Organization of dental care in the Russian Federation. Coursework organization of a dental clinic, department, office

Organization of dental care in the Russian Federation.

Therapeutic dental care is an integral structural component of comprehensive dental care for the population.
Dental care in our country is organized, directed, controlled and planned by the Ministry of Health and Social Development of the Russian Federation. In republics, regions, cities and rural areas, ministries, committees, departments or health departments under the administration of the respective territory manage the dental service. At all administrative levels of health management, a chief specialist in dentistry is appointed. In some cases, specialists in narrow sections of dentistry are appointed (therapeutic dentistry, maxillofacial surgery, etc.). The main specialists are appointed from among the most qualified dentists, professors, associate professors, researchers working in the field of dentistry and who know the organization of the dental assistance to the population. Most often, these positions
are occupied by chief doctors of regional (republican, regional) or large city dental clinics.

Therapeutic dental care for the population is provided by the following medical institutions:
republican (regional, regional) dental clinics;
dental clinics, departments and offices, yav-
clinical bases of educational higher and
secondary dental (dental) educational institutions and research institutes;
city, district and inter-district dental clinics;
dental departments and offices of multidisciplinary
polyclinics, antenatal clinics, regional and city
hospitals, central district hospitals, district hospitals, feldsher-obstetric stations, industrial enterprises and educational institutions;
dental departments and offices of departmental medical institutions.

Organization and structure of a dental clinic, a therapeutic department, a dental office. Sanitary and hygienic standards.

The dental clinic has the following departments:
division:
registry;
department of therapeutic dentistry;
department of surgical dentistry;
department of orthopedic dentistry with dental
laboratory;
periodontal office or department;
physiotherapy room;
x-ray room;
department of pediatric dentistry (in large cities, when the number
child population in the service area is
not less than 60-70 thousand people, independent
children's dental clinics);
administrative and economic part and accounting.

The dental clinic consists of a reception and medical departments: therapeutic, surgical, orthopedic rooms; radiologist, physiotherapist, examination, sterilization and dental laboratory. Currently, the structure of the dental clinic organizes the department (office) of anesthesiology, the department (office) for the treatment of periodontal and oral mucosa diseases, as well as restorative therapy, implantology, oral hygiene rooms and preventive departments. In large stoma. polyclinics can deploy functional diagnostic rooms, a clinical laboratory, centralized sterilization, and a pharmacy kiosk.

A dental office for one doctor should occupy an area of at least 14 m². Each additional seat is allocated 7 m². The height of the office must be at least 3 m. The walls of the dental office must be smooth, without cracks. The floor of the office should be covered with linoleum, which should go to the walls to a height of 10 cm. The joints of the linoleum should be puttied. Walls and floors must be painted in light colors: light gray. The office should have natural and artificial lighting (fluorescent lamps or incandescent lamps). When working with amalgam, a fume hood is installed in the office.

The cabinet must be provided with supply and exhaust ventilation, in the ratio of ⅔, there must be a quartz lamp.

The office should have workplaces for the doctor, nurse and nurse. The doctor's workplace provides for a stomat installation, a chair, a table for medicines and materials, a screw chair.

The nurse's workplace should include a table for sorting instruments, a dry-air cabinet, a sterile table and a screw chair.

The office should have a cabinet for storing materials and tools, a cabinet (A) for poisonous and a cabinet (B) for potent medicinal substances and a desk.

4. Staff Responsibilities therapeutic department (office) Dentist-therapist The dentist must:

- systematically improve their professional level, apply new methods and tools for the diagnosis, treatment and prevention of dental diseases;

– to ensure the effective provision of dental care and constantly improve the quality of patient care;

- correctly and accurately fill out all forms of accounting documentation;

- in dealing with patients, students and other persons, be attentive, observe the rules of deontology;

– be a model in work, labor discipline for middle and junior medical personnel;

- to carry out sanitary and educational work among the population according to the plan of the department;

– comply with safety regulations and fire prevention measures at the workplace;

– participate in the planned sanitation of the oral cavity of organized contingents of adults and children.

The dentist is responsible for:

- for refusing to provide assistance to the patient and, above all, to the patient with acute toothache;

- for the occurrence of complications after treatment due to his fault;

- for poor-quality and untimely maintenance of official medical records;

– for violations of labor discipline and rules of deontology. The orders of the dentist are binding on the secondary and

junior medical staff of the therapeutic office.

Nurse

The nurse is in charge of all the property of the office, is responsible for its safety and monitors the correct use, timely replenishment of the office with new inventory, tools and linen.

She is obliged to monitor the proper operation of lighting, plumbing, sewerage of the office, as well as the technical serviceability of equipment, dental units and chairs.

The nurse of the therapeutic office is obliged to receive medicines from the warehouse before starting work. Prepare the doctor's workplace. During the reception, he manages the admission of patients to the office, gives the doctor sterile instruments, prepares filling material, performs other work at the request of the doctor, treats the chair table with disinfectants.

The nurse is responsible for the cleanliness and sanitation of the office. She is obliged to monitor compliance with asepsis rules, is fully responsible for the storage of all medicines, monitors the economical use of materials, and observes safety precautions.

