringe
28. Needles for a carpool syringe
29. Color bar
30. Materials for dressings and temporary fillings
31. Silicate cements
32. Phosphate cements
33. Steloyionomer cements
34. Amalgams in capsules
35. Two-chamber capsules for mixing amalgam
30. Capsule mixer
37. Composite materials of chemical curing
38. Fluid Composites
39. Materials for medical and insulating pads
40. Adhesive systems for light-cured composites
41. Adhesive systems for chemically cured composites
42. Antiseptics for drug treatment oral cavity and carious cavity
43. Composite surface sealant, post-bonding
44. Fluoride-free abrasive pastes for cleaning the tooth surface
45. Pastes for polishing fillings and teeth
46. ​​Lamps for composite photopolymerization
47. Apparatus for electroodontodiagnostics
48. Wooden interdental wedges
49. Interdental wedges transparent
50. Matrices metal
51. Contoured steel matrices
52. Transparent matrices
53. Matrix holder
54. Matrix fixing system
55. Applicator gun for capsule composite materials
56. Applicators
57. Means for teaching the patient oral hygiene (toothbrushes, pastes, threads, holders for dental floss)

ADDITIONAL ASSORTMENT

1. Micromotor
2. High speed handpiece (angle) for turbine burs
3. Glasperlenic sterilizer
4. Ultrasonic device for cleaning burs
5. Standard cotton swabs
6. Box for standard cotton rolls
7. Aprons for the patient
8. Paper blocks mi kneading
9. Cotton balls for drying cavities
10. Quickdam (cofferdam)
11. Enamel knife
12. Gingiva trimmers
13. Tablets for coloring teeth during hygienic measures
14. Apparatus for diagnosing caries
15. Tools for creating contact points on molars and premolars
16. Fissurotomy burs
17. Strips for isolation of the ducts of the parotid salivary glands
18. Safety glasses
19. Protective screen

Appendix 2

to the Protocol for the management of patients "Dental caries"

GENERAL RECOMMENDATIONS FOR THE SELECTION OF HYGIENE PRODUCTS DEPENDING ON THE DENTAL STATUS OF THE PATIENT

Patient population	Recommended hygiene products
Population of areas with fluoride content in drinking water less than 1 mg/l. The patient has foci of demineralization of the mouse, hypoplasia	Toothbrush soft or medium hardness, anti-caries toothpastes - fluoride- and calcium-containing (according to age), dental floss (floss), fluoride-containing rinses
Population of areas with more than 1 mg/l fluoride content in drinking water. Patient presenting with fluorosis	Soft or medium hard toothbrush, fluoride-free, calcium-containing toothpastes; fluoride-free dental flosses, fluoride-free rinses
Patient has inflammatory periodontal disease (during exacerbation)	Soft bristled toothbrush, anti-inflammatory toothpastes (with medicinal herbs, antiseptics*, salt additives), dental flosses (flosses), rinses with anti-inflammatory components * Note: the recommended course of using toothpastes and rinses with antiseptics is 7-10 days
The patient has dental anomalies (crowding, dystopia of teeth)	Toothbrush of medium hardness and treatment-and-prophylactic toothpaste(according to age), dental floss (floss), dental brushes, rinses
The presence of braces in the patient's mouth	Orthodontic toothbrush of medium hardness, anti-caries and anti-inflammatory toothpastes (alternation), toothbrushes, single-bundle brushes, dental floss (floss), rinses with anti-caries and anti-inflammatory components, irrigators
The patient has dental implants	Toothbrush with different bristle heights*, anti-caries and anti-inflammatory toothpastes (alternating), toothbrushes, single-brush brushes, dental flosses (floss), alcohol-free rinses with anti-caries and anti-inflammatory components, irrigators Do not use toothpicks or chewing gum * Note: straight bristled toothbrushes are not recommended due to their lower cleaning efficiency
The patient has removable orthopedic and orthodontic structures	Removable denture toothbrush (double-sided, hard bristles), removable denture cleaning tablets
Patients with increased tooth sensitivity.	Soft-bristled toothbrush, desensitizing toothpastes (containing strontium chloride, potassium nitrate, potassium chloride, hydroxyanatite), dental flosses, mouth rinses for sensitive teeth
Patients with xerostomia	Very soft bristled toothbrush, low-price enzymatic toothpaste, alcohol-free rinse, moisturizing gel, dental floss

Appendix 3

to the Protocol for the management of patients "Dental caries"

FORM OF VOLUNTARY INFORMED CONSENT OF THE PATIENT WHEN IMPLEMENTING THE PROTOCOL APPENDIX TO THE MEDICAL CARD No. _____

A patient ____________________________________________________

FULL NAME _________________________________

receiving clarifications about the diagnosis of caries, received information:

about the features of the course of the disease ____________________________________________________________

probable duration of treatment _________________________________________________________________

about the probable forecast ___________________________________________________________________________

The patient was offered a plan of examination and treatment, including _________________________________

The patient was asked to __________________________________________________________________________

from materials _________________________________________________________________________________

The approximate cost of treatment is about ____________________________________________________

The patient knows the price list accepted in the clinic.

Thus, the patient received an explanation about the purpose of the treatment and information about the planned methods.

diagnosis and treatment.

The patient is informed about the need to prepare for treatment:

_____________________________________________________________________________________________

The patient was informed of the need during treatment

_____________________________________________________________________________________________

_____________________________________________________________________________________________

The patient received information about the typical complications associated with this disease, with the necessary diagnostic procedures and with treatment.

The patient is informed about the probable course of the disease and its complications in case of refusal of treatment. The patient had the opportunity to ask any questions of interest to him regarding his state of health, illness and treatment, and received satisfactory answers to them.

The patient received information about alternative methods of treatment, as well as their approximate cost.

The interview was conducted by the doctor ________________________ (physician's signature).

"___" ________________200___

The patient agreed with the proposed treatment plan, in which

signed with his own hand

(signature of the patient)

signed by his legal representative

that certify those present at the conversation __________________________________________________

(physician's signature)

_______________________________________________________

(witness signature)

The patient disagreed with the treatment plan

(refused the proposed type of prosthesis), which he signed with his own hand.

(signature of the patient)

or signed by his legal representative __________________________________________________________

(signature of legal representative)

that certify those who were present at the conversation ______________________________________________________

(physician's signature)

_______________________________________________________

(witness signature)

The patient expressed a desire:

In addition to the proposed treatment, undergo an examination

Get additional medical service

Instead of the proposed filling material, get

The patient received information about the specified method of examination/treatment.

Since this method of examination/treatment is also indicated for the patient, it is included in the treatment plan.

(signature of the patient)

_________________________________

(physician's signature)

Since this method of examination/treatment is not indicated for the patient, it is not included in the treatment plan.

"___" ___________________20____ _________________________________

(signature of the patient)

_________________________________

(physician's signature)

Appendix 4

to the Protocol for the management of patients "Dental caries"

ADDITIONAL INFORMATION FOR THE PATIENT

1. Filled teeth must be brushed with a toothbrush and paste in the same way as natural teeth - twice a day. Rinse your mouth after eating to remove food debris.

2. To clean the interdental spaces, you can use dental floss (floss) after learning how to use them and on the recommendation of a dentist.

3. If bleeding occurs when brushing your teeth, you should not stop hygiene procedures. If bleeding does not go away within 3-4 days, you should consult a doctor.

4. If, after filling and the end of anesthesia, the filling interferes with the closing of the teeth, then it is necessary to contact your doctor as soon as possible.

5. When fillings are made of composite materials, you should not eat food containing natural and artificial dyes (for example: blueberries, tea, coffee, etc.) during the first two days after tooth filling.

6. There may be a temporary appearance of pain (increased sensitivity) in a sealed tooth during the reception and chewing of food. If a indicated symptoms do not go away within 1-2 weeks, you need to contact your dentist.

7. If there is a sharp pain in the tooth, it is necessary to contact the attending dentist as soon as possible.

8. In order to avoid chipping the filling and the hard tissues of the tooth adjacent to the filling, it is not recommended to take and chew very hard food (for example: nuts, crackers), bite off large pieces (for example: from a whole apple).

9. Once every six months, you should visit a dentist for preventive examinations and necessary manipulations (for fillings made of composite materials - to polish the filling, which will increase its service life).

Annex 5

to the Protocol for the management of patients "Dental caries"

PATIENT CARD

Case history No. ____________________________

Name of institution

Date: start of observation _________________ end of observation _________________________________

FULL NAME. ____________________________________________________age.

