Home Wisdom teeth Oral examination - methods of examining a dental patient. Examination and examination of the oral cavity Examination of the oral cavity is normal conclusion

Wisdom teeth

Oral examination - methods of examining a dental patient. Examination and examination of the oral cavity Examination of the oral cavity is normal conclusion

After defining β previously calculated transformer data is updated (recalculated):

§ rod diameter d=Ax, Where x =

Based on the found diameter, the closest value is selected from the normalized series of rod diameters d n

After selecting the normalized diameter d n meaning to be specified

β n = β (d n / d) 4

§ active section of the rod Ps = 0.0355x 2 for copper windings or

Ps = 0.0386x 2(m 2 )

§ average diameter of the channel between the windings d 12 = a d n (m)

§ winding height l = πd 12 / β n (m)

§ rod height l c = l+2l 0 (m)

§ distance between the axes of the rods С=d 12 +a 12 +b*d+a 22 (m)

§ electromotive force of one turn u in =4.44*f*P s *V s (IN)

§ weight of steel G st (kg)

§ winding mass G o (kg)

§ wire weight G pr(kg)

§ current density J (A/m 2)

§ mechanical stress in the windings s p (MPa)

§ cost of the active part (in conventional units)

§ cost of the active part = * with st in monetary terms (RUB) ( with st – see table 14)

§ losses and no-load current Px (W) , i o (%)

Clinical anatomy oral organs healthy person. Examination of the oral cavity. Examination, determination of the clinical condition of the teeth. Inspection and examination of fissures, cervical area, contact surfaces.

Clinical anatomy of the oral cavity of a healthy person.

Oral cavity, cavitasoris is the beginning of the digestive apparatus.

The oral cavity is limited:

Ó in front - lips,

Ó from above - hard and soft palate,

Ó from below - the muscles that form the floor of the mouth, and the tongue,

On the sides - cheeks.

The oral cavity opens with a transverse oral fissure (rimaoris), bounded by the lips (labia). The latter are muscle folds, the outer surface of which is covered with skin, and the inner surface is lined with mucous membrane. Through the pharynx (fauces), more precisely, the isthmus of the pharynx (isthmus faucium), the oral cavity communicates with the pharynx.

The oral cavity is divided into two parts by the alveolar processes of the jaws and teeth:

1) The anterior outer part is called the vestibule of the mouth (vestibulumoris) and is an arched gap between the cheeks and gums with teeth.

2) The posterior internal cavity, located medially from the alveolar processes, is called the oral cavity itself (cavumorisproprium). In front and sides it is limited by the teeth, below - by the tongue and bottom oral cavity, and above - the palate.

The oral cavity is lined by the oral mucosa (tunicamucosaoris), covered with stratified squamous non-keratinizing epithelium. It contains a large number of glands. The area of the mucous membrane attached around the neck of the teeth on the periosteum of the alveolar processes of the jaws is called the gum (gingiva).

Cheeks (buccae)) are covered on the outside by skin, and on the inside by the mucous membrane of the mouth, which contains the ducts of the buccal glands and are formed by the buccal muscle (m. buccinator). Subcutaneous tissue is especially developed in the central part of the cheek. Between the chewing and buccal muscles is the fatty body of the cheek (corpus adiposumbuccae).

Top wall oral cavity (palate) is divided into two parts. The anterior part - the hard palate (palatium durum) - is formed by the palatine processes of the maxillary bones and horizontal plates of the palatine bones, covered with mucous membrane, along the midline of which there is a narrow white stripe, called the “suture of the palate” (raphepalati). Several transverse palatal folds (plicaepalatinae transversae) extend from the suture.

Posteriorly, the hard palate passes into the soft palate (palatium molle), formed mainly by muscles and aponeurosis of tendon bundles. In the posterior part of the soft palate there is a small conical protrusion called the uvula, which is part of the so-called velum palatine (velumpalatinum). Along the edges, the soft palate passes into the anterior arch, called the palatoglossus (arcus palatoglossus), which goes to the root of the tongue, and the posterior arch, the palatopharyngeus, which goes to the mucous membrane of the lateral wall of the pharynx. The palatine tonsils (tonsillaepalatinae) lie in the depressions formed between the arches on each side. The lower palate and arches are formed mainly by the muscles involved in the act of swallowing.

Language (lingua)- a mobile muscular organ located in the oral cavity and facilitating the processes of chewing food, swallowing, sucking and speech production. The tongue is divided into the body of the tongue (corpuslinguae), the apex of the tongue (apexlinguae), the root of the tongue (radixlinguae) and the back of the tongue (dorsumlinguae). The body is separated from the root by a border groove (sulcusterminalis), consisting of two parts converging at an obtuse angle, at the apex of which there is a blind opening of the tongue (foramencaecumlinguae).

From above, from the sides and partially from below, the tongue is covered with a mucous membrane, which fuses with its muscle fibers, contains glands, lymphoid formations and nerve endings, which are sensitive receptors. On the back and body of the tongue, the mucous membrane is rough due to the large number of tongue papillae (papillaelinguales).

From the lower surface of the tongue to the gums in the sagittal direction there is a fold of the mucous membrane, which is called the frenulum of the tongue (frenulumlinguae). On either side of it, at the bottom of the mouth, on the sublingual fold, the ducts of the submandibular gland (glandula submandibularis) and sublingual gland(glandula sublingualis), which secrete saliva and are therefore called salivary glands (glandulaes salivales).

Oral cavity examination carried out in the following order:

1. Examination of the oral mucosa:

Ó mucous membrane of the lips, cheeks, palate;

Ó condition of excretory ducts salivary glands, quality of discharge;

Ó mucous membrane of the back of the tongue.

2. Study of the architectonics of the oral vestibule:

Ó depth of the vestibule of the oral cavity;

Ó lip frenulum;

Ó lateral buccal cords;

o frenulum of the tongue.

