Download The Diary of the production practice for the students of dental faculty

Danylo Halytskyj Lviv National Medical University
Department of Therapeutic dentistry
RECOMMENDATIONS FOR PRACTICAL
WORK IN CONSERVATIVE DENTISTRY FOR
THE IVth YEAR STUDENTS OF DENTAL
FACULTY
Lviv-2013
Authors: O. Ripetska, M. Hysyk
Edited by prof. Volodymyr Zubachyk
Reviews: assist. assist. prof. L. Chervinska, assist. prof. N.
Krupnyk, assist. prof. O. Matvijchuk
Computer printing by Oxana Kochegarova
Danylo Halytskyj Lviv National Medical University,
Lviv-2013
Методичні рекомендації обговорені та схвалені на
засіданні
профільної
методичної
комісії
зі
стоматологічних дисциплін (протокол №___ від „____”
__________ 2013 року).
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Practical training for students of higher medical
educational establishment of the III-IV levels of accreditation
is an important link in the training of doctor and an integral
part of education. Teaching process and practical training are
closely interrelated.
The programme of practical training for the 4-year
students of institutions of higher medical education of the IIIIV levels of accreditation is worked out on speciality
„Dentistry” 7.110101 following the recommendations of the
educational- and qualified characteristic (EQC) as well as
vocational programme (VP) of specialists’ training approved
by the Ministry of Health Care of Ukraine (Order No239 dated
from 16.04.2003) and curriculum approved by the Ministry of
Health Care of Ukraine (Order No414 dated from 23.07.2007).
The goals of the practical training for the 4-year
students of Dentistry Faculty are in:
- strengthening knowledge and practical skills;
- extending and improvement of the students
academic and professionally – oriented experience;
- the ability to cope professionally with the working
conditions during the students practical training in
medical institutions;
- familiarizing with the peculiarities of the
physician’s work both in municipal (city) and
regional medical establishments;
- becoming familiar with the organization of the
medical, prophylactic work; with the principles of
ethic and medical deontology; with the skills of
samitary- and elucidative work;
- investigating the ways of health care organization
within the tasks, envisaged by the educational and
professional programme in specialists’ training on
„Dentistry”.
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The organization of education is carried out in
accordance with the modular credit transfer system and
modular rating assessment system according to the
Regulations of the Ministry of Health Care of Ukraine (Order
No414 dated from 23.07.2007). The extent of practical
training for the 4-year students includes: 4,5 credits, equal to
135 hours, including 45 hours for self-study.
The structure of practical training in dentistry for the ІV
years students of Dental Faculty
The structure of
practical training
Number of credit
hours ECTS
Module 1. Practical
training in
therapeutic dentistry
135 hours
4,5 credits
Type of
control
Current
educational
and final
module
control
Department
Therapeutic
Dentistry
The programme of practical training is presented by 1
module. According to the curriculum and syllabus, the
students of the Dentistry Faculty do their practical training
executing the functions of dental auxiliary/chair side assistant.
The duration of their practical training, is 2 weeks. The
institution of higher medical education and the bases of
practical training conclude a bilateral agreement as to the
forthcoming medical practice and its schedule (the document
should be signed by 2 parties/sides with 2-month interval
preceeding the beginning of the medical practice).
Out-patient departments of the regional municipal
(urban) and district hospitals; stomatological polyclinics and
private clinics. May serve as well – suited bases for practical
training. The succession of the practical training may be
determined by the institution of higher medical education
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individually and may be changed in case of need. The
students’ practical training is a form of their self-independent
work. The quality of the above work is supervised and by both
the Head (manager) of the bases of practical training and the
university teacher – employee of the Department of
Therapeutic Dentistry. The administration (authorities) of the
institution of Medical education is responsible for the
organization and supervision of the students’ medical practice.
Highly specialized, narrow purpose departments are
responsible for the educational and methodical realization and
for completing the programme of practical training.
The general organization of medical practice at the
university and its control is accomplished by the Head of the
Department of Medical practice. Rector of the University
authorizes the experienced university subject teachers (who
are engaged in the teaching process on therapeutic dentistry) to
execute the functions of managers (supervisors of practical
training).
The forms of control and assessment system meet both
the requirements of practical medical training programme and
assessment criteria should be done by specially trained
assessors in accordance with the modular credit transfer
system and modular rating assessment system approved by the
Regulations of the Ministry of Health Care of Ukraine (2005,
2009). The final modular control of practical medical practice
is carried out after its completion by the university teachers.
The aim of the practical medical practice is to:
- gain and consolidate the experience defined by the
programme of vocational education for specialists’
training on „Dentistry”;
- interview and examine patients as well as the
analyzing the obtained results;
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-
-
-
plan the schemes of parodontological patients
depending on the peculiarities of the clinical course
of a disease;
analyze the results of the laboratory tests and
instrumental investigations;
determine the main pathological symptoms in
periodontal pathology;
carry out the differential diagnosis of the main
disease of periodontium, methods of diagnosis and
rendering the urgent medical (dental aid);
gain practice in moral-deontological principles of
medical specialist and principles of professional
subordination.