Diagnosis main ________________________________________________________________________

Accompanying illnesses: ____________________________________________________________

Patient Model: ____________________________________________________________________________

The volume of non-drug medical care provided: ____________________________________

The code medical	Name of medical service	Multiplicity of execution
DIAGNOSTICS
A01.07.001	Collection of anamnesis and complaints in the pathology of the oral cavity
А01.07.002	Visual examination in the pathology of the oral cavity
А01.07.005	External examination of the maxillofacial region
А02.07.001	Examination of the oral cavity with additional instruments
А02.07.005	Thermal diagnostics of the tooth
А02.07.006	Definition of bite
А02.07.007	Percussion of the teeth
А03.07.001	Fluorescent stomatoscopy
А0З.07.003	Diagnosis of the state of the dentoalveolar system using methods and means of radiation imaging
А06.07.003	Targeted intraoral contact radiography
А12.07.001	Vital staining of dental hard tissues
A12.07.003	Determination of oral hygiene indices
А12.07.004	Determination of periodontal indices
А02.07.002	Examination of carious cavities using a dental probe
А05.07.001	Electroodontometry
A06.07.0I0	Radiovisiography of the maxillofacial region
A11.07.013	Deep fluoridation of hard dental tissues
A13.31.007	Oral hygiene training
A14.07.004	Controlled brushing
A16.07.002	Restoration of a tooth with a filling
A16.07.003	Tooth restoration with inlays, veneers, semi-crown
A16.07.004	Restoration of a tooth with a crown
А16.07.055	Professional oral and dental hygiene
A16.07.061	Sealing the fissure of the tooth with sealant
A16.07.089	Grinding hard tooth tissues
A25.07.001	Prescribing drug therapy for diseases of the oral cavity and teeth
A25.07.002	Prescribing dietary therapy for diseases of the oral cavity and teeth

Drug assistance (specify the drug used):

Drug complications (indicate manifestations): Name of the drug that caused them: Outcome (according to the classifier of outcomes):

Information about the patient was transferred to the institution monitoring the Protocol:

(Institution name) (Date)

Signature of the person responsible for protocol monitoring

in a medical institution: _____________________________________________________________

MONITORING CONCLUSION	Completeness of the implementation of the mandatory list of non-drug care	Yes	Not	NOTE
	Meeting deadlines for medical services	Yes	Not
	Completeness of implementation of the mandatory list of drug assortment	Yes	Not
	Compliance of treatment with the requirements of the protocol in terms of timing / duration	Yes	Not

PROTOCOL OF MANAGEMENT OF PATIENTS
TOTAL ABSENCE OF TEETH
(FULL SECONDARY Adentia)

The protocol for managing patients "Total absence of teeth (complete secondary adentia)" was developed by the Moscow State University of Medicine and Dentistry (Professor, MD A.Yu. Maly, junior researcher N.A. Titkina, E.V. Ershov), Moscow Medical Academy. THEM. Sechenov of the Ministry of Health and Social Development of the Russian Federation (Professor, MD P.A. Vorobyov, MD M.V. Avksentieva, PhD D.V. Lukyantseva), a dental clinic No. 2 in Moscow (A.M. Kocherov, S.G. Chepovskaya).

I. SCOPE

The patient management protocol "Total absence of teeth (complete secondary adentia)" is intended for use in the healthcare system of the Russian Federation.

II. NORMATIVE REFERENCES

Decree of the Government of the Russian Federation of 05.11.97 No. 1387 "On measures to stabilize and develop health care and medical science in the Russian Federation" (Sobraniye zakonodatelstva Rossiyskoy Federatsii, 1997, No. 46, item 5312).

Decree of the Government of the Russian Federation of October 26, 1999 No. 1194 "On Approval of the Program of State Guarantees for Provision of Citizens of the Russian Federation with Free Medical Care" (Sobraniye Zakonodatelstva Rossiyskoy Federatsii, 1997, No. 46, Art. 5322).

III. SYMBOLS AND ABBREVIATIONS

The following designations and abbreviations are used in this protocol:

ICD-10 - International Statistical Classification of Diseases and Related Health Problems, World Health Organization, Tenth Revision.

ICD-S - International classification of dental diseases based on ICD-10.

IV. GENERAL PROVISIONS

The protocol for managing patients "Total absence of teeth (complete secondary adentia)" was developed to solve the following problems:

Establishing uniform requirements for the procedure for diagnosing and treating patients with a complete absence of teeth (with complete secondary adentia);

Unification of the development of basic programs of compulsory health insurance and optimization of medical care for patients with complete absence of teeth (with complete secondary edentulism);

Ensuring optimal volumes, availability and quality of medical care provided to a patient in a medical institution and on the territory within the framework of state guarantees for providing citizens with free medical care.

The scope of this protocol is medical and preventive dental institutions of all levels, including specialized departments.

The present protocol uses the data evidence strength scale:

BUT) The evidence is compelling: there is strong evidence for the proposed assertion,

b) Relative strength of evidence: there is sufficient evidence to recommend this proposal.

c) There is not enough evidence: the available evidence is not sufficient to make a recommendation, but recommendations may be made in other circumstances.

D) Enough negative evidence: there is enough evidence to recommend that the drug should not be used in a given situation.

e) Strong negative evidence: there is sufficient evidence to exclude the drug or procedure from the recommendations.

V. RECORD KEEPING

The protocol is maintained by the Moscow State University of Medicine and Dentistry of the Ministry of Health of Russia. The reference system provides for the interaction of the Moscow State University of Medicine and Dentistry with all interested organizations.

VI. GENERAL ISSUES

According to statistics, the complete absence of teeth (complete secondary adentia) as a result of tooth extraction, loss due to an accident (trauma) or periodontal disease in our country is quite common. The incidence rates of complete absence of teeth (complete secondary adentia) increase incrementally (five times) in each subsequent age group: in the population aged 40-49 years, the incidence of complete secondary adentia is 1%, at the age of 50-59 years - 5.5% , and in people older than 60 years - 25%. In the general structure of providing medical care to patients in medical and preventive dental institutions, 17.96% of patients are diagnosed with "complete absence of teeth (complete secondary adentia)" of one or both jaws.

The complete absence of teeth (complete secondary adentia) directly affects the patient's quality of life. The complete absence of teeth (complete secondary adentia) causes a violation up to the final loss of a vital function of the body - chewing food, which affects the process of digestion and the intake of 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 (complete secondary adentia) for the social status of patients: articulation and diction disorders affect the communication abilities of the patient, these disorders, coupled with changes in appearance due to loss of teeth and developing atrophy of the chewing muscles, can cause changes in the psycho-emotional state up to violations psyche.

The complete absence of teeth (complete secondary adentia) is also one of the reasons for the development of specific complications in the maxillofacial region, such as dysfunction of the temporomandibular joint and the corresponding pain syndrome.

The concepts of "tooth loss due to accident, extraction of teeth or localized periodontitis" (ICD-C K08.1 - International Classification of Dental Diseases based on ICD-10) and terms such as "total secondary edentulism" and "total absence of teeth" ( unlike adentia - violations of the development and eruption of teeth - K 00.0), in fact, they are synonyms and apply both to each of the jaws and to both jaws.

The complete absence of teeth (complete secondary adentia) is a consequence of a number of diseases of the dentoalveolar system - caries and its complications, periodontal diseases, as well as injuries.

Caries in our country is one of the most common diseases. Its prevalence in the adult population aged 35 years and older is 98-99%. The development rates of caries complications are also significant: the percentage of removals in the age group over 35-44 years is 5.5, and in the next age group - 17.29%. Patients with pulpitis, which, as a rule, is a consequence of untreated caries, make up 28-30% in the structure of dental care in terms of accessibility.

The incidence of periodontal diseases is also high: the prevalence of signs of periodontal damage in the age group of 35-44 years is 86%, other authors call the frequency of occurrence pathological signs periodontal disease 98%.

These diseases with untimely and poor-quality treatment can lead to spontaneous loss of teeth due to pathological processes in periodontal tissues of an inflammatory and / or dystrophic nature, to loss of teeth due to the removal of teeth and their roots that cannot be treated with deep caries, pulpitis and periodontitis.

Untimely 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 in one or both jaws.

The clinical picture is characterized by changes in the configuration of the face (retraction of the lips), pronounced nasolabial and chin folds, drooping of the corners of the mouth, a decrease in the size of the lower third of the face, in some patients - maceration and "jamming" in the area of ​​​​the corners of the mouth, a violation of masticatory function. Often, the complete absence of teeth (complete secondary adentia) is accompanied by habitual subluxation or dislocation of the temporomandibular joint. After the loss or removal of all teeth, a gradual atrophy of the alveolar processes of the jaws occurs, progressing over time.

CLASSIFICATION
TOTAL ABSENCE OF TEETH
(FULL SECONDARY Adentia)

In clinical practice, the complete absence of teeth (complete secondary adentia) of the upper jaw, the complete absence of teeth (complete secondary adentia) of the lower jaw, the complete absence of teeth (complete secondary adentia) of both jaws are traditionally distinguished.

Several classifications of edentulous jaws have been proposed. Schroeder's classification for the edentulous upper jaw and Keller's for the edentulous lower jaw are the most widely used. In domestic practice, the classification of edentulous jaws by V.Yu. Kurlyandsky is also widely used. These classifications are based, first of all, on anatomical and topographic characteristics - the degree of atrophy of the alveolar process, as well as the level of attachment of the tendons of the masticatory muscles (classification according to Kurlyandsky). The classification according to I.M. Oksman is also used, who proposed a unified classification for the upper and lower edentulous jaws, taking into account the degree of atrophy of the alveolar processes.

In the complete absence of teeth (complete secondary adentia), it is impossible to distinguish the stages of the course of the disease.

GENERAL APPROACHES TO DIAGNOSIS
TOTAL ABSENCE OF TEETH (COMPLETE SECONDARY Adentia)

Diagnosis of the complete absence of teeth (complete secondary adentia) is made by clinical examination and anamnesis. Diagnosis is aimed at eliminating factors that prevent the immediate start of prosthetics. Such factors may include:

Not removed roots under the mucous membrane;
- exostoses;
- tumor-like diseases;
- inflammatory processes;
- diseases and lesions of the oral mucosa.