3. Assessment of periodontal condition.

4. Assessment of the condition of the bite.

5. Assessment of dental condition.

Sign	Norm	Pathology
Condition of the mucous membranes of the lips and cheeks.	The mucous membrane of the lips is pink, clean, moist, veins are visible on the inner surface of the lips, and there are nodular protrusions (mucous glands). On the mucous membrane of the cheeks along the line of closure of the teeth there are sebaceous glands (yellowish-gray tubercles). At the level of the second upper molar there is a papilla, into the apex of which the parotid duct opens salivary gland. Saliva flows freely when stimulated, in children 6-12 months. - physiological salivation.	The mucous membrane is dry, bright pink, coated, and there are rashes of elements. In place of the mucous gland there is a vesicle (blockage of the gland). Along the line where the teeth meet there are their imprints or small hemorrhages - traces of biting. There are whitish spots on the mucous membrane of the upper molars. The papilla is swollen and hyperemic. When stimulated, saliva flows with difficulty, is cloudy, or pus is released. In children over 3 years old - hypersalivation.
The nature of the frenulum of the lips and cords of the mucous membrane.	The frenulum of the upper lip is woven into the gum at the border of the free and attached parts; in children during the period of primary occlusion - at any level up to the top of the interdental papilla. The frenulum of the lower lip is free - when the lower lip is abducted to horizontal position There are no changes in the papilla. Lateral cords or ligaments of the mucous membrane do not change the condition of the gingival papillae when stretched.	Low attachment, bridle short, wide or short and wide. The frenulum of the lower lip is short; when the lip is retracted to a horizontal position, paleness (anemia) occurs and the gingival papilla peels off from the necks of the teeth. The ligaments are strong, attached to the interdental papillae and cause them to move when stretched.
Condition of the gums.	In schoolchildren, the gums are dense, have a pale pink color, and look like lemon peel. In preschoolers, the gums are brighter and their surface is smooth. The papillae in the area of single-rooted teeth are triangular, in the area of molars - triangular or trapezoidal, the gums fit tightly to the neck of the teeth. There is no dental plaque. Dental groove (groove) 1 mm.	The gingival margin is atrophied, the necks of the teeth are exposed. The papillae are enlarged, swollen, cyanotic, the apices are cut off, and covered with plaque. The gums peel off from the necks of the teeth. There are supra- and subgingival dental deposits. Physiological periodontal pocket more than 1 mm.
Tongue frenulum length	The frenulum of the tongue is of the correct shape and length.	The frenulum of the tongue is attached to the apex of the interdental papilla and, when stretched, causes it to move. The frenulum of the tongue is short, the tongue does not rise to the upper teeth, the tip of the tongue bends and bifurcates.
S.O. tongue, floor of the mouth, hard and soft palate.	The tongue is clean, moist, the papillae are pronounced. The bottom of the oral cavity is pink, large vessels are visible, the excretory ducts of the salivary glands are located on the frenulum, salivation is free. The mucous membrane of the palate is pale pink, clean, in the area of the soft palate it is pink, finely lumpy.	The tongue is coated, varnished, dry, with areas of desquamation of the filiform papillae. The mucous membrane of the bottom of the oral cavity is swollen, hyperemic, and salivation is difficult. The rollers swell sharply. There are areas of hyperemia on the palate mucosa. Elements of defeat.
Character of the bite.	Orthognathic, straight.	Distal, mesial, open, deep, crossed.
Condition of the dentition.	Dental rows of correct shape and length. Teeth of correct anatomical shape, color and size, correctly located in the dentition, individual teeth with fillings, after 3 years - physiological tremors.	The dentition is narrowed or expanded, shortened, individual teeth are located outside the dental arch, are absent, there are supernumerary or fused teeth. The structure of hard tissues has changed (caries, hypoplasia, fluorosis).
Dental formula.	Appropriate for age, healthy teeth.	Violation of the sequence and pairing of teeth eruption, carious cavities, fillings.
State of oral hygiene.	Good and satisfactory.	Bad and very bad.

When examining the oral cavity itself, first of all, a general examination is performed, paying attention to the color and moisture of the mucous membrane. Normally, it is pale pink, but it can become hyperemic, swollen, and sometimes acquires a whitish tint, which indicates the phenomenon of para- or hyperkeratosis.

When examining the palate, they determine the shape of the hard palate (highly curved, flattened), the mobility of the soft palate, the closure of the nasopharyngeal space by it (when pronouncing the drawn-out sound “a-a”), and the presence of various types of acquired and congenital defects. When examining the tongue, attention is paid to its shape, size, mobility, color, condition of the mucous membrane and the severity of the papillae, the presence of deformation (cicatricial curvature, fusion with underlying tissues, tongue defect, compaction, infiltration) and other changes.

Examination of the tongue begins with determining the condition of the papillae, especially if there are complaints of changes in sensitivity or burning and pain in any areas. A coated tongue may occur due to slower rejection of the outer layers of the epithelium. This phenomenon may be a consequence of disruption of the gastrointestinal tract, and possibly pathological changes in the oral cavity due to candidiasis. Sometimes there is increased desquamation of the papillae of the tongue in some area (usually on the tip and lateral surface). This condition may not bother the patient, but pain may occur from irritants, especially chemical ones. With atrophy of the papillae of the tongue, its surface becomes smooth, as if polished, and due to hyposalivation it becomes sticky. Individual areas, and sometimes the entire mucous membrane, may be bright red or crimson. This condition of the tongue is observed in pernicious anemia and is called Gunther's glossitis (named after the author who first described it). Hypertrophy of the papillae may also be observed, which, as a rule, does not cause concern to the patient.

When examining the tongue, one should remember the need to examine the lateral surfaces of the tongue in the area of the molars and the root of the tongue, where malignant neoplasms are often localized.

When examining the tongue, pay attention to its size and relief. If the size increases, the time of manifestation of this symptom (congenital or acquired) should be determined. It is necessary to distinguish macroglossia from edema. The tongue may be folded if there are a significant number of longitudinal folds, but patients may not know about this, since in most cases it does not bother them. The folding appears when the tongue is straightened. Patients mistake them for cracks. The difference is that with a crack, the integrity of the epithelial layer is broken, but with a fold, the epithelium is not damaged.

When examining the floor of the mouth, pay attention to the mucous membrane

shell. Its peculiarity is its pliability, the presence of folds, the frenulum of the tongue and the excretory ducts of the salivary glands, and sometimes droplets of accumulated secretion. In smokers, the mucous membrane may acquire a matte tint.

In the presence of keratinization, which manifests itself in areas of grayish- white, determine their density, size, adhesion to the underlying tissues, the level of elevation of the lesion above the mucous membrane, and pain.

Palpation. Palpation is understood as a clinical research method that allows one to determine by touch physical properties tissues and organs, their sensitivity to external influences, as well as some of their functional properties. Distinguish regular And bimanual palpation.

Palpation of the soft tissues of the cheek and floor of the mouth is best done with both hands ( bimanual). The index finger of one hand is used to palpate from the side of the oral mucosa, and one or more fingers of the other hand is used to palpate from the outside - from the side of the skin. If scars are present, their nature, shape, size are determined and it is noted whether they disrupt the function of the oral organs and what these violations are.

To palpate the tongue, the patient is asked to stick it out. Then big and index fingers With the left hand, using a gauze napkin, take the tongue by the tip and fix it in this position. Palpation is done with fingers right hand.

Palpation maxillofacial area and adjacent areas are carried out with the fingers of one hand ( normal palpation), and with the other hand

keep the head in the required position.

The order of palpation of a particular anatomical area is determined by the localization pathological process, since you should never start palpation from the affected area. It is recommended to palpate in the direction from “healthy” to “sick”.

All irregularities, thickenings, compactions, swelling, pain and other changes are noted, paying special attention to the condition of the lymphatic system. In the presence of inflammatory infiltration, its consistency (soft, dense), area of spread, soreness, adhesion to the underlying tissues, mobility of the skin over it (whether it folds or not), the presence of foci of softening, fluctuations, and the condition of regional lymph nodes are determined.

Fluctuation (fluctuare - oscillate in waves), or ripple - a symptom of liquid being in a closed cavity. It is defined as follows. One or two fingers of one hand are placed on the area to be examined. Then, with one or two fingers of the other hand, a sharp push is made in the area under study. The movement of liquid in the cavity caused by it is perceived by fingers applied to the area under study in two mutually perpendicular directions. A fluctuation perceived in only one direction is false. False fluctuation can be detected in the area of elastic tissues, in soft tumors (for example, lipomas).

If a tumor process is suspected, special attention is paid to the consistency of the neoplasm (softness, density, elasticity), size, nature of the surface (smooth, bumpy), mobility in various directions (horizontal, vertical). The most important, and sometimes decisive, importance is palpation of the regional lymph nodes.