The nurse is not allowed to leave the workplace during the reception of patients.

Nurse

The nurse is subordinate to the head of the department, the nurse and the housewife of the polyclinic.

Before starting work, the nurse is obliged to ventilate the office, do wet cleaning with disinfectants of the floor, window frames, window sills, panels and equipment. She performs wet cleaning of the floor at least 3-4 times per shift. And also monitors the cleanliness of the spittoon.

5.Accounting and reporting medical documentation.

Medical documentation- a system of accounting and reporting documents of the established form, intended for registration and analysis of data characterizing the health status of individuals and various groups of the population, the volume, content and quality of medical care provided, as well as the activities of medical facilities.

Used to manage and plan the organization of honey. assistance to the population. It is based on the principles of unity of indicators, methodology and receipt, compliance with the deadlines for reporting and submission to higher authorities.

Primary accounting documentation:

Medical card of the patient's stomatologist (f 043u),

A single coupon for an outpatient (f. 025-8),

Sheet of daily accounting for the work of vr-stomat (037),

Summary sheet of records of the work of vr-stomat (039),

Control card of medical observation (030),

Journal of outpatient operations (069).

Dental activity. polyclinics according to f 039: I. Medical work:

1. average number of visits in 1 day per 1 doctor = number of all visits / number of working days per year (worked out by all doctors).

2. Average number of medical visits per day per doctor = total number of medical visits / number of working days per year.

3. average number of fillings in 1 day per 1 doctor = total fillings applied / number of work days per year.

4. number of extracted teeth = number of removed teeth / number of working days per year.

5. ratio of fillings to removal = total fillings applied / number of extracted teeth

6. number of fillings per 1 primary patient = total fillings applied / number of primary patients.

7. number of visits per 1 filling = number of all visits for medical purposes / total fillings applied.

8. The ratio of uncomplicated caries to its complications = started and finished in one visit + continued and finished (treatment of caries) / started and finished in one visit + continued and finished (treatment of pulpitis and periodontitis).

9.% of pulpitis cured in one session = started and finished in one visit (pulpitis treatment) * 100% / number of pulpitis cured (started and finished + continued and finished).

10.% of periodontitis - the same.

11. number of sanitation per day per 1 doctor = total number of sanitized patients / number of working days per year.

12. number of visits per 1 sanitation = total number of visits for treatment / total number of sanitized patients

13. % sanitized patients = total number of sanitized patients * 100% / total number of initial visits.

TO THE URBAN POPULATION

1. ambulance

dentists,

dental institutions

c) dentist-orthopedist;

d) an orthodontist;

b) Dental technician:

b) Head of the orthopedic and orthodontic department 1 in the presence of at least 4 positions of orthopedic dentists and (or) orthodontists.

Functions of the dental clinic:

Organization and conduct of preventive medical examinations and sanitation of the mouth of the adult population in institutions of secondary, higher and postgraduate professional education, recruiting offices, enterprises and organizations;

Provision of emergency dental care to the adult population in case of acute diseases and injuries of the maxillofacial region;

Provision of primary health care and (or) specialized dental care to the adult population with dental diseases;

Organization of dispensary observation of the adult population with dental diseases with an assessment of the level of dental health;

Direction in accordance with the established procedure of the adult population with dental diseases for inpatient treatment in specialized maxillofacial and (or) dental departments;

Carrying out orthopedic treatment of the adult population with congenital and acquired defects of teeth, dentition, alveolar processes, jaws and face;

Carrying out complex orthodontic treatment of the adult population with dentofacial anomalies and deformities;

Examination of temporary incapacity for work, issuance of certificates of incapacity for work and recommendations for rational employment, referral to medical and social expert commissions of persons with signs of permanent disability;

Analysis of dental morbidity in the adult population and development of measures to reduce and eliminate the causes that contribute to the occurrence of diseases and their complications;

Introduction of modern methods of prevention, diagnosis and treatment of dental diseases of the maxillofacial region;

Carrying out sanitary and educational work among the population, including with the involvement of paramedical personnel of medical organizations, using the media;

Maintenance of accounting and reporting medical documentation and presentation of reports on activities, collection of data for registers, the maintenance of which is provided for by the legislation of the Russian Federation.

1. examination room;

2. department (office) of general practice, including mobile dental offices;

3. treatment and prevention department, including, among other things, dental offices in educational institutions of secondary, higher and postgraduate professional education, recruiting offices, enterprises and organizations;

4. department (office) of therapeutic dentistry with rooms for periodontology, endodontics and treatment of diseases of the oral mucosa;

5. department (office) of surgical dentistry;

6. department (office) of orthopedic dentistry;

7. orthodontic department (office);

8. department (office) of anesthesiology and resuscitation;

9. X-ray department (office);

10. physiotherapy room (department);

11. hygiene cabinet;

12. cabinet of functional diagnostics in dentistry;

13. registry;

14. organizational and methodological office;

15. centralized sterilization department (block);

16. dental (dental) laboratory;

17. cabinet of medical statistics;

18. administrative and economic part;

19. technical services;

20. other departments that meet the statutory goals of the medical organization (including the service department, software department, legal department).