GENERAL APPROACHES TO TREATMENT
TOTAL ABSENCE OF TEETH
(FULL SECONDARY Adentia)

The principles of treatment of patients with complete secondary adentia involve the simultaneous solution of several problems:

Restoration of sufficient functional ability of the dentoalveolar system;
- prevention of 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.

Prosthesis fabrication is not indicated if the existing prosthesis is still functional or if its function can be restored (eg, repair, relining). The manufacture of a prosthesis includes: examination, planning, preparation for prosthetics and all activities for the manufacture and fixation of the prosthesis, including the elimination of deficiencies and control. This includes also instructing and educating the patient in the care of the prosthesis and oral cavity.

The orthopedic dentist must determine the features of prosthetics, depending on the anatomical, physiological, pathological and hygienic condition of the patient's dental system. When choosing between equally effective types of prostheses, he should be guided by indicators of profitability.

In cases where it is impossible to immediately complete the treatment, the use of immediate prostheses is indicated, especially to prevent the development of pathology of the temporomandibular joint.

You can only use those materials and alloys that are approved for use, clinically tested, the safety of which has been proven and confirmed by clinical experience.

The basis of a complete removable denture should be made, as a rule, of plastic. Reinforcement of the basis of the prosthesis with special metal meshes can be used. For the manufacture of a metal base, a thorough justification is necessary.

With a confirmed allergic reaction of the tissues of the oral cavity to the material of the prosthesis, tests should be carried out and the material that has shown itself to be tolerated should be selected.

With an edentulous jaw, the removal of a functional cast (impression) is indicated, a functional formation of the edge of the prosthesis is necessary, i.e. to take an impression (impression), it is necessary to make an individual rigid impression (impression) tray.

Making a removable prosthesis for an edentulous jaw using a plastic or metal base includes the following: anatomical, functional casts (impressions) of both jaws, determining the central ratio of the jaws, checking the design of the prosthesis, applying, fitting, fitting, installation, remote control and corrections. If necessary, use soft pads under the prosthesis.

ORGANIZATION OF MEDICAL
HELP FOR PATIENTS
WITH TOTAL ABSENCE OF TEETH
(FULL SECONDARY Adentia)

Treatment of patients with complete secondary adentia is carried out in medical institutions of the dental profile, as well as in the departments of orthopedic dentistry. As a rule, treatment is carried out on an outpatient basis.

Assistance to patients with a complete absence of teeth (complete secondary adentia) is carried out by orthopedic dentists. In the process of providing assistance, paramedical personnel, including dental technicians, take part.

VII. CHARACTERISTICS OF REQUIREMENTS OF THE PROTOCOL

7.1. Patient Model

Nosological form: loss of teeth due to an accident, extraction of teeth or localized parodoititis
Stage: any
Phase: process stabilization
Complications: no complications

ICD-S code: K 08.1

7.1.1. Criteria and features that define the patient model

• Complete absence of teeth in one or both jaws.
• Healthy oral mucosa (moderately pliable, moderately mobile, pale pink in color, moderately secretes a mucous secret - Supple class I).
• Changing the configuration of the face (retraction of the lips).
• Pronounced nasolabial and chin folds, drooping corners of the mouth.
• Reducing the size of the lower third of the face.
• Absence of exasperations.
• The absence of pronounced atrophy of the alveolar process (with the complete absence of teeth on one or both jaws - class I according to Kurlyandsky, class I according to Oksman, with complete absence of teeth on
  upper jaw - type I according to Schroeder's classification, with complete absence of teeth in the lower jaw - type I according to Keller).
• The absence of severe pathology of the temporomandibular joint.
• Absence of diseases of the oral mucosa.

7.1.2. Procedure for including a patient in the protocol

The patient's condition that satisfies the criteria and features of the diagnosis of this patient model.

7.1.3. Requirements for the diagnosis of outpatient

The code	Name	multiplicity fulfillment
01.02.003	Muscle palpation	1
01.04.001	Collection of anamnesis and complaints in case of joint pathology	1
01.04.002	Visual examination of the joints	1
01.04.003	Joint palpation	1
01.04.004	Joint percussion	1
01.07.001	Collection of anamnesis and complaints in the pathology of the oral cavity	1
01.07.002	Visual examination in the pathology of the oral cavity	1
01.07.003	Palpation of the oral cavity	1
01.07.005	Visual inspection maxillofacial areas	1
01.07.006		1
01.07.007	Determining the degree of mouth opening and limiting the mobility of the lower jaw	1
02.04.003		1
02.04.004	Auscultation of the joint	1
02.07.001		1
02.07.004		1
06.07.001	Panoramic radiography of the upper jaw	1
06.07.002		1
09.07.001	Examination of smears-imprints of the oral cavity	On demand
09.07.002	Cytological examination of the contents of the cyst (abscess) of the oral cavity or the contents of the periodontal pocket	On demand
11.07.001		On demand

7.1.4. Characteristics of the algorithms and features of the implementation of non-drug care

The examination aims to establish a diagnosis corresponding to the patient model, exclusion possible complications, determination of the possibility to start prosthetics without additional diagnostic and treatment-and-prophylactic measures.

For this purpose, an anamnesis is taken, examination and palpation of the oral cavity and maxillofacial region, as well as other necessary studies.

Collection of anamnesis

When collecting an anamnesis, they find out the time and causes of tooth loss, whether the patient has previously used removable dentures, and an allergic history. Purposefully identify complaints of pain and discomfort in the area of ​​the temporomandibular joints. Find out the profession of the patient.

visual study

On examination, attention is paid to the pronounced and / or acquired asymmetry of the face and the severity of the nasolabial and chin folds, the nature of the closing of the lips, the presence of cracks and macerations in the corners of the mouth.

Pay attention to the degree of opening of the mouth, the smoothness and direction of movement of the lower jaw, the ratio of the jaws.

Pay attention to the color, moisture, integrity of the mucous membranes of the oral cavity in order to exclude concomitant pathology, including infectious diseases.

If you suspect the presence of diseases of the oral mucosa, a study of imprint smears is performed. If the result is positive, the patient is managed according to the appropriate patient model.

Palpation

When examining the oral cavity, pay attention to the severity and location of the frenulum and buccal folds.

Focus on the presence and degree of atrophy of the alveolar processes.

The presence of exostoses hidden under the mucous membrane of the roots of the teeth is revealed. If their presence is suspected, an X-ray examination (sighting or panoramic image of the jaw) is performed. If the result is positive, immediate prosthetics are postponed and surgical preparation for prosthetics is carried out (according to a different model of the patient).

Pay attention to the presence of tumor-like diseases. If their presence is suspected, a cytological examination, a biopsy. With a positive result, immediate prosthetics are postponed and appropriate treatment is carried out.

Palpation is performed to determine the torus, "dangling" crest and the degree of mucosal compliance.

Visual examination and palpation of the temporomandibular joints

On examination, pay attention to the color of the skin in the joints. Find out if there is a crunch (clicks) and pain in the area of ​​the temporomandibular joints during movements of the lower jaw. When opening the mouth, pay attention to the synchronism and symmetry of the movements of the articular heads.

If a pathology of the temporomandibular joints is suspected, an X-ray examination is performed - tomography of the joints with closed and open mouth. With a positive result, prosthetics must be combined with additional therapy (another patient model is complete secondary adentia with complications).

Anthropometric studies

These studies allow you to determine the height of the lower face, are mandatory and are always carried out at the stage of prosthetics.

7.1.5. Requirements for outpatient treatment

7.1.6. Characteristics of the algorithms and features of the implementation of non-drug care

The main method of treatment for the complete absence of teeth (complete secondary adentia) of one or both jaws is prosthetics with complete removable lamellar dentures. This allows you to restore the basic functions of the dentition: biting and chewing food, diction, as well as the aesthetic proportions of the face; prevents the progression of atrophy of the alveolar processes of the jawbone and atrophy of the muscles of the maxillofacial region (level of evidence A).

With the complete absence of teeth (complete secondary adentia) of both jaws, complete dentures for the upper and lower jaws are made simultaneously.

First visit.

After diagnostic studies and a decision on prosthetics, treatment is started at the same appointment.

The first stage is the removal of an anatomical cast (impression) for the manufacture of an individual rigid impression (impression) tray.

Special impression (impression) trays for edentulous jaws, alginate impression (impression) masses should be used.

The expediency of using special impression (impression) trays is due to the need to prevent extended boundaries, both in the manufacture of individual trays and in the manufacture of a prosthesis. As an alternative, in practice, standard impression (impression) trays are often used, which can lead to stretching of the mucosa along the transitional fold and subsequent expansion of the boundaries of the prosthesis, which leads to poor fixation of the prosthesis. The cost of special and standard spoons is the same.

After the cast (impression) is removed, its quality is controlled (display of the anatomical relief, absence of pores, etc.).

Next visit.

An individual rigid plastic impression (impression) tray is fitted. You should pay attention to the edges of the spoon made in the laboratory, which should be voluminous (about 1 mm thick). If necessary, the doctor himself can make an individual rigid plastic impression (impression) tray in the clinic.