Palpation of lymph nodes. By palpation, the condition of the submental, submandibular and cervical lymph nodes is determined.

Peripheral lymph nodes are grouped in the subcutaneous tissue of various areas of the body, where they can be detected by palpation, and with significant magnification, visually. The examination of lymph nodes is carried out in the same symmetrical areas. The method of superficial palpation is used. The doctor places his fingers on the skin of the area being examined and, without lifting his fingers, slides them along with the skin over the underlying areas. dense tissues(muscles or bones), pressing lightly on them. The movements of the fingers can be longitudinal, transverse or circular. By rolling the palpated lymph nodes under the fingers, the doctor determines their number, size and shape of each node, density (consistency), mobility, pain and adhesion of the lymph nodes to each other, to the skin and surrounding tissues. The presence of skin changes in the area of palpable lymph nodes is also visually determined: hyperemia, ulcerations, fistulas. The dimensions of the lymph nodes are indicated in cm. If the lymph node has a round shape, it is necessary to indicate its diameter, and if it is oval, the largest and smallest dimensions.

Feeling submandibular lymph nodes is an important diagnostic procedure in row recognition systemic diseases, oncological processes, as well as inflammatory processes. To palpate the lymph nodes, the doctor stands to the right of the patient, fixes his head with one hand, and uses the 2nd, 3rd, 4th fingers of the other hand, placed under the edge of the lower jaw, to palpate the lymph nodes through careful circular movements.

Starting palpation mental lymph nodes, the doctor asks the patient to slightly tilt his head forward and fixes it with his left hand. Places the closed and slightly bent fingers of the right hand in the middle of the chin area so that the ends of the fingers rest against the front surface of the patient’s neck. Then, palpating them towards the chin, he tries to bring the lymph nodes to the edge of the lower jaw and determine their properties.

Posterior cervical lymph nodes palpated simultaneously on both sides in the spaces located between the posterior edges of the sternocleidomastoid muscles.

On palpation anterior and posterior cervical lymph nodes fingers are placed perpendicular to the length of the neck. Palpation is carried out in the direction from top to bottom.

Normally, lymph nodes are usually not detected by palpation. If the nodes are palpable, then you should pay attention to their size, mobility, consistency, pain, and cohesion.

Having received, based on external examination and palpation, information about

changes in the maxillofacial region, proceed to the study of its individual anatomical areas.

Study of facial bones, jaws begin with an external examination, paying attention to their shape, size, and symmetry of location. Especially important acquires identification with deep palpation of deformations, changes in various departments jaws.

When examining the facial skeleton of a patient with a trauma to the maxillofacial region, the symmetry of the external nose and pain on palpation of the nasal bones are noted. The severity of the retraction of the bridge of the nose, the severity of the “step” symptom. Next, an axial load is applied to the zygomatic arches and upper jaw, noting the severity of the pain syndrome and the location of the pain. It is necessary to consistently determine the localization of pain during axial load on the lower jaw and the presence of a “step” symptom in the area of the mandibular edge, the severity of crepitus of bone fragments during palpation, and the presence of pathological mobility of bone fragments.

If there is a defect or deformation of the maxillofacial area, the nature of the deformation, the localization and boundaries of the defect leading to the deformation, and the condition of the skin at the border with the defect are described in detail. If there is a scar deformity, it is necessary to describe its size (in cm), the color of the scar, pain on palpation, the consistency of the scar, and its relationship with surrounding tissues.

In the presence of congenital pathology persons describe the severity of Cupid's bow (broken, not broken), the size of the cleft lip, palate along line A; type of cleft: one-sided, two-sided, complete, incomplete, through; presence of deformation of the alveolar process upper jaw; position of the premaxilla.

Examination of the jaws. The difference is anatomical structure and the location of the upper and lower jaws, as well as the unequal degree of their participation in performing various functions, determine the different course of pathological processes in them, and therefore various signs their manifestations.

Examination of the upper jaw. When treating patients with lesions of the upper jaw great importance have complaints and medical history. Much more often, symptoms such as pain, nasal discharge, tooth mobility appear at first, and only later late period jaw deformation occurs. However, to establish the pathological process, it is necessary to detail the above symptoms: in case of pain - determine the place of greatest pain, identify its intensity and irradiation: in the presence of nasal discharge - its nature (mucous, purulent, bloody, bloody-purulent, etc.), in case of deformation - its appearance (protrusion of the wall maxillary sinus, its destruction, etc.), size, localization, etc. To identify perforation of the maxillary sinus, among other examination methods, a nasal test is sometimes performed.

Examination of the lower jaw. When examining the lower jaw, pay attention to the shape, symmetry of both halves, size, the presence of irregularities, thickenings, acquired and congenital deformities. Palpation determines the nature of the surface of the thickening or tumor (smooth, lumpy), consistency (dense, elastic, soft).

Examination of the temporomandibular joint. The function of the temporomandibular joint can be judged to a certain extent by the degree of mouth opening and lateral movements of the lower jaws.

Normal mouth opening in an adult corresponds to 45-50 mm between the incisors. It should be considered more appropriate to measure the individual norm of mouth opening based on measuring the width of the fingers. So, if the patient opens his mouth to the width of his 3 fingers (index, middle and ring), then this can be considered the norm.

Checking the volume of lateral movements of the lower jaw consists of determining the distance in millimeters by which the lower jaw moves from the midline of the face when it moves in one direction or another. Then the area of the temporomandibular joint is examined and palpated, noting the condition of the tissues in this area: the presence of swelling, hyperemia, infiltration and pain. By pressing the tragus of the ear forward, the external auditory canal is examined, determining whether it is narrowed due to bulging of the anterior wall. In the absence of inflammation in the external ear canals the ends of the little fingers are inserted and when opening and closing the mouth, with lateral movements of the lower jaw, the degree of mobility is established articular heads, the appearance of pain, crunching or clicking in the joint.

Study of the salivary glands. When examining the salivary glands, first of all, attention is paid to the color of the skin and changes in tissue contours in the area of the anatomical location of the glands. If the contours are changed due to swelling, then its size and character are determined (spread out, limited, soft, dense, painful, areas of softening, fluctuations). If the change in the contours of the gland is caused by a tumor process, then the exact localization of the tumor in the gland, the clarity of its boundaries, size, consistency, mobility, and the nature of the surface (smooth, lumpy) are established. It is determined whether there is paresis or paralysis of the facial muscles and damage to the masticatory muscles. Then the excretory ducts are examined. To examine the mouths of the excretory ducts of the parotid salivary glands, which are located on the mucous membrane of the cheek along the line of closure of the teeth at the level of the second upper molar, the corner of the mouth is pulled forward and slightly outward with a dental mirror or a blunt hook. Lightly massaging the parotid salivary gland, observe the release of secretion from the mouth of the duct, while determining the nature of the secretion (clear, cloudy, purulent) and at least approximately its amount. In order to examine the excretory duct of the submandibular or sublingual salivary glands, the tongue is retracted posteriorly with a dental mirror. In the anterior section of the sublingual region, the outlet of the ducts is examined. By massaging the submandibular salivary gland, the nature and amount of its secretion is determined. By palpation along the duct from back to front, the presence of a stone or inflammatory infiltrate in the duct is determined. By palpating from the oral cavity and submandibular region (bimanually), the size and consistency of the submandibular and sublingual salivary glands can be more accurately determined. For certain indications (suspicion of the presence of a stone, deformation of the duct, its narrowing) and the absence inflammatory phenomena You can carefully probe the duct.

