FEDERAL STATE BUDGETARY EDUCATIONAL INSTITUTION OF HIGHER EDUCATION
"BASHKIR STATE MEDICAL UNIVERSITY»
MINISTRY OF HEALTH OF RUSSIA
Department of surgical dentistry
Approved by head of the department
F. Z. Mirsaeva
"30" __august_2018
METHODICAL RECOMMENDATION FOR TEACHERS
for a practical lesson on the topic:
Surgical Dentistry
Specialty 31.05.03-Dentistry
Course 5
Semester IX
Number of hours 44
Ufa-2018
The methodological developments were drawn up on the basis of the work program approved on January 11, 2018 and drawn up on the basis of the Federal State Educational Standard of Higher Education in the specialty 05/31/03-Dentistry, approved by order of the Ministry of Education and Science of the Russian Federation No. 96 "09" February 2016.
Reviewers:
1. Chuikin S.V., Doctor of Medical Sciences, Professor
2. Bulgakova A.I., Doctor of Medical Sciences, Professor
Author: Mirsaeva F.Z., Khalikova L.R.
Approval at meeting No. 1 of the Department of Surgical Dentistry dated August 31, 2018
TABLE OF CONTENTS
1. Dislocation and fractures of the tooth, alveolar bone, dislocation of the lower jaw. Clinic. Diagnostics. Treatment.
2. Non-gunshot fractures of the lower jaw. Classification. Clinic. Diagnostics. Treatment.
3. Non-gunshot fractures of the upper jaw. Classification. Clinic. Diagnostics. Treatment.
4. Non-gunshot fractures of the zygomatic bone, zygomatic arch, nasal bones. Clinic, diagnostics, treatment. Indications for imposition. Nutrition and nursing. Medical and physical methods of treating victims.
5. Concomitant injuries to the face. Features of the clinical course. Combined traumatic brain injury.
6. Complications of injuries mfr
TOPIC: DISCONNECTION AND FRACTURES OF THE TOOTH, ALVEOLAR PROCESS, DISPOSED OF THE LOWER JAW. CLINIC. DIAGNOSTICS. TREATMENT.
1. Relevance. Maxillofacial injuries are an important medical and social problem and are in the focus of attention of domestic and foreign researchers due to the prevalence, severity of cosmetic and functional disorders, and a high incidence of complications. Currently, there is a steady increase in injuries due to increased social instability, a worsening crime situation, cultural degradation, and an increase in the number of transport and industrial injuries. The proportion of head and neck injuries according to different authors is 6 - 17% of the total number of injuries.
In the practice of outpatient surgical dentistry, dislocations and fractures of teeth, fractures of the alveolar processes and dislocations of the mandible are more common. The above traumatic injuries are among the lungs, and therefore patients, as a rule, are treated in a polyclinic. The important features of these types of injuries include the possibility of their occurrence during dental procedures.
In connection with the above, students of the Faculty of Dentistry study the topic “Statistics and classification of injuries of the maxillofacial area. Methods of examination of patients with trauma of soft tissues and bones of the face. Dislocations and fractures of the teeth. Dislocation of the lower jaw. Fractures of the alveolar processes of the jaws. Clinic, treatment ”is mandatory.
2. Learning objectives:
• to acquire theoretical knowledge on statistics, classification of injuries of the maxillofacial area, clinic of dislocations and fractures of teeth, fractures of the alveolar processes and dislocations of the mandible;
• master the skills of examining patients with injuries of the maxillofacial region, providing qualified and specialized care for dislocations and fractures of teeth, fractures of the alveolar processes and dislocations of the lower jaw.
To form professional competencies, a student must know:
- anatomical and physiological features of organs and tissues of the maxillofacial region;
- anatomy of teeth and jaws;
- basic and additional research methods for injuries of the maxillofacial region;
- methods of examination of the patient by organs and systems;
- general characteristics and phases of the wound process;
- classification of non-fire injuries of the maxillofacial region;
- basic organizational principles of providing assistance to victims with dislocations and fractures of teeth, dislocations of the lower jaw, fractures of the alveolar processes of the jaws;
- principles and stages of preoperative preparation of patients with injuries of the maxillofacial region;
- methods of surgical treatment and immobilization in case of dislocations and fractures of teeth, dislocations of the lower jaw, fractures of the alveolar processes of the jaws;
- principles of drug and physical treatment for dislocations and fractures of teeth, dislocations of the lower jaw, fractures of the alveolar processes of the jaws;
- prevention of dislocations and fractures of teeth, dislocations of the lower jaw, fractures of the alveolar processes of the jaws;
- the procedure for the examination of working capacity in case of dislocations and fractures of teeth, dislocations of the lower jaw, fractures of the alveolar processes of the jaws.
To form professional competencies, a student must be able to:
- to examine patients with injuries of the maxillofacial region;
- draw up a plan for an additional examination;
- to evaluate the results of basic and additional research methods;
- to formulate a diagnosis in accordance with modern classifications;
- draw up a plan for the comprehensive treatment of victims with dislocations and
fractures of teeth, dislocations of the lower jaw, fractures
alveolar processes of the jaws;
- to carry out surgical and orthopedic treatment for dislocations and fractures of the teeth;
- to correct the dislocation of the lower jaw;
- on phantoms to carry out surgical and orthopedic treatment of fractures of the alveolar processes of the jaws;
- to carry out an examination of the ability to work;
- to carry out measures to prevent complications.
3. Type of lesson: practical lesson.
4. Duration of the lesson: 270 minutes.
5. Equipment: multimedia projector, slides, dummies, photographic materials, phantoms, radiographs, sets of tools and materials for practicing practical skills.
6. Content of the lesson:
6.1. Control of the initial level of knowledge and skills. Solving test items to control the initial level of knowledge (Appendix 1).
6.2. Analysis with the teacher of the key questions necessary to master the topic of the lesson.
Questions on the topic of the lesson:
1. Statistics and classification of injuries of the maxillofacial area.
2. Scheme of examination of patients with injuries of the maxillofacial region.
3. Additional research methods for injuries of the maxillofacial area.
4. Dislocation of teeth. Classification, etiology, pathogenesis.
5. Clinic, diagnosis and treatment of dislocated teeth.
6. Fractures of teeth. Classification, etiology, pathogenesis.
7. Clinic, diagnosis and treatment of tooth fractures.
8. Fractures of the alveolar processes. Classification, etiology, pathogenesis.
9. Clinical picture, diagnosis and treatment of fractures of the alveolar processes.
10. Dislocation of the lower jaw. Classification, etiology, pathogenesis.
11. Clinic, diagnosis and treatment of dislocation of the lower jaw.
6.3. Demonstration by the teacher of the methodology of practical techniques for
this topic.
6.4. Independent work of students under the supervision of a teacher (supervision of patients, preparation of medical documentation)
6.5. Control of mastering the topic of the lesson. Solving test tasks and situational tasks to control the mastering of the topic of the lesson (Appendix 2, 3).
Self-study venue: reading room, study room for independent work of students, patient rooms, functional diagnostics rooms, etc.
Educational and research work of students on this topic:
1. Modern methods of treatment of fractures and dislocations of teeth.
2. Iatrogenic dislocations and fractures of the teeth. Causes of occurrence and methods of prevention.
Appendices to the topic: “Statistics and classification of injuries of the maxillofacial area. Methods of examination of patients with trauma of soft tissues and bones of the face. Dislocations and fractures of the teeth. Dislocation of the lower jaw. Fractures of the alveolar processes. Clinic, treatment "
Annex 1
TEST PROBLEMS
TO CONTROL THE BASELINE LEVEL OF KNOWLEDGE
Choose one or more correct answers.
1. THE LOWER JAW LIFTING MUSCLES ARE
1) temporal
2) maxillary-hyoid
3) buccal
4) digastric
5) maxillary-hyoid
2. AT THE CONTRACT OF THE LOWER JAW OF THE FIRST DEGREE THE MOUTH OPENS ON
1) 3 cm
2) 2 cm
3) 4 cm
4) 5 cm
5) 1 cm
3. AT THE CONTRACT OF THE LOWER JAW OF THE THIRD DEGREE THE MOUTH OPENS ON
1) 3 cm
2) 2 cm
3) 4 cm
4) 5 cm
5) 1 cm
4. THE CHEWING MUSCLE IS INERVATED
1) trigeminal nerve
2) facial nerve
3) the lower alveolar nerve
4) the ear-temporal nerve
5) the recurrent nerve
5. MUSCLE ATTACHED TO THE CAPSULE OF THE TEMPERAMENTAL JOINT
1) temporal
2) actually chewing
3) buccal
4) lateral pterygoid
5) medial pterygoid
6. THE FORMATION OF THE FACIAL SKELETON IN HUMAN IS MAINLY FINISHED BY
1) 12 years old
2) 15 years old
3) 17 years old
4) 21 years old
5) 25 years old
7. REDUCTION OF TISSUE NEED FOR OXYGEN IS ACHIEVED BY APPLICATION
1) HBO
2) local administration of ozonized solutions
3) local hypothermia
4) antioxidants
5) UHF
8. REDUCTION OF THE EXPRESSION OF TISSUE SWEELING IN MECHANICAL INJURY IS ACHIEVED BY APPLICATION
1) local hypothermia
2) UHF
3) heparin electrophoresis
4) osmotic diuretics
5) prednisolone
9. VIABILITY OF THE PULP IN THE INCOMPLETE TOOTH DISCONTINUATION IS DETERMINED ON THE BASIS OF THE DATA
1) rheography
2) radiography
3) echoosteometry
4) densitometry
5) electroodontodiagnostics
10. A MANDATORY MEASURE WHEN CONDUCTING THE PRIMARY SURGICAL TREATMENT OF THE FACE WOUNDS IS THE INTRODUCTION
1) gamma globulin
2) rabies serum
3) anti-tetanus serum
4) staphylococcal toxoid
5) narcotic analgesics
11. THE STATE OF THE BLOOD FLOW IN THE AREA OF DAMAGE CAN BE ASSESSED WITH THE HELP
1) computed tomography
2) rheography
3) fistulography
4) contrast radiography
5) polarography
12. THE MOST ACCURATE METHOD FOR DETERMINING THE LOCALIZATION AND SIZES OF BONE TISSUE DEFECT
1) computed tomography
2) rheography
3) fistulography
4) contrast radiography
5) polarography
13. THE TRIPLE NERVE BY FUNCTION IS
1) motor
2) sensitive
3) vegetative
4) mixed
14. MIMIC MUSCLES INERVATE
1) facial nerve
2) trigeminal nerve
3) the oculomotor nerve
4) the vagus nerve
5) glossopharyngeal nerve
15. BRANCHES OF THE FACIAL NERVE ARE LOCATED IN
1) thicker skin
2) subcutaneous adipose tissue
3) thicker muscles
4) Haversian channels
5) fascial vagina
Appendix 2
TEST PROBLEMS
TO CONTROL THE LEVEL OF ASSEMBLY OF THE TOPIC
Choose one or more correct answers.
1. THE MAIN SYMPTOM OF BILATERAL ANTERIOR DISTRIBUTION OF THE LOWER JAW
1) pain when chewing
2) pain on palpation of the temporomandibular joints.
3) the impossibility of closing the jaws
4) pathological mobility of the lower jaw
5) post-traumatic edema, hematoma
2. WITH REDUCTION OF PULP EXCITABILITY ACCORDING TO EDI DATA IMMEDIATELY AFTER TOOTH INJURY,
1) extirpation of the pulp
2) biological methods for the treatment of pulpitis
3) monitoring the state of the pulp in dynamics
4) tooth extraction
3. INDICATION FOR TOOTH EXTRACTION IN INJURY IS
1) transverse fracture of the tooth crown with opening of the cavity
2) fracture of the tooth at the level of the neck
3) fracture of the lower third of the tooth root
4) fracture of the tooth at the level of the root apex
5) longitudinal fracture of the tooth root
4. X-RAY SIGN OF INVOLVED TOOTH DISTRIBUTION
1) expansion of the periodontal gap
2) the absence of a periodontal gap
3) uneven expansion of the periodontal gap
5. MANUFACTURING OF THE STUD PIN INSERTION IS POSSIBLE IN THE Fracture of the Tooth Root
1) comminuted
2) transverse
3) longitudinal
6. THE PERIOD OF IMMOBILIZATION IN THE FRACTURE OF THE TOOTH ROOT IS
1) 7-10 days
2) 2-3 weeks
3) 4-5 weeks
4) 6-7 weeks
7. THE PERIOD OF IMMOBILIZATION IN DRAWING A TOOTH IS
1) 2-3 weeks
2) 3-4 weeks
3) 7-10 days
4) 1-2 weeks
8. THE OPTIMAL METHOD OF TREATMENT FOR COMPLETE DISCONTINUATION OF A PERMANENT TOOTH WITH A FORMED ROOT IS
1) prosthetics
2) orthodontic treatment
3) replantation of the tooth
4) tooth extraction
9. WITH ONE-LATERAL ANTERIOR DISTRIBUTION, THE CHIN SHIFTS
1) towards a healthy joint
2) towards defeat
3) posteriorly
4) anteriorly
10. PATHOLOGY OF THE TEMPERAMENTAL JOINT, PROMOTING THE OCCURRENCE OF THE "HABITUAL" DISTRIBUTION
1) weakening of the ligamentous apparatus
2) false joint
3) contracture
4) ankylosis
Appendix 3
SITUATION TASKS
TO CONTROL THE LEVEL OF ASSEMBLY OF THE TOPIC
Problem 1. Patient S. three hours ago as a result of an accident hit the lower third of his face on the steering wheel. Complains about the mobility of the anterior teeth of the lower jaw.
Objectively. The configuration of the face was changed due to collateral edema of the lower lip and chin region. Palpation of the mandibular body revealed no bone pathology, symptoms of direct and indirect loading were negative. When examining the oral cavity, the mobility of the frontal group of teeth together with the alveolar process, edema of soft tissues in the area of the transitional fold is determined. The dentition is intact.
1. Formulate a preliminary diagnosis.
2. Make a plan for additional examination and complex treatment of the patient.
Task 2. During the extraction of the root of the 3.5 tooth with a direct elevator, the doctor noticed the emerging mobility of the intact 3.4 tooth.
1. Formulate a preliminary diagnosis.
2. Make a plan for additional examination and complex treatment of the patient.
Task 3. A 19-year-old patient came to the clinic with complaints of 2.1 tooth mobility, pain when eating and chewing. According to the patient, three days ago, during training, he missed a direct punch with his fist. I did not lose consciousness, there was no dizziness, nausea, vomiting. He did not seek medical help.
Objectively. The face configuration was changed due to collateral edema of the upper lip. On the mucous membrane of the upper lip there is a wound 0.5 cm long with crushed edges, covered with fibrin bloom. 2.1 tooth has mobility of the second degree, the cutting edge is below the level of the adjacent teeth, with percussion, there is a sharp soreness.
1. Formulate a preliminary diagnosis.
2. Make a plan for additional examination and complex treatment of the patient.
Problem 4. Patient M., returning to the car after a scheduled inspection of the gas distribution station, hit the bumper when falling, as a result of which he knocked out the central upper incisors. I turned to the clinic only a day later, I brought my teeth with me.
1. Formulate a preliminary diagnosis.
2. Make a comprehensive treatment plan for the patient.
Task 5. Patient K. complained of intense pain in the 1.1 tooth, aggravated by all types of stimuli. According to the patient, he received a blow with his fist several hours ago, after which he felt a sharp pain in his tooth.
Objectively. The face configuration has not been changed. The mucous membrane of the oral cavity is pale pink, moist. The coronal part of the 1.1 tooth is absent, bleeding pulp is visible, probing is sharply painful, percussion is sensitive, mobility is not determined.
1. Formulate a preliminary diagnosis.
2. Make a plan for additional examination and complex treatment of the patient.
Task 6. A 76-year-old patient with complete secondary edentulousness after a long operation to remove an impacted 4.8 tooth cannot close her mouth. Attempts to move the lower jaw cause severe pain. Chin displacement away from the midline is not noted.
1. Formulate a preliminary diagnosis.
2. Make a comprehensive treatment plan for the patient.
TOPIC: NON-FIRE FRACTURES OF THE LOWER JAW. CLASSIFICATION. CLINIC. DIAGNOSTICS. TREATMENT.
1. Relevance. Fractures of the mandible are the most common among all fractures of the bones of the facial skeleton and, according to different authors, range from 75 to 96.5%, and 28-36% of the total number of inpatient dental patients. In 67-82% of cases, fractures of the lower jaw are localized within the dentition and, therefore, are open. The reasons contributing to the occurrence of complications in fractures of the lower jaw are the late appeal of victims for specialized help, diagnostic errors at the prehospital stage, incomplete reposition and inadequate fixation of fragments, incorrect tactics in relation to the tooth in the fracture gap. At the same time, the high risk of developing infectious and inflammatory complications in a fracture is determined by the anatomical and physiological characteristics of the lower jaw and its surrounding soft tissues. Despite the constant improvement of the complex treatment of mandibular fractures, the incidence of inflammatory complications remains high and reaches 41%.
In connection with the above, students of the Faculty of Dentistry study the topic “Non-fire fractures of the lower jaw. Classification, clinic, diagnosis, treatment ”is mandatory.
2. The purpose of the lesson: to create conditions and promote the acquisition of theoretical knowledge by students in the classification, clinic, diagnosis and treatment of fractures of the mandible, the skills of providing qualified and specialized care.
To form professional competencies, a student must know:
- anatomical and physiological features of organs and tissues of the maxillofacial region;
- anatomy of the lower jaw;
- anatomy of the muscles that raise and lower the lower jaw, their functions in unilateral and bilateral contraction;
- methods of examination of the patient by organs and systems;
- basic and additional research methods for injuries of the maxillofacial region;
- general characteristics and phases of reparative osteogenesis;
- mechanisms of occurrence of fractures of the lower jaw;
- classification of non-firearm fractures of the lower jaw;
- mechanisms of displacement of fragments in fractures of the lower jaw;
- clinic of fractures of the lower jaw;
- basic organizational principles of rendering assistance to victims with fractures of the lower jaw;
- methods of temporary and permanent immobilization of bone fragments in case of jaw fractures;
- the basics of drug and physical treatment for injuries;
- principles and stages of preoperative preparation of patients with injuries of the maxillofacial region.
To form professional competencies, a student must be able to:
- to examine patients with injuries of the maxillofacial region;
- draw up a plan for an additional examination;
- to evaluate the results of basic and additional research methods;
- to formulate a diagnosis in accordance with modern classifications;
- draw up a plan for the comprehensive treatment of victims with fractures of the lower jaw;
- to carry out temporary immobilization in case of fractures of the lower jaw;
- to carry out reduction and fixation of fragments in fractures of the lower jaw using orthopedic methods;
- on phantoms to carry out the reduction and fixation of fragments in fractures of the lower jaw by surgical methods;
- to carry out an examination of the ability to work;
- to carry out measures to prevent complications.
3. Type of lesson: practical lesson.
4. Duration of the lesson: 270 minutes.
5. Equipment: multimedia projector, slides, dummies, photographic materials, phantoms, radiographs, sets of instruments and materials for temporary and permanent immobilization in case of mandibular fractures.
6. Structure of the lesson:
6.1. Organizational stage. Checking the readiness for the lesson (appearance, mark of those present) - 5 minutes;
6.2. Control of the initial level of students' knowledge. Solving tests to control the initial level of knowledge (see Appendices 1, 4) - 10 min.
6.3. Familiarization of students with the content of the lesson - 60 min. Presentation of the key questions of the topic of the lesson.
Questions on the topic of the lesson:
1. Features of examination of patients with fractures of the mandible.
2. Etiology and pathogenesis of non-fire fractures of the mandible.
3. Classification of non-gunshot fractures of the lower jaw.
4. Factors determining the direction and nature of the displacement of fragments in fractures of the lower jaw.
5. Additional research methods for fractures of the lower jaw.
6. Features of the clinic of fractures of the lower jaw, depending on the location.
7. Functional disorders in fractures of the lower jaw.
8. Methods of temporary immobilization in case of fractures of the lower jaw (types, indications and contraindications, technique).
9. The choice of the method of anesthesia for the reduction and fixation of the fragments of the lower jaw.
10. Orthopedic methods of permanent immobilization for fractures of the lower jaw (types, indications, technique).
11. Surgical methods of permanent immobilization for fractures of the lower jaw (types, indications, technique).
12. Medical and physical methods of treatment for fractures of the lower jaw.
6.4. Demonstration of practical techniques by the teacher on this topic - 30 min.
6.5. Independent work of students under the guidance of a teacher (supervision of patients, preparation of medical documentation) - 120 min.
6.6. Analysis of the conducted supervision - 25 min.
6.7. Control of students' mastering of the topic of the lesson. Solving test tasks and situational tasks to control the mastering of the topic of the lesson (Appendix 2, 3) - 20 min.
Self-study venue: reading room, study room for independent work of students, patient rooms, functional diagnostics rooms, etc.
Educational and research work of students on this topic:
1. Modern clinical and statistical characteristics of mandibular fractures.
2. Features of the clinic and the incidence of complications in fractures of the mandible in a region with a developed petrochemical industry.
Appendices to the topic: “Non-fire fractures of the mandible. Classification, clinic, diagnosis, treatment "
Annex 1
TESTS FOR CONTROL
INITIAL LEVEL OF KNOWLEDGE
Choose one or more correct answers.
1. A FRACTURE OF THE LOWER JAW ARISING FROM THE OPPOSITE SIDE OF THE PLACE OF FORCE APPLICATION IS CALLED
1) direct
2) reflected
3) combined
4) distant
5) atypical
2. FRACTURES OF THE LOWER JAW BY NATURE MAY BE
1) median
2) in the area of the corner
3) comminuted
4) festering
5) household
3. A SMALL FRACTURE IN THE FRACTURE OF THE LOWER JAW IN THE REGION OF THE CANINE SHIFTS PREVENTLY
1) up
2) down
3) posteriorly
4.In case of unilateral fracture of the condylar process of the lower jaw, the chin is displaced into
1) the side of the fracture
2) the healthy side
5. IN BILATERAL FRACTURE IN THE LATERAL REGIONS OF THE LOWER JAW BODY, THE MIDDLE FRACTURE IS DISPLACED
1) down and back
2) down and forward
3) up and back
4) up and forward
6. OPTIMAL X-RAY PROJECTIONS FOR DIAGNOSING LOWER JAW FRACTURES
1) straight
2) lateral
3) semi-axial
4) naso-chin
5) axial
7. DURING OPERATIONS ON THE BONE TISSUE OF THE LATERAL REGION OF THE LOWER JAW FROM CONDUCTOR ANESTHESIA IS APPLIED
1) torusal
2) tuberous
3) infiltration
4) intraosseous
5) mental
8. IMPAIRMENT OF EXTRAASSAL BLOOD CIRCULATION DURING OPERATIONS ON THE LOWER JAW OCCURS PREVENTLY AS A RESULT
1) violation of the integrity of the bone
2) the pressure exerted by the fixing structures
3) the use of vasoconstrictor drugs
4) skeletonization of bone fragments
5) immobilization of the jaw
9. DAMAGE TO THE LOWER ALVEOLAR NERVE LEADS TO
1) drooping of the corner of the mouth
2) numbness of the skin of the chin
3) violation of mouth opening
4) displacement of the chin towards the lesion
5) inability to close lips.
10. CROSSING THE MARGINAL BRANCH OF THE FACIAL NERVE LEADS TO
1) drooping of the corner of the mouth
2) drooping of the upper eyelid
3) violation of mouth opening
4) displacement of the chin towards the lesion
5) inability to close lips
Appendix 2
TESTS FOR CONTROL
LEVEL OF ASSEMBLY OF THE TOPIC
Choose one or more correct answers.