Fitting is carried out using functional tests according to Herbst. Samples are made with a half-closed mouth with a reduced range of motion of the lower jaw. When deviating from the method of fitting an individual rigid plastic impression (impression) tray using Herbst functional tests in a strict sequence, it is impossible to ensure the stabilization and fixation of future prostheses.

After fitting, the edges of the spoon are edged with wax and shaped in active (using functional muscle movements) and passive ways.

On the back edge of the spoon on the upper jaw, an additional strip of softened wax should be placed along line A in order to provide a full-fledged valve zone in this area. The distal valve on the spoon to the lower jaw should be closed, creating a sublingual wax roller according to Herbst. This technique ensures the closure of the distal valve and prevents the loss of fixation when biting off food.

The criterion for the completion of the fitting is the formation of a valve zone and fixation of an individual spoon on the jaw.

Obtaining a functional impression (impression): the removal (impression) of the impression is made with silicone impression (impression) masses using the appropriate adhesive material (adhesive for silicone masses). The edges of the impression are formed (impression) in active (using functional movements) and passive ways. Zinc-eugenol impression masses can also be used.

After removal, the quality of the cast (impression) is monitored (display of the anatomical relief, absence of pores, etc.).

Next visit.

Determination of the central ratio of the jaws by the anatomical and physiological method to determine the correct position of the lower jaw in relation to the upper jaw in three planes (vertical, sagittal and transversal).

Determination of the central ratio of the jaws is carried out using wax bases with occlusal rollers made in a dental laboratory. Pay special attention to the formation of the correct prosthetic plane, determination of the height of the lower face, determination of the smile line, midline, canine line.

The choice of color, size and shape of artificial teeth is made in accordance with individual characteristics(age of the patient, size and shape of the face).

Next visit.

Checking the design of the prosthesis (setting teeth on a wax basis, carried out in a dental laboratory) on a wax basis to assess the correctness of all previous clinical and laboratory stages of the manufacture of the prosthesis and make the necessary corrections.

It should be noted: when teeth are set according to the type of orthognathic bite, the upper frontal teeth should overlap the lower ones by a maximum of 1-2 mm. When closing the teeth between the upper and lower frontal teeth, there should be a horizontal gap of 0.25-0.50 mm.

Next visit.

Imposition and fitting of the finished prosthesis after the laboratory stage of replacing the wax base with a plastic one.

Before applying, evaluate the quality of the basis of the prosthesis (absence of pores, sharp edges, protrusions, roughness, etc.). Color may indicate insufficient polymerization.

The palatal part of the upper jaw prosthesis should be no thicker than 1 mm.

The dentures are inserted into the mouth, the tightness of the dentition and the fixation of the dentures are checked (it should be remembered that fixation usually improves by the 7th day of using the prosthesis).

Next visit.

The first correction is scheduled the next day after the delivery of the prosthesis, then according to indications (no more than once every three days). The adaptation period can last up to 1.5 months.

If pain occurs in the tissues of the prosthetic bed associated with a mucosal injury, the patient is advised to immediately stop using the prosthesis, come to the doctor's office, resuming use 3 hours before visiting the doctor.

At mechanical damage mucous membrane, the formation of ulcers, the areas of the prosthesis in these places are minimally ground. Correction of the basis of the prosthesis is carried out until the first subjective sensation of a decrease in pain.

Drug therapy is prescribed with anti-inflammatory drugs and agents that accelerate the epithelization of the oral mucosa.

Patients with severe torus

When making a working model, “insulate” in the area of ​​the torus in order to prevent overpressure.

Patients with allergic reactions to plastic

If an allergic history is detected, allergic skin tests should be performed on the material of the basis of the prosthesis. With a positive reaction, prostheses are made of colorless plastic, according to indications, the base of the prosthesis is silvered.

For patients with insufficiently favorable anatomical and topographic conditions of the prosthetic bed, the basis of the prosthesis can be made with a soft lining.

Indications:

The presence of sharp bone protrusions on the prosthetic bed, a sharp internal oblique line in the absence of absolute (clear) indications for surgical intervention to eliminate them;
- increased pain sensitivity in the oral cavity,
- the absence of a pronounced submucosal layer.

The need for a soft lining is revealed in the process of adaptation to a new prosthesis. Soft pads are made by clinical and laboratory method according to a known technique.

7.1.7. Requirements for outpatient drug care

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

The use of local anti-inflammatory and epithelial agents in the event of namin and ulcers on the mucous membrane, especially during the period of adaptation to the prosthesis, shows sufficient effectiveness in everyday dental practice.

ANALGESICS, NON-STEROID
ANTI-INFLAMMATORY DRUGS,
MEDICINES FOR THE TREATMENT OF RHEUMATIC
DISEASES AND GOUT

Usually prescribed rinses and / or baths with decoctions of oak bark, chamomile flowers, sage 3-4 times a day (level of evidence C). Applications on the affected areas with sea buckthorn oil - 2-3 times a day for 10-15 minutes (level of evidence B).

VITAMINS

Applications on the affected areas with an oily solution of retinol (vitamin A) - 2-3 times a day for 10-15 minutes (level of evidence C).

DRUGS AFFECTING THE BLOOD

Deproteinized hemodialysate - adhesive paste for the oral cavity - 3-5 times a day on the affected areas (level of evidence C).

7.1.9. Requirements for the regime of work, rest, treatment or rehabilitation

There are no special requirements.

7.1.10. Requirements for patient care and ancillary procedures

There are no special requirements.

7.1.11. Dietary requirements and restrictions

Refusal to use very hard drinks that require chewing hard pieces, from biting off pieces from hard foods, vegetables and fruits (for example, from a whole apple). Refusal to use very hot food.

7.1.12. Form of voluntary informed consent of the patient during the implementation of the protocol

Informed consent is given by the patient in writing.

7.1.13. Additional information for the patient and his family members

Evaluation of the cost of the protocol and the cost of quality

Clinical and economic analysis is carried out in accordance with the requirements of regulatory documents.

Comparison of results

When monitoring the protocol, an annual comparison is made of the results of fulfilling its requirements, statistical data, performance indicators of medical institutions (the number of patients, the number and types of manufactured structures, the timing of manufacture, the presence of complications).

The procedure for generating a report and its form

The annual report on the results of monitoring includes quantitative results obtained during the development of medical records and their qualitative analysis, conclusions, proposals for updating the protocol.

The report is submitted to the development team of this protocol. The materials of the report are stored in the department of standardization in health care of the Research Institute of Public Health and Health Care Management of the Moscow Medical Academy. THEM. Sechenov of the Ministry of Health of the Russian Federation and is stored in his archive.

RULES FOR THE USE OF REMOVABLE DENTURES

(Additional information for the patient)

1. Removable dentures should be cleaned with a toothbrush and toothpaste or toilet soap twice a day (morning and evening) and after meals whenever possible.

2. In order to avoid breakage of the prosthesis, as well as damage to the oral mucosa, it is not recommended to take and chew very hard food (for example, crackers), bite off large pieces (for example, from a whole apple).

3. At night, if the patient removes the dentures, they must be kept in a humid environment (after cleaning, wrap the dentures in a damp cloth) or in a vessel with water. You can sleep in dentures.

4. Avoid dropping dentures on tiled floors, sinks, or other hard surfaces to prevent breakage.

5. As hard plaque forms on dentures, they must be cleaned with special products that are sold in pharmacies.

6. In case of violation of the fixation of a removable prosthesis, which may be associated with a weakening of the clasp fixation, it is necessary to contact the clinic of orthopedic dentistry to activate the clasps.

7. In no case, under no circumstances should you attempt to correct, repair or otherwise affect the prosthesis yourself.

8. In the event of a break or crack in the base of a removable prosthesis, the patient must urgently contact the prosthetic dentistry clinic to repair the prosthesis.

PATIENT CARD

Case history No. _______________________
Name of institution _______________________
Date: start of observation _______________________
FULL NAME_______________________

End of observation _______________________
age_______________________

Diagnosis of the main _______________________
Accompanying illnesses:_______________________
Patient Model: _______________________
The volume of non-drug medical care provided:

The code	Name	Completion mark (multiplicity)
Diagnostics
01.02.003	Muscle palpation
01.04.001	Collection of anamnesis and complaints in case of joint pathology
01.04.002	Visual examination of the joints
01.04.003	Joint palpation
01.04.004	Joint percussion
01.07.001	Collection of anamnesis and complaints in the pathology of the oral cavity
01.07.002	Visual examination in the pathology of the oral cavity
01.07.003	Palpation of the oral cavity
01.07.005	External examination of the maxillofacial region
01.07.006	Palpation of the maxillofacial region
01.07.007	Determining the degree of mouth opening and limiting the mobility of the lower jaw
02.04.003	Measurement of joint mobility (angiometry)
02.04.004	Auscultation of the joint
02.07.001	Examination of the oral cavity with additional instruments
02.07.004	Anthropometric studies
06.07.001	Panoramic radiography of the upper jaw
06.07.002	Panoramic radiography of the lower jaw
09.07.001	Examination of smears-imprints of the oral cavity
09.07.002	Cytological examination of the contents of the cyst (abscess) of the oral cavity or the contents of the periodontal pocket
11.07.001	Biopsy of the oral mucosa
Treatment
16.07.026	Prosthetics with complete removable lamellar dentures
D01.01.04.03	Correction of a removable orthopedic structure
25.07.001	Prescribing drug therapy for diseases of the oral cavity and teeth
25.07.002	Prescribing dietary therapy for diseases of the oral cavity and teeth