The registry regulates the flow of patients according to the urgency and type of dental care, draws up medical records of the dental patient (f. No. 043-y), ensures their storage, selection, delivery to the office and layout after receiving patients, draws up disability certificates and registers them; ensures the reception of calls to the house and all activities of a reference and information nature; carries out financial settlements with patients for payment of paid medical services.

Repeated visits by patients to the polyclinic are appointed and regulated by the attending physicians. With proper organization of work, the patient is observed by one doctor until complete sanitation.

Some dental clinics operate on a district principle, which increases the responsibility of each doctor, allows you to evaluate the effectiveness of his work and control the quality of care.

The main sections of the work of a dentist are:

1.providing medical and preventive care upon request;

2.consulting for doctors of other specialties;

3.examination of temporary disability;

4. dispensary observation of certain groups of dental patients;

5. Carrying out planned sanitation of the oral cavity for certain contingents of the population;

6.sanitary and educational work and the formation of a healthy lifestyle.

Orthopedic care turns out to be at the final stage of treatment of dental patients, after a complete reorganization, it turns out mainly on a paid basis.

The orthopedic department of the dental clinic includes: an office of orthopedists and a dental laboratory, there may be an office of an orthodontist. Outpatient card in a dental clinic, department or office for a patient starts only one. When a patient contacts an orthopedist or orthodontist, an insert is filled in with the same card number issued, which indicates the dental formula, diagnosis, description of the dental status, records of all stages of treatment and is attached to the main outpatient card.

In the orthopedic department, prosthetics are made for defects in the dentition, crowns of teeth, dentures are repaired, and patients are advised on prosthetics.

Large dental clinics (departments) provide specialized orthodontic care.

Dental polyclinics, if necessary, provide assistance to patients at home at the call of doctors from territorial polyclinics. All types of assistance are provided at home, including dentures. Calls are served either by doctors specially allocated for this purpose, or by doctors of the polyclinic in the order of priority.

When providing citizens with free care, it is necessary to combine the well-known principles of centralization and decentralization in the organization of dental services.

Emergency dental care during the opening hours of polyclinics is provided by duty dentists, and on weekends and holidays and at night - in special emergency dental care centers, which are organized in several polyclinics of the city. During the reception, the necessary amount of further assistance is determined, the patients are distributed among the rooms for subsequent treatment, ensuring a uniform workload of specialist doctors.

PLANNED RENEWAL OF THE ORAL CAVITY

The basis of preventive work in dental practice is the planned sanitation of the oral cavity and teeth.

Sanitation of the oral cavity is a complete cure for all diseases of the oral cavity, which includes not only dental treatment, but also professional cleaning, preparation of the oral cavity for further orthodontic or orthopedic treatment.

An indicator characterizing the level of organization of preventive work is the need for sanitation of the oral cavity.

In children, the main task of the planned preventive sanitation of the oral cavity is to identify, through regular examinations, early uncomplicated stages of diseases of the teeth and oral cavity and their complete cure, prevention of complications.

A child should be considered sanitized if all temporary and permanent teeth affected by caries are sealed, destroyed teeth and roots that cannot be treated are removed, and inflammatory diseases of the oral mucosa are eliminated.

Sanitation forms:

1. Individual - by negotiability;

2. One-time or periodic organization of sanitation - the identification and complete cure of teeth in certain contingents of the population (pregnant women, workers employed in hazardous working conditions).

3. Planned preventive rehabilitation is the most effective method of prevention, carried out regularly in organized groups by some contingents of the adult population: disabled people and participants in the Great Patriotic War, pregnant women, pre-conscripts, students of vocational schools, technical schools, university students, representatives of some professions.

Stages of planned rehabilitation:

Stage 1 - examination of the oral cavity, determination of the need for various types of dental care and its volume.

Stage 2 - providing the necessary medical and preventive care as soon as possible.

Stage 3 - subsequent dispensary observation of patients.

Planned sanitation methods:

1. Centralized: dental clinic (department, office).

2. Decentralized: dental offices of schools, secondary schools and universities, health centers and other organizations. The advantage of this form is that maintenance takes place locally and permanently; there is the possibility of full medical care for employees or students; increases the possibility of closer contact between the doctor and the patient.

In providing dental care to children, a decentralized form of organization based on educational institutions is advisable.

3. Brigadier: specially equipped mobile sanitation rooms.

4. Mixed: inspection in schools, preschool institutions (DDU); sanitation in dental clinics.

Planned rehabilitation covers contingents of the population in accordance with the "Program of state guarantees for providing citizens of the Russian Federation with free medical care", approved annually by the Decree of the Government of the Russian Federation and the Republic of Belarus, which contains a basic program of compulsory medical insurance.

RURAL POPULATION

Taking into account the peculiarities of working conditions in agricultural production, living conditions and territorial disunity of settlements, medical assistance to rural residents is provided in stages. The phasing consists in organizing dental care for the rural population according to service levels.