1. IMMEDIATE COMPLICATION IN BILATERAL FRACTURE OF THE LOWER JAW BODY
1) dislocation asphyxia
2) valve asphyxia
3) bleeding from the external carotid artery
4) contracture of the lower jaw
5) ankylosis of the temporomandibular joint
2. MAIN SYMPTOM OF LOWER JAW FRACTURE
1) dizziness
2) restriction of mouth opening
3) pathological mobility of fragments
4) submucosal hematoma
5) pain with jaw movements
3. A SYMPTOM OF VENCAN ARISES IN FUNCTIONS
1) upper jaw
2) zygomatic bone
3) the lower jaw in the midline
4) the body of the lower jaw in the area of the molars
5) the neck of the articular process of the lower jaw
4. MAIN SYMPTOM OF LOWER JAW FRACTURE
1) limitation of lateral movements
2) malocclusion
3) post-traumatic edema
4) pain when swallowing
5) bleeding into the mouth
5. TEMPORARY IMMOBILIZATION FOR LOWER JAW FRACTURES
1) smooth brace
2) Tigerstedt tires
3) Rudko apparatus
4) intermaxillary ligature ligation according to Ivy
5) splint-kappa
6. IN FACTURE OF THE LOWER JAW IN THE BACKGROUND OF A FULL SECONDARY ADENTIA, A TIRE IS USED
1) Vasilieva
2) Porta
3) Weber
4) Tigerstedt
5) Mingazova
7. DURATION OF IMMOBILIZATION IN UNCOMPLICATED LOWER JAW FRACTURES
1) 3-5 weeks
2) 6-7 weeks
3) 8-9 weeks
4) 10-12 weeks
8. VASILIEV'S TAPE TIRE RELATED TO
1) dental
2) periodontal
3) supragingival
4) transport
5) combined
9. TIGERSTEDT TIRES RELATED TO
1) dental
2) periodontal
3) supragingival
4) transport
5) combined
10. INDICATION FOR APPLICATION OF SMOOTH STAPLE TIRE
1) fracture of the condylar process;
2) fracture of the angle of the lower jaw
3) impacted tooth dislocation
4) dislocation of the lower jaw
5) fracture of the alveolar bone
11. AT WHAT ANGLE TO THE VERTICAL AXIS OF THE TOOTH SHOULD BE LOCATED ON THE BIMAXILAR TIEGERSTEDT TIERSHEDT LOOP
1) 10-15
2) 35-45
3) 50 -55
4) 60 -75
5) 80 - 90
12. WHEN CARRYING OUT COMPRESSION-DISTRACTION OSTEOSYNTHESIS, THE TERM OF FORMATION OF PRIMARY BONE MAINS IS
1) 5 - 7 days
2) 14-16 days
3) 21-28 days
4) 30-40 days
5) 40-60 days
13. SURGICAL WOUND WHEN PERFORMING INTRAFOCUS OSTEOSYNTHESIS ON THE LOWER JAW WITH EXTERNAL ACCESS
1) sutured tightly on the skin, drained from the side of the oral cavity
2) in the oral cavity is sutured tightly, drained from the side of the skin
3) loosely tamponed with iodoform turunda
4) sutured after relief of acute inflammation
Appendix 3
SITUATION TASKS
TO CONTROL THE LEVEL OF ASSEMBLY OF THE TOPIC
Problem 1. A patient was punched in the face a few hours ago. After the injury, there was bleeding from the mouth. On admission, he complains of inability to chew due to pain in the lower jaw on the left. On external examination: edema of the lower part of the parotid-masticatory region on the left, sharp pain on palpation. When pressing on the chin, there is a sharp pain in the corner of the lower jaw on the left. An intraoral examination determines a malocclusion.
1. Formulate a preliminary diagnosis.
2. Make a plan for additional examination and complex treatment of the patient.
Task 2. The patient, 28 years old, was admitted to the clinic of surgical dentistry with a diagnosis: "Household traumatic bilateral fracture of the mandible body between 45 and 44 without displacement of fragments and condylar process with dislocation of the articular head on the left." The bite is broken, the dentition is intact.
1. Make a plan for additional examination and complex treatment of the patient.
Task 3. A patient came to the FAP with complaints of pain in the lower jaw, dizziness, nausea. From the anamnesis: he works as a cattleman, during the cleaning in the stable the horse hit the hoof, does not remember whether there was loss of consciousness, about an hour has passed since the injury. Objectively: Palpation of the body of the lower jaw is sharply painful in the area of the corner on the left and the body on the right, along the lower edge the symptom of a "step" in the projection of the 43 tooth is determined. The symptom of indirect loading is positive in the area of the corner of the lower jaw on the left and the body on the right. The bite is broken. When examining the dentition, the gap between 43 and 44 teeth is determined.
1. Formulate a preliminary diagnosis. Indicate the necessary measures of first aid.
2. Make a plan for additional examination and complex treatment of the patient.
Task 4. A patient has a fracture of the lower jaw between 36 and 37 teeth without displacement of fragments. The distal fragment is tightly mobile. A rupture of the mucous membrane is determined. The dentition is intact.
1. Make a comprehensive treatment plan for the patient.
Task 5. A patient was delivered to the dental clinic with a bilateral fracture of the lower jaw in the region of 34, 45 teeth without displacement. Complete absence of teeth in the upper and lower jaw.
Make a comprehensive treatment plan for the patient.
Task 6. A patient with a fracture of the lower jaw in the region of the condylar process with a displacement of a small fragment outward was delivered to the department of maxillofacial surgery.
Make a comprehensive treatment plan for the patient.
TOPIC: NON-FIRING FRACTURES UPPER
JAWS. CLASSIFICATION, CLINIC, DIAGNOSTICS,
TREATMENT.
1. Relevance. Fractures of the upper jaw account for 5.2% of all fractures of the bones of the facial skeleton.
All fractures of the upper jaw are considered to be open, since the fracture gap can pass through the nasal cavity or the walls of the paranasal sinuses, damaging the mucous membrane of these anatomical structures.
The nature of the fracture of the upper jaw is predetermined by the direction of the impact force relative to the buttresses. Due to the fact that the buttresses on the upper jaw are located in different planes, the direction of impact relative to one of them can be perpendicular, the other - at an angle, the third - parallel, as a result, multidirectional fractures can occur simultaneously. In addition, the interpretation of radiographs is complicated by the imposition of other bones, all this complicates the timely diagnosis and provision of specialized care.
In connection with the above, study of the topic “Non-fire fractures of the upper jaw. Classification, clinic, diagnosis, treatment ”by students of the Faculty of Dentistry is mandatory.
2. The purpose of the lesson: to create conditions and promote the acquisition of theoretical knowledge by students on classification, clinical features, diagnosis and treatment of fractures of the upper jaw, skills of providing qualified and specialized care.
To form professional competencies, a student must know:
- anatomical and physiological features of organs and tissues of the maxillofacial region;
- anatomy of the upper jaw;
- basic and additional research methods for injuries of the maxillofacial region;
- methods of examination of the patient by organs and systems;
- general characteristics and phases of reparative osteogenesis;
- classification of non-firearm fractures of the upper jaw;
- clinic of fractures of the upper jaw;
- basic organizational principles of providing assistance to victims with fractures of the upper jaw;
- principles and stages of preoperative preparation of patients with injuries of the maxillofacial region
- methods of temporary and permanent immobilization of bone fragments in case of jaw fractures;
- the basics of drug and physical treatment for injuries;
- the timing of the formation of primary and secondary callus in fractures of the upper jaw.
To form professional competencies, a student must be able to:
- to examine patients with injuries of the maxillofacial region;
- draw up a plan for an additional examination;
- to evaluate the results of clinical and laboratory-instrumental data;
- to formulate a diagnosis in accordance with modern classifications;
- draw up a plan for the comprehensive treatment of patients with fractures of the upper jaw;
- to carry out temporary immobilization in case of fractures of the upper jaw;
- to carry out reduction and fixation of fragments in case of fractures of the upper jaw by orthopedic and surgical methods;
- to carry out an examination of the ability to work;
- to carry out measures to prevent complications.
3. Type of lesson: practical lesson.
4. Duration of the lesson: 270 minutes.
5. Equipment: multimedia projector, slides, dummies, photographic materials, phantoms, radiographs, sets of instruments and materials for jaw immobilization.
6. Structure of the lesson:
6.1. Organizational stage. Checking the readiness for the lesson (appearance, mark of those present) - 5 minutes;
6.2. Control of the initial level of students' knowledge. Solving tests to control the initial level of knowledge (see Appendices 1, 4) - 10 min.
6.3. Familiarization of students with the content of the lesson - 60 min. Presentation of the key questions of the topic of the lesson
Questions on the topic of the lesson:
1. Classification of non-firearm fractures of the upper jaw.
2. Etiology and pathogenesis of non-fire fractures of the upper jaw.
3. Factors determining the direction and nature of the displacement of fragments in fractures of the upper jaw.
4. Functional disorders in case of non-fire fractures of the upper jaw.
5. Features of examination of patients with fractures of the upper jaw.
6. Features of the clinic of fractures of the upper jaw, depending on the location.
7. The choice of the method of pain relief.
8. Methods of temporary immobilization for fractures of the upper jaw (types, indications, technique).
9. Orthopedic methods of permanent immobilization in case of fractures of the upper jaw (types, indications, technique).
10. Surgical methods of permanent immobilization for fractures of the upper jaw (types, indications, technique).
11. Medical and physical methods of treatment for fractures of the upper jaw.
6.4. Demonstration of practical techniques by the teacher on this topic - 30 min.
6.5. Independent work of students under the guidance of a teacher (supervision of patients, preparation of medical documentation) - 120 min.
6.6. Analysis of the conducted supervision - 25 min.
6.7. Control of students' mastering of the topic of the lesson. Solving test tasks and situational tasks to control the mastering of the topic of the lesson (Appendix 2, 3) - 20 min.
To form professional competencies, a student must be able to:
- to examine patients with injuries of the maxillofacial region;
- draw up a plan for an additional examination;
- to evaluate the results of clinical and laboratory-instrumental data;
- to formulate a diagnosis in accordance with modern classifications;
- draw up a plan for the comprehensive treatment of patients with fractures of the upper jaw;
- to carry out temporary immobilization in case of fractures of the upper jaw;
- to carry out reduction and fixation of fragments in case of fractures of the upper jaw by orthopedic and surgical methods;
- to carry out an examination of the ability to work;
- to carry out measures to prevent complications.
3. Type of lesson: practical lesson.
4. Duration of the lesson: 270 minutes.
5. Equipment: multimedia projector, slides, dummies, photographic materials, phantoms, radiographs, sets of instruments and materials for jaw immobilization.
6. Structure of the lesson:
6.1. Organizational stage. Checking the readiness for the lesson (appearance, mark of those present) - 5 minutes;
6.2. Control of the initial level of students' knowledge. Solving tests to control the initial level of knowledge (see Appendices 1, 4) - 10 min.
6.3. Familiarization of students with the content of the lesson - 60 min. Presentation of the key questions of the topic of the lesson
Questions on the topic of the lesson:
1. Classification of non-firearm fractures of the upper jaw.
2. Etiology and pathogenesis of non-fire fractures of the upper jaw.
3. Factors determining the direction and nature of the displacement of fragments in fractures of the upper jaw.
4. Functional disorders in case of non-fire fractures of the upper jaw.
5. Features of examination of patients with fractures of the upper jaw.
6. Features of the clinic of fractures of the upper jaw, depending on the location.
7. The choice of the method of pain relief.
8. Methods of temporary immobilization for fractures of the upper jaw (types, indications, technique).
9. Orthopedic methods of permanent immobilization in case of fractures of the upper jaw (types, indications, technique).
10. Surgical methods of permanent immobilization for fractures of the upper jaw (types, indications, technique).
11. Medical and physical methods of treatment for fractures of the upper jaw.
6.4. Demonstration of practical techniques by the teacher on this topic - 30 min.
6.5. Independent work of students under the guidance of a teacher (supervision of patients, preparation of medical documentation) - 120 min.
6.6. Analysis of the conducted supervision - 25 min.
6.7. Control of students' mastering of the topic of the lesson. Solving test tasks and situational tasks to control the mastering of the topic of the lesson (Appendix 2, 3) - 20 min.
Appendices to the topic: “Non-fire fractures of the upper jaw. Classification, clinic, diagnosis, treatment "
Annex 1
TESTS FOR CONTROL
INITIAL LEVEL OF KNOWLEDGE
Choose one or more correct answers.
1. FOR REFINING THE LOCALIZATION OF THE UPPER JAW FRACTURE IS APPLIED
1) computed tomography
2) rheography
3) fistulography
4) contrast radiography
5) polarography.
2. THE MOST COMPLETE INFORMATION ABOUT THE FRACTURE OF THE UPPER JAW ALLOWS TO OBTAIN AN X-RAY
1) in frontal projection
2) intraoral
3) in lateral projection
4) in axial (semi-axial) projection
3. DISPLACEMENT OF FRAGMENTS IN THE FRACTURE OF THE UPPER JAW HAPPENS UNDER THE INFLUENCE
1) traumatic force
2) dead weight
3) traction muscles
4) edema of soft tissues
5) in the process of chewing
4. TYPE Fractures of the upper jaw, at which the gap BREAKING runs from the junction of the frontal sprouts upper jaw with the nasal part of the frontal bones and the bones of the nose, then the medial orbital wall, then along the bottom wall of the eye socket to the infraorbital EDGE, crossing it at SKULOCHELYUSTNOMU seam IS
1) bottom
2) average
3) top
5. TYPE Fractures of the upper jaw, at which the gap BREAKING pass over the alveolar process and the vault of the hard palate, starting at the edge of the pear-shaped hole, then near the bottom of the maxillary sinus, passing through the hill MAXILLA to the lower third of the pterygoid process of the sphenoid bone, IS
1) bottom
2) average
3) top
6. IMPAIRMENT OF SKIN SENSITIVITY IN THE IRREGULAR REGION ARISES WHEN FRACTURES OF THE UPPER JAW
1) top type
2) average type
3) lower type
7. ORTHOPEDIC METHOD OF PERMANENT IMMOBILIZATION FOR JAW FRACTURES
1) Tigerstedt tires
2) Rudko apparatus
3) intermaxillary ligature ligation according to Ivy
4) stiff chin sling
5) Kirschner spoke
8. SURGICAL METHOD OF PERMANENT IMMOBILIZATION FOR JAW FRACTURES
1) Tigerstedt tires
2) intermaxillary ligature ligation according to Ivy
3) splint-kappa
4) osteosynthesis with titanium miniplates
5) smooth brace
9. TRANSPORTATION IMMOBILIZATION FOR UPPER JAW FRACTURES
1) smooth brace
2) Tigerstedt tires
3) Rudko apparatus
4) intermaxillary ligature ligation according to Ivy
5) sling-like bandage
10. DIPLOPIA WITH FRACTURES OF THE UPPER JAW DEVELOPS AS A DUE TO
1) rupture of the optic nerve
2) compression by hematoma
3) intraorbital bleeding
4) displacement of the eyeball
5) retinal edema
Appendix 2
TESTS FOR CONTROL
LEVEL OF ASSEMBLY OF THE TOPIC
Choose one or more correct answers.
1. ONE OF THE CLINICAL SIGNS OF UPPER JAW Fracture MAY BE
1) paresis of the facial nerve
2) diplopia
3) hemorrhage in the area of the transitional fold of all groups of teeth
4) crepitus of bone fragments in the area of the zygomatic-alveolar suture
5) liquorrhea
2. CLINICAL SIGN OF UPPER JAW FRACTURE BY THE LOWER TYPE
1) the symptom of "glasses"
2) symptom of "steps" along the lower edge of the orbit
3) flattening of the face in the middle section
4) diplopia
5) violation of the sensitivity of the teeth
3. CLINICAL SIGN OF UPPER JAW FRACTURE
1) bleeding from the maxillary sinus
2) blindness
3) hematoma in the infraorbital region
4) crepitus of bone fragments in the area of the zygomatic suture
5) lengthening of the lower third of the face
4. THE MAIN SYMPTOM OF UPPER JAW FRACTURE IS
1) headache
2) nosebleeds
3) contusion, soft tissue hematoma
4) pathological mobility of the maxillary bones
5) ruptures of the mucous membrane of the alveolar processes
5. THE COMBINED METHOD OF FIXATION OF FRAGMENTS IN THE FRACTURE OF THE UPPER JAW IS
1) bone suture
2) Makienko method
3) Federspiel's method
4) Zbarzh method
6. SURGICAL METHOD FOR FIXATION OF FRAGMENTS IN FRACTURE OF THE UPPER JAW IS
1) Black's method
2) Makienko method
3) Federspiel's method
4) Adams method
7. FIXATION OF FRACTIONS OF SOLID SKY IS CARRIED OUT WITH THE HELP
1) palatine plate
2) Tigerstedt tires with strut bend
3) titanium spokes
4) Tigerstedt tires with an inclined plane
8. FIXATION OF UPPER JAW FRAGMENTS IS POSSIBLE WITH THE HELP
1) wire bone suture
2) intermaxillary ligature ligation
3) twisted seam
4) Rudko apparatus
9. THE METHOD OF Fragment Fixation in Case of Maxillary Fractures Along Zbarzh RELATES TO
1) surgical
2) orthopedic
3) combined
10. IMMOBILIZATION OF FRAGMENTS IN CASE OF UPPER JAW FRACTURE BY BIMAXILARY TIGERSHTEDT BUSES WITH CHAINING LOOPS IS PERFORMED IN COMBINATION WITH
1) sling-like bandage
2) intermaxillary ligature ligation
3) splint-kappa
4) Vasiliev's bus
Appendix 3
SITUATION TASKS
TO CONTROL THE LEVEL OF ASSEMBLY OF THE TOPIC
Task 1. Patient A. after an injury (falling from a height while repairing the roof of his own house) developed significant facial edema, hemorrhage appeared in the lower eyelids on both sides, paresthesia of the infraorbital region skin, and nosebleeds. Palpation is determined by the bone protrusion along the lower edge of the orbit on both sides and at the bridge. Examination of the oral cavity: open bite, molars in contact. There is hemorrhage along the transitional fold in the area of the first molars.
1. Formulate a preliminary diagnosis.
2. Make a plan for additional examination and complex treatment of the patient.
Task 2. After a car accident, a patient with post-traumatic facial edema was delivered to the clinic. On the left is hemorrhage in both eyelids, on the right - only in the lower one. On the left is a divergent squint. A pinkish liquid with small blood clots is released from the nose; when a drop is applied to a napkin, a yellowish border is formed around the pink spot. Paresthesia of the lower eyelid, wing of the nose and upper lip on the right is determined, bony protrusions along the lower edge of the orbit on the right and lateral on the left. The bite is broken. Hemorrhage into the transitional fold in 15-17 teeth and the anterior palatine arch on the left.
1. Formulate a preliminary diagnosis.
2. Make a plan for additional examination and complex treatment of the patient.
Task 3. Patient C., 30 years old, came to the clinic with complaints of pain in the upper jaw, inability to close his teeth. From the anamnesis: 3 days ago, in a fight, he received a blow with a fist in the anterior part of the upper jaw. I didn’t lose consciousness. Notes bleeding from the nose immediately after injury. He did not seek medical help. Objectively: lengthening of the lower part of the face, edema of the nasolabial triangle, open bite, submucous hematoma above the transitional fold throughout the entire dentition, pathological mobility of fragments.
1. Formulate a preliminary diagnosis.
2. Make a plan for additional examination and complex treatment of the patient.
Task 4. Patient D., 20 years old, came to the clinic with complaints of pain in the upper jaw on the right, inability to close his teeth. From the anamnesis: about an hour ago he was injured as a result of a fall from a tree. I didn’t lose consciousness. Marks bleeding from the right nasal passage. Objectively: the face configuration was changed due to collateral edema of the infraorbital region, upper lip on the right, submucosal hematoma above the transitional fold throughout the entire dentition of the upper jaw on the right, rupture of the mucous membrane in the palatine suture region, displacement of the fragment inward and downward.
1. Formulate a preliminary diagnosis.
2. Make a plan for additional examination and complex treatment of the patient.
Task 5. A patient came to FAP a few minutes after receiving an occupational injury with complaints of pain in the upper jaw, nosebleeds, inability to close his teeth, dizziness, and nausea. Notes a short-term loss of consciousness. The paramedic performed anterior nasal tamponade and intermaxillary ligature ligation. Since the only available transport was a truck, a mattress was placed in the back, the patient was laid on his back, and the accompanying foreman sat in the cab. Upon arrival at the Central Regional Hospital, they found that a hundred of the patient died, and upon examining the corpse, the doctor of the emergency room noted a sharp smell of vomit.
1. What could be the cause of the patient's death?
2. What actions of the paramedic contributed to this?
Task 6. A patient who was injured as a result of a fall from a bicycle consulted a doctor in a rural outpatient clinic. On examination, a preliminary diagnosis was established - fracture of the upper jaw, laceration of the upper lip. The wound is contaminated with earth.
Indicate the necessary first aid measures.
THEME: COMBINED FACE INJURIES. FEATURES OF THE CLINICAL CURRENT. COMBINED CRANIAL - BRAIN TRAUMA.
1. Relevance. The anatomical commonality of the facial and cerebral skull creates the prerequisites for the occurrence of associated injuries. Fractures of the bones of the face, including the zygomatic complex and nasal bones, can be combined with damage to the skull and other anatomical areas. According to the literature, concomitant trauma with fractures of the bones of the facial skeleton occurs in 30% of victims. Untimely or incomplete assistance rendered contributes to the development of complications, lengthening of terms and worsening of patient treatment outcomes. Patients with combined injuries of the maxillofacial region are of particular interest to clinicians due to the increasing frequency, variability of the clinical course, the difficulty of diagnosis and the choice of the optimal method of treatment.
In connection with the above, the study by students of the Faculty of Dentistry of the features of the clinic, diagnosis and treatment of fractures of the zygomatic complex, nasal bones and associated injuries of the maxillofacial region is mandatory.
2. The purpose of the lesson:
• to promote the acquisition of theoretical knowledge by students on the classification, clinical features and diagnosis of fractures and associated injuries of the maxillofacial region;
• create conditions and help students master the skills of examining patients with fractures and associated injuries of the maxillofacial region, providing qualified and specialized care.
To form professional competencies, a student must know:
- anatomical and physiological features of organs and tissues of the maxillofacial region;
- anatomy of the zygomatic complex and nasal bones;
- methods of examination of the patient by organs and systems;
- basic and additional research methods for injuries of the maxillofacial region;
- peculiarities of examination of patients with concomitant trauma of the maxillofacial region;
- general characteristics and phases of reparative osteogenesis;
- classification of non-firearms fractures of the zygomatic complex and nasal bones;
- Clinic for fractures of the zygomatic complex and nasal bones;
- features of the clinic of fractures of the bones of the facial skeleton in concomitant injury
- principles and stages of preoperative preparation of patients with injuries of the maxillofacial region;
- basic organizational principles of rendering assistance to victims with injuries of the maxillofacial region;
- methods of reduction and fixation of fragments in fractures of the zygomatic complex and nasal bones;
- principles of drug and physical treatment for fractures of the zygomatic complex and nasal bones;
- features of the complex treatment of patients with concomitant trauma of the maxillofacial region.
To form professional competencies, a student must be able to:
- to examine patients with injuries of the maxillofacial region;
- draw up a plan for an additional examination;
- to evaluate the results of basic and additional examination methods;
- to formulate a diagnosis in accordance with modern classifications;
- provide emergency care for fractures of the zygomatic complex, nasal bones and associated trauma;
- draw up a plan for comprehensive treatment of victims with fractures of the zygomatic complex, nasal bones and associated injuries;
- on phantoms, to carry out the reposition of fragments in case of fractures of the zygomatic complex using bloody and bloodless methods;
- on phantoms, carry out anterior and posterior tamponade of the nasal cavity, reduction and fixation of fragments in case of fractures of the nasal bones;
- to carry out an examination of the ability to work;
- to carry out measures to prevent complications.
3. Type of lesson: practical lesson.
4. Duration of the lesson: 270 minutes.
5. Equipment: multimedia projector, slides, dummies, photographic materials, phantoms, radiographs, sets of tools and materials for practicing practical skills.
6. Structure of the lesson:
6.1. Organizational stage. Checking the readiness for the lesson (appearance, mark of those present) - 5 minutes;
6.2. Control of the initial level of students' knowledge. Solving tests to control the initial level of knowledge (see Appendices 1, 4) - 10 min.
6.3. Familiarization of students with the content of the lesson - 60 min. Presentation of the key questions of the topic of the lesson.
Questions on the topic of the lesson:
1. Classification of non-gunshot fractures of the zygomatic complex.
2. Classification of non-gunshot fractures of the nasal bones.
3. Classification of combined injuries of the maxillofacial region.
4. Etiology and pathogenesis of non-fireball fractures of the zygomatic complex.
5. Etiology and pathogenesis of nasal bone fractures.
6. Etiology and pathogenesis of concomitant injuries in non-fire-related fractures of the bones of the facial skeleton.
7. Factors determining the direction and nature of displacement of fragments in fractures of the zygomatic complex and nasal bones.
8. Functional disturbances in non-fireball fractures of the zygomatic complex and nasal bones.
9. Functional disorders with combined injuries of the maxillofacial region.
10. Features of examination of patients with fractures of the zygomatic complex and nasal bones.
11. Additional research methods for fractures of the zygomatic complex and nasal bones.
12. Additional research methods for combined injuries.
13. Clinic of fractures of the zygomatic complex.
14. Clinic of fractures of the nasal bones.
15. Features of the clinic of fractures of the bones of the facial skeleton in concomitant injury.
16. Methods of reduction and fixation of fragments in fractures of the zygomatic complex and nasal bones.
17. Medical and physical methods of treatment for fractures of the zygomatic complex and nasal bones.
18. Features of the complex treatment of patients with concomitant trauma.
6.4. Demonstration of practical techniques by the teacher on this topic - 30 min.
6.5. Independent work of students under the guidance of a teacher (supervision of patients, preparation of medical documentation) - 120 min.