Principles of occupational health service and professional
hazard in dental practice
Dental room is a workplace of a dentist Dental health
team (dentists and dental auxiliary) while rendering aid to
dental patients are at high potential risk to their health to be
infected by inside – hospital infection.
Cross infection is a major occupational hazard in dental
practice. Cross-contamination can occur by direct contact with
microorganisms indirect contact with contaminated objects
droplet transmission and inhalation of airborne pathogene.
Both dental health care workers and dental patients may be
exposed to a great variety of microorganisms via oral or
respiratory secretions, blood etc. These microorganisms may
be: human immunodeficiency virus (HIV), viral hepatitis (B,
C), herpes simplex virus, infection, of the upper respiratory
tract, tuberculosis (TB), staphylococci, streptococci,
infections, grippe, adenovirus, syphilis, candidosis, etc.
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Efforts to present the spread of inside – hospital
infection and to protect both dental health team and patients
should include improved surveillance, risk assessment,
evaluation of measures to prevent exposure and studies of
prophylaxis. It is necessary to maintain hygiene in the dental
room and to follow – the sanitary and disinfectant regimen.
Such may lead to development of safer and more effective
devices, work practices and personal protective equipment.
Every dental patient on his/her first visit must be
provided with a patient’s dental record (form No043/0). The
dentist is to fill in all significant data about the dental patient:
family case history (past infectious diseases) and present case
history.
Despite taking accurate medical history, it may not be
known if a patient is carrying an infectious and dangerous
virus. Most patients are asymptomatic and, therefore not
identifiable. Thus, it is reasonable to assume that every patient
is a potential bacilli-carrier. That is why, it is obligatory for the
dentist as well as for dental health team to use individual
protective means: face shields, or surgical marks, disposable
gloves disposable needle, puncture – proof containers,
protective eyewear, etc.
Individual protective means
Individual protective means include:
- protective clothes;
- gloves;
- mask;
- glasses or shields.
Protective clothes. Medical gowns, caps, spare
(changeable) footwear are to protect the skin and the dentist’s
outer-clothes from blood, saliva, pus and other substance of
biological and non-biological origin. In case the working
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clothes become dirty due to the blood or some other biological
substances, a complete chemical treatment should be done.
The sanitary clothing should be kept in personal
cabinets, separately from other clothes. Dentists and medical
personnel are forbidden to eat, to smoke or to be outside the
dental clinic if they wear the sanitary working clothes.
Gloves. Latex gloves prove to be the effective
protection of dentist’s skin from the contact with the damaged
surface of the oral mucosa, blood, pus and liquid from the
patient’s mouth. Latex gloves are valid for one occasion only.
It is forbidden to use them twicely for another patient even if
they underwent a thorough disinfection. It should be
emphasized that disinfectants and detergents may damage the
gloves and as a result they may lose their protective power.
As a role, latex and vinyl gloves are used on examining
and treatment of patients. The rubber gloves should be used
while working with disinfectants and detergents. A thorough
hygienic cleaning of hands should precede the use of new pair
of rubber gloves.
Masks. The protective face masks and respirators serve
as reliable shield for the skin and oral mucous membranes of
the dentists from blood, liquid from the mouth of a patient.
Non-disposable protective masks are used only for one patient.
4-stratal masks are to be replaced for the new ones every 4
hours.
Glasses, shields (protective screens). The dentist must
take all necessary precautionary measures in order to protect
himself from the patient’s blood and liquid from the oral
cavity. Protective glasses and face shields (screens) serve a
reliable barrier for the upper part of the dentist’s face. The
disinfecting cleansing of the protective glasses and shields
should be done each time before a visit of the next patient. For
this purpose a serviette, soaked with a – 70% – alcohol
solution or disinfectant solution will do the best. Hands should
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be scrubbed and washed between patients in a disinfectant
solution before glowing. Any cuts and abrasions on the
dentist’s skin should be covered with waterproof dressings.
Disposable rubber gloves should be worn routinely. It should
be kept in mind that disposable articles are for single use only
and should be discarded appropriately.
The students must know: principles of Health care
Legislation of Ukraine the ways of organization of medical
work in therapeutic dentistry department; modern
classification of diseases; clinical, laboratory and instrumental
diagnostics of diseases tactics of treatment of the main
diseases in outpatient conditions and indications for
hospitalization of patients; contingents of patients that need
dispensary’s supervision.
The student must be able to: see patients, make a
diagnosis and render medical aid in outpatient department,
elicit the necessity of prophylactic medical examination and
define to what group should the patient be referred, give
recommendations as to the next examination and treatment;
administer an adequate psychotherapy, give advices as to the
diet, regime and occupation, physical culture, body hardening,
rest, hygiene, etc., direct a patient to the physiotherapeutic unit
for treatment.