According to the order of the Ministry of Health No. 900 of the USSR Ministry of Health of September 26, 1978 “Standard standards for medical personnel of polyclinics and outpatient clinics in cities and urban-type settlements with a population of up to 25 thousand people”, rural outpatient clinics and rural district hospitals have dental and dental offices.

At the 1st stage, in a rural medical district, emergency dental care can be provided at a feldsher-obstetric station (FAP).

The paramedic, using various analgesic and anti-inflammatory drugs, can relieve or reduce acute pain; timely refer to the dentist (dentist) of the district hospital, promotes hygiene skills in caring for teeth.

In the dental or dental offices of rural medical outpatient clinics (SVA) and rural district hospitals (SUH), emergency and planned treatment and preventive care is provided for diseases of the teeth and organs of the oral cavity. In difficult cases, as well as for prosthetics, patients are sent to the central district hospital (CRH).

At the II stage, specialized dental care is provided in district medical institutions: the dental department of the district clinic, the surgical department of the hospital of the Central District Hospital, the dental district clinic, commercial clinics, the children's dental clinic and other institutions.

At the same time, patients are provided with advisory assistance, therapeutic, orthopedic, surgical, periodontal.

Regional medical institutions carry out organizational and methodological work, emergency medical care, clinical examination of patients, rehabilitation, and implementation of preventive programs.

During the period of active agricultural work, dentists should more widely use single-session methods of treatment, thanks to which it becomes possible to prevent complications from incomplete treatment.

At the III stage, the Republican (regional, regional) hospital and the Republican (regional, regional) dental clinic (RSP) provide specialized dental outpatient and inpatient care, including VMP, to residents of the republic in all its types, both adults and children : therapeutic, surgical, orthopedic, orthodontic.

The republican hospital has a consultative polyclinic and a hospital (dental department for 30-60 beds).

The intensity of dental caries

To assess the intensity of dental caries, let's determine the KPU index - this is the sum of teeth affected by untreated caries (component "K"), filled teeth ("P") and extracted teeth ("U") per one examined child.

Caries intensity index - KPU: , where

K - the sum of teeth affected by untreated caries,

P - filled teeth;

Y - extracted teeth.

Criteria for evaluating the KPU index in children aged 12 (WHO):

Very low - 0.00-0.50

Low - 0.51- 1.50

Medium - 1.51- 3.00

High - 3.01- 6.50

Very high - 6.51-10.00

Epidemiological studies indicate the accumulation and growth of pathological processes in the hard tissues of the teeth, the development of a carious process, an increase in the number of periodontal diseases and dentoalveolar anomalies, which is due to the lack of volume and quality of systematic work on the sanitation of the oral cavity in children.

In children, the intensity of caries is assessed until the complete replacement of temporary teeth with permanent ones.

When examining the population, the most informative are the age groups of 12.15 years and 35-44 years. The susceptibility of teeth to caries at the age of 12 and the condition of the periodontium at the age of 15 make it possible to judge the effectiveness of preventive measures, and based on the KPU index at the age of 35-44, it is possible to assess the quality of dental care for the population. An analysis of the results of examining patients of different age groups shows that with age there is a tendency to increase caries in permanent teeth from 20-22% in 6-year-old children to 99% in people aged 65 years and older, who had an average of 20-22 teeth affected.

Information obtained from epidemiological dental surveys provides a basis for assessing the need for treatment, the number of personnel required at the regional level, and the cost of dental programs. The need for dental care is determined by the need to take measures to prevent and treat dental diseases, to provide surgical, orthopedic, orthodontic and other types of care.

Provision of the population

dental care

Indicators characterizing the level of provision of the population with dental care are calculated for a specific service area (city, district, etc.).

1. The rate of accessibility of the population for dental care:

2. Index of access to dental care:

3. Provision of the population with existing dental jobs per 10 thousand inhabitants:

4. Provision of the population with dentists (dentists) per 10 thousand inhabitants:

5. Indicator of provision of the population with dental beds:

Thus, mastering the knowledge of the basics of organizing dental care, aspects of the scientific organization of labor at the beginning of the 21st century will greatly contribute to the growth of the professional level of a dentist, which, along with the introduction of new methods of diagnosis, treatment and rehabilitation into clinical practice, will improve the quality of dental care. population.

CONTROL QUESTIONS

1. What are the stages of dental care?

2. List the types of institutions providing dental care?

3. How is outpatient dental care organized?

4. Give a classification of dental clinics.

6. What are the main tasks and functions of the dental clinic?

7. What are the staffing standards of the dental clinic: dentists; paramedical personnel; junior medical staff?

8. What is the structure of an independent dental clinic?

9. How is the work of the registry of a dental institution organized?

10. What are the main sections of the work of dentists?

11. How is emergency outpatient dental care organized?

12. How is the medical examination of the population carried out by dental institutions?

13. List the contingents of medical examinations?

14. How is the effectiveness of dispensary observation of dental patients evaluated?

15. What is the procedure for organizing the work of the orthopedic department?

16. What are the tasks and organization of work of periodontal cabinet?

17. What are the features of the organization of dental care in medical units (MSCh)?

18. How is dental care organized for children?

20. What activities should a pediatric dentist perform in providing medical care to children?

21. How is the activity of the dental office organized in educational teams?

22. What activities should an orthodontist provide medical care to children?

23. What activities should a dentist-surgeon provide medical care to children?

24. What activities should a dental hygienist provide medical care to children?

25. What are the features in the organization of dental care for the rural population?

26. Describe the stages of providing dental care to the rural population.

27. What is the structure and features of the organization of the work of republican (regional, regional) dental clinics?