6.6. Analysis of the conducted supervision - 25 min.
6.7. Control of students' mastering of the topic of the lesson. Solving test tasks and situational tasks to control the mastering of the topic of the lesson (Appendix 2, 3) - 20 min.
Self-study venue: reading room, study room for independent work of students, patient rooms, functional diagnostics rooms, etc.
Educational and research work of students on this topic:
1. Neurological symptoms in combined craniocerebral trauma.
2. Combined trauma of the maxillofacial region with fractures of the chest, limb bones and pelvis. Features of the clinic, diagnosis and treatment.
Appendices to the topic: “Combined facial injuries. Features of the clinical course. Combined traumatic brain injury "
Annex 1
TESTS FOR CONTROL
INITIAL LEVEL OF KNOWLEDGE
Choose one or more correct answers.
1. COMBINED INJURY IS CALLED INJURY
1) one anatomical region by different damaging factors
2) one anatomical region with one damaging factor
3) several anatomical regions with one damaging factor
4) several anatomical areas with different damaging factors
2. THE MOST ACCURATE METHOD FOR DETERMINING THE LOCALIZATION OF THE FREQUENCY OF THE ZYGAL COMPLEX
1) computed tomography
2) rheography
3) fistulography
4) contrast radiography
5) polarography.
3. X-RAY PROJECTION, ALLOWING TO OBTAIN THE MOST COMPLETE INFORMATION ABOUT Fracture of the Zygomatic Bone
1) frontal
2) intraoral
3) lateral
4) axial (semi-axial)
4. THE DISPLACEMENT OF FRAGMENTS IN THE FREQUENCY OF THE ZYGAL COMPLEX OCCURS UNDER THE INFLUENCE
1) facial muscles
2) dead weight
3) chewing muscles
4) edema of soft tissues
5. Damage to the infraorbital nerve leads to impairment
1) facial expressions
2) eyeball movements
3) sensitivity in the area of the upper incisors
4) sensitivity of the upper eyelid
5) nasal breathing
6. MUSCLE ATTACHING TO THE ZYGAL ARCH
1) temporal
2) chewable
3) medial pterygoid
4) lateral pterygoid
7. THE MOST ACCURATE METHOD FOR DETERMINING THE STATE OF THE BRAIN SOFT TISSUE STRUCTURES
1) computed tomography
2) rheography
3) magnetic resonance imaging
4) contrast radiography
5) polarography.
8. DIPLOPY IS
1) violation of the movement of the eyeball
2) impaired twilight vision
3) perverse perception of colors
4) double vision
5) protruding eyeballs
9. DAMAGE TO THE GAYMORIC SINK HAPPENS WHEN FRACTURING
1) zygomatic bone
2) the bones of the nose
3) mastoid process
4) the base of the skull
5) the temporal bone
10. Fracture of the bones of the face with damage to the maxillary sinus RELATED TO
1) closed
2) open
3) combined
4) combined
5) complicated
Appendix 2
TESTS FOR CONTROL
LEVEL OF ASSEMBLY OF THE TOPIC
Choose one or more correct answers.
1. THE MAIN SYMPTOM OF Fracture of the Zygomatic Complex
1) dizziness
2) nosebleeds
3) diplopia
4) post-traumatic edema
5) malocclusion
2. THE MAIN SYMPTOM OF FRACTURE OF THE BONES OF THE SKULL BASE
1) headache
2) nosebleeds
3) liquorrhea
4) "step symptom"
5) diplopia
3. Fracture of the bones of the base of the skull most often occurs when
1) separation of the alveolar process.
2) subbasal fracture of the upper jaw.
3) fracture of the zygomatic complex.
4) fracture of the nasal septum.
4. TRANSPORTATION OF A PATIENT WITH COMBINED INJURY OF THE HEAD AND SPINE IS CARRIED OUT IN THE Lying ON
1) side
2) belly
3) back
4) side with bent knees
5. THE PRESENCE OF AN IMMUNITY OF FLUORES IN BLEEDING FROM THE NOSE INDICATES
1) Malevich symptom
2) positive Wasserman reaction
3) positive double spot test
4) a decrease in the amount of albumin in the blood
5) the presence of crepitus in the area of the mastoid processes
6. FOR STOPPING BLEEDING FROM THE BACK REGIONS OF THE NOSE CAVITY USED
1) anterior tamponade
2) posterior tamponade
3) pressure bandage
4) ligation of the facial artery
5) ligation of the internal carotid artery
7. SYMPTOM OF CONCUSSION OF THE BRAIN
1) diplopia
2) bleeding from the ear
3) the mobility of the bones of the cranial vault
4) retrograde amnesia
5) the symptom of "glasses"
8. FIXATION OF FRAGMENTS IN THE FRACTURE OF NOSE BONES IS CARRIED OUT WITH THE HELP OF THE ANTERIOR TAMPONAD OF THE NOSE TRACKS AND
1) smooth tires
2) Kirschner needles
3) plaster cast
4) splints-mouthguards
5) naso-frontal suspension
9. FOR PREVENTION OF THE DEVELOPMENT OF BRAIN EADDY IN CONCUSSIONS AND EARS OF THE BRAIN, USE
1) pressure bandage
2) narcotic analgesics
3) antibacterial drugs
4) vasoconstrictor drugs
5) osmotic diuretics
10. LIMITATION OF LATERAL MOVEMENTS OF THE LOWER JAW IN FRACTURE OF THE ZYGAL COMPLEX IS CONDITIONED
1) contracture of the masticatory muscles
2) blocking the coronoid process
3) damage to the temporomandibular joint
4) blocking the condylar process
5) fracture of the branch of the lower jaw
Appendix 3
SITUATION TASKS
TO CONTROL THE LEVEL OF ASSEMBLY OF THE TOPIC
Task 1. A 26-year-old patient turned to the clinic with complaints of limited mouth opening. Anamnesis revealed that two weeks ago the patient was injured as a result of a fall, and did not seek medical help. Objectively: The configuration of the face is changed due to the retraction of the soft tissues of the right zygomatic region. Opening the mouth by 2 cm, limiting lateral movements by the jaw. On palpation of the zygomatic region, an unevenness of the lower edge of the orbit and the zygomatic arch is noted. Reduced sensitivity of the skin of the right infraorbital region.
1. Formulate a preliminary diagnosis.
2. Make a plan for additional examination and complex treatment of the patient.
Task 2. After falling into the sewer hatch, the patient complains of severe pain when breathing, turning the body, trying to close the mouth, when leaning on the right leg. On examination by the dentist, facial asymmetry was revealed, the chin was displaced to the left. There are deep abrasions on the skin of the chin. The left external auditory canal is narrowed, filled with a blood clot, anterior to the right ear tragus, a hard node is visible and palpable, weakly mobile when the chin is forcibly shifted to the sides. On the right, the frontal teeth are separated, only the last molar is in contact. Under load, there is pain in the left ear. On examination by the surgeon: palpation of the chest is sharply painful, there are sharp irregularities in the region of the 7th and 8th ribs on the right, extensive swelling of the right ankle joint.
1. Formulate a preliminary diagnosis.
2. Make a plan for additional examination and complex treatment of the patient.
Task 3. A 30-year-old patient was delivered by ambulance to the clinic. When interviewing the escorts, it was found that the team picked up the patient from the street, beaten, in serious condition, unconscious. When examining the patient: clothes and face in blood, the patient is indifferent to the environment, the pupils are wide, the skin is pale. AD-60-90 mm. rt. Art., pulse 130-140 beats per minute, shallow breathing. Swelling and hemorrhage in the tissue around the eyes on the right and left. A bony protrusion is palpated in the region of the lateral wall of the orbit. Examination of the oral cavity: open bite, the integrity of the mucous membrane is not violated. A clear liquid mixed with blood flows down the back of the pharynx.
1. Formulate a preliminary diagnosis.
2. Make a plan for additional examination and complex treatment of the patient.
Task 4. A patient with a domestic injury was admitted to the clinic (fell into the cellar). Complaints of pain in the midface area, malocclusion, abdominal pain, dizziness, vomiting. On physical examination, pronounced epistaxis from both nasal passages, aggravated by tilting the head forward. Palpation of the abdomen is sharply painful, tension of the muscles of the abdominal wall.
1. Formulate a preliminary diagnosis.
2. Make a plan for additional examination and complex treatment of the patient.
Task 5. A 27-year-old man consulted a dentist with complaints about the impossibility of biting off and chewing food, soreness of the parotid-chewing areas, malocclusion, nausea, vomiting after receiving a chin injury during a fight. The general condition is satisfactory. Facial contours are disturbed due to collateral edema of the soft tissues of the parotid-masticatory regions, chin and lengthening of the lower third of the face due to the open mouth.
The mucous membrane of the vestibule of the oral cavity is hyperemic, edematous, especially in the area of the crowded teeth of the frontal group of the lower jaw.
The symptom of indirect loading is positive in the area of the temporomandibular joints.
1. Formulate a preliminary diagnosis.
2. Make a plan for additional examination and treatment of the patient.
Problem 6. Patient R. In a fight about an hour ago he received a blow with his fist in the region of the nose. He did not lose consciousness, after the injury he notes bleeding from the nose. On examination, edema, hematoma of the eyelids on both sides, bone mobility, crepitus in the bridge of the nose are determined. Examination of the oral cavity was unremarkable.
1. Formulate a preliminary diagnosis.
2. Make a plan for additional examination and complex treatment of the patient.
Appendices to the topic: "Complications of trauma tsp."
Annex 1
TESTS FOR CONTROL
INITIAL LEVEL OF KNOWLEDGE
Choose one or more correct answers.
1. AFTER SUTURING THE SKIN WOUND, THE SEAMS ARE REMOVED BY
1) second day
2) 3-5 days
3) 7-10th day
4) 12-14th day
5) 16 -21st day
2. ACCELERATION OF WOUND CLEANING FROM NONCROTIZED TISSUES IS ACHIEVED THANKS TO THE USE
1) hemodialysis
2) dressings with hypertonic solution
3) treatment of wounds with hydrogen peroxide
4) proteolytic enzymes
5) collagen-based preparations
3. APPLICATION OF THE PRESSURE BANDAGE AFTER THE PRIMARY SURGICAL TREATMENT WITH WOUND SUSPENSION ALLOWS
1) reduce pain syndrome
2) fix the flaps in the desired position
3) reduce the likelihood of bruising
4) reduce stress on seams
5) stop ongoing bleeding
4. EXCESSIVE TIGHTENING OF NODE SEAMS CAUSES
1) displacement of the flaps
2) violation of the outflow of exudate
3) the formation of a retracted scar
4) severe pain syndrome
5) marginal flap necrosis
5. LATE SECONDARY BLEEDING ARE ARISING AS A RESULT
i) re-injury
ii) increased blood pressure
iii) bleeding disorders
iv) purulent fusion of a thrombus
v) early physical activity
6. IMMEDIATE COMPLICATION OF DAMAGE TO THE MAXILLOFACIAL AREA
1) suppuration of a bone wound
2) loss of consciousness
3) asphyxia
4) neuritis of the facial nerve
5) ankylosis of the temporomandibular joint
7. EARLY COMPLICATION OF DAMAGE TO THE MAXILLOFACIAL REGION
1) suppuration of a bone wound
2) false joint
3) loss of consciousness
4) ongoing bleeding
5) ankylosis of the temporomandibular joint
8. LATE COMPLICATION OF DAMAGE TO THE MAXILLOFACIAL AREA
1) suppuration of a bone wound
2) aspiration pneumonia
3) bleeding
4) periostitis
5) ankylosis of the temporomandibular joint
9. OBTURATION ASFIXIA ARISES WHEN
1) aspiration of vomit
2) the ingress of a foreign body into the upper respiratory tract
3) tongue sinking
4) compression of the trachea by a tumor, edema
5) closing the entrance to the larynx with a soft tissue flap
10. IN THE FIRST DAY OF SOFT TISSUE INJURY
1) UFO
2) UHF
3) dry heat
4) local hypothermia
5) antibiotics
Appendix 2
TESTS FOR CONTROL
LEVEL OF ASSEMBLY OF THE TOPIC
Choose one or more correct answers.
1. TREATMENT OF COMPLETE SALIVARY FISTULA CONSISTS IN
1) systematic washing of the duct of the gland
2) coagulation of the fistulous tract
3) the imposition of a purse-string suture
4) surgical movement of the fistulous tract into the oral cavity
5) layer-by-layer suturing of the fistula
2. EMERGENCY ASSISTANCE FOR VALVE ASFIXIA
1) artificial respiration
2) removal of a foreign body
3) tracheostomy
4) movement and fixation of the soft tissue flap
5) fixing the tongue to clothes
1. EMERGENCY HELP FOR STENOTIC ASFIXIA
1) artificial respiration
2) removal of a foreign body
3) tracheostomy
4) movement and fixation of the soft tissue flap
5) fixing the tongue to clothes
4. EMERGENCY ASSISTANCE FOR DISLOCATION ASFIXIA
1) artificial respiration
2) removal of a foreign body
3) tracheostomy
4) movement and fixation of the soft tissue flap
5) fixing the tongue to clothes
5. Rupture of the mucosa in case of injury, penetrating into the oral cavity
1) sutured, drained
2) heals by secondary intention
3) sutured tightly
4) covered with a protective plate
5) plugged with iodoform turunda
6. THE BASIC PREVENTION OF TRAUMATIC OSTEOMYELITIS IS
1) physiotherapy
2) immobilization of fragments after relief of acute inflammation
3) early and reliable immobilization of fragments
4) antibiotic therapy
5) antiseptic treatment of the oral cavity.
7. SEQUESTREECTOMY IN TRAUMATIC OSTEOMYELITIS IS CONDUCTED AFTER
1) physiotherapy
2) completion of the formation of sequestration
3) the appearance of the first signs of sequestration
4) antibacterial therapy
5) relief of inflammation
8. OSTEOTROPIC ANTIBACTERIAL DRUG USED FOR TREATMENT OF TRAUMATIC OSTEOMYELITIS
1) chloramphenicol
2) lincomycin
3) penicillin
4) ampicillin
5) erythromycin
9. THE MOST EFFECTIVE AND AVAILABLE METHOD FOR PREVENTING THE DEVELOPMENT OF RESISTANT CONTRACTURES IN DAMAGE TO THE SOFT TISSUE OF THE MAXILLOFACIAL REGION IS
1) redressing of the lower jaw
2) blockade with anesthetics
3) antibiotic therapy
4) early mechanotherapy
5) hyperbarotherapy
Appendix 3
SITUATION TASKS
TO CONTROL THE LEVEL OF ASSEMBLY OF THE TOPIC
Task 1. Patient S. came to the clinic with a wound on the lower lip. According to the patient, he was injured by a splinter of glass when installing a window frame 4 hours ago. The paramedic at the place of work stopped the bleeding and applied a bandage.
Objectively: the general condition is satisfactory. In the area of the lower lip there is a gaping wound with smooth edges, swelling of the tissues of the lower lip is noted.
1. Formulate a preliminary diagnosis.
2. Describe the sequence of carrying out the PHO of the wound.
Task 2. An ambulance delivered to the clinic a 25-year-old patient with a wound in the left cheek region. From the anamnesis it was found that he was injured an hour ago at work as a result of a blow by the rotating handle of the machine. I didn’t lose consciousness. A tight sterile bandage was applied.
Physical examination data: The dressing is soaked in blood. After its removal in the cheek area on the left, a linear wound is determined in the entire thickness of the cheek tissues, from the parotid-masticatory region to the corner of the mouth. The edges are jagged and gaping. Abundant outflow of blood in a pulsating stream from the lower edge of the wound. The teeth of the upper jaw are visible in the resulting “defect”. From the side of the oral cavity: except for the rupture of the buccal mucosa, no pathology was revealed.
1. Formulate a preliminary diagnosis.
2. Make a plan for the necessary additional examination and treatment. Describe the sequence of carrying out the PHO of the wound.
Problem 3. Patient P. was injured in a traffic accident 4 days ago. After the accident, an aseptic bandage was applied by an ambulance doctor. The victim refused to be hospitalized. There is a wound with uneven edges in the submandibular region on the left, involving its anterior and posterior parts. The body temperature is increased. Complaints of pain in the submandibular region. The bandage is wet with purulent-hemorrhagic discharge.
1. Formulate a preliminary diagnosis.
2. Make an additional examination plan and a comprehensive treatment plan for the patient.
FEDERAL STATE BUDGETARY EDUCATIONAL INSTITUTION OF HIGHER EDUCATION
"BASHKIR STATE MEDICAL UNIVERSITY»
MINISTRY OF HEALTH OF RUSSIA
Department of surgical dentistry
Approved by head of the department
F. Z. Mirsaeva
"31" __august_ 2018
METHODICAL RECOMMENDATION FOR STUDENTS
for a practical lesson on the topic:
Surgical Dentistry
Specialty 31.05.03-Dentistry
Course II
Semester IV
Number of hours 30
Ufa-2018
Methodical guidelines for students are based on the work program approved by the " 31 " of August 2018 and compiled on the basis of the FSES of specialty 31.05.03-Dentistry, approved by the order of the Ministry of education and science of the Russian Federation No. 96" 09 " of February 2016.
Reviewers
Head of the Department of surgical dentistry and maxillofacial surgery FSBEI HE SSMU (Arkhangelsk) MOH Russia, MD Minkin A. U.
Head of the Department of surgical dentistry and maxillofacial surgery FSBEI HE “Stavropol state medical University”, MD, professor Gandylyan K. S.
Freelance specialist MOH Republic of Bashkortostan in preventive dentistry, head physician SBIH RB Dental clinic №4, Ufa, Ph. D. Zubairova G. S.
Authors: MD, professor, F. Z. Mirsaeva, ass. L. R. Khalikova
Approval at session # 1 of the Department of surgical dentistry dated August 31, 2018.
TABLE OF CONTENTS
Local anesthetics and medications used for local anesthesia. Types of local anesthesia.
Potentiated local anesthesia. Preparations for potentiated local anesthesia.
Anestesia during surgical interventions in the maxillofacial region. Analgesia of tissues during surgical interventions on the maxilla jaw (infra-orbital, tuberal).
Anesthesia of tissues during surgical interventions on the maxilla (Palatine, incisive anesthesia, stem anesthesia - II branch of the trigeminal nerve).
Anesthesia of tissues during surgical interventions on the mandibula (mandibular anesthesia intraoral palpatory and apodactyl methods, mandibular anesthesia-extraoral methods)
Anesthesia of tissues during surgical interventions on the mandibula (thorusal and mental anesthesia, stem anesthesia-III branch of the trigeminal nerve. Anestesia by Bersche-Dubov).
Local complications with local anesthesia. Reasons. Diagnosis, treatment. Prevention.
General complications of local anesthesia. Causes, diagnosis, treatment. Prevention.
THE THEME OF THE LESSON №1. LOCAL ANESTHETICS AND MEDICATIONS USED FOR LOCAL ANESTHESIA. TYPES OF LOCAL ANESTHESIA. POTENTIATED LOCAL ANESTHESIA. PREPARATIONS FOR POTENTIATED LOCAL ANESTHESIA. (for 2 lessons)
Relevance. Topic "Local anesthetics and medications used for local anesthesia. Types of local analgesia" is relevant, because local analgesia can be achieved in various ways (by application, infiltration, nerve block, etc.) using one of the many well-known local anesthetics used in dentistry. Local anesthetics, in addition to the anesthetic, have other properties, as a result of which General complications may occur before and during surgery. General complications may also occur as a result of the patient's psychoemotional state associated with the upcoming surgical intervention. To achieve effective analgesia and successful surgical operation, it is necessary to know local anesthetics and their properties, types of local analgesia, as well as the ability to adequately assess the psycho-emotional state of the patient and conduct rational premedication.
The purpose of the lesson: to master the knowledge of the pharmacological properties of local anesthetics, drugs for potentiation, types of local anesthesia and the skills of selecting a local anesthetic, taking into account the patient's somatic diseases.
For the formation of professional competences the student must know:
- types of analgesia, indications and contraindications for each type of analgesia;
- local anesthetics, their physical and chemical properties;
- side effects of local anesthetics;
- methods of introduction of local anesthetics;
- higher single doses of local anesthetics;
- preparations for premedication, their properties, methods of administration, doses.
- patient examination;
- local anesthetics, small tranquilizers, narcotic and non-narcotic analgesics, sedatives;
- vasoconstrictor drugs, of their dose.
For the formation of professional competencies, the student must be able to:
- choose a local anesthetic individually for the patient, taking into account its pharmacological properties and somatic diseases of the patient;
- to evaluate the psychosocial status of the patient;
- choose an adequate premedication scheme individually for the patient;
- determine the indications for the use of local anesthetics with vasoconstrictors.
To form professional competencies, the student must possess:
1. EPC-5 (principles of analysis of its activities)
2.EPC-6 (analysis of the results of their own activities, skills in filling out medical documentation, methods of accounting and reporting documentation)
3. PC-9 (A/02.7) readiness to manage and treat patients with dental diseases in outpatient and day hospital settings.
Materials for self-training to master this topic:
Questions about the topic of the lesson:
1. The main components of the pain response (sensory, psycho-emotional, vegetative, psychomotor).
2. Types of local anesthetics;
3. Pharmacological properties of local anesthetics;
4. Higher single doses of local anesthetics;
5. Vasoconstrictor drugs, their doses;
6. Classification of types of local anesthesia;
7. Classification of nerve block and infiltration anesthesia;
8. Indications for various types of local anesthesia;
Type of lesson: practical
Duration of lessons: 8 academic hours
Equipment: diagrams, tables, sets of test problems
6.1 Didactic material (multimedia atlases and situational tasks, business games, phantoms, simulators, etc.)
The content of the lesson:
7.1. Control of the initial level of knowledge and skills.
Tasks for self-control: students solve individual sets of test tasks (Appendix 1)
7.2. Analysis with the teacher of the key issues necessary for the development of the topic of the lesson.
7.3. Demonstration by the teacher of methods of practical techniques on this topic.
7.4. Independent work of students under the supervision of a teacher (laboratory work, curation of patients, registration of the results of laboratory work, registration of medical documentation, etc.)
7.5. Control of the final level of mastering the topic:
Materials for monitoring the level of development of the topic: a set of test tasks, situational tasks (Appendix 2.3)
Place of self-training: reading room, study room for independent work of students.
Educational and research work of students on this topic:
1. The main components of the pain response: sensory, psycho-emotional, vegetative, psychomotor.
Appendices to the topic of the lesson: “LOCAL ANESTHETICS AND MEDICATIONS USED FOR LOCAL ANESTHESIA. TYPES OF LOCAL ANESTHESIA. POTENTIATED LOCAL ANESTHESIA. PREPARATIONS FOR POTENTIATED LOCAL ANESTHESIA.” (for 2 topics)
Appendix 1
TEST TASKS FOR MONITORING
INITIAL LEVEL OF KNOWLEDGE
Select one or more of the most correct answers.
1. LOCAL ANESTHETICS ARE MEDICATIONS
1) affecting efferent innervation
2) reducing the sensitivity of the endings of afferent nerves
3) regulating functions of the Central nervous system
2. LOCAL ANESTHETICS INCLUDE
1) anesthesin
2) analgin
3) promedol
4) lidocaine
3. LOCAL ANESTHETICS INCLUDE
1) phenacetin
2) dicaine
3) soukan
4) morphine
4. LOCAL ANESTHETICS INCLUDE
1) cocaine
2) novocaine
3) baralgin
4) acetylsalicylic acid
5. LOCAL ANESTHETICS INCLUDE
1) trimekain
2) paracetamol
3) cocaine
4) fentanyl
Appendix 2
TEST TASKS FOR MONITORING
LEVEL OF DEVELOPMENT OF THE TOPIC
Select one or more of the most correct answers.