During the practical training the students as dentist’s
assistant must be able to:
- render medical aid to patients in time and
professionally;
- be attentive to patient’s complaints;
- examine a patient thoroughly in order to make a
precise diagnosis and administer a proper
treatment;
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-
to perform the necessary medical manipulations
(interventions) under the supervision of a dentist
(curator) of the practical training.
Student’s while doing (undergoing) the practical
training must:
- be informed preliminarily by the Head of the
Department of Practical Training as to the duration
of practical training and the list of documents
required for dental practice, etc.;
- submit a direction from a dean’s office to be
allowed to undergo the practical training;
- come to the base of practical training at the right
time;
- fulfil his/her work quota envisaged by both the
programme of practical training and instructions of
the curators;
- learn and keep strictly to the labour safety
measures, accident prevention and sanitary-andhygienic standards;
- keep to the established order and regulations in the
clinic;
- keep a diary of practical training and other
documents stipulated by the programme of practical
training;
- pass the summative (final) module control in time.
Educational-and-scientific work
of
students
(ESRW)
The educational-and-scientific work of the 3-year
students of the Dentistry Faculty during their practical training
is an important form of top-quality and effectiveness of
cognitive, creative process that estimates the quality of the
dentist’s everyday work.
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The students’ educational-and-scientific research work
favours the deeper perception of a discipline (subject), assists
in developing the skills in analyzing and summarizing the
results obtained during the examination of a patient; stimulates
the ability to well-reasoned and logical conclusion in making
the clinical diagnosis and in prognosing the further, course of a
disease.
A great number of questions the students come across
while taking care of patients as well as the working indices of
the department are special preferences in determining the
theme of the ESRW. ESRW may include: stage-by-stage,
epicrisis, abstracts, reports at the clinical conferences.
The demands to the ESRW are as follows: the aim, the
main task, materials and methods and methods of
investigations, obtained results, discussion, conclusions, a list
of reference literature.
Program of students’ practical training is presented by one
module.
The structure of final module control 1
№
The content of practical lessons
Hours
1.
Principles of the organization of periodontal
department. Safety precautions. Rules of keeping
documentation. Ethics and deontology during the work
with patients.
Prophylactic measures in case of emergency in dental
clinic (collapses, hypertension, crisis, anaphylactic
reactions, etc).
Treatment of patients. Methods of investigations.
Conduction on the main clinical methods of patients
examination in periodontology. Estimation of obtained
data.
Treatment of patients. Special methods of diagnostic of
periodontal diseases. Periodontal indices. Results of
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2.
3.
4.
6
6
6
11
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
estimation.
Treatment of patients. X-ray diagnostic in periodontal
pathology.
Treatment of patients. Functional estimation of
periodontal and teeth condition (stomatoscopy,
investigation of the periodontal capillary firmness, test
of Kulazhenko, reography). Estimation of the obtained
data. Keeping of medical records.
Treatment of patients. Inflammatory periodontal
diseases − papillitis, gingivitis, localized periodontitis.
Clinical examination and diagnosis. Estimation of the
main syndromes. Differential diagnosis. Decision of
final diagnosis and methods of treatment. Keeping of
medical records.
Treatment of patients. Dystrophic-inflammatory and
dystrophic
periodontal
diseases
(generalized
periodontitis, periodontosis) Clinical examination and
diagnosis. Estimation of the main syndromes.
Differential diagnosis. Decision of final diagnosis and
methods of treatment. Keeping of medical records.
Treatment of patients. General principles in the
treatment of periodontal diseases. Plan of treatment for
the patients with periodontal pathology.
Methods of conduction of professional oral hygiene.
Different methods for removal of dental calculus.
Prescription of medications in patients with
periodontal pathology. Periodontal dressings. Filling
in of out-patient medical record.
Methods of conduction of closed and open curettage.
Filling in of out-patient medical record.
The method of splinting of movable teeth in
periodontitis. Filling in of out-patient medical record.
Treatment of patients. General treatment, indication
and contraindications in periodontal patients.
Medications used in general treatment. Physiotherapy
in periodontal diseases.
Treatment of patients. The practical use of hygienic
appliances and remedies in dentistry. Prescription of
different hygienic methods and appliances in complex
treatment of periodontal patients. Compulsory
examinational check-ups (dispensarization) of the
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6
6
6
6
6
6
6
6
6
12
15.
patients in periodontal treatment. Distribution of
patients in the special groups according to the
treatment needs, providing of maintenance care in
periodontology.
Final module control
Total hours
6
90
Types of self-education work for student during practical training
(45 hours)
№
1
2
3
4
5
6
7
8
9
10
Topic
Aseptic and antiseptics. Sterilization
and
taking
care
of
dental
instruments.
Estimation of leading symptoms in
periodontology.
Criterions
in
estimation of periodontal condition.
Rendering of emergency help.
Writing of medical (dental) history
report.
Documentation in periodontology.
Laboratory methods of investigation
in periodontal patients (clinical,
biochemical,
cytological,
microbiological,
immunological,
morphological).
Functional estimation of periodontal
and teeth condition (stomatoscopy,
investigation of the periodontal
capillary
firmness,
test
of
Kulazhenko, reography).