Drug assistance (specify the drug used):

Drug complications (specify manifestations):
________________________________________________
The name of the drug that caused them:
________________________________________________
Outcome (according to the classifier of outcomes):
________________________________________________
Information about the patient was transferred to the institution monitoring the Protocol:
________________________________________________
(name of institution) (date)
Signature of the person responsible for monitoring the OCT in a medical facility:
________________________________________________

MONITORING CONCLUSION	Completeness of the implementation of the mandatory list of non-drug care	Not really	NOTE
	Meeting deadlines for medical services	Not really
	Completeness of implementation of the mandatory list of drug assortment	Not really
	Compliance of treatment with protocol requirements in terms of timing/duration	Not really

INTERNATIONAL CLASSIFICATION OF DENTAL DISEASES ICD-C-3 BASED ON ICD-10

CLASS XI - DISEASES OF THE DIGESTIVE organ

Block (K00-K14) - Diseases of the oral cavity, salivary glands and jaws

K00 Disorders of development and eruption of teeth
COO. About Adentia

K00.00 Partial adentia [hypodentia] [oligodentia]

COO. O 1 Completely edentulous

K00.09 Unspecified adentia
K00.1 Supernumerary teeth

K00.10 Supernumerary teeth. Areas of the incisor and canine

K00.11 Supernumerary teeth. Premolar areas

K00.12 Supernumerary teeth. Molar areas

K00.19 Supernumerary teeth, unspecified
K00.2 Anomaly in size and shape of teeth

K00.20 Macrodentia

K00.21 Microdentia

K00.22 Fusion

K00.23 Merger and split

K00.24 Protrusion of teeth [accessory occlusal cusps]

K00.25 Invaded tooth [tooth in tooth] [dilated odontoma] and incisor anomalies
K00.26 Premolarization

K00.27 Abnormal bumps and enamel pearls [adamantoma]

K00.28 "Bull tooth" [taurodontism]

K00.29 Other unspecified anomalies in size and shape of teeth
K00.3 Mottled teeth

K00.30 Endemic (fluorous) mottling of enamel [dental fluorosis]

K00.31 Non-endemic mottling of enamel [non-fluorous opacification of enamel]

K00.39 Mottled teeth, unspecified
K00.4 Disorders of tooth formation
K00.40 Enamel hypoplasia
K00.41 Prenatal enamel hypoplasia
K00.42 Neonatal enamel hypoplasia
K00.43 Aplasia and hypoplasia of cementum
K00.44 Dilaceration [enamel crack]
K00.45 Odontodysplasia [regional odontodysplasia]
K00.46 Turner's tooth

K00.48 Other specified disorders of tooth development
K00.49 Disorders of tooth formation, unspecified
K00.5 Hereditary disorders of tooth structure, not elsewhere classified

K00.50 Incomplete amelogenesis
K00.51 Incomplete dentinogenesis
K00.52 Incomplete odontogenesis
K00.58 Other hereditary disorders of tooth structure
K00.59 Hereditary disorders of tooth structure, unspecified

K00.6 Teething disorders

K00.60 Natal (erupted at the time of birth) teeth
K00.61 Neonatal (prematurely erupted in a newborn) teeth

K00.62 Premature eruption [early eruption]
K00.63 Delay (persistent) change of primary [temporary] teeth

K00.64 Late eruption

K00.65 Premature loss of primary [temporary] teeth

K00.68 Other specified disorders of dentition
K00.69 Disorders of teething, unspecified

K00.7 Teething syndrome

K00.8 Other disorders of dental development

K00.80 Discoloration of teeth during formation due to incompatibility of blood types

K00.81 Discoloration of teeth during formation due to birth defect biliary system
K00.82 Discoloration of teeth during formation due to porphyria

K00.83 Discoloration of teeth during formation due to tetracycline use
K00.88 Other specified disorders of dental development
K00.9 Disturbance of development of teeth, unspecified
K01 Impacted and impacted teeth

KO 1.0 Impacted teeth

CR 1.1 Impact teeth

CR 1.10 Impact teeth. Upper jaw incisor
CR 1.11 Impact teeth. Mandibular incisor
CR 1.12 Impact teeth. Maxillary canine
CR 1.13 Impact teeth. Canine mandible
CR 1.14 Impact teeth. Maxillary premolar
CR 1.15 Impact teeth. Mandibular premolar
CR 1.16 Impact teeth. Maxillary molar
CR 1.17 Impact teeth. Mandibular molar
CR 1.18 Impact teeth. Supernumerary tooth
CR 1.19 Impact tooth, unspecified
K02 Dental caries

K02.0 Enamel caries

K02.1 Dentinal caries

K02.2 Cement caries

K02.3 Suspended dental caries

K02.4 Odontoclasia

K02.8 Other dental caries

K02.9 Dental caries, unspecified
GOAT Other diseases of hard tissues of teeth

GOAT. O Increased tooth wear

K03.00 Increased tooth wear. Occlusal
GOAT. O 1 Increased tooth wear. Approximate
KOZ.08 Other specified tooth wear
K03.09 Erasure of teeth, unspecified

GOAT. 1 Grinding teeth

GOAT. 10 Grinding teeth. Caused by tooth powder

K03.11 Grinding teeth. Habitual

GOAT. And grinding teeth. Professional

GOAT. 11 Grinding teeth. Traditional (ritual)

GOAT. 18 Other specified grinding of teeth

GOAT. 19 Grinding of teeth, unspecified

KOZ.2 Tooth erosion

KOZ.20 Erosion of teeth. Professional

KOZ.21 Erosion of teeth. Caused by persistent regurgitation or vomiting

KOZ.22 Erosion of teeth. Diet Conditioned
KOZ.23 Erosion of teeth. Caused by drugs and medicines
KOZ.24 Erosion of teeth. idiopathic
KOZ.28 Other specified dental erosion
KOZ.29 Erosion of teeth, unspecified
KOZ.3 Pathological tooth resorption

KOZ.30 Pathological resorption of teeth. External (external)
KOZ.31 Pathological resorption of teeth. Internal [internal granuloma] [pink spot]

KOZ.39 Pathological resorption of teeth, unspecified
K03.4 Hypercementosis
KOZ.5 Ankylosis of teeth
KOZ.6 Deposits (growths) on the teeth

KOZ.60 Deposits (growths) on the teeth. Pigmented plaque

KOZ.61 Deposits (growths) on the teeth. Conditioned by the habit of using tobacco

KOZ.62 Deposits (growths) on the teeth. Caused by the habit of chewing betel

KOZ.63 Deposits (growths) on the teeth. Other extensive soft deposits

KOZ.64 Deposits (growths) on the teeth. supragingival calculus

KOZ.65 Deposits (growths) on the teeth. Subgingival calculus

KOZ.66 Deposits (growths) on the teeth. Plaque
KOZ.68 Other specified deposits on teeth
KOZ.69 Deposits on teeth, not specified
KOZ.7 Discoloration of hard tissues of teeth after eruption
KOZ.70 Discoloration of hard tissues of teeth after eruption. Due to the presence of metals and metal compounds

KOZ.71 Discoloration of hard tissues of teeth after eruption. Caused by bleeding pulp
KOZ.72 Discoloration of hard tissues of teeth after eruption. Caused by the habit of chewing betel (tobacco)
KOZ.78 Other specified color changes
KOZ.79 Color change, unspecified

KOZ.8 Other specified diseases of dental hard tissues
KOZ.80 Sensitive dentin
KOZ.81 Radiation-induced enamel changes
KOZ.88 Other specified diseases of dental hard tissues

K03.9 Disease of hard tissues of teeth, unspecified

K04.0 Pulpitis

K04.00 Pulpitis. Initial (hyperemia)
K04.01 Pulpitis. Spicy

K04.02 Pulpitis. Purulent [pulp abscess]

K04.03 Pulpitis. Chronic

K04.04 Pulpitis. chronic ulcerative

K04.05 Pulpitis. Chronic hyperplastic [pulp polyp]

K04.08 Other specified pulpitis

K04.09 Pulpitis, not specified
K04.1 Pulp necrosis
K04.2 Pulp degeneration

K04.3 Abnormal formation of hard tissues in the pulp

K04.3X Secondary or irregular dentine
K04.4 Acute apical periodontitis of pulpal origin

K04.5 Chronic apical periodontitis

K04.6 Periapical abscess with fistula

K04.60 Periapical abscess with fistula. Having communication with the maxillary sinus

K04.61 Periapical abscess with fistula. Having communication with the nasal cavity

K04.62 Periapical abscess with fistula. Having communication with the oral cavity

K04.63 Periapical abscess with fistula. Having a message with the skin

K04.69 Periapical abscess with fistula, unspecified
K04.7 Periapical abscess without fistula
K04.8 Root cyst

K04.80 Root cyst. Apical and lateral

K04.81 Root cyst. Residual

K04.82 Root cyst. Inflammatory paradental

K04.89 Root cyst, unspecified
K04.9 Other and unspecified diseases of pulp and periapical tissues