1. A 0.1% SOLUTION OF EPINEPHRINE HYDROCHLORIDE IS ADDED TO LOCAL ANESTHETICS IN ORDER TO
1) vessel extensions
2) Vasoconstriction
3) lengthening the absorption of local anesthetic into the bloodstream
4) enhancing the effect of the anesthetic
5) reducing toxicity
2. FOR PROLONGATION OF ANESTHESIA TO 5 ML OF 2% SOLUTION OF NOVOCAINE ACTION ADD 0.01% SOLUTION OF EPINEPHRINE HYDROCHLORIDE
1) 0.005 ml
2) 0.05 ml
3) 0.1 ml
4) 1 ml
3. THE HIGHEST SINGLE DOSE OF 2% NOVOCAINE SOLUTION
1) 0.25 g
2) 0.1 g
3) 1.25 g
4) 1.5 g
4. THE AVERAGE THERAPEUTIC DOSE OF 2% SOLUTION OF TRIMECAINE
1) 0.25
2) 0.125
3) 1.0
4) a 1.5
5. AVERAGE THERAPEUTIC DOSE OF 2% LIDOCAINE SOLUTION
1) 0.25
2) 0.5
3) 1.25
4) 0.75
6. THE HIGHEST SINGLE DOSE OF DICAINE
1) 0.03
2) 0.09
3) 3.0
4) a 1.5
7. WHEN CONDUCTING A COLOR TEST FOR NOVOCAINE, A SOLUTION IS USED
1) solution of furacilinum
2) solution of hydrogen peroxide
3) solution of potassium permanganate
4) solution of ammonia
5) solution of citric acid
8. WHAT NOVOCAINE SOLUTION IS USED FOR LOCAL ANESTHESIA OF SOFT TISSUES
1) 1%
2) 0.5%
3) 0.25%
4) 2%
5) 5%
9. WHAT LIDOCAINE SOLUTION IS USED FOR LOCAL ANESTHESIA IN THE MAXILLOFACIAL REGION
1) 5%
2) 10%
3) 1%
4) 2%
5) 0.25%
10. WHAT TRIMEKAIN SOLUTION IS USED FOR LOCAL ANESTHESIA IN MAXILLOFACIAL REGION
1) 2%
2) 0.5%
3) 1%
4) 0.25%
5) 5%
11. THE HIGHEST SINGLE DOSE OF 2% NOVOCAINE SOLUTION
1) 5 ml
2) 10 ml
3) 15 ml
4) 20 ml
5) 30 ml
12. THE HIGHEST SINGLE DOSE OF 2% SOLUTION OF TRIMECAINE
1) 5 ml
2) 10 ml
3) 15 ml
4) 20 ml
5) 30 ml
13. HOW MUCH DRY MATTER IS NEEDED
TO PREPARE 250 ML of 2% NOVOCAINE SOLUTION
1) 1.5 g
2) 3.0 g
3) 5 g
4) 7 g
5) 10 g
14. HOW MUCH 0.25% SOLUTION CAN BE PREPARED
OF 1,5 G of NOVOCAINE DRY MATTER
1) 10 ml
2) 300 ml
3) 100 ml
4) 150 ml
5) 200 ml
15. HOW MUCH 0.25% SOLUTION CAN BE PREPARED
OF 5 G of NOVOCAINE DRY MATTER
1) 250 ml
2) 500 ml
3) 1000 ml
4) 2000 ml
5) 1500ml
16. WHICH DRUG BELONGS TO THE GROUP OF ANTIHISTAMINES?
1) novocaine
2) epinephrine hydrochloride
3) seduxen
4) diphenhydramine
5) the Elenium
17. Which drug belongs to small tranquilizers
1) novocaine
2) epinephrine hydrochloride
3) seduxen
4) analgin
5) omnopon
18. WHAT DRUGS ARE USED FOR SEDATION?
1) Dimedrol
2) analgin
3) novocaine
4) camphor
5) trioxazine
19. WHAT COMBINATION OF DRUGS IS MOST OFTEN USED IN THE CLINIC FOR PREMEDICATION?
1) sleeping pills + non-narcotic analgesics
2) sleeping pills + narcotic analgesics
3) sleeping pills + antihistamines
4) sleeping pills + small tranquilizers
5) small tranquilizers + narcotic analgesics
20. WHAT DRUGS ARE USED FOR NEUROLEPTANALGESIA?
1) analgin
2) fentanyl
3) promedol
4) droperidol
5) dehydrobenzperidol
Appendix 3
TEST TASKS OF THE SECOND ORDER
TO CONTROL THE ASSIMILATION OF THE LESSON TOPIC
1. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 0.25% solution of novocaine
2) 0.5% solution of novocaine
3) 1% solution of novocaine
4) 2% solution of novocaine
5) 10% solution of novocaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
2. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 0.25% solution of trimecaine
2) 0.5% solution of trimecaine
3) a 1% solution of trimecaine
4) 2% solution of trimecaine
5) 5% solution of trimecaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
3. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 0,5% solution of lidocaine
2) 1% lidocaine solution
3) 2% lidocaine solution
4) 5% lidocaine solution
5) 10% solution of lidocaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
4. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 1% solution of dicaine
2) 2% solution of dicaine
3) 3% solution of dicaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
5. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 1% solution of cocaine
2) 2% solution of cocaine
3) 3% solution of cocaine
4) 5% solution of cocaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
6. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 2% solution of novocaine
2) 10% solution of lidocaine
3) 0.5% solution of trimecaine
4) 2% solution of dicaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
7. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) anesthesin
2) analgin
3) seduxen
4) the Elenium
A. Local anesthesia
B. Potentiated analgesia
8. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) trioxazine
2) diphenhydramine
3) novocaine
4) acetylsalicylic acid
A. Local anesthesia
B. Potentiated analgesia
9. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) sibazon
2) lidocaine
3) cocaine
4) aspirin
A. Local anesthesia
B. Potentiated analgesia
10. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) sodium meprobamate
2) diazepam
3) dicaine
4) trimekain
A. Local anesthesia
B. Potentiated analgesia
11. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) clhasinit
2) Mezapamum
3) nozepam
4) lidocaine
A. Local anesthesia
B. Potentiated analgesia
12. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) tincture of Valerian
2) tincture of motherwort
3) potassium bromide
4) sodium bromide
A. Local anesthesia
B. Potentiated analgesia
TOPIC OF THE LESSON: “ANALGESIA OF TISSUES DURING SURGICAL INTERVENTIONS IN THE MAXILLOFACIAL AREA. ANALGESIA OF TISSUES DURING SURGICAL INTERVENTIONS ON THE MAXILLA (INFRAORBITAL, TUBERAL, PALATINE, INCISIVE ANESTHESIA, STEM ANESTHESIA - II BRANCH OF THE TRIGEMINAL NERVE)”. (for 2 topics)
1. Relevance. Analgesia is one of the most urgent problems of dentistry, since the interventions performed by a dentist are accompanied by pain. Pain causes a reflex twitch of a part of the body from the damaging object, a reflex release of epinephrine and vasopressin etc., which can lead to local and General complications. For high-quality performance of any intervention that is accompanied by pain, knowledge and skill of methods of analgesia is necessary.
2. The purpose of the lesson: to master the knowledge and skills of techniques for performing infiltration and nerve blockage types of analgesia during surgical interventions on the maxilla.
To form professional competencies, students must know:
- topographic anatomy of the maxillary nerve and its branches;
- innervation of the maxilla (teeth, bones of the periosteum and mucous membrane);
- innervation of soft tissues adjacent to the maxilla;
- anatomical features of the maxilla;
- aseptics and antiseptics;
-methods of infiltration anesthesia on the maxilla;
-method of tuberal anesthesia on the maxilla;
- method of conducting infra-orbital anesthesia on the maxilla;
- choose a local anesthetic individually for the patient, taking into account its pharmacological properties and somatic diseases of the patient;
- evaluate the psycho-emotional state of the patient;
- choose an adequate premedication scheme individually for the patient;
- determine the indications for the use of local anesthetics with vasoconstrictors.
To form professional competencies, students must be able to:
- choose a local anesthetic individually for the patient, taking into account its pharmacological properties and somatic diseases of the patient;
- evaluate the psycho-emotional state of the patient;
- choose an adequate premedication scheme individually for the patient;
- determine the indications for the use of local anesthetics with vasoconstrictors.
To form professional competencies, students must possess:
1. OPC-5 (principles of analysis of its activities)
2. OPC-6 (analysis of results of own activity, skills of filling in medical documentation, methods of accounting and reporting documentation)
3. PC-9 (A / 02.7) readiness to manage and treat patients with dental diseases in outpatient and day hospital settings.
3. Materials for self-training to master this topic:
Questions about the topic of the lesson:
1. What are the three ways to find the projection of the foramen infraorbitale in the patient?
2. At what distance and in which direction from the projection of the foramen infraorbitale is an injection made during infraorbital anesthesia by an extra-oral method?
3. What are the guidelines for determining whether an injection needle enters the infraorbital canal?
4. How deep can the needle be moved in the infraorbital canal?
5. Which nerves are turned off during infraorbital anesthesia?
6. What is the pain relief zone for infra-orbital anesthesia?
7. Which areas of the nerve are turned off during infiltration anesthesia?
8. What are the indications for the use of infiltration anesthesia on the upper jaw?
9. What is the volume of mouth opening during intraoral infra-orbital anesthesia?
10. Where is the injection point when performing intraoral method of infraorbital anesthesia?
11. In what direction and how deep does the needle move in the intraoral method of infraorbital anesthesia?
12. How wide should the patient's mouth be opened during tuberal anesthesia?
13. Where is the injection point when performing tuberal anesthesia?
14. In what direction and how deep the needle moves during tuberales anesthesia?
15. Which nerves are turned off during tuberal anesthesia?
16. What is the pain relief zone for tuberal anesthesia?
17. How to find the projection of a foramen palatinum majus ?
18. Where is the needle injected during Palatine anesthesia?
19. Which nerve is switched off during Palatine anesthesia?
20. What is the pain relief zone for Palatine anesthesia?
21. How to find the projection of incisive foramen?
22. In what position is the head of the patient when conducting the incisive anesthesia?
23. Where do you inject the needle during incisive anesthesia?
24. In what direction and how deep the needle moves during incisive anesthesia?
25. What is a tragoorbital line?
26. How do we find the injection point for switching off the II branch of the trigeminal nerve using the Weissblatt method?
27. What additional devices and how long is the needle used for nerve blockage anesthesia using the Weissblatt method?
28. How deep and on what plane to insert the needle in stem anesthesia using the Weissblatt method?
29. How many degrees and in what direction should the syringe be turned after removing the needle halfway or to the subcutaneous fat when switching off the II branch of the trigeminal nerve using the Weissblatt method?
30. What is the pain relief zone when the second branch of the trigeminal nerve is turned off?
4. Type of studies: practical
5. Duration of lessons: 8 academic hours
6. Equipment: diagrams, tables, and test task suites
6.1 Didactic materials (multimedia atlases and situational tasks, business games, phantoms, simulators, etc.)
7. The content of the class:
7.1. Control of the initial level of knowledge and skills.
Tasks for self-control: students solve individual sets of test tasks (Appendix 1)
7.2. Analysis with the teacher of the key issues necessary for the development of the topic of the lesson.
7.3. demonstration by the teacher of methods of practical techniques on this topic.
7.4. Independent work of students under the supervision of a teacher (laboratory work, curation of patients, registration of the results of laboratory work, registration of medical documentation, etc.)
7.5. Control of the final level of mastering the topic:
Materials for monitoring the level of development of the topic: a set of test tasks, situational tasks (Appendix 2.3)
Place of self-training: reading room, study room for independent work of students.
8. Educational and research work of students on this topic:
The main components of the pain response: sensory, psycho-emotional, vegetative, psychomotor.
Appendices to the lesson topic: "Analgesia of tissues during surgical interventions in the maxillofacial area. analgesia of tissues during surgical interventions on the maxilla (infraorbital, tuberal, palatine, incisive anesthesia, stem anesthesia - II branch of the trigeminal nerve" (for 2 lessons).
Appendix 1
TEST TASKS FOR MONITORING
INITIAL LEVEL OF KNOWLEDGE
Select one or more of the most correct answers.
1. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) affecting efferent innervation
2) reducing the sensitivity of afferent nerve endings
3) regulating functions of the Central nervous system
2. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) anesthesin
2) analgin
3) promedol
4) lidocaine
3. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) phenacetin
2) dicaine
3) soukan
4) morphine
4. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) cocaine
2) novocaine
3) baralgin
4) acetylsalicylic acid
5. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) trimekain
2) paracetamol
3) cocaine
4) fentanyl
Appendix 2
TEST TASKS FOR MONITORING
LEVEL OF DEVELOPMENT OF THE TOPIC
Select one or more of the most correct answers.
1. WHAT IS THE PURPOSE TO LOCAL ANESTHETICS ADD 0.1% SOLUTION OF EPINEPHRINE HYDROCHLORIDE?
1) vessel extensions
2) vasoconstriction
3) lengthening the absorption of local anesthetic into the bloodstream
4) enhancing the action of the anesthetic
5) reducing toxicity
2. WHAT IS THE VOLUME OF 0.01% SOLUTION OF EPINEPHRINE HYDROCHLORIDE ADDED TO 5 ML OF 2% SOLUTION OF NOVOCAINE TO PROLONG THE ACTION?
1)0.005 ml
2)0.05 ml
3) 0.1 ml
4) 1 ml
3. THE HIGHEST SINGLE DOSE OF 2% NOVOCAINE SOLUTION
1)0.25 g
2) 0.1 g
3)1.25 g
4)1.5 g
4. THE AVERAGE THERAPEUTIC DOSE OF 2% SOLUTION OF TRIMECAINE
1)0,25
2)0,125
3) 1.0
4) 1.5
5. AVERAGE THERAPEUTIC DOSE OF 2% LIDOCAINE SOLUTION
1)0,25
2)0,5
3)1,25
4) 0.75
6. THE HIGHEST SINGLE DOSE OF DICAINE
1)0,03
2)0,09
3)3.0
4) 1.5
7. WHAT SOLUTION IS USED WHEN CONDUCTING A COLOR TEST FOR NOVOCAINE?
1) furacilinum
2) hydrogen peroxide
3) potassium permanganate
4)ammonia
5) citric acid
8. WHAT NOVOCAINE SOLUTION IS USED FOR LOCAL ANESTHESIA OF SOFT TISSUES?
1)1%
2)0,5%
3)0,25%
4)2%
5)5%
9. WHAT LIDOCAINE SOLUTION IS USED FOR LOCAL ANESTHESIA IN THE MAXILLOFACIAL AREA?
1)5%
2)10%
3)1%
4)2%
5)0.25%
10. WHAT TRIMECAIN SOLUTION IS USED FOR LOCAL ANESTHESIA IN THE MAXILLOFACIAL AREA?
1)2%
2)0,5%
3)1%
4)0,25%
5)5%
11. THE HIGHEST SINGLE DOSE OF 2% NOVOCAINE SOLUTION
1) 5 ml
2) 10 ml
3) 15 ml
4) 20 ml
5)30 ml
12. THE HIGHEST SINGLE DOSE OF 2% SOLUTION OF TRIMECAINE
1) 5 ml
2) 10 ml
3) 15 ml
4) 20 ml
5) 30 ml
13. WHAT AMOUNT OF DRY MATTER IS NEEDED TO PREPARE 250 ML OF 2% NOVOCAINE SOLUTION?
1)1.5 g
2)3.0 g
3)5 g
4)7 g
5)10 g
14. WHAT VOLUME OF NOVOCAINE SOLUTION (0.5%) CAN BE PREPARED FROM 1.5 G OF DRY MATTER?
1) 10 ml
2) 300 ml
3)100 ml
4) 150 ml
5) 200 ml
15. WHAT VOLUME OF NOVOCAINE SOLUTION (0.25%) CAN BE PREPARED FROM 5 G OF DRY MATTER?
1) 250 ml
2) 500 ml
3)1000 ml
4) 2000 ml
5)1500ml
16. ANTIHISTAMINES INCLUDE
1) novocaine
2) epinephrine hydrochloride
3) seduxen
4) diphenhydramine
5) Elenium
17. SMALL TRANQUILIZERS INCLUDE
1) novocaine
2) epinephrine hydrochloride
3) seduxen
4) analgin
5) omnopon
18. WHAT DRUGS ARE USED FOR SEDATION?
1) Dimedrol
2) analgin
3) novocaine
4) camphor
5) trioxazine
19. WHAT COMBINATION OF DRUGS IS USED MOST OFTEN IN THE CLINIC FOR PREMEDICATION?
1) sleeping pills + non-narcotic analgesics
2) sleeping pills + narcotic analgesics
3) sleeping pills + antihistamines
4) sleeping pills + small tranquilizers
5) small tranquilizers + narcotic analgesics
20. WHAT DRUGS ARE USED FOR NEUROLEPTOANALGESIA?
1) analgin
2) fentanyl
3) promedol
4) droperidol
5) dehydrobenzperidol
Appendix 3
TEST TASKS OF THE SECOND ORDER
TO CONTROL THE ASSIMILATION OF THE LESSON TOPIC
1. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 0.25% solution of novocaine
2) 0.5% solution of novocaine
3) 1% solution of novocaine
4) 2% solution of novocaine
5) 10% solution of novocaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
2. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 0.25% solution of trimecaine
2) 0.5% solution of trimecaine
3) a 1% solution of trimecaine
4) 2% solution of trimecaine
5) 5% solution of trimecaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
3. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 0,5% solution of lidocaine
2) 1% lidocaine solution
3) 2% lidocaine solution
4) 5% lidocaine solution
5) 10% solution of lidocaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
4. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 1% solution of dicaine
2) 2% solution of dicaine
3) 3% solution of dicaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
5. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 1% solution of cocaine
2) 2% solution of cocaine
3) 3% solution of cocaine
4) 5% solution of cocaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
6. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 2% solution of novocaine
2) 10% solution of lidocaine
3) 0.5% solution of trimecaine
4) 2% solution of dicaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
7. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) anesthesin
2) analgin
3) seduxen
4) the Elenium
A. Local anesthesia
B. Potentiated analgesia
8. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) trioxazine
2) diphenhydramine
3) novocaine
4) acetylsalicylic acid
A. Local anesthesia
B. Potentiated analgesia
9. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) sibazon
2) lidocaine
3) cocaine
4) aspirin
A. Local anesthesia
B. Potentiated analgesia
10. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) sodium meprobamate
2) diazepam
3) dicaine
4) trimekain
A. Local anesthesia
B. Potentiated analgesia
11. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) clhasinit
2) Mezapamum
3) nozepam
4) lidocaine
A. Local anesthesia
B. Potentiated analgesia
12. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) tincture of Valerian
2) tincture of motherwort
3) potassium bromide
4) sodium bromide
A. Local anesthesia
B. Potentiated analgesia
TOPIC OF THE LESSON: “ANALGESIA OF TISSUES DURING SURGICAL INTERVENTIONS IN THE MAXILLOFACIAL AREA. ANALGESIA OF TISSUES DURING SURGICAL INTERVENTIONS ON THE MAXILLA (INFRAORBITAL, TUBERAL, PALATINE, INCISIVE ANESTHESIA, STEM ANESTHESIA - II BRANCH OF THE TRIGEMINAL NERVE)”. (for 2 topics)
1. Relevance. Analgesia is one of the most urgent problems of dentistry, since the interventions performed by a dentist are accompanied by pain. Pain causes a reflex twitch of a part of the body from the damaging object, a reflex release of epinephrine and vasopressin etc., which can lead to local and General complications. For high-quality performance of any intervention that is accompanied by pain, knowledge and skill of methods of analgesia is necessary.
2. The purpose of the lesson: to master the knowledge and skills of techniques for performing infiltration and nerve blockage types of analgesia during surgical interventions on the maxilla.
To form professional competencies, students must know:
- anatomy of the mandibula;
- topographic anatomy of the mandibular nerve and its branches;
- innervation of the mandibula (bones, periosteum, teeth and mucous membrane of the alveolar part of the mandibula);
- innervation of the cheek and soft tissues adjacent to the mandibula;
- rules of asepsis and antiseptics;
-methods of infiltration anasthesia;
- intra-oral and extra-oral methods of mandibular analgesia;
-methods of conducting intra-oral and extra-oral methods of mental analgesia;
- choose a local anesthetic individually for the patient, taking into account its pharmacological properties and somatic diseases of the patient;
- to evaluate the psychosocial status of the patient;
- choose an adequate premedication scheme individually for the patient;
- determine the indications for the use of local anesthetics with vasoconstrictors.
To form professional competencies, students must be able to:
- choose a local anesthetic individually for the patient, taking into account its pharmacological properties and somatic diseases of the patient;
- to evaluate the psychosocial status of the patient;
- choose an adequate premedication scheme individually for the patient;
- determine the indications for the use of local anesthetics from blood vessels.
To form professional competencies, students must possess:
1. OPC-5 (principles of analysis of its activities)
2. OPC-6 (analysis of results of own activity, skills of filling in medical documentation, methods of accounting and reporting documentation)
3. PC-9 (A / 02.7) readiness to manage and treat patients with dental diseases in outpatient and day hospital settings.
3. Materials for self-training to master this topic:
Questions about the topic of the lesson:
A. Mandibular anesthesia - apodictically method
1. What is the volume of opening the mouth with this anesthesia?
2. Where is the syringe located when performing this anesthesia?
3. What anatomical formations are guided when determining the injection point for this anesthesia?
4. The injection Point for this anesthesia?
5. What is the direction and what is the depth of movement of the needle?
6. Which nerves are turned off during this anesthesia?
7. What is the pain relief zone?
B. Mandibular anesthesia-palpatory method
1. What is the volume of opening the mouth with this anesthesia?
2. Location of the syringe?
3. What anatomical structures need to find a palpable and where is injection of the needle?
4. What is the direction and what is the depth of movement of the needle?
5. Which nerves are turned off during this anesthesia?
6. What is the pain relief zone?
C. Extra-Oral submandibular method of mandibular anesthesia
1. What anatomical formations should be guided when determining the injection point?
2 What is the direction and what is the depth of movement of the needle?
3. Which nerves are turned off during this anesthesia?
4. What is the pain relief zone?
D. Extra-Oral infrazygomatic method of mandibular anesthesia (anesthesia according to Dubov)
1. How do I determine the injection point?
2. What is the direction and what is the depth of movement of the needle?
3. Which nerves are turned off during this anesthesia?
4. What is the pain relief zone?
E. Torusal anesthesia
1. Where is the depot of anesthetics for torusal anesthesia created?
2. To what extent do open your mouth when conducting torusal anesthesia?
3. How is the injection point determined?
4. Where is the syringe located?
5. What is the direction and what is the depth of movement of the needle?
6. The amount of anesthetic administered?
7. Which nerve is switched off?
8. What is the pain relief zone?
F. Extra-Oral method of mental anesthesia
1. How to find the projection of the mental hole on the skin?
2. How to determine the point of the injection point?
3. What is the depth and direction of the needle?
4. How many mm should the needle advance in the channel?
5. Which nerve is switched off?
6. What is the pain relief zone?
G. Intraoral method of mental anesthesia
1. How to determine the projection of the foremen mentale in the vestibule of the oral cavity?
2. How to determine the point of the injection point?
3. What is the direction and what is the depth of movement of the needle?
4. How many mm is the needle moving in the mandibular canal?
5. Which nerve is turned off by this type of analgesia?
6. What is the pain relief zone?
H. Anesthesia by Berchet
1. How do I determine the injection point?
2. What is the plane and to what depth of movement of the needle?
3. How many milliliters of anesthetic is necessary for this type of anesthesia?
4. Which nerves are turned off?
5. What are the indications for this anesthesia?
I. Deactivation of the III branch of the trigeminal nerve at the base of the skull by Weissblatt
1. How to determine the point of puncture?
a) How to find tragoorbital line?
b) How to find the point of puncture, focusing on tragoorbital line?
2. Which needle is used for this anesthesia?
3. What additional devices are needed when performing this anesthesia?
4. What is the initial depth of needle insertion?
5. What are the next steps?
6. What is direction and what is the angle of the needle removing to the subcutaneous fat (or to half of its depth)?
7. How deep is the needle inserted after turning it in the appropriate direction for this anesthesia?
8. Which nerve is switched off?
9. What is the pain relief zone?
J. Switching off the lingual nerve
1. In which area (the oral cavity) is only the lingual nerve turned off?
2. How to find the injection point?
3. What is the direction and what is the depth of movement of the needle?
4. What is the pain relief zone?
K. switching off the buccal nerve
1. How to determine the injection point when switching off only the buccal nerve separately?
2. What is the direction and what is the depth of movement of the needle?
3. What is the pain relief zone?
4. Type of studies: practical
5. Duration of lessons: 8 academic hours
6. Equipment: diagrams, tables, and test task suites
6.1 Didactic materials (multimedia atlases and situational tasks, business games, phantoms, simulators, etc.)
7. The content of the class:
7.1. Control of the initial level of knowledge and skills.
Tasks for self-control: students solve individual sets of test tasks (Appendix 1)
7.2. Analysis with the teacher of the key issues necessary for the development of the topic of the lesson.
7.3. demonstration by the teacher of methods of practical techniques on this topic.
7.4. Independent work of students under the supervision of a teacher (laboratory work, curation of patients, registration of the results of laboratory work, registration of medical documentation, etc.)
7.5. Control of the final level of mastering the topic:
Materials for monitoring the level of development of the topic: a set of test tasks, situational tasks (Appendix 2.3)
Place of self-training: reading room, study room for independent work of students.
8. Educational and research work of students on this topic:
The main components of the pain response: sensory, psycho-emotional, vegetative, psychomotor.