Estimation of the main periodontal
symptoms.
Classification of treatment methods
in periodontology.
Idiopathic
diseases
of
the
periodontium.
Analysis
of
the
results
of
Hours
3
Type of control
3
3
Змістовий
модульний
контроль
3
3
3
3
3
3
3
13
cytological,
microbiological,
histological investigations.
11 Conduction and estimation of
editional methods of patients
examination.
12 Methods
of
elimination
of
periodontal pockets and gingival
recession.
13 Methods
of
local
surgical
procedures.
Gingivotomy,
Gingivectomy.
14 Prostatic
treatment
in
periodontology. Occlusal adjustment.
Temporary splinting.
15 Algorithms of individual hygiene of
oral cavity in patients with different
periodontal pathology.
Total hours
The
structure of
practical
training
Module 1.
Practical
training in
therapeutic
dentistry
Number of hours
Number Practical
of credit classes
hours
ECTS
135
hours
90
hours
4,5
credits
3
3
3
3
3
45
Conversion of
marks into grades
Self
study
Minimal
number of
grades
„5” „4” „3” „2”
8,5
7
5
0
70
(5 grades ×
14 days)
45
hours
Forms of control and assessment system of practical
training are performed in accordance with the programme of
medical practice for the 4-year students of the Dentistry
Faculty III-IV levels of Accreditation (2009) and instructions
as to the assessment systems of the Ministry of Health Care of
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Ukraine, the modular credit transfer system and modular rating
system is being introduced and approved in Ukraine (2005).
The mark for the module is equal to the sum of all
marks of the current control of the thematic modules in grades
and the mark for the Final module control in grades. These
forms of assessment are used to check the level of students’
practical skills that corresponds to the list of various types and
techniques stipulated by the programme of practical training.
The highest possible number of grades the student may
receive (credit test) is 200 grades, including both the marks for
the thematic module – 120 grades and the results of the Final
module control – 80 grades.
The current control of the students’ activities in the
therapeutic department of the polyclinic is monitored by the
university subject teaches and the managers of the base’s
practical training. The current control is carried out on each
thematic module. Every student is imposed to keep a daily
diary of practical training while the managers of practical
training and university teachers are to sign it. After completing
the thematic module the student must fill in the summary
report. The student is allowed to take the Final module control
only in case if the above-mentioned report is filled in properly
and signed.
Both managers of the base’s practical training and the
university teachers analyze:
- the work done by the student in the departments;
- his/her discipline and behavior;
- attendance or non-attendance of practical training;
- the quality of keeping the dairy with reasoning and
exact wording of diagnosis and defining the plan of
examination and treatment;
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-
the level of practical skills and their use in clinical,
laboratory and instrumental diagnostics;
- participation in the emergencies;
- the use of ethical and deontological principles in
medical practice.
The summary report on each of the thematic module
makes it possible for the evaluators to assess the student’s
activities in the proper way. If the practical skills acquired by
the students are less than 50% (no less than 15 grades out of
30 for each thematic module), then those students who
received 60 grades out of 120 for 4 thematic modules are
allowed to take the Final module control.
Each theme of the thematic module is estimated in
accordance with the 4-grade assessment criteria (traditional
scale), later the marks are converted into grades. The
programme stipulates the conversion of traditional makes into
grades:
Traditional mark
Conversion into
grades
„5”
„4”
„3”
„2”
8,5
7
5
0
The Final module control takes place during the last
practical class (control lesson), on condition that all the themes
of the module which were to be learned are completed.
Those students who completed all types of work
envisaged by the curriculum; can show the documents that
meet the requirements (learning diary and summary-figure
report) and received no less than 75 grades are allowed to take
the Final module control.
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The forms of the Final module control are to be
standardized. Both theoretical and practical training practical
skills and gained experience that are demonstrated by the
students are to be the components of the summative module
control.
The highest possible number of grades the student may
receive (during the module control) is 80 grades. The Final
module control is validated if the student received no less than
50 grades.
Marks on discipline (subject) should be awarded to
those students who:
- succeeded in completion the programme of
practical training;
- have all the necessary documents that meet the
requirements;
- received no less than 75 grades for their current
activities;
- passed their Final module control for no less than
50 grades.
No
1.
2.
3.
4.
5.
The list of practical skills for the Final module control from
thematic module No1
Content of practical training (Titles)
No of
hours
Prepare the dental unit, working place, dental equipment
4
for work in therapeutic dentistry. Safety precautions during
the work in dental office.
Be able to render the first medical aid in emergency cases.
4
Open the periodontal abscess.
Be able to conduct clinical examination of the patient with
4
periodontitis. Filling in of out-patient medical record.
Be able to measure gingival and periodontal indices and
4
check the results.
Be able to conduct additional methods of investigations in
4
patients with periodontal diseases – Kulazhenko test,
reoparodontography.
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6.
Be able to analyze X-rays of teeth and periodontal
structures.
7.