Study of the function of the trigeminal, facial, glossopharyngeal and vagus nerves. When researching functional state trigeminal nerve (n.trigemini) assess tactile, pain and temperature sensitivity in areas innervated by sensory nerves, and the motor function of the masticatory muscles. To test sensitivity with the patient's eyes closed, they alternately touch the skin of the test area with a piece of paper (tactile sensitivity), a needle (pain sensitivity) and test tubes with warm and cold water(temperature sensitivity) and ask the patient to say what he feels. The sensitivity of the cornea, conjunctiva, and mucous membranes of the oral cavity and nose is also checked. Determine perception taste sensations from the anterior two-thirds of the tongue. By palpating the place where the sensory nerves exit the skull in the area of the superciliary arch, in the infraorbital area and in the chin area, the presence of pain points is determined.

When checking the motor function of the trigeminal nerve, the tone and strength of the masticatory muscles are determined, as well as the correct position of the lower jaw during its movements. In order to determine the tone of the masticatory muscles, the patient is asked to firmly clench and unclench his teeth: while doing this, the well-contoured masticatory and temporal muscles themselves are palpated. To test the strength of the masticatory muscles during open mouth The patient's chin is covered with the thumb and forefinger of the right hand and the patient is asked to close his mouth, while trying to hold the lower jaw by the chin.

Facial nerve (n.facialis ) innervates facial muscles

tsa, therefore, when studying its functions, the state of the facial muscles at rest and during their contraction is determined. Observing the state of the muscles at rest, note the severity of skin folds (wrinkles) on the right and left sides of the forehead, the width of both palpebral slits, the relief of the right and left nasolabial folds, and the symmetry of the corners of the mouth.

The contractility of the facial muscles is tested by raising and frowning the eyebrows, closing the eyes, baring the teeth, puffing out the cheeks and protruding the lips.

When studying the function glossopharyngeal nerve (n.glossopharyngeus) determine the perception of taste sensations from the back third of the tongue and observe the act of swallowing.

Nervus vagus (n.vagus) is mixed. It consists of motor and sensory fibers. It is of interest to study one of its branches - the recurrent nerve (n.recurens), which supplies motor fibers to the muscles of the palate, stylopharyngeal muscle, pharyngeal constrictors, and laryngeal muscles.

The study of its function consists of determining the timbre of the voice, the mobility of the soft palate and vocal cords, as well as observing the act of swallowing.

Based on the data from the survey, examination and basic research methods (palpation and percussion), the preliminary diagnosis. To clarify the diagnosis in most cases, additional research methods are necessary.

Inspection is the first method of objective research. It should be done in good lighting, preferably daylight. This is especially important when examining the skin and mucous membrane of the mouth.

The purpose of the examination is to identify changes that have arisen due to diseases of the maxillofacial area. The examination schematically consists of an external examination and examination of the oral cavity. During an external examination, attention is paid to the general appearance of the patient, his position, the presence of asymmetry, swelling, and fistula tracts. Thus, during inflammatory processes, tumors, and injuries, a change in the configuration of the face occurs. It can also change with some endocrine diseases, in particular myxedema (mucoedema), acromegaly. With hyperfunction thyroid gland(Graves' disease) protrusion of the eyeball (exophthalmos), enlargement is noted; size of the thyroid gland (goiter). The configuration of the face can change due to swelling due to nephritis, diseases of the cardiovascular system; In allergic conditions, swelling of the face (Quincke's edema) may occur. If the patient complains of changes in the oral mucosa or the appearance of any lesions, it is necessary to carefully examine the skin.

When complaining about painful sensations in the mucous membrane of the nose and eyes, a thorough examination is required. Some diseases, such as pemphigus, affect the mucous membranes of the mouth, nose and eyes.

Determining the condition of the lymph nodes is important in the diagnosis of a number of diseases of the maxillofacial region. First of all, the submandibular, mental and cervical lymph nodes are determined, and attention should be paid to the size, mobility and pain, as well as their adhesion to the surrounding tissues.

Inspection of the oral cavity begins from the vestibule of the mouth with the jaws closed, raising the upper and lowering the lower lip or pulling the cheek with a dental mirror. First of all, carefully examine the red border of the lips and the corners of the mouth. On the inner surface of the lip, small elevations are sometimes found due to small salivary glands. The tone of the chewing muscles and the condition of the facial muscles are determined. The definition of occlusion is important point, since an incorrect relationship of the dentition may be the cause of the pathological process.

Then the mucous membrane of the gums is examined. Normally, it is pale pink and tightly covers the neck of the tooth, forming a periodontal pocket 1-2 mm deep. Gingival papillae pale pink, occupying interdental spaces. In some diseases, pathological periodontal pockets are formed, the depth of which is determined with an angled probe with notches applied every 2 mm. Examination of the gums allows you to determine the type of inflammation (catarrhal, ulcerative-necrotic, hyperplastic), the nature of the course (acute, chronic, in the acute stage), the extent, severity of inflammation (mild, moderate, severe gingivitis). There may be an increase in the size of the gingival papillae, which become swollen, cyanotic, and bleed easily from touch. In pathological periodontal pockets, subgingival tartar is deposited, which can be detected upon careful examination by the presence of a dark stripe at the neck of the tooth along the line of contact of the gum to the tooth. Tartar in periodontal pockets is also determined by the feeling of roughness when passing a probe along the surface of the cervical part of the tooth root.

Tumors and swellings of various shapes and consistencies can form on the gums. Along the transitional fold there may be fistula tracts, which most often arise as a result of chronic inflammatory process in the periodontium. The location of the fistula tract close to the gingival margin indicates that it arose as a result of an inflammatory process in the pathological periodontal pocket.

When examining the vestibule of the oral cavity, pay attention to the color of the mucous membrane of the cheeks. Derivatives can be located along the line of teeth closure sebaceous glands, which should not be mistaken for pathology. These are pale yellow nodules with a diameter of 1-2 mm, not rising above the mucous membrane. It must be remembered that on the cheeks at level 7|7 there are papillae on which the excretory ducts open parotid glands. They are sometimes also mistaken for pathology. In case of swelling, there may be teeth marks on the cheeks.

The examination of the oral cavity itself (cavum oris propria) begins with a general examination of the oral mucosa, which, instead of the usual color (normally pale pink), can be changed in pathological processes. During inflammation, areas of hyperemia are noted, sometimes with a bluish tint, which indicates the duration of this process. You should pay attention to the severity of the papillae of the tongue, especially if there are complaints of changes in sensitivity or pain. Sometimes increased desquamation of the papillae of the tongue occurs in some area (usually on the tip and lateral surface of the tongue), but this may not bother the patient. Sometimes atrophy of the papillae of the tongue is observed. In such cases, its mucous membrane becomes smooth (polished tongue). Sometimes areas of atrophy become bright red, the tongue is poorly moisturized and painful. This condition of the tongue occurs, for example, with pernicious anemia; it was called “Guntor glossitis” after the name of the author who described it. Atrophy of the papillae of the tongue can occur in its posterior and middle thirds, in the center in the form of a diamond (diamond-shaped glossitis). Papillary hypertrophy may also be observed. It should be remembered that on the lateral surface at the root of the tongue there is lymphoid tissue (pink, sometimes with a bluish tint), which is mistaken for pathology.