Appendices to the lesson topic: "Analgesia of tissues during surgical interventions in the maxillofacial area. analgesia of tissues during surgical interventions on the maxilla (infraorbital, tuberal, palatine, incisive anesthesia, stem anesthesia - II branch of the trigeminal nerve" (for 2 lessons).
Appendix 1
TEST TASKS FOR MONITORING
INITIAL LEVEL OF KNOWLEDGE
Select one or more of the most correct answers.
1. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) affecting efferent innervation
2) reducing the sensitivity of afferent nerve endings
3) regulating functions of the Central nervous system
2. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) anesthesin
2) analgin
3) promedol
4) lidocaine
3. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) phenacetin
2) dicaine
3) soukan
4) morphine
4. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) cocaine
2) novocaine
3) baralgin
4) acetylsalicylic acid
5. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) trimekain
2) paracetamol
3) cocaine
4) fentanyl
Appendix 2
TEST TASKS FOR MONITORING
LEVEL OF DEVELOPMENT OF THE TOPIC
Select one or more of the most correct answers.
1. WHAT IS THE PURPOSE TO LOCAL ANESTHETICS ADD 0.1% SOLUTION OF EPINEPHRINE HYDROCHLORIDE?
1) vessel extensions
2) vasoconstriction
3) lengthening the absorption of local anesthetic into the bloodstream
4) enhancing the action of the anesthetic
5) reducing toxicity
2. WHAT IS THE VOLUME OF 0.01% SOLUTION OF EPINEPHRINE HYDROCHLORIDE ADDED TO 5 ML OF 2% SOLUTION OF NOVOCAINE TO PROLONG THE ACTION?
1)0.005 ml
2)0.05 ml
3) 0.1 ml
4) 1 ml
3. THE HIGHEST SINGLE DOSE OF 2% NOVOCAINE SOLUTION
1)0.25 g
2) 0.1 g
3)1.25 g
4)1.5 g
4. THE AVERAGE THERAPEUTIC DOSE OF 2% SOLUTION OF TRIMECAINE
1)0,25
2)0,125
3) 1.0
4) 1.5
5. AVERAGE THERAPEUTIC DOSE OF 2% LIDOCAINE SOLUTION
1)0,25
2)0,5
3)1,25
4) 0.75
6. THE HIGHEST SINGLE DOSE OF DICAINE
1)0,03
2)0,09
3)3.0
4) 1.5
7. WHAT SOLUTION IS USED WHEN CONDUCTING A COLOR TEST FOR NOVOCAINE?
1) furacilinum
2) hydrogen peroxide
3) potassium permanganate
4)ammonia
5) citric acid
8. WHAT NOVOCAINE SOLUTION IS USED FOR LOCAL ANESTHESIA OF SOFT TISSUES?
1)1%
2)0,5%
3)0,25%
4)2%
5)5%
9. WHAT LIDOCAINE SOLUTION IS USED FOR LOCAL ANESTHESIA IN THE MAXILLOFACIAL AREA?
1)5%
2)10%
3)1%
4)2%
5)0.25%
10. WHAT TRIMECAIN SOLUTION IS USED FOR LOCAL ANESTHESIA IN THE MAXILLOFACIAL AREA?
1)2%
2)0,5%
3)1%
4)0,25%
5)5%
11. THE HIGHEST SINGLE DOSE OF 2% NOVOCAINE SOLUTION
1) 5 ml
2) 10 ml
3) 15 ml
4) 20 ml
5)30 ml
12. THE HIGHEST SINGLE DOSE OF 2% SOLUTION OF TRIMECAINE
1) 5 ml
2) 10 ml
3) 15 ml
4) 20 ml
5) 30 ml
13. WHAT AMOUNT OF DRY MATTER IS NEEDED TO PREPARE 250 ML OF 2% NOVOCAINE SOLUTION?
1)1.5 g
2)3.0 g
3)5 g
4)7 g
5)10 g
14. WHAT VOLUME OF NOVOCAINE SOLUTION (0.5%) CAN BE PREPARED FROM 1.5 G OF DRY MATTER?
1) 10 ml
2) 300 ml
3)100 ml
4) 150 ml
5) 200 ml
15. WHAT VOLUME OF NOVOCAINE SOLUTION (0.25%) CAN BE PREPARED FROM 5 G OF DRY MATTER?
1) 250 ml
2) 500 ml
3)1000 ml
4) 2000 ml
5)1500ml
16. ANTIHISTAMINES INCLUDE
1) novocaine
2) epinephrine hydrochloride
3) seduxen
4) diphenhydramine
5) Elenium
17. SMALL TRANQUILIZERS INCLUDE
1) novocaine
2) epinephrine hydrochloride
3) seduxen
4) analgin
5) omnopon
18. WHAT DRUGS ARE USED FOR SEDATION?
1) Dimedrol
2) analgin
3) novocaine
4) camphor
5) trioxazine
19. WHAT COMBINATION OF DRUGS IS USED MOST OFTEN IN THE CLINIC FOR PREMEDICATION?
1) sleeping pills + non-narcotic analgesics
2) sleeping pills + narcotic analgesics
3) sleeping pills + antihistamines
4) sleeping pills + small tranquilizers
5) small tranquilizers + narcotic analgesics
20. WHAT DRUGS ARE USED FOR NEUROLEPTOANALGESIA?
1) analgin
2) fentanyl
3) promedol
4) droperidol
5) dehydrobenzperidol
Appendix 3
TEST TASKS OF THE SECOND ORDER
TO CONTROL THE ASSIMILATION OF THE LESSON TOPIC
1. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 0.25% solution of novocaine
2) 0.5% solution of novocaine
3) 1% solution of novocaine
4) 2% solution of novocaine
5) 10% solution of novocaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
2. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 0.25% solution of trimecaine
2) 0.5% solution of trimecaine
3) a 1% solution of trimecaine
4) 2% solution of trimecaine
5) 5% solution of trimecaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
3. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 0,5% solution of lidocaine
2) 1% lidocaine solution
3) 2% lidocaine solution
4) 5% lidocaine solution
5) 10% solution of lidocaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
4. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 1% solution of dicaine
2) 2% solution of dicaine
3) 3% solution of dicaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
5. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 1% solution of cocaine
2) 2% solution of cocaine
3) 3% solution of cocaine
4) 5% solution of cocaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
6. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 2% solution of novocaine
2) 10% solution of lidocaine
3) 0.5% solution of trimecaine
4) 2% solution of dicaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
7. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) anesthesin
2) analgin
3) seduxen
4) the Elenium
A. Local anesthesia
B. Potentiated analgesia
8. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) trioxazine
2) diphenhydramine
3) novocaine
4) acetylsalicylic acid
A. Local anesthesia
B. Potentiated analgesia
9. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) sibazon
2) lidocaine
3) cocaine
4) aspirin
A. Local anesthesia
B. Potentiated analgesia
10. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) sodium meprobamate
2) diazepam
3) dicaine
4) trimekain
A. Local anesthesia
B. Potentiated analgesia
11. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) clhasinit
2) Mezapamum
3) nozepam
4) lidocaine
A. Local anesthesia
B. Potentiated analgesia
12. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) tincture of Valerian
2) tincture of motherwort
3) potassium bromide
4) sodium bromide
A. Local anesthesia
B. Potentiated analgesia
Topic of the lesson: “LOCAL COMPLICATIONS OF LOCAL ANESTHESIA. REASONS. DIAGNOSIS AND TREATMENT. PREVENTION. GENERAL COMPLICATIONS OF LOCAL ANESTHESIA. CAUSES, DIAGNOSIS, AND TREATMENT. PREVENTION.”
1. Relevance. Local anesthesia in the maxillofacial area can be accompanied by a number of local and general complications. Most local complications occur when the rules of asepsis and antiseptics are violated, the technique of anesthesia is performed, or they are caused by anatomical, topographic and physiological features of the maxillofacial region. Emerging local complications affect the General state of the body, loss of working capacity, and some of them (osteomyelitis, phlegmon), in turn, can be complicated by sepsis, mediastinitis and pose a serious threat to the patient's life. In addition, psychoemotional stress preceding surgery, as well as an overdose of an anesthetic, hypersensitivity or allergic reaction to the administered anesthetic is accompanied by the development of common complications such as fainting, hypertensive crisis, collapse, urticaria, Quincke's edema, intoxication, idiosyncrasy, anaphylactic shock. The occurrence of the above-mentioned complications requires urgent qualified assistance from the doctor. All of the above confirms the relevance of the topic under study.
2. The purpose of the lesson: to master the knowledge and skills of techniques for performing infiltration and nerve blockage types of analgesia during surgical interventions on the maxilla.
To form professional competencies, students must know:
- rules of asepsis and antiseptics;
- local anesthetics, their physical and chemical properties;
- side effects of local anesthetics;
- methods of administration of local anesthetics;
- higher single doses of local anesthetics;
- preparations for premedication, their properties, methods of administration, doses.
- patient examination;
- local anesthetics, small tranquilizers, narcotic and non-narcotic analgesics, sedatives;
- vasoconstrictor drugs, their doses;
- anatomy of the upper and lower jaw;
- technique of infiltration and conducting analgesics for surgical interventions on the upper and lower jaws;
- the nature of local complications that occur during local anesthesia of the maxillofacial area;
- causes that contribute to the development of local complications in local anesthesia of the maxillofacial region;
- clinic, diagnostics of local complications;
- treatment of local complications;
- prevention of local complications with local anesthesia of the maxillofacial area.
To form professional competencies, students must be able to:
- choose a local anesthetic individually for the patient, taking into account its pharmacological properties and somatic diseases of the patient;
- to evaluate the psychosocial status of the patient;
- choose an adequate premedication scheme individually for the patient;
- determine the indications for the use of local anesthetics from blood vessels.
To form professional competencies, students must possess:
1. OPC-5 (principles of analysis of its activities)
2. OPC-6 (analysis of results of own activity, skills of filling in medical documentation, methods of accounting and reporting documentation)
3. PC-9 (A / 02.7) readiness to manage and treat patients with dental diseases in outpatient and day hospital settings.
3. Materials for self-training to master this topic:
Questions about the topic of the lesson:
1. Types of local complications that occur during infiltration and conduction analgesics in the maxillofacial region.
2. Causes of ischemia and tissue necrosis. Clinic, treatment, prevention.
3. Traumatic neuritis. What types of analgesia may develop this complication? Clinic, treatment, prevention.
4. Contracture of the chewing muscle group. What types of analgesia may develop this complication? Clinic, diagnosis, treatment, prevention.
5. Paresis of the facial muscles. What types of analgesia may develop this complication? Clinic, diagnosis, treatment, prevention.
6. Fracture of the injection needle. Reasons. Types of anesthesia in which the possible occurrence of this complication. Tactics of the doctor in the event of this complication.
7. Hematoma. Types of analgesia that may cause this complication.
8. Abscesses and phlegmons of cellular spaces. The reasons for the development of this complication. Types of analgesia that may cause the development of this complication. Prevention.
9. Diplopia. Types of analgesia that may cause this complication. Clinic, treatment, prevention.
10. Subcutaneous emphysema. Reason. Clinic, treatment, prevention.
11. Post-Injection pain. Cause, clinic, diagnosis, treatment, and prevention.
12. Cause, mechanism of development and clinical manifestations:
Fainting
Collapse's
Anaphylactic shock
Hypertensive crisis
Intoxications
Idiosyncrasies
Urticarias
Quincke's Edema
13. Assistance:
• Swoon
•Collapse
•Anaphylactic shock
•Hypertensive crisis
•Intoxications
•Idiosyncrasies
•Urticaria
• The Angioedema
14. Resuscitation measures for respiratory and cardiac arrest.
15. Intensive care for emergencies.
4. Type of studies: practical
5. Duration of lessons: 8 academic hours
6. Equipment: diagrams, tables, and test task suites
6.1 Didactic materials (multimedia atlases and situational tasks, business games, phantoms, simulators, etc.)
7. The content of the class:
7.1. Control of the initial level of knowledge and skills.
Tasks for self-control: students solve individual sets of test tasks (Appendix 1)
7.2. Analysis with the teacher of the key issues necessary for the development of the topic of the lesson.
7.3. Demonstration by the teacher of methods of practical techniques on this topic.
7.4. Independent work of students under the supervision of a teacher (laboratory work, curation of patients, registration of the results of laboratory work, registration of medical documentation, etc.)
7.5. Control of the final level of mastering the topic:
Materials for monitoring the level of development of the topic: a set of test tasks, situational tasks (Appendix 2.3)
Place of self-training: reading room, study room for independent work of students.
8. Educational and research work of students on this topic:
The main components of the pain response: sensory, psycho-emotional, vegetative and psychomotor.
Appendices to the lesson topic: "Analgesia of tissues during surgical interventions in the maxillofacial area. analgesia of tissues during surgical interventions on the maxilla (infraorbital, tuberal, palatine, incisive anesthesia, stem anesthesia - II branch of the trigeminal nerve" (for 2 lessons).
Appendix 1
TEST TASKS FOR MONITORING
INITIAL LEVEL OF KNOWLEDGE
Select one or more of the most correct answers.
1. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) affecting efferent innervation
2) reducing the sensitivity of afferent nerve endings
3) regulating functions of the Central nervous system
2. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) anesthesin
2) analgin
3) promedol
4) lidocaine
3. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) phenacetin
2) dicaine
3) soukan
4) morphine
4. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) cocaine
2) novocaine
3) baralgin
4) acetylsalicylic acid
5. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) trimekain
2) paracetamol
3) cocaine
4) fentanyl
Appendix 2
TEST TASKS FOR MONITORING
LEVEL OF DEVELOPMENT OF THE TOPIC
Select one or more of the most correct answers.
1. WHAT IS THE PURPOSE TO LOCAL ANESTHETICS ADD 0.1% SOLUTION OF EPINEPHRINE HYDROCHLORIDE?
1) vessel extensions
2) vasoconstriction
3) lengthening the absorption of local anesthetic into the bloodstream
4) enhancing the action of the anesthetic
5) reducing toxicity
2. WHAT IS THE VOLUME OF 0.01% SOLUTION OF EPINEPHRINE HYDROCHLORIDE ADDED TO 5 ML OF 2% SOLUTION OF NOVOCAINE TO PROLONG THE ACTION?
1)0.005 ml
2)0.05 ml
3) 0.1 ml
4) 1 ml
3. THE HIGHEST SINGLE DOSE OF 2% NOVOCAINE SOLUTION
1)0.25 g
2) 0.1 g
3)1.25 g
4)1.5 g
4. THE AVERAGE THERAPEUTIC DOSE OF 2% SOLUTION OF TRIMECAINE
1)0,25
2)0,125
3) 1.0
4) 1.5
5. AVERAGE THERAPEUTIC DOSE OF 2% LIDOCAINE SOLUTION
1)0,25
2)0,5
3)1,25
4) 0.75
6. THE HIGHEST SINGLE DOSE OF DICAINE
1)0,03
2)0,09
3)3.0
4) 1.5
7. WHAT SOLUTION IS USED WHEN CONDUCTING A COLOR TEST FOR NOVOCAINE?
1) furacilinum
2) hydrogen peroxide
3) potassium permanganate
4)ammonia
5) citric acid
8. WHAT NOVOCAINE SOLUTION IS USED FOR LOCAL ANESTHESIA OF SOFT TISSUES?
1)1%
2)0,5%
3)0,25%
4)2%
5)5%
9. WHAT LIDOCAINE SOLUTION IS USED FOR LOCAL ANESTHESIA IN THE MAXILLOFACIAL AREA?
1)5%
2)10%
3)1%
4)2%
5)0.25%
10. WHAT TRIMECAIN SOLUTION IS USED FOR LOCAL ANESTHESIA IN THE MAXILLOFACIAL AREA?
1)2%
2)0,5%
3)1%
4)0,25%
5)5%
11. THE HIGHEST SINGLE DOSE OF 2% NOVOCAINE SOLUTION
1) 5 ml
2) 10 ml
3) 15 ml
4) 20 ml
5)30 ml
12. THE HIGHEST SINGLE DOSE OF 2% SOLUTION OF TRIMECAINE
1) 5 ml
2) 10 ml
3) 15 ml
4) 20 ml
5) 30 ml
13. WHAT AMOUNT OF DRY MATTER IS NEEDED TO PREPARE 250 ML OF 2% NOVOCAINE SOLUTION?
1)1.5 g
2)3.0 g
3)5 g
4)7 g
5)10 g
14. WHAT VOLUME OF NOVOCAINE SOLUTION (0.5%) CAN BE PREPARED FROM 1.5 G OF DRY MATTER?
1) 10 ml
2) 300 ml
3)100 ml
4) 150 ml
5) 200 ml
15. WHAT VOLUME OF NOVOCAINE SOLUTION (0.25%) CAN BE PREPARED FROM 5 G OF DRY MATTER?
1) 250 ml
2) 500 ml
3)1000 ml
4) 2000 ml
5)1500ml
16. ANTIHISTAMINES INCLUDE
1) novocaine
2) epinephrine hydrochloride
3) seduxen
4) diphenhydramine
5) Elenium
17. SMALL TRANQUILIZERS INCLUDE
1) novocaine
2) epinephrine hydrochloride
3) seduxen
4) analgin
5) omnopon
18. WHAT DRUGS ARE USED FOR SEDATION?
1) Dimedrol
2) analgin
3) novocaine
4) camphor
5) trioxazine
19. WHAT COMBINATION OF DRUGS IS USED MOST OFTEN IN THE CLINIC FOR PREMEDICATION?
1) sleeping pills + non-narcotic analgesics
2) sleeping pills + narcotic analgesics
3) sleeping pills + antihistamines
4) sleeping pills + small tranquilizers
5) small tranquilizers + narcotic analgesics
20. WHAT DRUGS ARE USED FOR NEUROLEPTOANALGESIA?
1) analgin
2) fentanyl
3) promedol
4) droperidol
5) dehydrobenzperidol
Appendix 3
TEST TASKS OF THE SECOND ORDER
TO CONTROL THE ASSIMILATION OF THE LESSON TOPIC
1. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 0.25% solution of novocaine
2) 0.5% solution of novocaine
3) 1% solution of novocaine
4) 2% solution of novocaine
5) 10% solution of novocaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
2. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 0.25% solution of trimecaine
2) 0.5% solution of trimecaine
3) a 1% solution of trimecaine
4) 2% solution of trimecaine
5) 5% solution of trimecaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
3. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 0,5% solution of lidocaine
2) 1% lidocaine solution
3) 2% lidocaine solution
4) 5% lidocaine solution
5) 10% solution of lidocaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
4. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 1% solution of dicaine
2) 2% solution of dicaine
3) 3% solution of dicaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
5. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 1% solution of cocaine
2) 2% solution of cocaine
3) 3% solution of cocaine
4) 5% solution of cocaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
6. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 2% solution of novocaine
2) 10% solution of lidocaine
3) 0.5% solution of trimecaine
4) 2% solution of dicaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
7. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) anesthesin
2) analgin
3) seduxen
4) the Elenium
A. Local anesthesia
B. Potentiated analgesia
8. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) trioxazine
2) diphenhydramine
3) novocaine
4) acetylsalicylic acid
A. Local anesthesia
B. Potentiated analgesia
9. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) sibazon
2) lidocaine
3) cocaine
4) aspirin
A. Local anesthesia
B. Potentiated analgesia
10. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) sodium meprobamate
2) diazepam
3) dicaine
4) trimekain
A. Local anesthesia
B. Potentiated analgesia
11. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) clhasinit
2) Mezapamum
3) nozepam
4) lidocaine
A. Local anesthesia
B. Potentiated analgesia
12. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) tincture of Valerian
2) tincture of motherwort
3) potassium bromide
4) sodium bromide
A. Local anesthesia
B. Potentiated analgesia
FEDERAL STATE BUDGETARY EDUCATIONAL INSTITUTION OF HIGHER EDUCATION
"BASHKIR STATE MEDICAL UNIVERSITY»
MINISTRY OF HEALTH OF RUSSIA
Department of surgical dentistry
Approved by head of the department
F. Z. Mirsaeva
"31" __august_ 2018
METHODICAL RECOMMENDATION FOR STUDENTS
for a practical lesson on the topic:
Surgical Dentistry
Specialty 31.05.03-Dentistry
Course II
Semester IV
Number of hours 30
Ufa-2018
Methodical guidelines for students are based on the work program approved by the " 31 " of August 2018 and compiled on the basis of the FSES of specialty 31.05.03-Dentistry, approved by the order of the Ministry of education and science of the Russian Federation No. 96" 09 " of February 2016.
Reviewers
Head of the Department of surgical dentistry and maxillofacial surgery FSBEI HE SSMU (Arkhangelsk) MOH Russia, MD Minkin A. U.
Head of the Department of surgical dentistry and maxillofacial surgery FSBEI HE “Stavropol state medical University”, MD, professor Gandylyan K. S.
Freelance specialist MOH Republic of Bashkortostan in preventive dentistry, head physician SBIH RB Dental clinic №4, Ufa, Ph. D. Zubairova G. S.
Authors: MD, professor, F. Z. Mirsaeva, ass. L. R. Khalikova
Approval at session # 1 of the Department of surgical dentistry dated August 31, 2018.
TABLE OF CONTENTS
Local anesthetics and medications used for local anesthesia. Types of local anesthesia.
Potentiated local anesthesia. Preparations for potentiated local anesthesia.
Anestesia during surgical interventions in the maxillofacial region. Analgesia of tissues during surgical interventions on the maxilla jaw (infra-orbital, tuberal).
Anesthesia of tissues during surgical interventions on the maxilla (Palatine, incisive anesthesia, stem anesthesia - II branch of the trigeminal nerve).
Anesthesia of tissues during surgical interventions on the mandibula (mandibular anesthesia intraoral palpatory and apodactyl methods, mandibular anesthesia-extraoral methods)
Anesthesia of tissues during surgical interventions on the mandibula (thorusal and mental anesthesia, stem anesthesia-III branch of the trigeminal nerve. Anestesia by Bersche-Dubov).
Local complications with local anesthesia. Reasons. Diagnosis, treatment. Prevention.
General complications of local anesthesia. Causes, diagnosis, treatment. Prevention.
THE THEME OF THE LESSON №1. LOCAL ANESTHETICS AND MEDICATIONS USED FOR LOCAL ANESTHESIA. TYPES OF LOCAL ANESTHESIA. POTENTIATED LOCAL ANESTHESIA. PREPARATIONS FOR POTENTIATED LOCAL ANESTHESIA. (for 2 lessons)
Relevance. Topic "Local anesthetics and medications used for local anesthesia. Types of local analgesia" is relevant, because local analgesia can be achieved in various ways (by application, infiltration, nerve block, etc.) using one of the many well-known local anesthetics used in dentistry. Local anesthetics, in addition to the anesthetic, have other properties, as a result of which General complications may occur before and during surgery. General complications may also occur as a result of the patient's psychoemotional state associated with the upcoming surgical intervention. To achieve effective analgesia and successful surgical operation, it is necessary to know local anesthetics and their properties, types of local analgesia, as well as the ability to adequately assess the psycho-emotional state of the patient and conduct rational premedication.
The purpose of the lesson: to master the knowledge of the pharmacological properties of local anesthetics, drugs for potentiation, types of local anesthesia and the skills of selecting a local anesthetic, taking into account the patient's somatic diseases.
For the formation of professional competences the student must know:
- types of analgesia, indications and contraindications for each type of analgesia;
- local anesthetics, their physical and chemical properties;
- side effects of local anesthetics;
- methods of introduction of local anesthetics;
- higher single doses of local anesthetics;
- preparations for premedication, their properties, methods of administration, doses.
- patient examination;
- local anesthetics, small tranquilizers, narcotic and non-narcotic analgesics, sedatives;
- vasoconstrictor drugs, of their dose.
For the formation of professional competencies, the student must be able to:
- choose a local anesthetic individually for the patient, taking into account its pharmacological properties and somatic diseases of the patient;
- to evaluate the psychosocial status of the patient;
- choose an adequate premedication scheme individually for the patient;
- determine the indications for the use of local anesthetics with vasoconstrictors.
To form professional competencies, the student must possess:
1. EPC-5 (principles of analysis of its activities)
2.EPC-6 (analysis of the results of their own activities, skills in filling out medical documentation, methods of accounting and reporting documentation)
3. PC-9 (A/02.7) readiness to manage and treat patients with dental diseases in outpatient and day hospital settings.
Materials for self-training to master this topic:
Questions about the topic of the lesson:
1. The main components of the pain response (sensory, psycho-emotional, vegetative, psychomotor).
2. Types of local anesthetics;
3. Pharmacological properties of local anesthetics;
4. Higher single doses of local anesthetics;
5. Vasoconstrictor drugs, their doses;
6. Classification of types of local anesthesia;
7. Classification of nerve block and infiltration anesthesia;
8. Indications for various types of local anesthesia;
Type of lesson: practical
Duration of lessons: 8 academic hours
Equipment: diagrams, tables, sets of test problems
6.1 Didactic material (multimedia atlases and situational tasks, business games, phantoms, simulators, etc.)
The content of the lesson:
7.1. Control of the initial level of knowledge and skills.
Tasks for self-control: students solve individual sets of test tasks (Appendix 1)
7.2. Analysis with the teacher of the key issues necessary for the development of the topic of the lesson.
7.3. Demonstration by the teacher of methods of practical techniques on this topic.
7.4. Independent work of students under the supervision of a teacher (laboratory work, curation of patients, registration of the results of laboratory work, registration of medical documentation, etc.)