K05 Gingivitis and periodontal disease
K05.0 Acute gingivitis

K05.00 Acute streptococcal gingivostomatitis

K05.08 Other specified acute gingivitis
K05.1 Chronic gingivitis

K05.10 Chronic gingivitis. Simple marginal

K05.11 Chronic gingivitis. hyperplastic

K05.12 Chronic gingivitis. ulcerative

K05.13 Chronic gingivitis. Desquamative

K05.18 Other specified chronic gingivitis

K05.19 Chronic gingivitis, unspecified
K05.2 Acute periodontitis

K05.20 Periodontal abscess [periodontal abscess] of gingival origin without fistula

K05.21 Periodontal abscess [periodontal abscess] of gingival origin with fistula

K05.22 Acute pericoronitis

K05.28 Other specified acute periodontitis

K05.29 Acute periodontitis, unspecified
K05.3 Chronic periodontitis

K05.30 Chronic periodontitis. Localized

K05.31 Chronic periodontitis. generalized

K05.32 Chronic pericoronitis

K05.33 Thickened follicle (papilla hypertrophy)

K05.38 Other specified chronic periodontitis

K05.39 Chronic periodontitis, unspecified
K05.4 Periodontal disease
K05.5 Other periodontal diseases
K06 Other changes in the gums and edentulous alveolar margin
K06.0 Gingival recession

K06.00 Gingival recession. Local

K06.01 Gingival recession. Generalized

K06.09 Gingival recession, unspecified
K06.2 Lesions of gingiva and edentulous alveolar margin due to trauma

K06.20 Lesions of the gums and edentulous alveolar margin due to traumatic occlusion

K06.21 Lesions of gingiva and edentulous alveolar margin due to brushing

K06.22 Lesions of the gingiva and edentulous alveolar margin due to trauma. Frictional [functional] keratosis

K06.23 Irritant hyperplasia [associated with removable prosthesis]

K06.28 Other specified lesions of gingiva and edentulous margin due to trauma

K06.29 Unspecified lesions of gingiva and edentulous alveolar margin due to trauma
K06.8 Other specified changes in gingiva and edentulous alveolar margin

K06.80 Adult gingival cyst

K06.81 Giant cell peripheral granuloma [giant cell epulis]
K06.82 Fibrous epulis
K06.83 Pyogenic granuloma
K06.84 Ridge atrophy, partial

K06.88 Other gingival and edentulous alveolar margins

K06.9 Change in gingiva and edentulous alveolar margin, unspecified

K07 Maxillofacial anomalies [including malocclusion]
K07.0 Major anomalies of jaw size

K07.00 Maxillary macrognathia [maxillary hyperplasia]

K07.01 Mandibular macrognathia [mandibular hyperplasia]

K07.02 Macrognathia of both jaws

K07.03 Maxillary micrognathia [maxillary hypoplasia]

K07.04 Mandibular micrognathia [mandibular hypoplasia]

K07.05 Micrognathia of both jaws
K07.08 Other specified jaw size anomalies
K07.09 Anomaly of jaw size, unspecified
K07.1 Anomalies of maxillo-cranial relations
K07.10 Asymmetries

K07.ll Prognathism of mandible
K07.12 Prognathism of the upper jaw
K07.13 Retrognathia of mandible
K07.14 Maxillary retrognathia

K07.18 Other specified anomalies of maxillo-cranial relations

K07.19 Anomaly of maxillo-cranial relations, unspecified

K07.2 Anomalies in the relationship of dental arches
K07.20 Distal bite
K07.21 Overbite

K07.22 Overbite [horizontal overlap]

K07.23 Excessively deep vertical bite [vertical overlap]
K07.24 Open bite

K07.25 Cross bite [anterior, posterior]
K07.26 Displacement of dental arches from the midline
K07.27 Posterior lingual bite of lower teeth
K07.28 Other specified anomalies of dental arch relationships
K07.29 Anomaly of ratios of dental arches, not specified
K07.3 Anomalies in the position of the teeth
K07.30 Crowding
K07.31 Offset

K07.32 Turn

K07.33 Violation of interdental spaces
K07.34 Transposition

K07.35 Impacted or impacted teeth with irregular
position of their or neighboring teeth
K07.38 Other specified anomalies of tooth position
K07.39 Anomaly of tooth position, unspecified
K07.4 Malocclusion, unspecified

K07.5 Maxillofacial anomalies of functional origin

K07.50 Improper closure of jaws

K07.51 Malocclusion due to swallowing disorder

K07.54 Malocclusion due to mouth breathing

K07.55 Malocclusion due to tongue, lip or finger sucking

K07.55 Other specified maxillofacial anomalies of functional origin

K07.59 Maxillofacial anomaly of functional origin, unspecified
K07.6 Diseases of the temporomandibular joint

K07.60 Temporomandibular joint pain dysfunction syndrome [Costen's syndrome]
K07.61 Snapping jaw

K07.62 Recurrent dislocation and subluxation of temporomandibular joint

K07.63 Temporomandibular joint pain, not elsewhere classified

K07.64 Temporomandibular joint stiffness, not elsewhere classified
K07.65 Osteophyte of the temporomandibular joint
K07.68 Other specified diseases of temporomandibular joint
K07.69 Disease of temporomandibular joint, unspecified
K08 Other changes in teeth and their support apparatus

K08.0 Tooth exfoliation due to systemic disorders
K08.1 Loss of teeth due to accident, extraction or localized periodontal disease
K08.2 Atrophy of edentulous alveolar margin
K08.3 Retention of the tooth root [retention root]
K08.8 Other specified changes in teeth and their supporting apparatus
K08.80 Toothache NOS

K08.81 Irregular shape of alveolar process
K08.82 Hypertrophy of alveolar margin NOS
K08.88 Other changes in teeth and their supporting apparatus
K08.9 Unspecified change in teeth and their supporting apparatus

cysts areas of the mouth not elsewhere classified

K09.0 Cysts formed during tooth formation

By 09.00 Teething cyst

K 09.01 Gingival cyst

K 09.02 Horny [primary] cyst

K C09.03 Follicular [odontogenic] cyst

K 09.04 Lateral periodontal cyst

K 09.08 Other specified odontogenic cysts formed during tooth formation

K 09.09 Odontogenic cyst formed in the process of tooth formation, unspecified
K09. 1 Growth (non-odontogenic) cysts of the mouth area
K 09.10 Globulomaxillary [maxillary sinus] cyst
K 09.11 Midpalatal cyst
K 09.12 Nasopalatine [incisive canal] cyst
K 09.13 Palatal papillary cyst

C09.18 Other specified growth (nonodontogenic) cysts of the oral region

K09.19 Growth (nonodontogenic) cyst of the mouth, unspecified

K09.2 Other jaw cysts
K 09.20 Aneurysmal bone cyst
K 09.21 Single [traumatic] [hemorrhagic] cyst
K 09.22 Epithelial cysts of the jaws, not identifiable as odontogenic or non-odontogenic
K 09.28 Other specified jaw cysts
K 09.29 Jaw cyst, unspecified

K09.8 Other specified oral cysts, not elsewhere classified

K 09.80 Dermoid cyst

K 09.81 Epidermoid cyst

K 09.82 Newborn gum cyst

K 09.83 Neonatal palate cyst

K 09.84 Nasoalveolar [nasolabial] cyst

K 09.85 Lymphoepithelial cyst

K 09.88 Other specified oral cysts

K09.9 Cyst of mouth region, unspecified

Other diseases of the jaws

By 10.00 Torus of the lower jaw

K 10.01 Torus of hard palate

K 10.02 Hidden bone cyst

K 10.08 Other specified disorders of jaw development
K 10.09 Violation of jaw development, unspecified
K10. 1 Giant cell granuloma central

K10.2 Inflammatory diseases of the jaws
K10.20 Ostitis of the jaw
K10.21 Osteomyelitis of the jaw
K10.22 Periostitis of jaw
K10.23 Chronic periostitis of jaw
K10.24 Neonatal osteomyelitis of maxilla [neonatal maxillitis]
K10.25 Sequestration

K10.26 Radiation osteonecrosis

K10.28 Other specified inflammatory diseases of jaws

K10.29 Inflammatory disease jaws not specified
K10.3 Alveolitis of jaws
K10.8 Other specified diseases of jaws

K10.80 Cherubism

K10.81 Unilateral hyperplasia of condylar process of mandible

K10.82 Unilateral hypoplasia of condylar process of mandible

K10.83 Fibrous dysplasia of jaw

K10.88 Other specified diseases of jaws

K 10.9 Disease of jaw, unspecified
K11 Disease of the salivary glands

K11.0 Salivary gland atrophy

K11.1 Salivary gland hypertrophy

K11.2 Sialoadenitis

K11.3 Salivary gland abscess

K11.4 Fistula of the salivary gland

K11.5 Sialolithiasis

K11.6 Salivary gland mucocele

K11.60 Mucous retention cyst

K11.61 Mucous cyst with exudate

K11.69 Salivary gland mucocele, unspecified
K11.7 Disorders of salivary gland secretion

K11.70 Hyposecretion

K11.71 Xerostomia

K11.72 Hypersecretion [ptyalism]

K11.78 Other specified disorders of salivary gland secretion
K11.79 Disturbance of secretion of salivary glands, unspecified
K11.8 Other diseases of the salivary glands