When examining the tongue, pay attention to its size. The tongue may be folded. Often, patients themselves take this for a pathology: folds are considered as cracks. However, with a folded tongue, unlike cracks, the integrity of the epithelium is not impaired.

Then the floor of the mouth, cheeks, and palate are carefully examined, paying special attention to the nature of the changes. It must be remembered that the success of diagnosis largely depends on the recognition of elements of damage to the oral mucosa.

If there are areas of keratinization, their density, size, adhesion to the underlying tissues, and the level of elevation of the elements above the mucous membrane are determined. It must be remembered that foci of keratinization can become a source of neoplasms.

If there is erosion or ulceration, the possibility of injury to this area should be excluded or confirmed, which is an important factor in making the diagnosis. It should be remembered that when opening the mouth and protruding the tongue, tissue displacement occurs, and in this position the injured area may not correspond to the sharp edge of the tooth or denture. In such cases, the patient is asked to open and close his mouth several times to clarify the location of the tissues in a calm state.

In the occurrence of a pathological process in the oral cavity, the function of salivation is important. Therefore, it is necessary to pay attention to the degree of moisture in the oral mucosa. The function of the parotid salivary glands is determined by the secretion of a drop of clear secretion when light massage glands. If the secretion is not released or a cloudy secretion appears after a long massage, this indicates a change in the function of the gland and requires special examination.

In cases where any elements are found on the oral mucosa, the skin should be carefully examined. Elements of damage to the oral mucosa and red border of the lips are similar to those with skin damage. Some of their differences are determined by the anatomical, histological and functional characteristics of the oral cavity. There are primary elements of the lesion and secondary ones, developing from the primary ones. The primary infiltrative elements of the lesion include a spot, nodule, tubercle, node, vesicle, abscess, bubble, blister, cyst. Secondary morphological elements are erosion, ulcer, crack, crust, scale, scar, pigmentation.

spot (macula)). Limited change in color of the mucous membrane. The lesion does not protrude above the level of surrounding areas. An inflammatory spot with a diameter of up to 1.5 cm is defined as roseola, more - as erythema. Example: spots due to burns, measles, scarlet fever, drug disease, vitamin B12 deficiency. The spots can be the result of hemorrhages (petechiae, purpura, ecchymosis), vascular birthmarks, telangiectasia. Dark spots arise as a result of melanin deposition (physiological pigmentation, Addison's disease, liver damage) or exogenous pigments during treatment (taking bismuth preparations, rinsing the mouth with solutions of chloramine, potassium permanganate, etc.) or occupational hazards (lead preparations, paints). White spots of keratinization in the simple form of leukoplakia are found only on the mucous membranes, but not on the skin.

Nodule (papula). A cavityless element up to 5 mm in size, rising above the level of the surrounding mucous membrane, capturing the epithelium and surface layers of the mucous membrane itself. Papules in the oral cavity are usually of inflammatory origin; with them, hyper- and para-keratosis and acanthosis are detected in the epithelium. Example of papules: lichen planus, drug disease, syphilis. Merged papules (more than 0.5 cm in size) form a plaque (plaquae). Papules with a sharp proliferation of the epithelium are defined as papillomas.

Node. Different from a nodule large sizes and involvement of all layers of the mucous membrane. It is determined by palpation as a rounded infiltrate.

Tuberculum. Similar to a papule, but covers the entire depth of the mucous membrane itself. Its dimensions are up to 5-7 mm. In the oral cavity, the epithelium covering the tubercle quickly becomes necrotic and ulcers appear. As it heals, a scar forms.

Vesicula. Cavity round formation up to 5 mm, protruding above the level of the mucous membrane. The vesicle has serous or hemorrhagic contents, is often located intraepithelially in the styloid layer, and is easily opened. Example: simplex and herpes zoster, foot and mouth disease, allergic rashes.

Abscess (pustula). The same as a vesicle, but with purulent contents. It usually does not form in the oral cavity. It can be observed on the skin and red border of the lips.

Bubble. Differs from a bubble in its larger size. It can be located intraepithelially (acantholytic pemphigus) and subepithelially (non-acantholytic pemphigus, erythema multiforme exudative, bullous form of red lichen planus). In the oral cavity, blisters are observed very rarely due to their rapid opening, especially with an intraepithelial location.

Blister (urtica). Sharply expressed limited swelling of the mucous membrane itself. In the oral cavity, blisters quickly turn into blisters and open, unlike the skin, where the reverse development of blisters occurs without compromising the integrity of the epithelium. Example: drug-induced lesions.

Cyst. Cavity formation, lined with epithelium and having a connective tissue membrane.

Erosion (erosio). It is characterized by a defect in the epithelium at one depth or another, but does not penetrate into the connective tissue. It occurs after the opening of a vesicle, pustule, bubble, blister, or develops at the site of a papule, on a plaque, or as a result of injury. Erosion of traumatic origin - an abrasion - is called excoriation (excoriationes). It heals without a scar.

Ulcer (ulcus). Typical for it is a defect not only of the epithelium, but also of the underlying tissues - the mucous membrane itself, and with deep ulcers, necrosis can involve the submucosal, muscular layers, etc. In contrast to erosion, in an ulcer, not only the bottom, but also the walls are distinguished . Example: traumatic, cancer, tuberculosis, syphilitic ulcers, etc. Shallow ulcers in the oral cavity can heal without a scar, deeper ones lead to scarring.

Scale (squma). Separation of keratinized cells during normal or pathological keratinization.

crust). Formed at the site of drying of exudate, pus or blood.

Crack (rhagades). A linear defect that occurs when tissue loses its elasticity.

Aphta. An oval-shaped erosion, covered with a fibrinous coating, surrounded by a hyperemic rim.

Tripe (cicatrix). Replacement of lost tissue with connective tissue.

Pigmentation. Change in color of the mucous membrane or skin at the site of the inflammatory process due to the deposition of melanin or other pigment (often after hemorrhages). It is necessary to distinguish between general changes in the epidermis, which, as a rule, develop as a result of various pathological processes occurring in the mucous membrane.

Spongiosis. Accumulation of fluid between the cells of the styloid layer.

Ballooning degeneration. Disruption of communication between the cells of the spinous layer, which leads to the free arrangement of individual cells or their groups in the exudate of the resulting vesicles (in the form of balloons).

Acantholysis- degenerative changes in the cells of the thyroid layer, expressed in the melting of intercellular, protoplasmic bridges.

Acanthosis- thickening of the cells of the spinous layer. Characteristic of many species chronic inflammation mucous membrane.

Hyperkeratosis- excessive keratinization due to lack of desquamation or increased production of keratinized cells.

Parakeratosis- disruption of the keratinization process, which is expressed in incomplete keratinization of the surface cells of the spinous layer.

Papillomatosis- proliferation of the papillary layer of the oral mucosa.

When examining the oral cavity, it is necessary to examine all the teeth, and not just the one about which the patient complains. Otherwise, the true cause of the pain may remain undetected, since the pain can radiate to a healthy tooth.