7.5. Control of the final level of mastering the topic:
Materials for monitoring the level of development of the topic: a set of test tasks, situational tasks (Appendix 2.3)
Place of self-training: reading room, study room for independent work of students.
Educational and research work of students on this topic:
1. The main components of the pain response: sensory, psycho-emotional, vegetative, psychomotor.
Appendices to the topic of the lesson: “LOCAL ANESTHETICS AND MEDICATIONS USED FOR LOCAL ANESTHESIA. TYPES OF LOCAL ANESTHESIA. POTENTIATED LOCAL ANESTHESIA. PREPARATIONS FOR POTENTIATED LOCAL ANESTHESIA.” (for 2 topics)
Appendix 1
TEST TASKS FOR MONITORING
INITIAL LEVEL OF KNOWLEDGE
Select one or more of the most correct answers.
1. LOCAL ANESTHETICS ARE MEDICATIONS
1) affecting efferent innervation
2) reducing the sensitivity of the endings of afferent nerves
3) regulating functions of the Central nervous system
2. LOCAL ANESTHETICS INCLUDE
1) anesthesin
2) analgin
3) promedol
4) lidocaine
3. LOCAL ANESTHETICS INCLUDE
1) phenacetin
2) dicaine
3) soukan
4) morphine
4. LOCAL ANESTHETICS INCLUDE
1) cocaine
2) novocaine
3) baralgin
4) acetylsalicylic acid
5. LOCAL ANESTHETICS INCLUDE
1) trimekain
2) paracetamol
3) cocaine
4) fentanyl
Appendix 2
TEST TASKS FOR MONITORING
LEVEL OF DEVELOPMENT OF THE TOPIC
Select one or more of the most correct answers.
1. A 0.1% SOLUTION OF EPINEPHRINE HYDROCHLORIDE IS ADDED TO LOCAL ANESTHETICS IN ORDER TO
1) vessel extensions
2) Vasoconstriction
3) lengthening the absorption of local anesthetic into the bloodstream
4) enhancing the effect of the anesthetic
5) reducing toxicity
2. FOR PROLONGATION OF ANESTHESIA TO 5 ML OF 2% SOLUTION OF NOVOCAINE ACTION ADD 0.01% SOLUTION OF EPINEPHRINE HYDROCHLORIDE
1) 0.005 ml
2) 0.05 ml
3) 0.1 ml
4) 1 ml
3. THE HIGHEST SINGLE DOSE OF 2% NOVOCAINE SOLUTION
1) 0.25 g
2) 0.1 g
3) 1.25 g
4) 1.5 g
4. THE AVERAGE THERAPEUTIC DOSE OF 2% SOLUTION OF TRIMECAINE
1) 0.25
2) 0.125
3) 1.0
4) a 1.5
5. AVERAGE THERAPEUTIC DOSE OF 2% LIDOCAINE SOLUTION
1) 0.25
2) 0.5
3) 1.25
4) 0.75
6. THE HIGHEST SINGLE DOSE OF DICAINE
1) 0.03
2) 0.09
3) 3.0
4) a 1.5
7. WHEN CONDUCTING A COLOR TEST FOR NOVOCAINE, A SOLUTION IS USED
1) solution of furacilinum
2) solution of hydrogen peroxide
3) solution of potassium permanganate
4) solution of ammonia
5) solution of citric acid
8. WHAT NOVOCAINE SOLUTION IS USED FOR LOCAL ANESTHESIA OF SOFT TISSUES
1) 1%
2) 0.5%
3) 0.25%
4) 2%
5) 5%
9. WHAT LIDOCAINE SOLUTION IS USED FOR LOCAL ANESTHESIA IN THE MAXILLOFACIAL REGION
1) 5%
2) 10%
3) 1%
4) 2%
5) 0.25%
10. WHAT TRIMEKAIN SOLUTION IS USED FOR LOCAL ANESTHESIA IN MAXILLOFACIAL REGION
1) 2%
2) 0.5%
3) 1%
4) 0.25%
5) 5%
11. THE HIGHEST SINGLE DOSE OF 2% NOVOCAINE SOLUTION
1) 5 ml
2) 10 ml
3) 15 ml
4) 20 ml
5) 30 ml
12. THE HIGHEST SINGLE DOSE OF 2% SOLUTION OF TRIMECAINE
1) 5 ml
2) 10 ml
3) 15 ml
4) 20 ml
5) 30 ml
13. HOW MUCH DRY MATTER IS NEEDED
TO PREPARE 250 ML of 2% NOVOCAINE SOLUTION
1) 1.5 g
2) 3.0 g
3) 5 g
4) 7 g
5) 10 g
14. HOW MUCH 0.25% SOLUTION CAN BE PREPARED
OF 1,5 G of NOVOCAINE DRY MATTER
1) 10 ml
2) 300 ml
3) 100 ml
4) 150 ml
5) 200 ml
15. HOW MUCH 0.25% SOLUTION CAN BE PREPARED
OF 5 G of NOVOCAINE DRY MATTER
1) 250 ml
2) 500 ml
3) 1000 ml
4) 2000 ml
5) 1500ml
16. WHICH DRUG BELONGS TO THE GROUP OF ANTIHISTAMINES?
1) novocaine
2) epinephrine hydrochloride
3) seduxen
4) diphenhydramine
5) the Elenium
17. Which drug belongs to small tranquilizers
1) novocaine
2) epinephrine hydrochloride
3) seduxen
4) analgin
5) omnopon
18. WHAT DRUGS ARE USED FOR SEDATION?
1) Dimedrol
2) analgin
3) novocaine
4) camphor
5) trioxazine
19. WHAT COMBINATION OF DRUGS IS MOST OFTEN USED IN THE CLINIC FOR PREMEDICATION?
1) sleeping pills + non-narcotic analgesics
2) sleeping pills + narcotic analgesics
3) sleeping pills + antihistamines
4) sleeping pills + small tranquilizers
5) small tranquilizers + narcotic analgesics
20. WHAT DRUGS ARE USED FOR NEUROLEPTANALGESIA?
1) analgin
2) fentanyl
3) promedol
4) droperidol
5) dehydrobenzperidol
Appendix 3
TEST TASKS OF THE SECOND ORDER
TO CONTROL THE ASSIMILATION OF THE LESSON TOPIC
1. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 0.25% solution of novocaine
2) 0.5% solution of novocaine
3) 1% solution of novocaine
4) 2% solution of novocaine
5) 10% solution of novocaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
2. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 0.25% solution of trimecaine
2) 0.5% solution of trimecaine
3) a 1% solution of trimecaine
4) 2% solution of trimecaine
5) 5% solution of trimecaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
3. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 0,5% solution of lidocaine
2) 1% lidocaine solution
3) 2% lidocaine solution
4) 5% lidocaine solution
5) 10% solution of lidocaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
4. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 1% solution of dicaine
2) 2% solution of dicaine
3) 3% solution of dicaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
5. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 1% solution of cocaine
2) 2% solution of cocaine
3) 3% solution of cocaine
4) 5% solution of cocaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
6. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 2% solution of novocaine
2) 10% solution of lidocaine
3) 0.5% solution of trimecaine
4) 2% solution of dicaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
7. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) anesthesin
2) analgin
3) seduxen
4) the Elenium
A. Local anesthesia
B. Potentiated analgesia
8. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) trioxazine
2) diphenhydramine
3) novocaine
4) acetylsalicylic acid
A. Local anesthesia
B. Potentiated analgesia
9. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) sibazon
2) lidocaine
3) cocaine
4) aspirin
A. Local anesthesia
B. Potentiated analgesia
10. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) sodium meprobamate
2) diazepam
3) dicaine
4) trimekain
A. Local anesthesia
B. Potentiated analgesia
11. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) clhasinit
2) Mezapamum
3) nozepam
4) lidocaine
A. Local anesthesia
B. Potentiated analgesia
12. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) tincture of Valerian
2) tincture of motherwort
3) potassium bromide
4) sodium bromide
A. Local anesthesia
B. Potentiated analgesia
TOPIC OF THE LESSON: “ANALGESIA OF TISSUES DURING SURGICAL INTERVENTIONS IN THE MAXILLOFACIAL AREA. ANALGESIA OF TISSUES DURING SURGICAL INTERVENTIONS ON THE MAXILLA (INFRAORBITAL, TUBERAL, PALATINE, INCISIVE ANESTHESIA, STEM ANESTHESIA - II BRANCH OF THE TRIGEMINAL NERVE)”. (for 2 topics)
1. Relevance. Analgesia is one of the most urgent problems of dentistry, since the interventions performed by a dentist are accompanied by pain. Pain causes a reflex twitch of a part of the body from the damaging object, a reflex release of epinephrine and vasopressin etc., which can lead to local and General complications. For high-quality performance of any intervention that is accompanied by pain, knowledge and skill of methods of analgesia is necessary.
2. The purpose of the lesson: to master the knowledge and skills of techniques for performing infiltration and nerve blockage types of analgesia during surgical interventions on the maxilla.
To form professional competencies, students must know:
- topographic anatomy of the maxillary nerve and its branches;
- innervation of the maxilla (teeth, bones of the periosteum and mucous membrane);
- innervation of soft tissues adjacent to the maxilla;
- anatomical features of the maxilla;
- aseptics and antiseptics;
-methods of infiltration anesthesia on the maxilla;
-method of tuberal anesthesia on the maxilla;
- method of conducting infra-orbital anesthesia on the maxilla;
- choose a local anesthetic individually for the patient, taking into account its pharmacological properties and somatic diseases of the patient;
- evaluate the psycho-emotional state of the patient;
- choose an adequate premedication scheme individually for the patient;
- determine the indications for the use of local anesthetics with vasoconstrictors.
To form professional competencies, students must be able to:
- choose a local anesthetic individually for the patient, taking into account its pharmacological properties and somatic diseases of the patient;
- evaluate the psycho-emotional state of the patient;
- choose an adequate premedication scheme individually for the patient;
- determine the indications for the use of local anesthetics with vasoconstrictors.
To form professional competencies, students must possess:
1. OPC-5 (principles of analysis of its activities)
2. OPC-6 (analysis of results of own activity, skills of filling in medical documentation, methods of accounting and reporting documentation)
3. PC-9 (A / 02.7) readiness to manage and treat patients with dental diseases in outpatient and day hospital settings.
3. Materials for self-training to master this topic:
Questions about the topic of the lesson:
1. What are the three ways to find the projection of the foramen infraorbitale in the patient?
2. At what distance and in which direction from the projection of the foramen infraorbitale is an injection made during infraorbital anesthesia by an extra-oral method?
3. What are the guidelines for determining whether an injection needle enters the infraorbital canal?
4. How deep can the needle be moved in the infraorbital canal?
5. Which nerves are turned off during infraorbital anesthesia?
6. What is the pain relief zone for infra-orbital anesthesia?
7. Which areas of the nerve are turned off during infiltration anesthesia?
8. What are the indications for the use of infiltration anesthesia on the upper jaw?
9. What is the volume of mouth opening during intraoral infra-orbital anesthesia?
10. Where is the injection point when performing intraoral method of infraorbital anesthesia?
11. In what direction and how deep does the needle move in the intraoral method of infraorbital anesthesia?
12. How wide should the patient's mouth be opened during tuberal anesthesia?
13. Where is the injection point when performing tuberal anesthesia?
14. In what direction and how deep the needle moves during tuberales anesthesia?
15. Which nerves are turned off during tuberal anesthesia?
16. What is the pain relief zone for tuberal anesthesia?
17. How to find the projection of a foramen palatinum majus ?
18. Where is the needle injected during Palatine anesthesia?
19. Which nerve is switched off during Palatine anesthesia?
20. What is the pain relief zone for Palatine anesthesia?
21. How to find the projection of incisive foramen?
22. In what position is the head of the patient when conducting the incisive anesthesia?
23. Where do you inject the needle during incisive anesthesia?
24. In what direction and how deep the needle moves during incisive anesthesia?
25. What is a tragoorbital line?
26. How do we find the injection point for switching off the II branch of the trigeminal nerve using the Weissblatt method?
27. What additional devices and how long is the needle used for nerve blockage anesthesia using the Weissblatt method?
28. How deep and on what plane to insert the needle in stem anesthesia using the Weissblatt method?
29. How many degrees and in what direction should the syringe be turned after removing the needle halfway or to the subcutaneous fat when switching off the II branch of the trigeminal nerve using the Weissblatt method?
30. What is the pain relief zone when the second branch of the trigeminal nerve is turned off?
4. Type of studies: practical
5. Duration of lessons: 8 academic hours
6. Equipment: diagrams, tables, and test task suites
6.1 Didactic materials (multimedia atlases and situational tasks, business games, phantoms, simulators, etc.)
7. The content of the class:
7.1. Control of the initial level of knowledge and skills.
Tasks for self-control: students solve individual sets of test tasks (Appendix 1)
7.2. Analysis with the teacher of the key issues necessary for the development of the topic of the lesson.
7.3. demonstration by the teacher of methods of practical techniques on this topic.
7.4. Independent work of students under the supervision of a teacher (laboratory work, curation of patients, registration of the results of laboratory work, registration of medical documentation, etc.)
7.5. Control of the final level of mastering the topic:
Materials for monitoring the level of development of the topic: a set of test tasks, situational tasks (Appendix 2.3)
Place of self-training: reading room, study room for independent work of students.
8. Educational and research work of students on this topic:
The main components of the pain response: sensory, psycho-emotional, vegetative, psychomotor.
Appendices to the lesson topic: "Analgesia of tissues during surgical interventions in the maxillofacial area. analgesia of tissues during surgical interventions on the maxilla (infraorbital, tuberal, palatine, incisive anesthesia, stem anesthesia - II branch of the trigeminal nerve" (for 2 lessons).
Appendix 1
TEST TASKS FOR MONITORING
INITIAL LEVEL OF KNOWLEDGE
Select one or more of the most correct answers.
1. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) affecting efferent innervation
2) reducing the sensitivity of afferent nerve endings
3) regulating functions of the Central nervous system
2. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) anesthesin
2) analgin
3) promedol
4) lidocaine
3. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) phenacetin
2) dicaine
3) soukan
4) morphine
4. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) cocaine
2) novocaine
3) baralgin
4) acetylsalicylic acid
5. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) trimekain
2) paracetamol
3) cocaine
4) fentanyl
Appendix 2
TEST TASKS FOR MONITORING
LEVEL OF DEVELOPMENT OF THE TOPIC
Select one or more of the most correct answers.
1. WHAT IS THE PURPOSE TO LOCAL ANESTHETICS ADD 0.1% SOLUTION OF EPINEPHRINE HYDROCHLORIDE?
1) vessel extensions
2) vasoconstriction
3) lengthening the absorption of local anesthetic into the bloodstream
4) enhancing the action of the anesthetic
5) reducing toxicity
2. WHAT IS THE VOLUME OF 0.01% SOLUTION OF EPINEPHRINE HYDROCHLORIDE ADDED TO 5 ML OF 2% SOLUTION OF NOVOCAINE TO PROLONG THE ACTION?
1)0.005 ml
2)0.05 ml
3) 0.1 ml
4) 1 ml
3. THE HIGHEST SINGLE DOSE OF 2% NOVOCAINE SOLUTION
1)0.25 g
2) 0.1 g
3)1.25 g
4)1.5 g
4. THE AVERAGE THERAPEUTIC DOSE OF 2% SOLUTION OF TRIMECAINE
1)0,25
2)0,125
3) 1.0
4) 1.5
5. AVERAGE THERAPEUTIC DOSE OF 2% LIDOCAINE SOLUTION
1)0,25
2)0,5
3)1,25
4) 0.75
6. THE HIGHEST SINGLE DOSE OF DICAINE
1)0,03
2)0,09
3)3.0
4) 1.5
7. WHAT SOLUTION IS USED WHEN CONDUCTING A COLOR TEST FOR NOVOCAINE?
1) furacilinum
2) hydrogen peroxide
3) potassium permanganate
4)ammonia
5) citric acid
8. WHAT NOVOCAINE SOLUTION IS USED FOR LOCAL ANESTHESIA OF SOFT TISSUES?
1)1%
2)0,5%
3)0,25%
4)2%
5)5%
9. WHAT LIDOCAINE SOLUTION IS USED FOR LOCAL ANESTHESIA IN THE MAXILLOFACIAL AREA?
1)5%
2)10%
3)1%
4)2%
5)0.25%
10. WHAT TRIMECAIN SOLUTION IS USED FOR LOCAL ANESTHESIA IN THE MAXILLOFACIAL AREA?
1)2%
2)0,5%
3)1%
4)0,25%
5)5%
11. THE HIGHEST SINGLE DOSE OF 2% NOVOCAINE SOLUTION
1) 5 ml
2) 10 ml
3) 15 ml
4) 20 ml
5)30 ml
12. THE HIGHEST SINGLE DOSE OF 2% SOLUTION OF TRIMECAINE
1) 5 ml
2) 10 ml
3) 15 ml
4) 20 ml
5) 30 ml
13. WHAT AMOUNT OF DRY MATTER IS NEEDED TO PREPARE 250 ML OF 2% NOVOCAINE SOLUTION?
1)1.5 g
2)3.0 g
3)5 g
4)7 g
5)10 g
14. WHAT VOLUME OF NOVOCAINE SOLUTION (0.5%) CAN BE PREPARED FROM 1.5 G OF DRY MATTER?
1) 10 ml
2) 300 ml
3)100 ml
4) 150 ml
5) 200 ml
15. WHAT VOLUME OF NOVOCAINE SOLUTION (0.25%) CAN BE PREPARED FROM 5 G OF DRY MATTER?
1) 250 ml
2) 500 ml
3)1000 ml
4) 2000 ml
5)1500ml
16. ANTIHISTAMINES INCLUDE
1) novocaine
2) epinephrine hydrochloride
3) seduxen
4) diphenhydramine
5) Elenium
17. SMALL TRANQUILIZERS INCLUDE
1) novocaine
2) epinephrine hydrochloride
3) seduxen
4) analgin
5) omnopon
18. WHAT DRUGS ARE USED FOR SEDATION?
1) Dimedrol
2) analgin
3) novocaine
4) camphor
5) trioxazine
19. WHAT COMBINATION OF DRUGS IS USED MOST OFTEN IN THE CLINIC FOR PREMEDICATION?
1) sleeping pills + non-narcotic analgesics
2) sleeping pills + narcotic analgesics
3) sleeping pills + antihistamines
4) sleeping pills + small tranquilizers
5) small tranquilizers + narcotic analgesics
20. WHAT DRUGS ARE USED FOR NEUROLEPTOANALGESIA?
1) analgin
2) fentanyl
3) promedol
4) droperidol
5) dehydrobenzperidol
Appendix 3
TEST TASKS OF THE SECOND ORDER
TO CONTROL THE ASSIMILATION OF THE LESSON TOPIC
1. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 0.25% solution of novocaine
2) 0.5% solution of novocaine
3) 1% solution of novocaine
4) 2% solution of novocaine
5) 10% solution of novocaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
2. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 0.25% solution of trimecaine
2) 0.5% solution of trimecaine
3) a 1% solution of trimecaine
4) 2% solution of trimecaine
5) 5% solution of trimecaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
3. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 0,5% solution of lidocaine
2) 1% lidocaine solution
3) 2% lidocaine solution
4) 5% lidocaine solution
5) 10% solution of lidocaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
4. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 1% solution of dicaine
2) 2% solution of dicaine
3) 3% solution of dicaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
5. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 1% solution of cocaine
2) 2% solution of cocaine
3) 3% solution of cocaine
4) 5% solution of cocaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
6. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 2% solution of novocaine
2) 10% solution of lidocaine
3) 0.5% solution of trimecaine
4) 2% solution of dicaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
7. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) anesthesin
2) analgin
3) seduxen
4) the Elenium
A. Local anesthesia
B. Potentiated analgesia
8. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) trioxazine
2) diphenhydramine
3) novocaine
4) acetylsalicylic acid
A. Local anesthesia
B. Potentiated analgesia
9. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) sibazon
2) lidocaine
3) cocaine
4) aspirin
A. Local anesthesia
B. Potentiated analgesia
10. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) sodium meprobamate
2) diazepam
3) dicaine
4) trimekain
A. Local anesthesia
B. Potentiated analgesia
11. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) clhasinit
2) Mezapamum
3) nozepam
4) lidocaine
A. Local anesthesia
B. Potentiated analgesia
12. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) tincture of Valerian
2) tincture of motherwort
3) potassium bromide
4) sodium bromide
A. Local anesthesia
B. Potentiated analgesia
TOPIC OF THE LESSON: “ANALGESIA OF TISSUES DURING SURGICAL INTERVENTIONS IN THE MAXILLOFACIAL AREA. ANALGESIA OF TISSUES DURING SURGICAL INTERVENTIONS ON THE MAXILLA (INFRAORBITAL, TUBERAL, PALATINE, INCISIVE ANESTHESIA, STEM ANESTHESIA - II BRANCH OF THE TRIGEMINAL NERVE)”. (for 2 topics)
1. Relevance. Analgesia is one of the most urgent problems of dentistry, since the interventions performed by a dentist are accompanied by pain. Pain causes a reflex twitch of a part of the body from the damaging object, a reflex release of epinephrine and vasopressin etc., which can lead to local and General complications. For high-quality performance of any intervention that is accompanied by pain, knowledge and skill of methods of analgesia is necessary.
2. The purpose of the lesson: to master the knowledge and skills of techniques for performing infiltration and nerve blockage types of analgesia during surgical interventions on the maxilla.
To form professional competencies, students must know:
- anatomy of the mandibula;
- topographic anatomy of the mandibular nerve and its branches;
- innervation of the mandibula (bones, periosteum, teeth and mucous membrane of the alveolar part of the mandibula);
- innervation of the cheek and soft tissues adjacent to the mandibula;
- rules of asepsis and antiseptics;
-methods of infiltration anasthesia;
- intra-oral and extra-oral methods of mandibular analgesia;
-methods of conducting intra-oral and extra-oral methods of mental analgesia;
- choose a local anesthetic individually for the patient, taking into account its pharmacological properties and somatic diseases of the patient;
- to evaluate the psychosocial status of the patient;
- choose an adequate premedication scheme individually for the patient;
- determine the indications for the use of local anesthetics with vasoconstrictors.
To form professional competencies, students must be able to:
- choose a local anesthetic individually for the patient, taking into account its pharmacological properties and somatic diseases of the patient;
- to evaluate the psychosocial status of the patient;
- choose an adequate premedication scheme individually for the patient;
- determine the indications for the use of local anesthetics from blood vessels.
To form professional competencies, students must possess:
1. OPC-5 (principles of analysis of its activities)
2. OPC-6 (analysis of results of own activity, skills of filling in medical documentation, methods of accounting and reporting documentation)
3. PC-9 (A / 02.7) readiness to manage and treat patients with dental diseases in outpatient and day hospital settings.
3. Materials for self-training to master this topic:
Questions about the topic of the lesson:
A. Mandibular anesthesia - apodictically method
1. What is the volume of opening the mouth with this anesthesia?
2. Where is the syringe located when performing this anesthesia?
3. What anatomical formations are guided when determining the injection point for this anesthesia?
4. The injection Point for this anesthesia?
5. What is the direction and what is the depth of movement of the needle?
6. Which nerves are turned off during this anesthesia?
7. What is the pain relief zone?
B. Mandibular anesthesia-palpatory method
1. What is the volume of opening the mouth with this anesthesia?
2. Location of the syringe?
3. What anatomical structures need to find a palpable and where is injection of the needle?
4. What is the direction and what is the depth of movement of the needle?
5. Which nerves are turned off during this anesthesia?
6. What is the pain relief zone?
C. Extra-Oral submandibular method of mandibular anesthesia
1. What anatomical formations should be guided when determining the injection point?
2 What is the direction and what is the depth of movement of the needle?
3. Which nerves are turned off during this anesthesia?
4. What is the pain relief zone?
D. Extra-Oral infrazygomatic method of mandibular anesthesia (anesthesia according to Dubov)
1. How do I determine the injection point?
2. What is the direction and what is the depth of movement of the needle?
3. Which nerves are turned off during this anesthesia?
4. What is the pain relief zone?
E. Torusal anesthesia
1. Where is the depot of anesthetics for torusal anesthesia created?
2. To what extent do open your mouth when conducting torusal anesthesia?
3. How is the injection point determined?
4. Where is the syringe located?
5. What is the direction and what is the depth of movement of the needle?
6. The amount of anesthetic administered?
7. Which nerve is switched off?
8. What is the pain relief zone?
F. Extra-Oral method of mental anesthesia
1. How to find the projection of the mental hole on the skin?
2. How to determine the point of the injection point?
3. What is the depth and direction of the needle?
4. How many mm should the needle advance in the channel?
5. Which nerve is switched off?
6. What is the pain relief zone?
G. Intraoral method of mental anesthesia
1. How to determine the projection of the foremen mentale in the vestibule of the oral cavity?
2. How to determine the point of the injection point?
3. What is the direction and what is the depth of movement of the needle?
4. How many mm is the needle moving in the mandibular canal?
5. Which nerve is turned off by this type of analgesia?
6. What is the pain relief zone?
H. Anesthesia by Berchet
1. How do I determine the injection point?
2. What is the plane and to what depth of movement of the needle?
3. How many milliliters of anesthetic is necessary for this type of anesthesia?
4. Which nerves are turned off?
5. What are the indications for this anesthesia?
I. Deactivation of the III branch of the trigeminal nerve at the base of the skull by Weissblatt
1. How to determine the point of puncture?
a) How to find tragoorbital line?
b) How to find the point of puncture, focusing on tragoorbital line?