K11.80 Benign lymphoepithelial lesion of salivary gland

K11.81 Mikulich's disease

K11.82 Stenosis [narrowing] of the salivary duct

C11.83 Sialectasia
C11.84 Sialosis

C11.85 Necrotizing sialometaplasia

C11.88 Other specified diseases of salivary glands

C11.9 Disease of the salivary gland, unspecified

Stomatitis and related lesions

C12.0 Recurrent oral aphthae

From 12.00 Recurrent (small) aphthae

C12.01 Recurrent muco-necrotic periadenitis
C12.02 Stomatitis herpetiformis [rash herpetiformis]
C12.03 Afty Bednar

C12.04 Recurrent aphthae. traumatic ulceration

C 12.08 Other specified recurrent oral aphthae

C12.09 Recurrent oral aphthae, unspecified

C12. 1 Other forms of stomatitis

C12.10 Arterial stomatitis

C12.11 "Geographic" stomatitis

C12.12 Dental stomatitis

C12.13 Papillary hyperplasia of the palate

C12.14 Contact stomatitis

C12.18 Other specified forms of stomatitis

C12.19 Stomatitis, unspecified

C12.2 Phlegmon and oral abscess

Other diseases of the lips and oral mucosa

C13.0 Diseases of the lips

C13.00 Angular cheilitis

C13.01 Cheilitis glandular apostematous

C13.02 Cheilitis, exfoliative

C13.03 Cheilitis NOS

С13.04 Cheilodynia

C13.08 Other specified diseases of lips
C13.09 Lip disease, unspecified
C13. 1 Cheek and lip biting

C13.2 Leukoplakia and other changes in the epithelium of the oral cavity, including the tongue

C13.20 Idiopathic leukoplakia

C13.21 Leukoplakia associated with tobacco use

From 13.22 Erythroplakia

C13.23 Leukedemia

C13.24 Smoker's palate [nicotinic leukokeratosis palate] nicotinic stomatitis]

C 13.28 Other epithelial changes

C13.29 Unspecified changes in epithelium

C13.3 Hairy leukoplakia

K13.4 Granuloma and granuloma-like lesions of the oral mucosa

K13.40 Pyogenic granuloma

K13.41 Eosinophilic granuloma of oral mucosa

K13.42 Verrucous xanthoma [Histiocytosis Y]

K13.48 Other specified granulomas and granuloma-like lesions of oral mucosa

K13.49 Granuloma and granuloma-like lesions of oral mucosa, unspecified
K13.5 Submucosal fibrosis of the oral cavity
K13.6 Hyperplasia of the oral mucosa due to irritation

K13.7 Other and unspecified lesions of oral mucosa

K13.70 Excess melanin pigmentation

K 13.71 Fistula of the oral cavity

K 13.72 Voluntary tattoo

K13.73 Focal oral mucinosis

K13.78 Other specified lesions of oral mucosa

K13.79 Disorder of oral mucosa, unspecified

K14 Diseases of the tongue

K14.0 Glossitis

K14.00 Tongue abscess
K14.01 Traumatic ulceration of the tongue
K14.08 Other specified glossites

K 14.09 Glossitis, unspecified

K14.1 "Geographical" language

K14.2 Median rhomboid glossitis

K14.3 Hypertrophy of tongue papillae
K14.30 Coated tongue
K14.31 Hairy tongue
K14.32 Hypertrophy of foliate papillae
K14.38 Other specified hypertrophy of papillae of tongue
K14.39 Hypertrophy of papillae of tongue, unspecified

K14.4 Atrophy of tongue papillae

K14.40 Atrophy of the papillae of the tongue. Caused by tongue cleaning habits

K 14.41 Atrophy of the papillae of the tongue. Caused by a systemic disorder

K 14.42 Atrophic glossitis NOS

K14.48 Other specified atrophy of tongue papillae. Manifestations in the oral cavity

K14.49 Atrophy of papillae of the tongue, unspecified
K14.5 Folded tongue
K14.6 Glossodynia

K14.60 Glossopyrosis [burning tongue]

K14.61 Glossodynia [tongue pain]

K14.68 Other specified glossodynia

K14.69 Glossodynia, unspecified
K14.8 Other diseases of the tongue

K14.80 Serrated tongue [tongue with imprints of teeth]

K14.81 Hypertrophy of the tongue

K14.82 Atrophy of tongue

K14.88 Other specified diseases of tongue
K14.9 Disease of the tongue, unspecified

All over the world, it is customary to use a UNIFIED classification for the unification of medical diagnoses: the International Classification of Diseases (hereinafter referred to as the ICD). At the moment, the tenth edition of the ICD-10 is in force in the world. The classification of diagnoses is developed and approved by the World Health Organization (WHO). The publication of a new revision (ICD-11) is planned by WHO in 2022.

In Russia, the International Classification of Diseases of the 10th revision (ICD-10) is adopted as a single regulatory document for accounting for morbidity, reasons for medical institutions all departments, causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170. Those. It is a full-fledged normative legal 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 a diagnosis is not made according to the ICD, then it is legally considered not to be made at all. And this 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 was not previously included in the WHO system, and therefore used its own classifications. They are not good or bad, they are just different. But you, colleagues, should clearly know - NO classification other than ICD-10 has legal significance.

Let us clarify that the law is allowed to SUPPLEMENT (and not replace!) diagnoses according to ICD-10 with an additional diagnosis according to any domestic classification.

For example: a diagnosis from ICD-10 K08.1 Loss of teeth due to an accident, extraction or local periodontal disease can be supplemented (specified) with a diagnosis according to the Kennedy classification (grade 1, etc.). Those. it is quite acceptable, and sometimes correct, to write two or more diagnoses.

But once again we pay attention - the main diagnosis must be according to ICD-10. If you wrote only a diagnosis from the “old Soviet” classification, then even if it is correct, you have not made a legal diagnosis.

Unfortunately, absolutely no attention is paid to the legal side of the issue of diagnostics at the institute and even in postgraduate education. And this directly affects the risks of a doctor's insecurity in the face of ever-increasing pressure from patients and government agencies. And they know the laws very well and apply them literally. I am sure that many colleagues, having read this material, will realize the need to become more familiar with the ICD-10 and its possibilities. correct application in your practice.

Let's look at a few examples typical mistakes and delusions of dentists. Let's take not the most standard cases.

Example 1:

Starting situation - the patient comes to the dentist - ORTHOPEDIST with implants already installed, they have shapers, no crowns. It does not matter if he is partially missing teeth or completely. There is no pathology in the oral cavity, the implants are integrated, the gums are healthy, only prosthetics are required. The question is what diagnosis should the orthopedist make in this case? The vast majority of podiatrists answer this question as follows: K08.1 Loss of teeth due to accident, extraction or localized periodontal disease. And that's it. But the answer is not correct or not complete (depends on the number of missing teeth and those replaced by implants).
The fact is that for such a situation, the ICD-10 provides for its own separate diagnosis. And it sounds like this: Z96.5 Presence of dental and jaw implants. Next, we simply make a clarification - in the area of ​​\u200b\u200bwhich teeth the implants are installed. And if toothless areas remain in the jaw, then we quite correctly supplement this diagnosis with another, familiar and familiar “K08.1 Loss of teeth due to an accident, extraction or local periodontal disease”. If all extracted teeth are replaced by implants, then we leave only the diagnosis Z96.5. The diagnosis of K08.1 is relevant for the surgeon when he is only planning to place implants. For an orthopedist with already installed implants, the diagnosis is different.

Example 2:

The patient comes to the appointment with previously installed orthopedic structures. There is no pathology, orthopedics, teeth, implants, gums, roots are in perfect order. Appealed for professional examination or hygiene. What is the diagnosis?

Almost all doctors answer that since there are no complaints and pathologies, since nothing needs to be done, then there is no need to make a diagnosis. And for some reason, they do not take into account the fact that the presence of turned teeth, implants, artificial orthopedic structures cannot be considered a healthy condition without a diagnosis. For such cases, the ICD-10 has a ready-made diagnosis: Z97.2 Presence of a dental prosthetic device. If the prostheses are on implants, we add Z96.5 already known to us. We specify in the description the number of teeth, where is orthopedics, where are implants, etc. If removable prosthetics are used, we add everyone's favorite adentia: K08.1, you can also class according to Kennedy or Gavrilov there. Remember that if you find some kind of pathology or the patient comes with complaints that are confirmed in the form of a diagnosis, then it is the diagnosis that will be the main one, and then all the auxiliary ones in the form of the presence of prostheses or implants.

Example 3:

Visit for fitting and correction of orthopedic construction. Let's take the example of a single crown on a tooth, when all other c=teeth in the oral cavity are preserved and intact. What will be the diagnosis of an orthopedist? For some reason, all doctors are eager to repeat the THERAPEUTIC diagnosis that took place earlier - caries, pulpitis, periodontitis, trauma (chip). But that's not true! At the time of prosthetics, there was no caries, no pulpitis, no periodontitis, the therapist cured them. Moreover, it is forbidden to prosthetic teeth with such diagnoses until they are eliminated. So what do we write on the map? And we will write another special diagnosis from ICD-10, specially created for such cases: Z46.3 Trying on and fitting a dental prosthetic device. Those. cured tooth requiring prosthetics. Everything is simple and clear, and most importantly legally correct. We write the same diagnosis when we try on any orthopedic construction.