Analyze the results of laboratory methods of investigations
in periodontal patients (clinical, biochemical, cytological,
microbiological, immunological, morphological).
8.
Conduct professional hygiene in periodontal patients.
9.
Conduct the occlusal adjustment in periodontal patients.
10. Be able to conduct irrigations, instillations and applications
of the medications in periodontal patients.
11. Conduct the procedure of close curettage of periodontal
pockets in periodontal patients.
12. Preparation of hard and partly hard periodontal dressings in
periodontal patients.
13. Recommend the general treatment according to the stage of
periodontal pathology. Prescriptions of recipes.
14. Decide the indications to physiotherapeutic treatment.
Filling in of out-patient periodontal record.
15. Demonstrate the skills to conduct diatermocoagulation and
electrophoresis in therapeutic dentistry.
16. Demonstrate the skills to check the periodontal capillary
firmness (test of Kulazhenko) in periodontal patients.
17. Demonstrate the skills of professional hygiene of oral
cavity.
18. Decide the group of patients for compulsory check-ups
(dispensarization) in periodontal treatment. Be able to
distribute the patients in special groups according to the
treatment needs and provide the maintenance care in
periodontology.
19. Choose the proper hygienic appliances according to the
treatment needs and the stage of periodontal treatment.
20. Sanitation education work with the periodontal patients.
Discussions and lectures with the patients.
Total hours
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
80
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19
PERIODONTAL DISEASES
Classification of the periodontal diseases by
Danilevskij N.F., 1994
I. Inflammatory diseases.
1.
Gingivitis.
Papillitis
(inflammation
of
interdental papillae).
Forms: catarrhal, hypertrophic, ulcerative, atrophic.
The course of the disease: acute, chronic.
The depth of the lesion: in the gingival tissues,
osteoporosis of interdental septa.
The spread of the pathological process: localized,
generalized.
2.
Localized periodontitis
Forms: catarrhal, hypertrophic, ulcerative, atrophic.
The course of the disease: acute, chronic.
The depth of lesion: gingival tissues, alveolar bone.
The stage of disease progression: initial stage, I stage,
II stage, III stage.
The spread of the pathological process: localized.
II. Dystrofic – inflammatory diseases.
1. Generalized periodontitis
The course of the disease: chronic, exacerbated,
stabilized.
The stage of the disease progression: initial stage, I
stage, II stage, III stage.
The spread of the pathological process: diffuse process
in the periodontal tissues.
2. Periodontosis (Parodontosis).
The course of the disease: chronic.
The stage of the disease progression: initial stage, I
stage, II stage, III stage.
20
The spreading of the pathological process: diffuse
injury of the periodontal tissues.
III. Progressing idiopatic diseases of the
periodontium.
1. Periodontal diseases in the presence of
haematologic diseases (cyclic neutropenias,
leukemias, agranulocytosis).
2. Histiocytosis
X:
eosinophylic
granuloma
(Taratynov’s diseases).
3. Periodontal diseases in endocrinologic diseases
(Niemann-Pick disease, Gaucher's disease,
Papillon-Lefevre syndrome).
4. Periodontal condition in inherent diseases (Down
syndrome, akatalasia, desmodontosis).
IV. Tumor-like processes in the periodontal tissue
Benign tumors
Malignant tumors
CLASSIFICATION OF PERIODONTAL DISEASES
according to the 1999 International Workshop for
Classification of Periodontal Diseases and Conditions in Oak
Brook (Illinois, USA), 30. 10. 1999 to 2. 11. 1999. The first
international workshop on classification of periodontal
diseases.