28. List the activities related to the primary, secondary and tertiary levels of prevention of dental diseases?

29. List the main forms and methods of planned sanitation of the oral cavity.

30. Specify the features of oral cavity sanitation in organized groups?

31. Which child is considered sanitized?

32. What are the main accounting and reporting documents in the dental service?

33. Describe the main sections of the annual report of the dental service.

34. What are the main quality indicators of the dental service.

SITUATIONAL TASKS:

Task number 1.

In the group of children examined at the age of 12 out of 120, 75 had carious, filled and extracted teeth. Assess the prevalence of dental caries in the surveyed group of children.

Task number 2.

Assess the intensity index of dental caries in the age group of children 12 years old, if it is known that 240 children were examined, caries was detected in 180, including 220 teeth affected by untreated caries, 150 fillings and 120 removals performed prematurely, before their physiological resorption.

Task number 3.

In the dental clinic of the city of N. in the reporting year, 137,906 patients were admitted, of which 79,343 were primary patients, 98,123 teeth were sealed, to determine and evaluate the proportion of primary visits to the dentist and dentists and the number of visits per treatment of one cured tooth.

STANDARDS FOR SOLVING PROBLEMS

Solution to problem number 1.

1. Calculation of caries prevalence:

WHO assessment criteria for the prevalence of caries for 12-year-old children: low - 0-30%; medium - 31-80%; high - 81-100%.

Conclusion: the prevalence of caries in this group of children was 62.5%, which corresponds to the average level of caries prevalence according to the WHO assessment criteria.

Solution to problem number 2.

To assess the intensity of dental caries, let's determine the index of the KPU - this is the sum of teeth affected by untreated caries (component "K"), filled teeth (component "P") and extracted teeth (component "U") per one examined child. Intensity Index - KPU = 2,04

Criteria for evaluating the KPU index in children aged 12 (WHO): Very low - 0.00-0.50; Low - 0.51-1.50; Medium - 1.51-3.00; High - 3.01- 6.50; Very high - 6.51-10.00.

Conclusion: the intensity of caries in this group of children was 2.04, which corresponds to the average level of caries prevalence according to the WHO assessment criteria.

Solution to problem number 3.

1. Share of primary visits to dentists and dentists:

2.Number of visits for the treatment of one cured tooth:

Conclusion: The analysis of the activities of the dental clinic in N. showed that the share of primary visits in the reporting year was 57.5%. The average number of visits for the treatment of one cured tooth corresponds to the recommended figures - 1.4.

ORGANIZATION OF DENTAL CARE

TO THE URBAN POPULATION

The provision of medical care to the population in case of dental diseases of the teeth, periodontium, oral mucosa, tongue, salivary glands, jaws, face and head is carried out in accordance with the procedures and standards of provision regulated by the order of the Ministry of Health and Social Development of Russia No. 1496 dated 07.12.2011. “On Approval of the Procedure for Providing Medical Care to the Adult Population in Dental Diseases” and Order of the Ministry of Health and Social Development of Russia No. 946n dated December 3, 2009 “On Approving the Procedure for Providing Medical Care to Children Suffering from Dental Diseases”.

Medical care for the adult population with dental diseases is provided in the form of:

1. ambulance

2. primary health care

3. specialized, including high-tech.

The availability of dental care to the population depends on many factors: organizational forms of its provision, pricing policy, provision of the population with dentists (dentists), etc.

There are the following forms of organization of dental care to the population:

1. Centralized - the reception of the population is carried out in a dental clinic or department (office) as part of another health facility.

2. Decentralized - permanent dental offices as part of health centers of industrial enterprises and organizations and in educational institutions.

3. The exit form is most effective in the countryside, for children in preschool institutions, the disabled, lonely and elderly citizens.

Currently, the dental service in Russia consists of state, municipal and private institutions. In 2010, the process of reorganization of dental institutions into autonomous healthcare institutions began.

As part of the ambulance, including specialized ambulance, medical care for the adult population with dental diseases is provided by feldsher and medical mobile ambulance teams in accordance with the Order of the Ministry of Health and Social Development of Russia dated 01.11.2004. No. 179 "On approval of the procedure for the provision of emergency medical care."

Primary health care for the adult population with dental diseases on an outpatient basis is provided:

Dentists (general dentists, general dentists, surgeons, orthopedists, orthodontists, maxillofacial surgeons),

dentists,

dental hygienists,

dental technicians, paramedics,

doctors of other specialties.