2. Which needle is used for this anesthesia?
3. What additional devices are needed when performing this anesthesia?
4. What is the initial depth of needle insertion?
5. What are the next steps?
6. What is direction and what is the angle of the needle removing to the subcutaneous fat (or to half of its depth)?
7. How deep is the needle inserted after turning it in the appropriate direction for this anesthesia?
8. Which nerve is switched off?
9. What is the pain relief zone?
J. Switching off the lingual nerve
1. In which area (the oral cavity) is only the lingual nerve turned off?
2. How to find the injection point?
3. What is the direction and what is the depth of movement of the needle?
4. What is the pain relief zone?
K. switching off the buccal nerve
1. How to determine the injection point when switching off only the buccal nerve separately?
2. What is the direction and what is the depth of movement of the needle?
3. What is the pain relief zone?
4. Type of studies: practical
5. Duration of lessons: 8 academic hours
6. Equipment: diagrams, tables, and test task suites
6.1 Didactic materials (multimedia atlases and situational tasks, business games, phantoms, simulators, etc.)
7. The content of the class:
7.1. Control of the initial level of knowledge and skills.
Tasks for self-control: students solve individual sets of test tasks (Appendix 1)
7.2. Analysis with the teacher of the key issues necessary for the development of the topic of the lesson.
7.3. demonstration by the teacher of methods of practical techniques on this topic.
7.4. Independent work of students under the supervision of a teacher (laboratory work, curation of patients, registration of the results of laboratory work, registration of medical documentation, etc.)
7.5. Control of the final level of mastering the topic:
Materials for monitoring the level of development of the topic: a set of test tasks, situational tasks (Appendix 2.3)
Place of self-training: reading room, study room for independent work of students.
8. Educational and research work of students on this topic:
The main components of the pain response: sensory, psycho-emotional, vegetative, psychomotor.
Appendices to the lesson topic: "Analgesia of tissues during surgical interventions in the maxillofacial area. analgesia of tissues during surgical interventions on the maxilla (infraorbital, tuberal, palatine, incisive anesthesia, stem anesthesia - II branch of the trigeminal nerve" (for 2 lessons).
Appendix 1
TEST TASKS FOR MONITORING
INITIAL LEVEL OF KNOWLEDGE
Select one or more of the most correct answers.
1. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) affecting efferent innervation
2) reducing the sensitivity of afferent nerve endings
3) regulating functions of the Central nervous system
2. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) anesthesin
2) analgin
3) promedol
4) lidocaine
3. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) phenacetin
2) dicaine
3) soukan
4) morphine
4. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) cocaine
2) novocaine
3) baralgin
4) acetylsalicylic acid
5. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) trimekain
2) paracetamol
3) cocaine
4) fentanyl
Appendix 2
TEST TASKS FOR MONITORING
LEVEL OF DEVELOPMENT OF THE TOPIC
Select one or more of the most correct answers.
1. WHAT IS THE PURPOSE TO LOCAL ANESTHETICS ADD 0.1% SOLUTION OF EPINEPHRINE HYDROCHLORIDE?
1) vessel extensions
2) vasoconstriction
3) lengthening the absorption of local anesthetic into the bloodstream
4) enhancing the action of the anesthetic
5) reducing toxicity
2. WHAT IS THE VOLUME OF 0.01% SOLUTION OF EPINEPHRINE HYDROCHLORIDE ADDED TO 5 ML OF 2% SOLUTION OF NOVOCAINE TO PROLONG THE ACTION?
1)0.005 ml
2)0.05 ml
3) 0.1 ml
4) 1 ml
3. THE HIGHEST SINGLE DOSE OF 2% NOVOCAINE SOLUTION
1)0.25 g
2) 0.1 g
3)1.25 g
4)1.5 g
4. THE AVERAGE THERAPEUTIC DOSE OF 2% SOLUTION OF TRIMECAINE
1)0,25
2)0,125
3) 1.0
4) 1.5
5. AVERAGE THERAPEUTIC DOSE OF 2% LIDOCAINE SOLUTION
1)0,25
2)0,5
3)1,25
4) 0.75
6. THE HIGHEST SINGLE DOSE OF DICAINE
1)0,03
2)0,09
3)3.0
4) 1.5
7. WHAT SOLUTION IS USED WHEN CONDUCTING A COLOR TEST FOR NOVOCAINE?
1) furacilinum
2) hydrogen peroxide
3) potassium permanganate
4)ammonia
5) citric acid
8. WHAT NOVOCAINE SOLUTION IS USED FOR LOCAL ANESTHESIA OF SOFT TISSUES?
1)1%
2)0,5%
3)0,25%
4)2%
5)5%
9. WHAT LIDOCAINE SOLUTION IS USED FOR LOCAL ANESTHESIA IN THE MAXILLOFACIAL AREA?
1)5%
2)10%
3)1%
4)2%
5)0.25%
10. WHAT TRIMECAIN SOLUTION IS USED FOR LOCAL ANESTHESIA IN THE MAXILLOFACIAL AREA?
1)2%
2)0,5%
3)1%
4)0,25%
5)5%
11. THE HIGHEST SINGLE DOSE OF 2% NOVOCAINE SOLUTION
1) 5 ml
2) 10 ml
3) 15 ml
4) 20 ml
5)30 ml
12. THE HIGHEST SINGLE DOSE OF 2% SOLUTION OF TRIMECAINE
1) 5 ml
2) 10 ml
3) 15 ml
4) 20 ml
5) 30 ml
13. WHAT AMOUNT OF DRY MATTER IS NEEDED TO PREPARE 250 ML OF 2% NOVOCAINE SOLUTION?
1)1.5 g
2)3.0 g
3)5 g
4)7 g
5)10 g
14. WHAT VOLUME OF NOVOCAINE SOLUTION (0.5%) CAN BE PREPARED FROM 1.5 G OF DRY MATTER?
1) 10 ml
2) 300 ml
3)100 ml
4) 150 ml
5) 200 ml
15. WHAT VOLUME OF NOVOCAINE SOLUTION (0.25%) CAN BE PREPARED FROM 5 G OF DRY MATTER?
1) 250 ml
2) 500 ml
3)1000 ml
4) 2000 ml
5)1500ml
16. ANTIHISTAMINES INCLUDE
1) novocaine
2) epinephrine hydrochloride
3) seduxen
4) diphenhydramine
5) Elenium
17. SMALL TRANQUILIZERS INCLUDE
1) novocaine
2) epinephrine hydrochloride
3) seduxen
4) analgin
5) omnopon
18. WHAT DRUGS ARE USED FOR SEDATION?
1) Dimedrol
2) analgin
3) novocaine
4) camphor
5) trioxazine
19. WHAT COMBINATION OF DRUGS IS USED MOST OFTEN IN THE CLINIC FOR PREMEDICATION?
1) sleeping pills + non-narcotic analgesics
2) sleeping pills + narcotic analgesics
3) sleeping pills + antihistamines
4) sleeping pills + small tranquilizers
5) small tranquilizers + narcotic analgesics
20. WHAT DRUGS ARE USED FOR NEUROLEPTOANALGESIA?
1) analgin
2) fentanyl
3) promedol
4) droperidol
5) dehydrobenzperidol
Appendix 3
TEST TASKS OF THE SECOND ORDER
TO CONTROL THE ASSIMILATION OF THE LESSON TOPIC
1. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 0.25% solution of novocaine
2) 0.5% solution of novocaine
3) 1% solution of novocaine
4) 2% solution of novocaine
5) 10% solution of novocaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
2. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 0.25% solution of trimecaine
2) 0.5% solution of trimecaine
3) a 1% solution of trimecaine
4) 2% solution of trimecaine
5) 5% solution of trimecaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
3. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 0,5% solution of lidocaine
2) 1% lidocaine solution
3) 2% lidocaine solution
4) 5% lidocaine solution
5) 10% solution of lidocaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
4. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 1% solution of dicaine
2) 2% solution of dicaine
3) 3% solution of dicaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
5. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 1% solution of cocaine
2) 2% solution of cocaine
3) 3% solution of cocaine
4) 5% solution of cocaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
6. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 2% solution of novocaine
2) 10% solution of lidocaine
3) 0.5% solution of trimecaine
4) 2% solution of dicaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
7. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) anesthesin
2) analgin
3) seduxen
4) the Elenium
A. Local anesthesia
B. Potentiated analgesia
8. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) trioxazine
2) diphenhydramine
3) novocaine
4) acetylsalicylic acid
A. Local anesthesia
B. Potentiated analgesia
9. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) sibazon
2) lidocaine
3) cocaine
4) aspirin
A. Local anesthesia
B. Potentiated analgesia
10. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) sodium meprobamate
2) diazepam
3) dicaine
4) trimekain
A. Local anesthesia
B. Potentiated analgesia
11. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) clhasinit
2) Mezapamum
3) nozepam
4) lidocaine
A. Local anesthesia
B. Potentiated analgesia
12. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) tincture of Valerian
2) tincture of motherwort
3) potassium bromide
4) sodium bromide
A. Local anesthesia
B. Potentiated analgesia
Topic of the lesson: “LOCAL COMPLICATIONS OF LOCAL ANESTHESIA. REASONS. DIAGNOSIS AND TREATMENT. PREVENTION. GENERAL COMPLICATIONS OF LOCAL ANESTHESIA. CAUSES, DIAGNOSIS, AND TREATMENT. PREVENTION.”
1. Relevance. Local anesthesia in the maxillofacial area can be accompanied by a number of local and general complications. Most local complications occur when the rules of asepsis and antiseptics are violated, the technique of anesthesia is performed, or they are caused by anatomical, topographic and physiological features of the maxillofacial region. Emerging local complications affect the General state of the body, loss of working capacity, and some of them (osteomyelitis, phlegmon), in turn, can be complicated by sepsis, mediastinitis and pose a serious threat to the patient's life. In addition, psychoemotional stress preceding surgery, as well as an overdose of an anesthetic, hypersensitivity or allergic reaction to the administered anesthetic is accompanied by the development of common complications such as fainting, hypertensive crisis, collapse, urticaria, Quincke's edema, intoxication, idiosyncrasy, anaphylactic shock. The occurrence of the above-mentioned complications requires urgent qualified assistance from the doctor. All of the above confirms the relevance of the topic under study.
2. The purpose of the lesson: to master the knowledge and skills of techniques for performing infiltration and nerve blockage types of analgesia during surgical interventions on the maxilla.
To form professional competencies, students must know:
- rules of asepsis and antiseptics;
- local anesthetics, their physical and chemical properties;
- side effects of local anesthetics;
- methods of administration of local anesthetics;
- higher single doses of local anesthetics;
- preparations for premedication, their properties, methods of administration, doses.
- patient examination;
- local anesthetics, small tranquilizers, narcotic and non-narcotic analgesics, sedatives;
- vasoconstrictor drugs, their doses;
- anatomy of the upper and lower jaw;
- technique of infiltration and conducting analgesics for surgical interventions on the upper and lower jaws;
- the nature of local complications that occur during local anesthesia of the maxillofacial area;
- causes that contribute to the development of local complications in local anesthesia of the maxillofacial region;
- clinic, diagnostics of local complications;
- treatment of local complications;
- prevention of local complications with local anesthesia of the maxillofacial area.
To form professional competencies, students must be able to:
- choose a local anesthetic individually for the patient, taking into account its pharmacological properties and somatic diseases of the patient;
- to evaluate the psychosocial status of the patient;
- choose an adequate premedication scheme individually for the patient;
- determine the indications for the use of local anesthetics from blood vessels.
To form professional competencies, students must possess:
1. OPC-5 (principles of analysis of its activities)
2. OPC-6 (analysis of results of own activity, skills of filling in medical documentation, methods of accounting and reporting documentation)
3. PC-9 (A / 02.7) readiness to manage and treat patients with dental diseases in outpatient and day hospital settings.
3. Materials for self-training to master this topic:
Questions about the topic of the lesson:
1. Types of local complications that occur during infiltration and conduction analgesics in the maxillofacial region.
2. Causes of ischemia and tissue necrosis. Clinic, treatment, prevention.
3. Traumatic neuritis. What types of analgesia may develop this complication? Clinic, treatment, prevention.
4. Contracture of the chewing muscle group. What types of analgesia may develop this complication? Clinic, diagnosis, treatment, prevention.
5. Paresis of the facial muscles. What types of analgesia may develop this complication? Clinic, diagnosis, treatment, prevention.
6. Fracture of the injection needle. Reasons. Types of anesthesia in which the possible occurrence of this complication. Tactics of the doctor in the event of this complication.
7. Hematoma. Types of analgesia that may cause this complication.
8. Abscesses and phlegmons of cellular spaces. The reasons for the development of this complication. Types of analgesia that may cause the development of this complication. Prevention.
9. Diplopia. Types of analgesia that may cause this complication. Clinic, treatment, prevention.
10. Subcutaneous emphysema. Reason. Clinic, treatment, prevention.
11. Post-Injection pain. Cause, clinic, diagnosis, treatment, and prevention.
12. Cause, mechanism of development and clinical manifestations:
Fainting
Collapse's
Anaphylactic shock
Hypertensive crisis
Intoxications
Idiosyncrasies
Urticarias
Quincke's Edema
13. Assistance:
• Swoon
•Collapse
•Anaphylactic shock
•Hypertensive crisis
•Intoxications
•Idiosyncrasies
•Urticaria
• The Angioedema
14. Resuscitation measures for respiratory and cardiac arrest.
15. Intensive care for emergencies.
4. Type of studies: practical
5. Duration of lessons: 8 academic hours
6. Equipment: diagrams, tables, and test task suites
6.1 Didactic materials (multimedia atlases and situational tasks, business games, phantoms, simulators, etc.)
7. The content of the class:
7.1. Control of the initial level of knowledge and skills.
Tasks for self-control: students solve individual sets of test tasks (Appendix 1)
7.2. Analysis with the teacher of the key issues necessary for the development of the topic of the lesson.
7.3. Demonstration by the teacher of methods of practical techniques on this topic.
7.4. Independent work of students under the supervision of a teacher (laboratory work, curation of patients, registration of the results of laboratory work, registration of medical documentation, etc.)
7.5. Control of the final level of mastering the topic:
Materials for monitoring the level of development of the topic: a set of test tasks, situational tasks (Appendix 2.3)
Place of self-training: reading room, study room for independent work of students.
8. Educational and research work of students on this topic:
The main components of the pain response: sensory, psycho-emotional, vegetative and psychomotor.
Appendices to the lesson topic: "Analgesia of tissues during surgical interventions in the maxillofacial area. analgesia of tissues during surgical interventions on the maxilla (infraorbital, tuberal, palatine, incisive anesthesia, stem anesthesia - II branch of the trigeminal nerve" (for 2 lessons).
Appendix 1
TEST TASKS FOR MONITORING
INITIAL LEVEL OF KNOWLEDGE
Select one or more of the most correct answers.
1. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) affecting efferent innervation
2) reducing the sensitivity of afferent nerve endings
3) regulating functions of the Central nervous system
2. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) anesthesin
2) analgin
3) promedol
4) lidocaine
3. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) phenacetin
2) dicaine
3) soukan
4) morphine
4. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) cocaine
2) novocaine
3) baralgin
4) acetylsalicylic acid
5. WHAT DRUGS ARE LOCAL ANESTHETICS?
1) trimekain
2) paracetamol
3) cocaine
4) fentanyl
Appendix 2
TEST TASKS FOR MONITORING
LEVEL OF DEVELOPMENT OF THE TOPIC
Select one or more of the most correct answers.
1. WHAT IS THE PURPOSE TO LOCAL ANESTHETICS ADD 0.1% SOLUTION OF EPINEPHRINE HYDROCHLORIDE?
1) vessel extensions
2) vasoconstriction
3) lengthening the absorption of local anesthetic into the bloodstream
4) enhancing the action of the anesthetic
5) reducing toxicity
2. WHAT IS THE VOLUME OF 0.01% SOLUTION OF EPINEPHRINE HYDROCHLORIDE ADDED TO 5 ML OF 2% SOLUTION OF NOVOCAINE TO PROLONG THE ACTION?
1)0.005 ml
2)0.05 ml
3) 0.1 ml
4) 1 ml
3. THE HIGHEST SINGLE DOSE OF 2% NOVOCAINE SOLUTION
1)0.25 g
2) 0.1 g
3)1.25 g
4)1.5 g
4. THE AVERAGE THERAPEUTIC DOSE OF 2% SOLUTION OF TRIMECAINE
1)0,25
2)0,125
3) 1.0
4) 1.5
5. AVERAGE THERAPEUTIC DOSE OF 2% LIDOCAINE SOLUTION
1)0,25
2)0,5
3)1,25
4) 0.75
6. THE HIGHEST SINGLE DOSE OF DICAINE
1)0,03
2)0,09
3)3.0
4) 1.5
7. WHAT SOLUTION IS USED WHEN CONDUCTING A COLOR TEST FOR NOVOCAINE?
1) furacilinum
2) hydrogen peroxide
3) potassium permanganate
4)ammonia
5) citric acid
8. WHAT NOVOCAINE SOLUTION IS USED FOR LOCAL ANESTHESIA OF SOFT TISSUES?
1)1%
2)0,5%
3)0,25%
4)2%
5)5%
9. WHAT LIDOCAINE SOLUTION IS USED FOR LOCAL ANESTHESIA IN THE MAXILLOFACIAL AREA?
1)5%
2)10%
3)1%
4)2%
5)0.25%
10. WHAT TRIMECAIN SOLUTION IS USED FOR LOCAL ANESTHESIA IN THE MAXILLOFACIAL AREA?
1)2%
2)0,5%
3)1%
4)0,25%
5)5%
11. THE HIGHEST SINGLE DOSE OF 2% NOVOCAINE SOLUTION
1) 5 ml
2) 10 ml
3) 15 ml
4) 20 ml
5)30 ml
12. THE HIGHEST SINGLE DOSE OF 2% SOLUTION OF TRIMECAINE
1) 5 ml
2) 10 ml
3) 15 ml
4) 20 ml
5) 30 ml
13. WHAT AMOUNT OF DRY MATTER IS NEEDED TO PREPARE 250 ML OF 2% NOVOCAINE SOLUTION?
1)1.5 g
2)3.0 g
3)5 g
4)7 g
5)10 g
14. WHAT VOLUME OF NOVOCAINE SOLUTION (0.5%) CAN BE PREPARED FROM 1.5 G OF DRY MATTER?
1) 10 ml
2) 300 ml
3)100 ml
4) 150 ml
5) 200 ml
15. WHAT VOLUME OF NOVOCAINE SOLUTION (0.25%) CAN BE PREPARED FROM 5 G OF DRY MATTER?
1) 250 ml
2) 500 ml
3)1000 ml
4) 2000 ml
5)1500ml
16. ANTIHISTAMINES INCLUDE
1) novocaine
2) epinephrine hydrochloride
3) seduxen
4) diphenhydramine
5) Elenium
17. SMALL TRANQUILIZERS INCLUDE
1) novocaine
2) epinephrine hydrochloride
3) seduxen
4) analgin
5) omnopon
18. WHAT DRUGS ARE USED FOR SEDATION?
1) Dimedrol
2) analgin
3) novocaine
4) camphor
5) trioxazine
19. WHAT COMBINATION OF DRUGS IS USED MOST OFTEN IN THE CLINIC FOR PREMEDICATION?
1) sleeping pills + non-narcotic analgesics
2) sleeping pills + narcotic analgesics
3) sleeping pills + antihistamines
4) sleeping pills + small tranquilizers
5) small tranquilizers + narcotic analgesics
20. WHAT DRUGS ARE USED FOR NEUROLEPTOANALGESIA?
1) analgin
2) fentanyl
3) promedol
4) droperidol
5) dehydrobenzperidol
Appendix 3
TEST TASKS OF THE SECOND ORDER
TO CONTROL THE ASSIMILATION OF THE LESSON TOPIC
1. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 0.25% solution of novocaine
2) 0.5% solution of novocaine
3) 1% solution of novocaine
4) 2% solution of novocaine
5) 10% solution of novocaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
2. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 0.25% solution of trimecaine
2) 0.5% solution of trimecaine
3) a 1% solution of trimecaine
4) 2% solution of trimecaine
5) 5% solution of trimecaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
3. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 0,5% solution of lidocaine
2) 1% lidocaine solution
3) 2% lidocaine solution
4) 5% lidocaine solution
5) 10% solution of lidocaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
4. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 1% solution of dicaine
2) 2% solution of dicaine
3) 3% solution of dicaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
5. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 1% solution of cocaine
2) 2% solution of cocaine
3) 3% solution of cocaine
4) 5% solution of cocaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
6. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) 2% solution of novocaine
2) 10% solution of lidocaine
3) 0.5% solution of trimecaine
4) 2% solution of dicaine
A. Surface anesthesia
B. Infiltration anesthesia
B. Nerve block anesthesia
7. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) anesthesin
2) analgin
3) seduxen
4) the Elenium
A. Local anesthesia
B. Potentiated analgesia
8. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) trioxazine
2) diphenhydramine
3) novocaine
4) acetylsalicylic acid
A. Local anesthesia
B. Potentiated analgesia
9. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) sibazon
2) lidocaine
3) cocaine
4) aspirin
A. Local anesthesia
B. Potentiated analgesia
10. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) sodium meprobamate
2) diazepam
3) dicaine
4) trimekain
A. Local anesthesia
B. Potentiated analgesia
11. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) clhasinit
2) Mezapamum
3) nozepam
4) lidocaine
A. Local anesthesia
B. Potentiated analgesia
12. FOR EACH NUMBERED QUESTION SELECT THE APPROPRIATE ANSWER INDICATED BY A LETTER INDEX
1) tincture of Valerian
2) tincture of motherwort
3) potassium bromide
4) sodium bromide
A. Local anesthesia
B. Potentiated analgesia
FEDERAL STATE BUDGETARY EDUCATIONAL INSTITUTION OF HIGHER EDUCATION
"BASHKIR STATE MEDICAL UNIVERSITY»
MINISTRY OF HEALTH OF RUSSIA
Department of surgical dentistry
Approved by head of the department
F. Z. Mirsaeva
"31" __august_2018
METHODICAL RECOMMENDATION FOR STUDENTS
for a practical lesson on the topic:
Surgical Dentistry
Specialty 31.05.03-Dentistry
Course III
Semester VI
Number of hours 48
Ufa-2018
Methodical guidelines for students are based on the work program approved by the " 31 " of August 2018 and compiled on the basis of the FSES of specialty 31.05.03-Dentistry, approved by the order of the Ministry of education and science of the Russian Federation No. 96" 09 " of February 2016.
Reviewers
Head of the Department of surgical dentistry and maxillofacial surgery FSBEI HE SSMU (Arkhangelsk) MOH Russia, MD Minkin A. U.
Head of the Department of surgical dentistry and maxillofacial surgery FSBEI HE “Stavropol state medical University”, MD, professor Gandylyan K. S.
Freelance specialist MOH Republic of Bashkortostan in preventive dentistry, head physician SBIH RB Dental clinic №4, Ufa, Ph. D. Zubairova G. S.
Authors: MD, professor, F. Z. Mirsaeva, ass. L. R. Khalikova
Approval at session # 1 of the Department of surgical dentistry dated August 31, 2018.