Examination of all teeth on the first visit allows you to outline a general plan for the treatment of existing oral diseases, i.e., a plan for health measures (sanitation), which is the main task of the dentist. It is recommended to always carry out the inspection in the same order, i.e. according to a specific system. For example, the examination should always be done from right to left, starting with the teeth of the lower jaw (molars), and then from left to right in the same sequence, examining the teeth of the upper jaw. Teeth are examined using a dental mirror and probe. The mirror allows you to examine poorly accessible areas and direct a beam of light to the desired area, and the probe checks all the depressions, pigmented areas, etc. If the integrity of the enamel is not broken, then the probe slides freely over the surface of the tooth, without lingering in the depressions and folds of the enamel. If there is a carious cavity in the tooth, sometimes invisible to the eye, the probe gets stuck in it. You should especially carefully examine the contact surfaces of the teeth, since it is quite difficult to detect a cavity on them if the chewing surface is not damaged. In such cases, the cavity can only be detected using a probe or special research methods. Probing also helps to determine the presence of softened dentin, the depth of the carious cavity, communication with the tooth cavity, the location of the canal mouths, and the presence of pulp in them.

Tooth color can be an important clue when making a diagnosis. In adults, teeth are usually white with a yellowish tint (permanent), in children - with a bluish tint (temporary). Regardless of the shade, the enamel of all healthy teeth is characterized by special transparency - the vibrant shine of the enamel. In some cases, the enamel loses its characteristic shine and becomes dull. A change in tooth color is sometimes the only symptom of a particular pathological process. So, for example, at the beginning of the carious process, cloudiness appears in the enamel, a chalky spot is formed, which can later become pigmented and acquire Brown color. However, discoloration of tooth enamel on the labial or chewing surface can occur if there is a cavity at the contact surface. Depulped teeth lose their vibrant enamel shine and take on a dark gray tint. The same color change, and sometimes more intense, is observed in intact teeth in which pulp necrosis has occurred. Quite often, patients do not pay attention to the darkening of the tooth and this is revealed only during examination.

The color of the tooth can be changed due to the action external factors: smoking (dark brown plaque), metal fillings (staining the tooth a dark color), chemical treatment canals (dark color after using the silvering method, orange - after the resorcinol-formalin method, yellow - after filling the canal with chlortetracycline paste).

The shape and size of teeth also play a role in diagnosis. Each tooth has its typical shape and size. Deviations from these norms depend on the state of the body during the formation of teeth. Some forms of dental abnormalities are characteristic of certain diseases. Thus, Hutchinson's teeth, Fournier's teeth, along with other signs, are characteristic of congenital syphilis.

PAGE 5

METHODOLOGICAL DEVELOPMENT

practical lesson No. 2

By section

IV semester).

Subject: Clinical anatomy of the oral cavity of a healthy person. Examination and examination of the oral cavity. Determination of the clinical condition of teeth. Inspection and examination of fissures, cervical area, contact surfaces.

Target: Recall the anatomy of the oral cavity of a healthy person. Teach students to conduct examinations and examinations of the oral cavity, determine the clinical condition of the teeth.

Class location: Hygiene and prevention room of State Clinical Hospital No. 1.

Material support:Typical equipment of a hygiene room, workplace dentist - prevention, tables, stands, exhibition of hygiene and prevention products, laptop.

Duration of classes: 3 hours (117 min).

Lesson plan

Lesson stages	Equipment	Training aids and controls	Place	Time per minute
1. Checking the initial data.	Lesson content plan. Laptop.	Control questions and tasks, tables, presentation.	Hygiene room (clinic).
2. Solving clinical problems.	Laptop, tables.	Forms with control situational tasks.	\|\|	74,3%
3. Summing up the lesson. Assignment for the next lesson.		Lectures, textbooks, additional literature, methodological developments.	\|\|

The lesson begins with the teacher briefing on the content and goals of the lesson. During the survey, find out the students' initial level of knowledge. During the lesson, students understand the concepts: primary, secondary and tertiary prevention, as well as the introduction of primary prevention of dental diseases, the center of which is the formation of a healthy lifestyle regarding the organs and tissues of the oral cavity and the body as a whole, associated with determining the level and criteria of health .

The basis of the concept of a “healthy child” in dentistry, in our opinion (Leontiev V.K., Suntsov V.G., Gontsova E.G., 1983; Suntsov V.G., Leontiev V.K. et al., 1992), the principle of the absence of any negative impact of the state of the oral cavity on the child’s health should be based. Therefore, children with the absence of acute, chronic and congenital pathology of the dental system should be classified as healthy in dentistry. These should include children with no signs of active caries, with filled carious teeth, in the absence of complicated forms of caries, without periodontal diseases, without the oral mucosa, without any surgical pathology, with cured dental anomalies. The KPU index, KP + KPU should not exceed the average regional values for each age group of children. In every practically healthy person, certain abnormalities can be found in the oral cavity, which, however, cannot be considered manifestations of the disease and, therefore, they are not necessarily subject to treatment. Therefore, it is widely used in medicine important indicator health as "the norm". In practically real conditions, the range of indicators determined statistically is most often taken as the norm. Within this interval, the body or organs should be in a state of optimal functioning. In dentistry, such average statistical indicators are various indices - KP, KPU, RMA, hygiene indices, etc., which make it possible to quantitatively assess the condition of teeth, periodontal disease, and oral hygiene.

A healthy lifestyle in relation to the organs and tissues of the oral cavity includes three main sections: hygienic education of the population, carried out through sanitary educational work; training and implementation of rational oral hygiene; balanced diet; elimination of bad habits and risk factors in relation to the organs and tissues of the oral cavity, as well as correction harmful influence environmental factors.

Determining the level of a person’s dental health is the starting point for planning individual treatment and preventive measures. To do this, it is necessary to develop a survey methodology with a detailed analysis of risk zones in hard tissues teeth and soft tissues of the oral cavity. During the examination, attention is paid to the sequence of examination.

Test questions to identify background knowledge students:

Features of the structure of the oral cavity.
The concept of a healthy lifestyle.
The concept of health and norms in dentistry.
What instruments are used for examining and examining the oral cavity.
Identification and quantitative reflection of detected pathological abnormalities.