Following intensive discussions based on a comprehensive
review of literature a decision was made on a new
classification of the diseases. The following classification of
periodontal diseases was proposed:
I. Gingival diseases (G)
II. Chronic periodontitis (CP)
III. Aggressive periodontitis (AP)
21
IV. Periodontitis as a manifestation of systemic diseases
(PS)
V. Necrotizing periodontal diseases (NP)
VI. Periodontal abscesses
VII. Periodontitis with endodontic lesion
VIII. Developed and acquired deformations and conditions
I. Gingival diseases (G)
A. Gingival diseases caused by plaque
1. Gingivitis exclusively caused by plaque
a. With no local modifying factors
b. with local modifying factors (see VIIIA)
2. Gingival diseases modified with systemic factors
a. connected with hormonal influences
1) gingivitis connected with puberty
2) gingivitis connected with the menstrual cycle
3) connected with pregnancy
a) gingivitis in pregnancy
b) pyogenic granuloma
4) gingivitis connected with diabetes mellitus
b. connected with blood disease
1) gingivitis connected with leukaemia
2) other diseases
3. Gingival diseases modified by application of
medications
a. gingival diseases caused by medications
1) gingival growths caused by medications
2) gingivitis caused by medications
a) gingivitis connected with oral contraceptives
b) other medications
4. Gingival diseases caused by malnutrition
a. gingivitis due to lack of vitamin C
b. others
22
B. Gingival lesions not induced by plaque
1. Gingival diseases of specific bacterial aetiology
a. lesions connected with Neisseria gonorrhoeae
b. lesions connected with Treponema pallidum
c. lesions connected with streptococci
d. others
2. Gingival diseases of viral aetiology
a. infection with the herpes virus
1) primary herpetic gingivostomatitis
2) recurring oral herpes
3) varicello zoster infection
b. others
3. Gingival diseases of fungal aetiology
a. infection with candida
1) generalised gingival candidiasis
b. linear gingival erythema
c. histoplasmosis
d. others
4. Gingival diseases of genetic aetiology
a. inherited fibromatosis of the gingiva
b. others
5. Systemic diseases which manifest on the gingiva
a. changed mucous membrane
1) lichen planus
2) pemphigoid
3) pemphigus vulgaris
4) erythema multiformis
5) lupus erythematosus
6) caused by medications
7) others
b. allergic reactions
1) material in restorative dentistry
a) mercury
b) nickel
23
c) acrylic
d) others
2) reaction to:
a) toothpaste
b) mouthwashes
c) additives in chewing gum
d) nutritive substitutes
3) others
6. Traumatic lesions (iatrogenic, accidents)
a. chemical
b. physical
c. thermal
7. Reaction to foreign bodies
8. Not otherwise defined
II. Chronic periodontitis (CP)
A. Localised
B. Generalised
III. Aggressive periodontitis (AP)
A. Localised
B. Generalised
IV. Periodontitis as a manifestation of systemic diseases
(NP)
A. Connected with blood diseases
1. Acquired neutropenia
2. Leukaemia
3. Others
B. Connected with genetic disorders
1. Family or cyclic neutropenia
2. Down’s syndrome
3. Leucocyte adhesive deficiency syndrome
4. Papillon-Lefevre syndrome
5. Chediak-Higashi syndrome
6. Histiocytosis or eosinophilic granuloma syndrome
7. Glycogen storage syndrome
24
8. Infantile genetic agranulocytosis
9. Cohen’s syndrome
10. Ehlers-Danlos syndrome, type IV and VIII AD
11. Hypophosphatasia
12. Others
C. Not otherwise defined
V. Necrotizing periodontal diseases
A. Necrotizing ulcerous gingivitis /NUG)
B. Necrotizing ulcerous periodontitis (NUP)
VI. Periodontal abscesses
A. Gingival abscess
B. Periodontal abscess
C. Pericoronal abscess
VII. Periodontitis with endodontal lesions
A. Combined paro-endo lesion
VIII. Developmental and acquired deformation and
conditions
A. Localised dental factors which encourage plaque,
caused by gingivitis / periodontitis
1. Anatomy of the teeth
2. Reconstruction of teeth/effect of the device
3. Fractured root
4. Resorption of roots and (cement pearls)
B. Mucogingival deformities and relations in the tooth
vicinity
1. Recession
a. facially and orally
b. approximally
2. Lack of gingival keratinization
3. Shortened gingival attachment
4. Localisation of the tongue or lip frenulum
5. Gingival enlargement
a. Pseudo-pockets
b. Irregular development of the gingival edge
25
c. Excessive gingival presentation
d. Gingival enlargement (see I.A.3. and I.B.4.)
6. Abnormal staining
C. Changed mucous membrane on an edentulous ridge
1. Loss of vertical or horizontal bone dimension
2. Loss of gingiva, i.e. keratinized tissue
3. Gingival growths, i.e. of soft tissue
4. Abnormal localisation of the tongue or lip frenulum
5. Reduced vestibulum depth
6. Abnormal staining
D.Occlusal trauma
1. Primary occlusal trauma
2. Secondary occlusal trauma
When the new classification is analysed essential
differences can be seen compared to the classification of 1989,
which was used in previous years. Contrary to the former
classification, which did not include gingival diseases, the new
classification classifies them in two groups: gingival diseases
caused by plaque and those not caused by plaque.
The term „adult periodontitis (AP) has been changed to
chronic periodontitis (CP)”. The term AP was the cause of
constant dilemma for clinicians, due to the fact that this type of
periodontitis can also be found in adolescents. Consequently,
the term „adult” was completely unsuitable with regard to the
age of such subjects. The term CP, therefore, is more suitable
as it is not limited by the age of the patient. Some of the
characteristics of CP are:
 Generally occurs in adults but can also occur in children
and adolescents.
 Periodontal destruction is clearly related to local irritating
factors.
 Frequent presence of subgingival plaque.
 Microbial composition of the plaque varies.
26
 Usually of slow progression, with possible active
recurrence.
 May be further classified on the basis of distribution and
degree of severity.
 May be associated with a local specific factor, particularly
iatrogenic irritation.
 May be modified or associated with systemic diseases (e.g.
diabetes mellitus or HIV-infection).
 May be modified with risk factors, e.g. tobacco smoking
and emotional stress.