There is another ICD-10 diagnosis for orthopedists used for fitting: Z46.7 Fitting and fitting of an orthopedic device (brace, removable denture). You can also use it in the cases described in it (removable prosthetics).

Example 4:

The orthodontist repeatedly adjusts, activates, modifies his orthodontic appliance. What diagnosis shall we write? It seems to be asking for the one with which the treatment began. And in some cases it will be right. But often the devices are used at a time when, after prolonged treatment, crowding, distalization, dystopias, tremas have already been eliminated and the occlusion has a completely different appearance (and hence the diagnosis), which does not coincide with that at the time of the start of treatment. So, in order not to invent anything and not bother, use a special diagnosis for such cases from ICD-10: Z46.4 Fitting and fitting of orthodontic appliance.

Example 5:

Not so often, but there is a situation in our practice when a patient asks to perform not medical, but cosmetic work. Those. when he has NO medical problem at all.
Two typical cases are teeth whitening and veneers. The patient either asks to make the color lighter, or to use the veneers solely for cosmetic purposes (shape, bleach color). The reasons for these desires may be different, but in any case, the patient has the right to want to look like this, and the doctor has every right to provide this assistance to him if there are no contraindications.

Now the main question - since the patient is not sick with anything, the teeth are intact, and we are doing something to him - what will we write in the card as a diagnosis? The situation is very similar to plastic surgery, when a purely cosmetic correction of the shape of the ears, nose, eyebrows, lips, chest, etc. is done without any diseases and pathologies. And of course, for such situations, the ICD provides its own code and diagnosis: Z41.8 Other non-therapeutic procedures We write it and then we specify the type of procedure.

Example 6:

Now the surgeons will rejoice. In practice, it is a frequent case when, after bone grafting, it is necessary to remove non-resorbable membranes and pins. At the same time, the initial diagnosis in the form of atrophy of the alveolar process can no longer be written - it has already been restored just by this very bone grafting. The diagnosis of adentia does not correlate with the planned intervention, because adentia is not treated by removing a titanium membrane or a pin. Z47.0 Removal of plate after healing of fracture and other internal fixation device(Removal: nails, plates, rods, screws). Let no one be confused by the word "fracture", this is part of the diagnosis, what is important for us is what is written after "... and also." Those. if we simply remove the titanium membrane, pins or pins and do nothing else on this visit, we write like this: Z47.0 Removal of __________ (name of what was removed).

Example 7:

Now about the complications after implantation, early and late.

T84.9 Complications of internal orthopedic prosthetic device, implant and graft, unspecified

The most "favorite" diagnosis of implantologists - PERI-IMPLANTITIS - oddly enough, is not in the ICD-10. So what to do? There is a replacement in the ICD for peri-implantitis.

To diagnose complications after implantation, there are diagnoses in the ICD, divided according to the basis - mechanical or infectious.

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

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 failure, displacement, perforation, malposition, protrusion (protrusion), leakage).

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

We write the same diagnosis T84.3 when the implant breaks.

What if the Schneider's membrane is torn during a sinus lift?

Then here:

T81.2 Accidental puncture or tear during procedure, not elsewhere classified

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

T81.0 Bleeding and hematoma complicating procedure

Example 8:

About the unpleasant - namely, about complications after anesthesia or other drugs. We will not dwell on simple ones, such as fainting or collapse, everything is clear there. What do we write about shock, if it suddenly happened?

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

T88.2 Shock due to anesthesia in which the required drug was correctly administered

T88.6 Anaphylactic shock due to abnormal reaction to an adequately prescribed and correctly applied drug

T88.7 Abnormal reaction to drug or medicaments, unspecified

Example 9:

An ambiguous situation when a patient makes complaints that are not confirmed in any way. Simply - lying. He presses, rubs, interferes, uncomfortable - but in reality this is not so. The ICD has a separate diagnosis for such situations:

Z76.5 Simulation of illness [conscious simulation].

If you are 100% sure that you are being fooled, feel free to make such a diagnosis and refuse any honey based on it. interventions. The key word here is 100% sure.

Example 10:

We often conduct various kinds of examinations as a preventive measure. For reference to school or work, etc.

Do not confuse them with consultations, they are different things. If during the examination any suspicion of a pathology is revealed, then a consultation of a specialized specialist is appointed.

The ICD has its own ready-made codes for such actions:

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

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

Z02.1 Pre-employment screening

Z02.5 Examination in connection with sports

Z02.6 Examination in connection with insurance

Z02.8 Other surveys for administrative purposes

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

If a patient wants beautiful straight teeth, we immediately think about veneers in the smile line.
But what to do if the patient has all the teeth intact, there is no caries, no wear, no 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 in this case do not treat anything, but only perform a cosmetic function. The same applies to cosmetic procedures - fillers, threads, etc., plastic surgery - breast augmentation, changing the shape of the nose, ears, eye shape, etc.

In conclusion: the ability to make a correct diagnosis is a gift, experience, work and a bit of luck for a doctor. Do not cope alone - collect a council or a medical commission. But don't treat a patient without a diagnosis. He won't thank you for it.

The ability to correctly formulate a diagnosis is a legal necessity. Follow the advice given in the article. There is nothing criminal in the fact that you write the correct diagnosis, but, of course, it will not be according to the old classification - a competent expert will understand and accept it in any case. But this difference is how to prosthetize the central incisor with a punch or a refractor. Learn to be literate and modern.

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

Such a diagnosis with the code K07.3 according to ICD-10 (International Classification of Diseases, 10th revision) is made by an orthodontist if the tooth erupted with an inclination or displacement, or even appeared outside the dental arch. Mostly this happens with the lower eighth molars, incisors and canines.

Dystopia can also be accompanied by other anomalies in the position of the teeth - crowding, displaced or open bite, as well as retention.

Reasons for the appearance

• Heredity. If a child has inherited, for example, large teeth from his father, and a small jaw from his mother, dystopia cannot be avoided. In addition, it can be inherited by itself.
• Atypical formation of the rudiments of dental tissue in the embryo.
• Injuries and bad habits: prolonged use of a pacifier, the habit of biting a pencil, etc.
• Early removal of milk teeth.
• Peculiarities of eruption time. For example, if fangs appear late, that is, after 9 years, there may no longer be room for them in the arch.
• Often, dystopia is caused by polyodontia (“extra teeth”), macrodentia (abnormally large), partial absence of teeth, or a sharp discrepancy between the size of milk and permanent ones.

Types of dystopia

Depending on how and where the crown is displaced, there are several types of pathology:

• The slope towards the vestibule of the mouth means that we are talking about the vestibular position of the dystopic tooth, and if, on the contrary, into the depths of the oral cavity, it is about the oral position.
• When the tooth body is completely outside the arch and moves forward or backward, the dentist will mark the presence of a mesial or distal position on the map, respectively.
• Does the newcomer cut above the rest? - Such an anomaly will be called a supraposition. If lower, infraposition.
• Rare anomalies are torto- and transposition. In the first case, the tooth rotates around its axis, in the second, it changes places with its neighbor, for example, the canine takes the place of the premolar.

Depending on which particular tooth occupies the wrong position, there are dystopias of incisors, canines, molars and premolars or “eights”.

Eighth molars are the last to appear, and that is why they are associated with the greatest risk of dystopia.

The bone tissue is already formed, and often there is no place for a beginner in the dental arch. In addition, any indigenous is preceded by a dairy trailblazer who "breaks" the way. The “wise” molar does not have such an assistant, just as there are no neighboring teeth that determine the correct position on the arc.

Possible Complications

A dystopian tooth can injure the oral mucosa, tongue and cheeks, resulting in decubital ulcers.

Anomalies in the position of the crowns and malocclusion - common cause caries: oral hygiene becomes more complicated, it is difficult to completely remove plaque and food debris from the interdental spaces.

Another complication is problems with diction and chewing food.

Also, over the part of the crown that has not yet erupted, inflammation often occurs - pericoronitis. And in the most difficult cases, the “problem” tooth erupts outside the alveolar arch, which, of course, entails not only serious discomfort, but also diseases of other organs.

The method of therapy depends on the condition of the dystopic tooth and its payload. Sometimes it is enough just to grind the sharp edges and give a shape that will not injure the mucous membrane.

Most often, when the tooth is in the wrong position, they resort to orthodontic methods of treatment. Bracket systems allow you to cope with serious malocclusion. If there is no place for a tooth, and this, for example, is an important canine from the point of view of functionality and aesthetics, then it will be necessary to remove its neighbors and only then begin orthodontic treatment.

Treatment of dystopia with braces

When to remove a dystopic tooth

Removal is not a pleasant procedure, and therefore it is always a last resort. It is used in such cases:

• in the presence of pulpitis, periodontitis or cysts;
• if it is a wisdom tooth that complicates the treatment of caries of the seventh molars;
• when the anomaly is accompanied by osteomyelitis or periostitis;
• if the surrounding tissues are seriously injured.

If there are no such indications, the dentist will do everything possible to save the dystopic tooth. Note that it is optimal to undergo treatment before the end of the growth of the facial skeleton, that is, up to 14-16 years. In this case, you will see the results faster, and they will be noticeably better than with a later visit to a specialist.