Sequence of examination of a child by a dentist

Stage	Norm		Pathology
Complaints and anamnesis	No complaints The mother's pregnancy was without pathology, she was breastfed, the child was healthy, the diet was rational without excess carbohydrates, and oral care was regular.		Complaints about aesthetic imperfection, violation of form, function, pain Toxicosis and illnesses of the mother during pregnancy, illnesses of the child, taking medications, artificial feeding, excess carbohydrates in food, lack of systematic dental care, bad habits.
Visual inspection:
Emotional condition	The child is calm and friendly.	The child is excited, capricious, and inhibited.
Physical development	Body length corresponds to age.	In growth, he is ahead of his peers or behind them.
Posture, gait	Direct, energetic, free.	Slouched, lethargic.
Head position	Direct symmetrical.	The head is lowered, thrown back, tilted to the side.
Symmetrical face and neck	The face is straight, symmetrical.	The neck is pubescent, thrown back, tilted to the side. The face and neck are asymmetrical, the neck is curved and shortened.
Functions of breathing, closing lips	Breathing is done through the nose. The lips are closed, muscle tension is not visually or palpably determined, the nasolabial and chin folds are moderately pronounced.	Breathing is carried out through the mouth, through the nose and mouth. The nostrils are narrow, the mouth is slightly open, the lips are dry, the bridge of the nose is wide. The lips are open, muscle tension is noted when closing, the nasolabial folds are smoothed.
Speech production function	The pronunciation of sounds is correct.	Impaired pronunciation of sounds.
Swallowing functions	Swallowing is free, movements of facial muscles are invisible. The tongue rests on the hard palate behind the upper incisors (somatic variant).	Facial muscles and the neck muscles are tense, there is a “thimble symptom”, lip protrusion, the lower third of the face is enlarged. The tongue rests on the lips and cheeks (infantile version).
Bad habits	Not identified.	Sucking a finger, tongue, pacifier, biting lips, cheeks, etc.
Condition of the lymphatic system of the maxillofacial area.	are not palpable or mobile lymph nodes are identified, painless on palpation, elastic consistency, no larger than a pea (0.5 × 0.5 cm).	The lymph nodes are enlarged, painful on palpation, have a sweaty consistency, and are fused with the surrounding tissues.
Mobility of the temporomandibular joint	Movements of the head in the joint are free in all directions, smooth, painless. The amplitude of movement vertically is 40 mm, horizontally 30 mm.	Movements of the lower jaw are limited or excessive, spasmodic, painful on palpation, crunching or clicking is detected.
Shape of the auricle. The condition of the skin along the line of rotation of the maxillary processes with the mandibular ones.	Correct. The skin is smooth and clean.	Wrong. Along the line of rotation of the processes, in front of the tragus of the ear, deflections of the skin are determined, not changed in color, soft and painless on palpation (one should look for other symptoms of a violation of the formation of the I - II gill arches).
Condition of the skin and red border of the lips.	The skin is pink in color, moderate humidity, clean, moderate turgor.	The skin is pale or bright pink, dry, turgor is reduced, there are rashes (spots, crusts, papules, pustules, scratches, peeling, scars, blisters, vesicles, swelling).
Oral examination:
Condition of the mucous membranes of the lips and cheeks.	The mucous membrane of the lips is pink, clean, moist, veins are visible on the inner surface of the lips, and there are nodular protrusions (mucous glands). On the mucous membrane of the cheeks along the line of closure of the teeth there are sebaceous glands (yellowish-gray tubercles). At the level of the second upper molar there is a papilla, into the apex of which the duct of the parotid salivary gland opens. Saliva flows freely when stimulated, in children 6-12 months. - physiological salivation.	The mucous membrane is dry, bright pink, coated, and there are rashes of elements. In place of the mucous gland there is a vesicle (blockage of the gland). Along the line where the teeth meet there are their imprints or small hemorrhages - traces of biting. There are whitish spots on the mucous membrane of the upper molars. The papilla is swollen and hyperemic. When stimulated, saliva flows with difficulty, is cloudy, or pus is released. In children over 3 years old: hypersalivation.
Depth of the vestibule of the oral cavity.
The nature of the frenulum of the lips and cords of the mucous membrane.	The frenulum of the upper lip is woven into the gum at the border of the free and attached parts, in children during the period of primary occlusion at any level up to the top of the interdental papilla. The frenulum of the lower lip is free - when the lower lip is abducted to a horizontal position, there are no changes in the papilla. Lateral cords or ligaments of the mucous membrane, when stretched, do not change the condition of the gingival papillae.	Low attachment, bridle short, wide or short and wide. The frenulum of the lower lip is short; when the lip is retracted to a horizontal position, paleness (anemia) occurs and the gingival papilla peels off from the necks of the teeth. The ligaments are strong, attached to the interdental papillae and cause them to move when stretched.
Condition of the gums.	In schoolchildren, the gums are dense, have a pale pink color, and look like lemon peel. In preschoolers, the gums are brighter and their surface is smooth. The papillae in the area of single-rooted teeth are triangular, in the area of molars - triangular or trapezoidal, the gums fit tightly to the neck of the teeth. There is no dental plaque. Dental groove (groove) 1 mm.	The gingival margin is atrophied, the necks of the teeth are exposed. The papillae are enlarged, swollen, cyanotic, the apices are cut off, and covered with plaque. The gums peel off from the necks of the teeth. There are supra- and subgingival dental deposits. Physiological periodontal pocket more than 1 mm.
Tongue frenulum length	Tongue frenulum correct form and length.	The frenulum of the tongue is attached to the apex of the interdental papilla and, when stretched, causes it to move. The frenulum of the tongue is short, the tongue does not rise to the upper teeth, the tip of the tongue bends and bifurcates.
Condition of the mucous membrane of the tongue, floor of the mouth, hard and soft palate.	The tongue is clean, moist, the papillae are pronounced. The bottom of the oral cavity is pink, large vessels are visible, the excretory ducts of the salivary glands are located on the frenulum, salivation is free. The mucous membrane of the palate is pale pink, clean, in the area of the soft palate it is pink, finely lumpy.	The tongue is coated, varnished, dry, with areas of desquamation of the filiform papillae. The mucous membrane of the bottom of the oral cavity is swollen, hyperemic, and salivation is difficult. The rollers swell sharply. There are areas of hyperemia on the palate mucosa. Elements of defeat.
Condition of the pharyngeal tonsils.	The pharynx is clean, the tonsils do not protrude from the palatine arches. The mucous membrane of the palatine arches is pink and clean.	The mucous membrane of the pharynx is hyperemic, there are elements of damage, the tonsils are enlarged and protrude from behind the palatine arches.
Character of the bite.	Orthognathic, straight, deep incisal overjet.	Distal, mesial, open, deep, crossed.
Condition of the dentition.	Dental rows of correct shape and length. Teeth of correct anatomical shape, color and size, correctly located in the dentition, individual teeth with fillings, after 3 years physiological tremors.	The dentition is narrowed or expanded, shortened, individual teeth are located outside the dental arch, are absent, there are supernumerary or fused teeth. The structure of hard tissues has changed (caries, hypoplasia, fluorosis).
Dental formula.	Appropriate for age, healthy teeth.	Violation of the sequence and pairing of teeth eruption, carious cavities, fillings.
State of oral hygiene.	Good and satisfactory.	Bad and very bad.

Scheme of the indicative basis of action

examination and examination of the oral cavity, filling out medical documentation

Methodical techniques examination of the patient
Visual inspection.	Attention is drawn to the color of the skin of the face, the symmetry of the nasolabial folds, the red border of the lips, and the chin fold.
Examination of the vestibule of the oral cavity.	We pay attention to the color of the mucous membrane, the condition of the excretory ducts of the parotid salivary glands, the attachment points and size of the lip frenulum, and shape. Moisture of the periodontal papillae. On the mucous membrane and vestibule of the oral cavity, the frenulum, gingival groove, retromolar space are a risk zone.
Examination of the oral cavity itself.	We begin the examination with the mucous membrane of the cheeks, hard and soft palate, tongue, pay attention to the frenulum of the tongue, and the excretory ducts of the submandibular salivary glands, then we proceed to the examination of the teeth according to the generally accepted method, starting on the right on the lower jaw, then on the left on the lower jaw, on the left on the upper jaw and finally on the right side of the upper jaw. When examining teeth, we pay attention to the number of teeth, their shape, color, density, and the presence of acquired structures of the oral cavity. Special attention We pay attention to risk areas on teeth - these are fissures, cervical areas, and proximal surfaces.
Completing medical documentation.	After the inspection, and most often during the inspection, we fill out medical documentation and assess the patient’s health level and prescribe appropriate therapeutic and preventive measures

Situational tasks

A 3-year-old child was born to a healthy mother. In the first half of pregnancy, the mother had toxicosis. Does this child need prophylaxis if no pathology has been identified in the oral cavity?
A 2.5 year old child was born to a mother suffering from chronic pneumonia. During pregnancy, exacerbations of the disease were observed, the mother took antibiotics. The child has multiple caries in the oral cavity. Does this child need prophylaxis?
A four-year-old child was born to a healthy mother with a normal pregnancy; no changes in the oral cavity were detected. Does this child need prophylaxis?