With regard to involvement CP is divided into
„localised” when it involves less than 30%, and generalised”
when it involves more than 30% of the affected area. Based on
the degree of severity and loss of attachment (CAL), CP may
be mild (CAL = 1-2mm), moderate (CAL = 3-4mm) and
advanced (CAL>5mm).
The term „Early-onset periodontitis”, which was used
earlier (AAP 1989 and the European Classification 1993) and
which included different periodontal diseases in young people
(prepuberty, juvenile, rapid progressive periodontitis), has
been changed to „aggressive periodontitis” (AP). Some of the
characteristics of AP are:
 Apart from periodontitis patients are clinically healthy.
 Tissue destruction is rapidly progressive.
 Significant frequency in the family.
 Disparity between the amount of the bacterial deposit and
the extent of tissue destruction.
 Increased number of bacteria of the genus Actinobacillus
Actinomycetemcomitans, and in some populations P.
gingivalisa.
 Abnormal phagocytic function.
 Hyperreactive phenotype macrophage with increased PGE2
and ILs production.
27
 Tissue destruction may be self-limiting.
AP can be localised and generalised. The localised
form commences during puberty, involving first the molars
and the central incisors, and has a high antibody titar against
the verified bacteria. The generalised form occurs in patients
younger than 30 years, with loss of attachment of at least three
teeth, apart from the first molars and central incisors. There is
acute exacerbation and the antibody titar against the verified
bacteria is low.
The new classification no longer contains „refractory
periodontitis”, and ulceronecrotic periodontitis has been
changed by the term „Necrotizing Periodontal Diseases”.
Other categories have also been added, „Periodontal
Abscesses”, „Periodontitis with Endodontal Lesions” and
„Developmental and Acquired Deformations and Conditions.
At first sight the new classification appears
complicated and too comprehensive, particularly from the
clinical aspect. However, some of the former classifications
which looked much simpler were frequently unsuitable and
confusing to use. The new classification of periodontal
diseases has on the whole removed the dilemma with regard to
some terms and has thus facilitated application in practice. As
previously remarked neither is this classification ideal.
However, it is the first time that a group of internationally
acknowledged experts have produced a generally accepted and
scientifically founded classification of periodontal diseases.
While treating periodontitis, the student has to confirm
his/her knowledge of examining the patients, to learn how to
use indices in estimating periodontal conditions, to make the
proper diagnosis, and to plan the treatment. The student should
be able to scale and polish the exposed tooth cementum, to
perform the medicational treatment of periodontal tissues, to
apply periodontal dressings. It is essential for a future dental
practitioner to have a profound knowledge of medicines used
28
in periodontal treatment and to write out prescriptions
correctly as well as to prescribe appropriate physiotherapeutic
manipulations. The student has also to educate patients
concerning the prophylactic measures in oral hygiene and
periodontal hygiene in particular.
INTERNATIONAL CLASSIFICATION OF THE
DISEASES, 1998
All the necessary for Health services information is
included in the international diseases classification with the
series of modules, connectected with the „family”
classification conception. This classification is build in three
and four steps levels of alphabet-figure scheme of coding,
what gives the possibility to balance chapters contents and
leave enough space for future changes.
Diseases of oral cavity, salivary glands and jaws as a
separate part K00-K14 are included into group of the Diseases
of digestive system class XI part K00-K93. This class has 9
part more of digestive system diseases: based on anatomical
classification.
The abbreviator (WFI) – without future instructions.
29
Diseases of oral cavity, salivary glands and jaws
(K00-K14)
К05
Gingivitis and Periodontal diseases
К05.0 Acute gingivitis
With the exception: acute necrotizing ulcerative
gingivitis (А69.1)
Herpetic gingivostomatitis (В00.2)
К05.1 Chronic gingivitis
Gingivitis (chronic):
 WFI
 Desquamative
 Hyperplastic
 Simple marginal
 Ulcerative
К05.2 Acute periodontitis
Acute periocorontitis
Periodontal abscess
With the exception:
acute apical periodontitis (К04.4)
periapical abscess (К04.4)
with a cavity (К04.6)
К05.3 Chronic periodontitis
Chronic pericoronitis
Periodontitis:
 WFI
 Complicated
 Simple
30
К05.4 Periodontosis
Juvenile periodontosis
К05.5 Other periodontal disease
К05.6 Periodontal disease without precise definition
К06
Other diseases of gums and toothless alveolar
process (K08.2)
With the exception: (atrophied) toothless alveolar
process (К08.2)
gingivitis:
 WFI (К05.1)
 acute (К05.0)
 chronic (К05.1)
К06.0 Gingival recession
Gingival recession
(generalized)
(postinfectional) (postoperative)
(localized)
К06.1 Gingival hypertrophy
Gingival fibromatosis
К06.2 Injuries of gums and toothless alveolar process,
connected with trauma
Hypertrophy due to the irritation of toothless
alveolar process (hypertrophy due to the prosthetics)
If necessary indentificate the reason with additional
code of external reason (class ХХ)
31
К06.8 Other specified lesions of gums and toothless
alveolar process
Fibrous epulis
Atrophied toothless alveolar process
Giantcell epulis
Peripheral giantcell granuloma
Piogenic gums granuloma
К06.9 Lesions of gums and toothless alveolar process
not specified
32
LIST OF TOPICS FOR RESEARCH DURING
PRACTICAL TRAINING.