Outpatient dental care for the urban population - the most accessible type of specialized care for dental patients is provided in the following institutions:

1) state, municipal dental clinics,

2) dental departments (offices) as part of territorial polyclinics, centers of general medical (family) practice, medical units (MSCh), hospitals, dispensaries, antenatal clinics, health centers of industrial enterprises, etc.);

3) dental offices in educational institutions (schools, preschool institutions, higher and secondary specialized educational institutions);

4) private dental organizations ("IP" - individual entrepreneurs, "LLC" - a limited liability company).

The bulk of private dental institutions are small clinics (for 2-3 chairs) and separate rooms. In the conditions of a free market of medical services, the population has a real opportunity to choose a dental institution and a doctor. Competition between clinics to attract a patient to a certain extent contributes to improving the quality of dental care in general.

Specialized, including high-tech, medical care for the adult population with dental diseases is provided in stationary conditions and in a day hospital by dentists.

ORGANIZATION OF THE WORK OF THE DENTAL POLYCLINIC

A dental clinic is an independent medical organization or a structural subdivision of a multidisciplinary medical organization, organized to provide primary health care and specialized medical care.

The dental clinic is the leading institution providing dental care to the population. More than 99% of all patients in need of this type of care are treated in outpatient clinics. The activity of dental clinics is characterized by territorial accessibility for the population and the preventive focus of the measures taken.

The organizational structure and staffing of medical and other personnel of the dental clinic is determined taking into account the number of people served, the structure of morbidity and other characteristics and needs.

The equipment of the dental clinic is carried out in accordance with the standard for equipping the dental clinic, depending on the volume and type of medical care provided.

Dental clinics differ:

1) by the level of service: republican, city, district;

2) by subordination: territorial, departmental;

3) according to the source of financing: budgetary, self-supporting;

Staffing standards for medical personnel

dental institutions

The staffing standards for medical personnel of dental institutions are determined by order of the Ministry of Health and Social Development of Russia No. 1496n dated 07.12.2011. (Appendix No. 6 "Recommended staffing standards for medical and other personnel of the dental clinic").

The positions of dentists are established on the basis of:

a) a dentist and a dentist-therapist 5 positions per 10 thousand of the adult population;

b) dentist-surgeon 1.5 positions per 10,000 adults;

c) dentist-orthopedist;

1.5 positions per 10,000 urban adults;

0.7 positions per 10 thousand adult rural population;

0.8 positions per 10 thousand adults in other settlements

d) an orthodontist;

1.0 position per 10,000 urban adults;

0.5 positions per 10 thousand adults in other settlements.

Positions of paramedical personnel:

a) Nurse 1 for 1 position of a dentist;

b) Dental technician:

2.5 for 1 position of a dentist-orthopedist;

2.0 for 1 post of orthodontist.

The positions of heads of departments are established:

a) Head of the dental department 1 for 8 positions of dentists of all specialties.

b) Head of the orthopedic and orthodontic department

Dental clinic headed by the chief physician. (40 or more medical posts are allocated the rate of the deputy chief)

Distinguish:

Service level: republican, regional, regional, city, district.

By subordination: territorial and departmental.

By source of funding: budgetary, self-supporting

By form of ownership: federal, municipal, private

Main tasks :

Carrying out activities to prevent diseases of the maxillofacial region among the population and in organized groups

Carrying out and organizing activities aimed at early detection of patients with diseases of the maxillofacial region and their timely treatment

Provision of qualified outpatient dental care to the population

Structure :

Registry

Specialized departments: therapeutic dentistry, surgical dentistry, orthopedic dentistry with a dental laboratory, pediatric dentistry

Primary examination room

Dental emergency room

X-ray room

Physiotherapy room

Works on territorial principle: the entire service area of the polyclinic is divided into sections with a certain population, each of which has its own permanent district dentist. At the dentist, the population on the site corresponds to two therapeutic ones and is about 3400 people.

Work according to the district principle ensures the dynamics of monitoring patients, increases the responsibility of doctors for the quality of work, allows you to evaluate the performance of each doctor and control the quality of care.

Dental polyclinics, if necessary, provide assistance at home on the call of doctors from territorial polyclinics. To provide dental care at home, the clinic has portable equipment. All types of assistance are provided at home, including dentures.

In the clinic, doctors work on rolling chart. It is compiled in such a way that the reception is carried out both in the morning and in the afternoon for the convenience of patients.

Labor accountingdentists based on measuring the volume of their work in conditional units of labor intensity (UET). For 1 UET, the amount of work of a doctor is taken, which is necessary for applying a filling with an average caries.

A doctor with a six-day working week must perform 21 UETs, with a five-day working week - 25 UETs per working day.

One of the most important sections of the doctor's work in the clinic is examination of working capacity. In case of temporary disability, when the violations are reversible, doctors issue certificates of disability to working persons, taking into account both the patient's condition and the nature of the work performed by him. The medical institution maintains a special "Book of registration of certificates of incapacity for work" (f. OZb / y), which are stored in the same way as monetary documents.

Held health education and preventive work, all medical personnel are involved. The doctor, with the help of a nurse, conducts lectures and talks for the population on the following topics: prevention of caries in children, prevention of dental diseases, etc.