List of literature for preparation for classes in the section

"Prevention and epidemiology of dental diseases"

Department of Pediatric Dentistry Omsk State Medical Academy ( IV semester).

Educational and methodological literature (basic and additional with the stamp of educational qualifications), including those prepared at the department, electronic textbooks, network resources:

Prevention section.

A. BASIC.

Pediatric therapeutic dentistry. National leadership: [with adj. on CD] / ed.: V.K. Leontiev, L.P. Kiselnikova. M.: GEOTAR-Media, 2010. 890 p. : ill.- (National Project “Health”).
Kankanyan A.P. Periodontal diseases (new approaches in etiology, pathogenesis, diagnosis, prevention and treatment) / A.P. Kankanyan, V.K. Leontiev. - Yerevan, 1998. 360s.
Kuryakina N.V. Preventive dentistry (guidelines for primary prevention of dental diseases) / N.V. Kuryakina, N.A. Savelyeva. M.: Medical book, N. Novgorod: NGMA Publishing House, 2003. - 288 p.
Kuryakina N.V. Therapeutic dentistry childhood / ed. N.V. Kuryakina. M.: N. Novgorod, NGMA, 2001. 744 p.
Lukinykh L.M. Treatment and prevention of dental caries / L.M. Lukinykh. - N. Novgorod, NGMA, 1998. - 168 p.
Primary dental prevention in children. / V.G. Suntsov, V.K. Leontiev, V.A. Distel, V.D. Wagner. Omsk, 1997. - 315 p.
Prevention of dental diseases. Textbook Manual / E.M. Kuzmina, S.A. Vasina, E.S. Petrina et al. M., 1997. 136 p.
Persin L.S. Pediatric dentistry / L.S. Persin, V.M. Emarova, S.V. Dyakova. Ed. 5th revised and expanded. M.: Medicine, 2003. - 640 p.
Handbook of pediatric dentistry: trans. from English / ed. A. Cameron, R. Widmer. 2nd ed., revised. And additional M.: MEDpress-inform, 2010. 391 p.: ill.
Dentistry of children and adolescents: Per. from English / ed. Ralph E. MacDonald, David R. Avery. - M.: Medical information Agency, 2003. 766 pp.: ill.
Suntsov V.G. Basic scientific works Department of Pediatric Dentistry / V.G. Suntsov, V.A. Distel and others - Omsk, 2000. - 341 p.
Suntsov V.G. The use of therapeutic and prophylactic gels in dental practice / ed. V.G. Suntsova. - Omsk, 2004. 164 p.
Suntsov V.G. Dental prevention in children (a guide for students and doctors) / V.G. Suntsov, V.K. Leontyev, V.A. Distel. M.: N. Novgorod, NGMA, 2001. 344 p.
Khamadeeva A.M., Arkhipov V.D. Prevention of major dental diseases / A.M. Khamdeeva, V.D. Arkhipov. - Samara, SamSMU 2001. 230 p.

B. ADDITIONAL.

Vasiliev V.G. Prevention of dental diseases (Part 1). Educational and methodological manual / V.G. Vasiliev, L.R. Kolesnikova. Irkutsk, 2001. 70 p.
Vasiliev V.G. Prevention of dental diseases (Part 2). Educational and methodological manual / V.G. Vasiliev, L.R. Kolesnikova. Irkutsk, 2001. 87 p.
Comprehensive program dental health of the population. Sonodent, M., 2001. 35 p.
Teaching materials for doctors, preschool teachers, school accountants, students, parents / ed. V.G. Vasilyeva, T.P. Pinelis. Irkutsk, 1998. 52 p.
Ulitovsky S.B. Oral hygiene - primary prevention dental diseases. // New in dentistry. Specialist. release. 1999. - No. 7 (77). 144 p.
Ulitovsky S.B. Individual hygienic program for the prevention of dental diseases / S.B. Ulitovsky. M.: Medical book, N. Novgorod: NGMA Publishing House, 2003. 292 p.
Fedorov Yu.A. Oral hygiene for everyone / Yu.A. Fedorov. St. Petersburg, 2003. - 112 p.

The staff of the Department of Pediatric Dentistry published educational and methodological literature with the stamp of UMO

Since 2005

Suntsov V.G. Guide to practical classes in pediatric dentistry for students of the pediatric faculty / V.G. Suntsov, V.A. Distel, V.D. Landinova, A.V. Karnitsky, A.I. Mateshuk, Yu.G. .Khudoroshkov. Omsk, 2005. -211 p.
Suntsov V.G. Guide to pediatric dentistry for students of the pediatric faculty / V.G. Suntsov, V.A. Distel, V.D. Landinova, A.V. Karnitsky, A.I. Mateshuk, Yu.G. Khudoroshkov. - Rostov-on-Don, Phoenix, 2007. - 301 p.
The use of therapeutic and prophylactic gels in dental practice. Guide for students and doctors / Edited by Professor V.G. Suntsov. - Omsk, 2007. - 164 p.
Dental prophylaxis in children. Guide for students and doctors / V.G. Suntsov, V.K. Leontyev, V.A. Distel, V.D. Wagner, T.V. Suntsova. - Omsk, 2007. - 343 p.
Distel V.A. Main directions and methods of prevention of dental anomalies and deformations. A manual for doctors and students / V.A. Distel, V.G. Suntsov, A.V. Karnitsky. Omsk, 2007. - 68 p.

Electronic tutorials

Program for ongoing monitoring of students' knowledge (preventive section).
Methodological developments for practical classes of 2nd year students.
“On increasing the efficiency of providing dental care to children (draft order dated February 11, 2005).”
Requirements for sanitary and hygienic, anti-epidemic regimes and working conditions for workers in non-state health care facilities and the offices of private dental practitioners.
Structure of the Dental Association of the Federal District.
Educational standard for postgraduate professional training of specialists.
Illustrated material for state interdisciplinary exams (04.04.00 “Dentistry”).

Since 2005, employees of the department have published electronic teaching aids:

Tutorial Department of Pediatric Dentistry Omsk State Medical Academyunder the section “Prevention and Epidemiology of Dental Diseases”(IV semester) for students of the Faculty of Dentistry /V.G.Suntsov, A.Zh.Garifullina, I.M.Voloshina, E.V.Ekimov. Omsk, 2011. 300 Mb.

Videos

Educational cartoon on teeth cleaning from Colgate (pediatric dentistry, prevention section).
“Tell Doctor”, 4th scientific and practical conference:

G.G. Ivanova. Oral hygiene, hygiene products.

V.G. Suntsov, V.D. Wagner, V.G. Bokaya. Problems of dental prevention and treatment.

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