PERIODONTOLOGY
1. Carry out index estimation of periodontal tissues condition
using:
- gingival index PMA,
- gingival index,
- periodontal index
- CPITN
In all the indices make tables with explanations of their
calculating.
2. Evaluate oral hygiene by the indices
- Fedorov-Volodkina index,
- Green-Vermilleon index,
Present results in the table and explain the procedure of
calculation.
3.
Determine Shilerew-Pisarev test in 10 patients with
inflammatory periodontal diseases and in 10 healthy
persons. The work can be presented as short commentary
at the Students’ Scientific Society.
4.
Carry out X-ray estimation of the periodontal status in
gingivitis and periodontitis.
Results present in the table.
5. Research the organization of dental patients care at the
clinical base (number of patients under observation,
number of departments and subdepartments, provision of
the clinic with the necessary equipment, the presence of
33
specialized dental rooms, the clinical staff, annual and
weekly dentist’s work load).
Present as passports with the tables and commentaries.
34
EXAMPLE OF THE DIARY
№
Date
First and
second name,
date of birth
Visit
Complaints
Objective
examination
1.
20.07.0
3
Pavluk N.P.,
1952
1
Gingival bleeding
on
the
teeth
brushing
and
mastication
Gingival papillae
are
bluish,
oedematic
and
bleed on probing,
periodontal
pockets 3-4 mm,
supra- and subgingival calculus,
GI – 2 points
Diagnosis
Chronic
generalized
periodontitis,
I stage
Treatment
Anesthesia,
scaling,
polishing of
roots cement,
closed
curettage,
paste
with
antioxidants,
periodontal
dressing
„Repin”
Recommendat
ions:
- individual
oral
hygiene,
- dispensary
check-ups
35
36
SUMMARY REPORT OF THE CARRIED OUT
WORK
IN PERIODONTOLOGY
№
1.
2.
List of practical skills
Number of working days
Patients’ examination:
- first visits
- repeated visit
3.
Caries treatment: overall
number
finished
treatment of
deep caries
4.
Pulpitis
treatment:
overall number
By devitalized pulp
extirpation
Vital pulp extirpation
Combined method of
treatment
5.
Treatment of the apical
periodontitis
(pericementitis): overall
number
completed treatment in a
single visit
6.
Examination
of
the
patients with periodontal
diseases (estimate in
indices)
7.
Removal
of
dental
Minimal
Quantity
12
45-50
NumWorking
ber of units
treated
patients
50-60
20
5
1
1,5
3
4-6
2
3,5-5,5
15
15
1,0
37
8.
9.
10.
11.
12.
13.
deposits in the area of
two teeth
Closed curettage in the
region of two teeth
Medication
of
periodontal pockets in
the area of two teeth
Treatment
of
teeth
(hyperesthesia)
Physical therapy in the
treatment of
а) pulpitis
б) apical periodontitis
в) periodontitis
Number
of
treated
patients
Control of oral hygiene
5
1,0
5
1,0
2
0,5
1
1
3
5
25
0,5
38
SCIENTIFIC-PRACTICAL WORK OF THE STUDENTS
DURING PRACTICE (PERIODONTOLOGY)
(character of work, title, conclusion, estimation)
Local Advisor
Lecturer-Head of the practice
CHARACTERISTIC
Signature of the Advisor
(local Head of the practice)
Signature of the Lecturer-Head of the practice
The following aspects have to be taken into
consideration: the level of theoretical knowledge, practical
skills, the ability to reassure the patient and to communicate
with the colleagues, participation in public activities.
39
References
1.
2.
3.
4.
5.
6.
7.
8.
Данилевский М.Ф., Борисенко А.Ф. Заболевания
пародонта. – Київ: Здоров’я, 2000. – 402 с.
The American Academy of Periodontology: Glossary of
Periodontal Terms, ed. 3. Chicago, The American Academy
of Periodontology, 1992.
Эльмар Хельвиг, Йоахим Климек, Томас Аттин.
Терапевтическая стоматология. Львів: Галдент, 1999.
409 с.
Терапевтична стоматологія /За ред. проф. А.К.
Ніколішина. Полтава, 2007. Т.2. 279 с.
Brad W. Neville, Duglas D. Damm, Carl M. Allen, Jerry E.
Bouquot. Oral and Maxillofacial Pathology. W.B. Saunders
Company, 2002.
Цепов Л.Н., Николаев А.И. Диагностика и лечение
заболеваний пародонта. М.: МЕДпресс-информ.,
2002. 192 с.
Мюллер Х.-П. Пародонтология /пер. с нем. Львов:
ГалДент, 2004. 256 с.
Терапевтическая стоматология: Учебник для студентов
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Мед. инф. агентство, 2004. 798 с.
40