REGIONAL MEDICAL INSTITUTIONS :

. regional hospital with a consultative polyclinic

. regional specialized centers

. regional dispensaries and specialized hospitals

. Regional Center for Sanitary and Epidemiological Surveillance

. clinics of medical institutes, research institutes and other medical institutions of the regional center

On the basis of these institutions, the rural population is provided highly qualified, including highly specialized medical care.

The main tasks of the regional hospital are:

. providing the population of the region with highly qualified specialized advisory, polyclinic and inpatient care

. provision of emergency and planned advisory medical care by means of air ambulance and ground transport with the involvement of specialists from various institutions

Providing organizational and methodological assistance to the health care facilities of the region in improving
health care for the population

Management and control over statistical accounting and reporting of health care facilities of the region.

A feature of the organization of stomatology. assistance that is provided in a specialized clinic of the medical university, which acts as a regional medical and advisory specialized center. Dental outpatient and inpatient care for residents of the region (adults and children) is provided for all types of activities: therapeutic, surgical, orthopedic, orthodontic, highly qualified care on a paid basis.

An important section is the planned sanitation of the oral cavity and teeth. Mandatory rehabilitation is subject to children of pre-school and school age, adolescents, pregnant women, as well as specialists engaged in agricultural production and working at industrial enterprises. For on-site examinations of the listed contingents, mobile dental rooms are organized in the Central District Hospital and regional medical institutions.

Centralized method

Planned sanitation of the oral cavity is carried out directly in the dental clinic or the dental department in the structure of a medical institution (HCF), which allows organizing the admission of patients with the necessary laboratory and instrumental studies, consultations of specialists. However, in some cases it is difficult to organize a visit to the polyclinic by persons subject to planned sanitation, especially children. In this case, a decentralized method of planned rehabilitation is used.

decentralized method

Sanitation of the oral cavity is carried out directly in preschool institutions, schools and enterprises by organizing dental offices. With an insufficient number of students in schools (less than 800 people), a dental office is opened in one of them, which serves children from 2-3 nearby attached schools.

This ensures the necessary level of accessibility of dental care to children, the maximum coverage of their sanitation and preventive measures. The weak side of the method lies in the insufficient equipment of dental offices with special equipment, so children with complex diseases and, if necessary, additional diagnostic tests are sent to a dental clinic.

brigade method

Planned sanitation of the oral cavity is carried out by a mobile team of dentists of a district or regional dental clinic. Teams, as a rule, consist of 3-5 doctors and one nurse, they go directly to schools, preschool institutions, enterprises, where children and adults are sanitized for the required period of time. For these purposes, specially equipped vehicles are used.

mixed method

It provides for a combination of certain methods of planned sanation of the oral cavity based on the capabilities of the territorial health care system, the availability of dental institutions, their provision with qualified personnel, the necessary diagnostic and treatment equipment.

In children, the method of planned rehabilitation, as a rule, is implemented in two stages.

The first stage is an examination of the child's oral cavity and determination of the necessary types of dental care.
The second stage is the provision of dental care as soon as possible until complete sanitation.

In some cases, planned rehabilitation provides for a third stage - subsequent active dynamic monitoring of sick children.

Planned sanitation of the oral cavity in children should be considered as the main means of preventing dental caries and timely correction of maxillofacial anomalies. Planned rehabilitation, regardless of the forms and methods used, provides for mandatory repeated (control) examinations of children every 6 months.

The success of the planned rehabilitation of children in organized children's groups largely depends on the coordinated actions of the leaders of children's dental clinics and preschool and school educational institutions. To do this, planned sanitation schedules are drawn up in advance, organization and control of their implementation are provided.

O.P. Shchepin, V.A. Medic

Dental therapeutic care occupies a leading position in the system of dental services. The work of representatives of other dental specialties also depends on how assistance is provided to patients in therapeutic dentistry.

Due to organizational shortcomings, the quality of assistance provided is not always at the proper level. There are still errors in diagnosis and treatment where the basic principles of organizing a clinic of therapeutic dentistry are not observed.

The first principle of organizing therapeutic care in dentistry is the observance of strict sanitary and hygienic requirements, which should ensure the work of a dentist under strict aseptic conditions.

Compliance with certain rules, special organization of work, proper distribution of staff time - this is the key to successful work.

Departments and offices should be located in bright spacious rooms, each chair should have at least 7 m2. There should not be anything superfluous on the doctor's table. All materials and medicines are on a movable nursing table. In departments, it is advisable to appoint a doctor on duty on a daily basis, who would monitor the order and condition of the workplaces.

Strong substances, drugs, novocaine should be stored in special cabinets. A sterile table with instruments and material is covered daily, bacteriological checks are periodically carried out.

It has become normal to allocate specialized general examination rooms in dental departments for the treatment of patients with diseases of the oral mucosa and periodontium, which should have special equipment, tools, and documentation. In these rooms, space should be provided for a couch on which the patient could be laid.

Of particular importance in the clinic of therapeutic dentistry should be given to the observance of deontological norms. Appropriate relationships between medical personnel, both among themselves and with patients, are determined by the second principle of the organization of the clinic. The success of treatment depends to a certain extent on the approach of the doctor to the patient. The patient must trust the doctor. This trust is made up of many factors: the behavior of the doctor and staff, the state of the office, equipment, organization of the workplace, pain relief during medical manipulations, etc.

The third principle of the organization of the clinic of therapeutic dentistry is the use of modern methods of diagnosis and treatment. The constant introduction into practice of modern, most effective methods of diagnosis and treatment allows not only to improve preventive work, but also to reduce the number of patients at the reception.

The application of the district principle in the work of the department makes it possible to cover a larger number of the population with dental prophylaxis. In some polyclinics, departments of dental prophylaxis have been set up, where doctors and staff are engaged exclusively in preventive work - both in the polyclinic, and in schools and at work. These departments have special portable equipment.

The state of medical work in the clinic of therapeutic dentistry is based on the use of complex methods of treatment. At present, it is no longer possible to apply any therapeutic method without taking into account the pathogenesis of the disease. The use of classifications based on the etiological principle in the clinic makes it possible to apply the most effective methods of treatment. The so-called sparing methods of treatment are being introduced more and more into the practice of dentistry.

Complex methods of treatment of dental diseases consist in the fact that at the same time they prescribe drugs that act both directly on the tissues and organs of the maxillofacial region, and on the internal organs and systems of the body that affect the course of the dental disease.

Treatment of periodontal diseases should be carried out with the participation of dentists, surgeons, orthopedists, as well as general medicine specialists. Treatment of a number of diseases of the oral mucosa must be started in stationary conditions (dental departments of clinics, hospitals). Subsequently, when the diagnosis is finally established and the first course of treatment is carried out, it is possible to treat patients in outpatient conditions with relapses of the disease.

Particular attention is paid to patients with multiple caries, who should also be treated using methods of local and general exposure.

Dental outpatient clinics should have close contact with inpatient departments. The periodic work of polyclinic doctors in a hospital, and inpatient doctors in polyclinics, makes it possible to constantly improve the qualifications of specialists.

Therapeutic dental clinics of the republics, territories, regions should be organizational and methodological centers for all medical institutions of the dental profile. The organization of medical work, the specialization and improvement of doctors on local bases, the testing of new methods, the development of recommendations, the holding of scientific and practical conferences, patient consultations - all this is the responsibility of therapeutic dentistry clinics.

An important stage in the development of modern therapeutic dentistry was the introduction of anesthesia methods into wide practice. Processing of hard tissues, curettage of gingival pockets, manipulations on the pulp are now performed under local and general anesthesia. Anesthesiologists and anesthetist nurses have been introduced into the staff of dental institutions. In many clinics, general anesthesia is widely used for dental treatment.

New methods of pain relief have been developed, including devices for electrical anesthesia of hard dental tissues. Electroanesthesia proved to be the most effective in pediatric dentistry. The presence of portable devices, the simplicity of the technique should contribute to the successful use of electrical anesthesia in the daily practice of dentists. Now it is impossible not to have an anesthesia specialist in dental clinics. Many methods and means of pain relief can be applied only where this issue is given constant attention, where anesthesia rooms are specially organized and there are well-trained anesthesiologists.

The introduction of special methods of treatment of periodontal disease into practice led to the creation of periodontal departments and offices.

Specially trained doctors - periodontists, surgeons and orthopedists should work in periodontal departments and offices. Their responsibilities include identifying patients with various forms and stages of periodontal disease, gingivitis in the service area, drawing up a plan for their treatment, conducting dynamic monitoring of patients, implementing the principles of clinical examination and treating the most difficult patients. The remaining patients after a comprehensive examination and the planned treatment plan are transferred to the doctors of the respective areas. The attending physicians carry out the whole complex of the planned treatment, draw up dispensary cards and transfer them to periodontists, who distribute the cards according to the nature of the disease and the degree of need for re-treatment. A call for a dispensary examination for re-treatment is carried out by periodontists. Attending dentists should participate in the examination of patients who are called to periodontal rooms.

Below is a work plan of periodontal rooms.

One day in the office three specialists are receiving - a periodontist, a surgeon, an orthopedist. All primary patients are accepted.

They are prescribed a comprehensive examination and draw up a treatment plan. The most difficult patients with severe forms of the disease are left for treatment in the parodontology room. The rest of the patients, as mentioned above, are transferred for treatment to general departments. Surgical and orthopedic treatment is carried out simultaneously, and not after the end of treatment by a general practitioner.

The second day is allocated for re-examination and examination of patients who need a comprehensive examination during treatment or after completion of the first course of treatment. Repeated examination and examination is also carried out in a complex with the participation of a periodontist, surgeon and orthopedist. The experience of a number of institutions has shown the feasibility of such a methodology for the work of periodontal departments and offices.

If clinics have departments of dental prophylaxis, then periodontal rooms can be part of preventive departments. Preventive departments or cabinets should include two groups in their structure. One of them is engaged in methodical work, documentation, reports, accounting, control. The second group carries out preventive measures both in the clinic and in organized groups. The department should be equipped with a mobile cabinet, portable equipment. The current state of dentistry requires constant improvement of methods for organizing therapeutic dentistry.