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Classification of inflammatory diseases of the maxillofacial region. Etiology and pathogenesis of odontogenic inflammatory diseases. |
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Immunobiological features of the tissues of the maxillofacial region. Influence of antibacterial resistance of oral tissues on the development of odontogenic infection. Technogenic pollution and their influence on the human immune system, on the development and course of inflammatory diseases of the maxillofacial region |
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Periodontitis. Classification. Etiology, pathogenesis, pathological anatomy. Clinic, diagnosis, treatment of acute periodontitis |
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Chronic periodontitis. Clinic, diagnostics, treatment. |
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Surgical treatment of periodontal diseases |
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Ways of spreading odontogenic infection. Causes of exacerbation of chronic odontogenic infection. Periostitis of the jaws. Classification, etiology and pathogenesis. Acute odontogenic periostitis of the jaws. Pathological anatomy. Clinic, diagnostics, differential diagnostics, treatment. |
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Diseases of teething. Causes. Clinic, diagnostics, treatment. Difficulty erupting the third lower molar. Clinic, diagnostics. Complications with difficult teething of wisdom teeth, treatment. |
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Odontogenic osteomyelitis of the jaws. Classification. Etiology. Modern concepts of pathogenesis. Pathological anatomy. Acute stage of jaw osteomyelitis. Clinic, diagnostics, differential diagnostics. Treatment. |
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Subacute and chronic stages of odontogenic osteomyelitis of the jaws. Clinic, diagnostics, differential diagnostics, treatment. |
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Odontogenic maxillary sinusitis. Pathogenesis. Classification. Clinic, diagnostics, differential diagnostics. Treatment. Perforation and fistula of the maxillary sinus. Clinic, diagnostics. Doctor's tactics for maxillary sinus perforation. |
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Abscesses and phlegmon of the Chlo. Etiology, pathogenesis, pathological anatomy. Classification. Clinical symptoms characteristic of abscesses and phlegmons of the ChLO. |
CONTENT
THEME: “CLASSIFICATION OF INFLAMMATORY DISEASES OF THE PALOFACIAL REGION. ETIOLOGY AND PATHOGENESIS OF ODONTOGENIC INFLAMMATORY DISEASES "
Relevance. Acute odontogenic inflammatory diseases are infectious and inflammatory processes arising from the introduction of pathogenic microflora through the destroyed tooth tissues or the marginal periodontium into the underlying tissues.
Microorganisms that make up the permanent microflora of the oral cavity are the direct causative agents of inflammatory diseases of the maxillofacial region. When these microorganisms are introduced into the nearby tissues of the tooth, a local inflammatory process can develop, the nature of the course of which and the development of complications are determined by various pathological processes occurring in the periapical tissues, as well as by the state of the body's defenses. Often there is a severe, progressive course, complicated by sepsis, mediastinitis, intracranial complications that can lead to death.
There are various classifications of inflammatory diseases, taking into account the causative agent of the disease, clinical course, localization of the process.
Knowledge of the etiology, pathogenesis and classification of odontogenic inflammatory diseases will allow a graduate of the Faculty of Dentistry to carry out rational preventive work, correctly formulate a diagnosis, prescribe timely etiopathogenetic treatment and prevent the development of complications.
The purpose of the lesson: to create conditions and assist students in mastering theoretical knowledge on the etiology and pathogenesis of odontogenic inflammatory diseases and medical skills in formulating the diagnosis of inflammatory diseases of the maxillofacial region.
To form professional competencies, the student must know:
- anatomy of teeth and jaws;
- histology of the oral mucosa;
- blood circulation in the maxillofacial region;
- the lymphatic system of the maxillofacial region;
- the role of saliva as a protective factor;
- the mechanism of migration of leukocytes into the oral cavity - completed and incomplete phagocytosis;
- the etiology of odontogenic inflammatory diseases of the maxillofacial region;
- pathogenesis of odontogenic inflammatory diseases of the maxillofacial region.
- pathophysiological manifestations of the clinic of inflammation;
- pathomorphological changes in tissues during the development of inflammation;
- classification of inflammatory diseases of the maxillofacial region.
To form professional competencies, the student must own:
1. OPK-5 (principles of analysis of its activities)
2.OPK-6 (analysis of the results of their own activities, skills in filling out medical documentation, methods of maintaining accounting and reporting documentation)
3. PC-2 (A / 04.7), theoretical knowledge on methods of examination of injuries of soft tissues of the maxillofacial region, clinical course, diagnosis, differential diagnosis of injuries of the maxillofacial region;
4. PC-5 (A / 01.7), PC-6 (A / 01.7) skills of examination of patients with soft tissue injuries of the maxillofacial region, diagnosis and treatment of soft tissue injuries of the maxillofacial region.
5. PC-6 (A / 01.7) the ability to determine in patients the main pathological conditions, symptoms, syndromes of dental diseases, nosological forms in accordance with the International Statistical Classification of Diseases and Problems Related to Health.
6. PC-9 (A / 02.7) readiness for the management and treatment of patients with dental diseases on an outpatient basis and in a day hospital.
To form professional competencies, a student must be able to:
- to assess the safety of the body's natural barriers along the pathways of infection;
- to determine the etiology of the disease;
- to assess the pathomorphological and pathophysiological changes in the patient's body in case of odontogenic inflammatory diseases;
- to carry out the prevention of odontogenic inflammatory diseases;
- to use in practice the generally accepted classification of inflammatory diseases of the maxillofacial region.
3. Necessary basic knowledge and skills (knowledge gained in the study of previous disciplines):
- Human Anatomy: Head and Neck Anatomy
Know:
- anatomical terms (Russian and Latin);
- anatomy and topography of the maxillofacial region;
- the relationship of organs with each other; projection of organs on the surface of the body;
- the main stages of development of the maxillofacial region (organogenesis);
- the main options for the structure and possible malformations of the salivary glands;
- the regularities of the structure of the human body as a whole, anatomical and functional relationships of individual parts of the body with each other.
- histology, embryology, cytology - histology of the oral cavity
Know:
- the main patterns of development and life of the human body based on the structural organization of cells, tissues and organs;
- histofunctional features of the tissue elements of the maxillofacial area; methods of their research.
- normal physiology - physiology of the maxillofacial region
Know:
- basic properties and conditions of excitable tissues, understanding of the mechanisms of bioelectric phenomena;
- functional properties and features of the salivary glands and saliva;
- principles of organization and functioning of the central nervous system (CNS);
- the role of proteins, fats, carbohydrates, minerals, vitamins and water in the body;
- physiological features of metabolism and energy in the body, between the body and the external environment;
- concept and classification of pain
- pharmacology
Know:
-classification and basic characteristics of drugs, pharmacodynamics and pharmacokinetics, indications and contraindications for the use of drugs;
- side effects when using drugs;
- general principles for the preparation of prescriptions and the preparation of prescription drug prescriptions.
4.Type of lesson: practical
5. Duration of the lesson: 4 academic hours.
6. Equipment: diagrams, tables, sets of test problems
6.1 Didactic material (multimedia atlases and situational tasks, business games, phantoms, simulators, etc.)
Questions on the topic of the lesson:
1. The concept of odontogenic infection.
2. Etiology of odontogenic inflammatory diseases of the maxillofacial region.
3. Factors contributing to the development of odontogenic infection.
4. Pathogenesis of odontogenic inflammatory diseases of the maxillofacial region.
5. Classification of inflammatory diseases of the maxillofacial region.
Place of self-training: reading room, study room for independent work of students.
Educational and research work of students on this topic
1. Modern views on the etiology of odontogenic inflammatory diseases of the maxillofacial region.
2. Modern views on the pathogenesis of odontogenic inflammatory diseases of the maxillofacial region.
Appendices to the topic: “Classification of inflammatory diseases of the maxillofacial region. Etiology and pathogenesis of odontogenic inflammatory diseases "
Annex 1
TESTS FOR CONTROL
INITIAL LEVEL OF KNOWLEDGE
Choose one of the most correct answer
1. THE COMPOSITION OF THE PERMANENT MICROFLORA OF THE ORAL CAVITY OF A HEALTHY MAN-AGE INCLUDES
1) bacteria, fungi, protozoa, viruses
2) mushrooms, spirochetes, protozoa, escherichia, viruses
3) bacteria, fungi, protozoa, bacilli, viruses
4) bacteria, clostridia, fungi, protozoa, viruses
2. DYSBACTERIOSIS OF THE ORAL CAVITY IS DUE TO
1) caries treatment
2) treatment of pulpitis
3) treatment of periodontitis
4) antibiotic therapy
3. THE MUCOSA OF THE Oral Cavity Lined
1) stratified squamous keratinizing and non-keratinizing epithelium
2) stratified squamous keratinizing epithelium
3) stratified cubic epithelium
4) stratified cubic epithelium with ciliated cilia
4. THE MOST DEVELOPED SUBMUCOSULAR BASIS IS AVAILABLE IN THE MUCOSA
1) the floor of the mouth and the transitional fold
2) hard palate
3) cheeks
4) gum
5. OUTFLOW FROM THE PERIODONT OF THE CUTTERS AND CANCES OF THE LOWER JAW IS PREVENTLY CARRIED OUT INTO THE LYMPH NODES
1) buccal region
2) the parotid region
3) the chin area
4) submandibular region
6. OUTFLOW FROM THE PERIODONT OF SMALL AND LARGE RED TEETH OF THE LOWER JAW IS PREVENTLY CARRIED OUT INTO THE LYMPH NODES
1) buccal region
2) the parotid region
3) the chin area
4) submandibular region
7. THE END PRODUCT OF THE ACTIVITY OF ORAL CAVITY MICROORGANISMS IS
1) hyaluronic acid
2) hydrochloric acid
3) lactic acid
4) chondroitin sulfuric acid
8. IN THE ALTERATIVE INFLAMMATORY PROCESS, THAT PROCESSES DOMINATE AS
1) damage, degeneration and necrosis
2) exudation and emigration of leukocytes
3) multiplication of cells of hematogenous and histogenic origin
4) dystrophy and exudation
9. THE PHENOMENON OF ARTYUS-SAKHAROV IS REPRESENTED BY ITSELF
1) a local inflammatory process with symptoms of alteration
2) anaphylactic reaction
3) the cytolysis reaction
4) the reaction of damage by the immune complex
10. THE MOST BRIGHT CLINICAL PICTURE OF INFLAMMATORY PRO-CESS IS MANIFESTED AT
1) dystrophies
2) proliferation
3) exudation
4) alterations
11. THE BASIC BUFFERING SYSTEM OF MIXED SALIVA IS
1) protein
2) phosphate
3) hydrocarbonate
4) protein-phosphate
12. PROLIFERATION IS CALLED
1) short-term spasm of arterioles, which is subsequently replaced by their long-term expansion
2) the stage of inflammation, which ensures the limitation of the infectious and inflammatory focus and the compensation of the resulting tissue defect
3) primary tissue damage by exotoxins
4) introduction of microbes into proper tissues
13. EXUDATION IS CALLED
1) activation of lysosomal enzymes
2) limitation of the infectious and inflammatory focus
3) the appearance of leukocyte infiltrate
4) the release of plasma into the tissue of the focus of inflammation
Appendix 2
TESTS FOR CONTROL
LEVEL OF ASSEMBLY OF THE TOPIC
Choose one or more correct answers
1. EXOGENOUS ETIOLOGICAL FACTORS PROMOTING THE DEVELOPMENT OF INFLAMMATORY DISEASES OF THE MAXILLOFACIAL REGION
1) physical, chemical, biological
2) physical, chemical, biological, hereditary
3) hereditary, constitutional, age and gender
4) biological, chemical and body reactivity
2. A MORE SEVERE CURRENT OF ACUTE ODONTOGENIC INFLAMMATORY DISEASES CAUSES
1) associative fungal-bacterial form of anaerobes
2) staphylococcus
3) streptococcus
4) diplococcus
3. IN PATIENTS WITH PERIODONTITIS, THE MICROFLORA OF THE INFECTIOUS FOCUS IS PRESENTED
1) mixed flora with a predominance of streptococci
2) mixed flora with a predominance of staphylococci
3) mixed flora with a predominance of diplococci
4) fungal-bacterial form of anaerobes
4. IN PATIENTS WITH PERIOSTITIS, MICROFLORA OF THE INFECTIOUS FOCUS IS PRESENTED
1) mixed flora with a predominance of staphylococci
2) mixed flora with a predominance of diplococci
3) mixed flora with a predominance of streptococci
4) fungal-bacterial form of anaerobes.
5. IN PATIENTS WITH PHLEGMONS OF THE MAXILLOFACIAL REGION MICROFLO-RA OF THE INFECTIOUS FOCUS IS PRESENTED
1) mixed flora with a predominance of streptococci
2) mixed flora with a predominance of diplococci
3) fungal-bacterial form of anaerobes
4) mixed flora with a predominance of staphylococci
6. IN PATIENTS WITH ODONTOGENOUS OSTEOMYELITIS OF THE JAWS, MICRO-FLORA IS PRESENTED
1) mixed flora with a predominance of staphylococci in combination with β-hemolytic streptococcus
2) mixed flora with a predominance of diplococci
3) fungal-bacterial form of anaerobes
4) mixed flora with a predominance of streptococci
7. RADIATION OF ODONTOGENOUS INFLAMMATORY PROCESS WAYS
1) resorcinol - formalin treatment for periodontitis
2) treatment of pulpitis with a biological method
3) caries treatment
4) an increase in the virulence of microflora due to a violation of the outflow of exudate through the canal of the tooth root
8. THE INFLAMMATORY PROCESS CAUSED BY A TOOTH IS CALLED
1) dermatogenic
2) odontogenic
3) stomatogenic
4) rhinogenic
9. WITH SUFFICIENT VOLTAGE OF NON-SPECIFIC REACTIVITY OF THE BODY, LOW LEVEL OF SENSITIZATION AND HIGH VIRALITY OF MICROFLORA, INFLAMMATORY REACTION PROCEEDS BY TI-PU
1) hypoergic
2) hyperergic
3) normative
4) anergic
10. AT A LOW LEVEL OF NON-SPECIFIC IMMUNITY, EXPRESSED SENSITIZATION OF THE BODY AND HIGH VIRULENCE OF MICROFLORA, THE INFLAMMATORY REACTION PROCEEDS BY TYPE
1) hypoergic
2) hyperergic
3) normal
4) anergic
11. AT A LOW LEVEL OF NON-SPECIFIC REACTIVITY AND SENSI-BILIZATION OF THE BODY TO MICROFLORA HAVING A Mild VIRULENCE, THE INFLAMMATORY REACTION PROCEEDS BY TYPE
1) hypoergic
2) hyperergic
3) normative
4) anergic
12. CLASSIFICATION BY THE NATURE OF DISTRIBUTION PROCESSES
1) limited
2) local
3) developing
4) diffuse
13. AMONG ODONTOGENIC INFLAMMATORY PROCESSES, SOFT TISSUE DIFFERENT
1) phlegmon
2) carbuncles
3) abscesses
4) boils
THEME: “IMMUNOBIOLOGICAL FEATURES OF TISSUES OF THE MAXILLOFACIAL REGION. INFLUENCE OF ANTIBACTERIAL RESISTANCE OF ORAL TISSUES ON THE DEVELOPMENT OF ODONTOGENIC INFECTION. TECHNOLOGICAL CONTAMINATIONS AND THEIR INFLUENCE ON THE IMMUNE SYSTEM OF HUMAN, ON THE DEVELOPMENT AND PROGRESS OF INFLAMMATORY DISEASES OF THE MAXILLOFACIAL REGION "
1. Relevance. The development of the inflammatory process of the maxillofacial region depends on the state of the defense mechanisms of the tissues of the maxillofacial region and on the immunoreactivity of the whole organism.
The tissues of the maxillofacial region have their own specific immunological characteristics, which protects them from the pathogenic effects of various unfavorable factors of an infectious and non-infectious nature on them.
The spread of the infectious and inflammatory process is associated with the structural features of the maxillofacial region, namely the presence of a developed dense network of capillaries and lymphatic vessels, through which the infection can penetrate into the cranial cavity and mediastinum, which often leads to death.
The exacerbation of chronic odontogenic infection is facilitated not only by an increase in the virulence of microflora, a decrease in the body's resistance, but also by the impact on the body of external environmental factors, leading to hypothermia, overheating, physical and emotional overstrain, excessive ultraviolet radiation, pathogenic action chemical factors.
An increase in the level of urbanization of the planet leads to a deterioration in the ecological state of the area, due to an increase in technogenic pollution. Being an additional source of sensitization of the body, ecotoxicants and technogenic pollution of the environment can lead to a decrease in the reactivity of the body, thereby determining the nature of the course and the development of inflammatory diseases of the body in general and the maxillofacial region in particular.
In connection with the above, a graduate of the Faculty of Dentistry needs, based on knowledge about the immunological characteristics of the tissues of the maxillofacial region and violations of antibacterial resistance as a result of environmental factors, to be able to carry out measures to prevent exacerbations of chronic odontogenic infection, the development of purulent-inflammatory diseases. -diseases and prevention of the development of their complications.
2. The purpose of the lesson: to create conditions and assist students in mastering theoretical knowledge on the immunobiological features of the tissues of the maxillofacial region, the effect of antibacterial resistance of the oral cavity tissues on the development of odontogenic infection, the effect of ecotoxicants and technogenic pollution on the human immune system, on the development and course of inflammatory diseases of the maxillofacial region; development of clinical thinking on the ways of spreading odontogenic infection, causes of exacerbation of chronic odontogenic infection.
To form professional competencies, the student must know:
- the concept of immunity;
- types of immunity;
- features of the influence of exogenous and endogenous factors on the change in general and local immunity;
- blood physiology;
- immunobiological features of the tissues of the maxillofacial region;
- the concept of sensitization;
- the concept of resistance;
- ways to activate the body's nonspecific defense;
- the impact of ecotoxicants and man-made pollution on the human immune system;
- the influence of ecotoxicants and technogenic pollution on the development and course of inflammatory diseases of the maxillofacial region;
- ways of spreading odontogenic infection from the teeth of the upper jaw;
- ways of spreading odontogenic infection from the teeth of the lower jaw;
- causes of exacerbation of chronic odontogenic infection.
To form professional competencies, the student must own:
1. OPK-5 (principles of analysis of its activities)
2.OPK-6 (analysis of the results of their own activities, skills in filling out medical documentation, methods of maintaining accounting and reporting documentation)
3. PC-2 (A / 04.7), theoretical knowledge on methods of examination of soft tissue injuries of the maxillofacial region, clinical course, diagnosis, differential diagnosis of injuries of the maxillofacial region;
4. PC-5 (A / 01.7), PC-6 (A / 01.7) skills of examination of patients with soft tissue injuries of the maxillofacial region, diagnosis and treatment of soft tissue injuries of the maxillofacial region.
5. PC-6 (A / 01.7) the ability to determine in patients the main pathological conditions, symptoms, syndromes of dental diseases, nosological forms in accordance with the International Statistical Classification of Diseases and Problems Related to Health.
6. PC-9 (A / 02.7) readiness for the management and treatment of patients with dental diseases on an outpatient basis and in a day hospital.
To form professional competencies, the student must be able to:
- to interpret the data of secretory and humoral immunity;
- to analyze the results of the study of white and red blood, biochemical studies of blood and saliva;
- to identify the causes of exacerbation of chronic odontogenic infection and to carry out their prevention;
- to identify possible ways of spreading the infection.
3. Necessary basic knowledge and skills (knowledge gained in the study of previous disciplines):
- Human Anatomy: Head and Neck Anatomy
Know:
- anatomical terms (Russian and Latin);
- anatomy and topography of the maxillofacial region;
- the relationship of organs with each other; projection of organs on the surface of the body;
- the main stages of development of the maxillofacial region (organogenesis);
- the main options for the structure and possible malformations of the salivary glands;
- the regularities of the structure of the human body as a whole, anatomical and functional relationships of individual parts of the body with each other.
- histology, embryology, cytology - histology of the oral cavity
Know:
- the main patterns of development and life of the human body based on the structural organization of cells, tissues and organs;
- histofunctional features of the tissue elements of the maxillofacial area; methods of their research.
- normal physiology - physiology of the maxillofacial region
Know:
- basic properties and conditions of excitable tissues, understanding of the mechanisms of bioelectric phenomena;
- functional properties and features of the salivary glands and saliva;
- principles of organization and functioning of the central nervous system (CNS);
- the role of proteins, fats, carbohydrates, minerals, vitamins and water in the body;
- physiological features of metabolism and energy in the body, between the body and the external environment;
- concept and classification of pain
- pharmacology
Know:
-classification and basic characteristics of drugs, pharmacodynamics and pharmacokinetics, indications and contraindications for the use of drugs;
- side effects when using drugs;
- general principles for the preparation of prescriptions and the preparation of prescription drug prescriptions.
4. Type of lesson: practical.
5. Duration of the lesson: 4 academic hours.
6. Equipment: multimedia projector, slides, diagrams, tables, sets of test items
Questions on the topic of the lesson:
1. Immunobiological features of the facial skin of the maxillofacial region
2. Immunobiological features of the oral mucosa
3. Influence of ecotoxicants and technogenic pollution on the human immune system
4. Influence of ecotoxicants and technogenic pollution on the development and course of inflammatory diseases of the maxillofacial region
5. Ways of spreading odontogenic infection from the teeth of the upper jaw
Place of self-training: reading room, study room for independent work of students.
Educational and research work of students on this topic
1. Influence of ecotoxicants on the development and course of inflammatory diseases of the maxillofacial region.
2. Factors causing exacerbation of chronic odontogenic infection.
Appendices to the topic: “Immunobiological features of the tissues of the maxillofacial region. The effect of antibacterial resistance of oral tissues on the development of odontogenic infection. Technogenic pollution and their influence on the human immune system, on the development and course of inflammatory diseases of the maxillofacial region. "
Annex 1
TESTS FOR CONTROL
INITIAL LEVEL OF KNOWLEDGE
Choose one of the most correct answer
1. IMMUNITY ARISING FROM A PREVIOUS INFECTIOUS DISEASE IS CALLED
1) congenital
2) active
3) passive
4) passive transplacental
2. NON-SPECIFIC PROTECTION FACTORS RELATED TO
1) complement
2) interferon
3) immunoglobulin
4) lysozyme
3. CELLULAR IMMUNE RESPONSE CONDITIONED
1) activation of complement
2) the action of antibodies
3) activation of macrophages
4) the action of plasma cells
4. HUMORAL CELL RESPONSE CONDITIONED
1) activation of B-lymphocytes
2) the action of NK cells (natural killer cells)
3) cytoxic T-lymphocytes
4) activation of macrophages
5. ONE OF THE MOST IMPORTANT FACTORS OF NON-SPECIFIC PRO-TIVOVIRAL IMMUNITY IS
1) interferon
2) T-lymphocytes
3) B-lymphocytes
4) Mucin
6. CELLULAR IMMUNE RESPONSE RELATED TO
1) a non-specific type of immune response
2) a specific type of immune response
3) humoral immune response
4) secretory type of immune response
7. HUMORAL IMMUNE RESPONSE RELATED TO
1) a non-specific type of immune response
2) a specific type of immune response
3) cellular immune response
4) secretory type of immune response
8. CELL MEDIATORS OF INFLAMMATION ARE RELATED TO
1) histamine, serotonin, proteinases
2) bradykinin, kallidin
3) histamine, bradykinin
4) serotonin, kallidin, proteinases
9. HUMORAL INFLAMMATION MEDIATORS ARE
1) histamine, serotonin, proteinases
2) bradykinin, kallidin
3) histamine, bradykinin
4) serotonin, kallidin, proteinases
10. AT THE PRIMARY IMMUNE RESPONSE IS DEVELOPED
1) only Ig M
2) only Ig G
3) first Ig M, then Ig G
4) first Ig G, then Ig M
11. CHEMOTAXIS IS
1) adhesion of phagocytes to the endothelium
2) activation of phagocyte metabolism
3) directional movement of the phagocyte
4) antigen cleavage
12. THE OPPONIZATION PROCESS IS
1) directional movement of the phagocyte to the antigen
2) the release of phagocytes into the extravascular bed
3) adhesion of phagocytes to the endothelium
4) enveloping the surface of foreign particles with antibodies or components of the complement
13. THE MAIN REGULATOR CELLS OF THE IMMUNE RESPONSE IS
1) T-helpers, T-killers
2) T-helpers, T-suppressors
3) T-killers, T-suppressors
4) macrophages, B-lymphocytes
14. LYSOCYME HAS PROPERTIES
1) anti-fungal protection
2) digestive ability
3) anti-virus and antibacterial protection
4) lubricity
15. THE FIRST PROTECTIVE FACTOR ON THE WAY OF PENETRATION OF EXO-GENE INFECTION IS
1) skin and mucous membrane
2) lymph nodes
3) circulatory system
4) all of the above
16. THE MAIN ELEMENTS OF THE SKIN IMMUNE SYSTEM ARE
1) keratinocytes
2) lysozyme
3) mucin
4) B-lymphocytes
17. IN THE EFFECTORAL AREA OF THE MUCOSA OF THE ORAL CAVITY ACCUMULATE
1) B-lymphocytes
2) T-lymphocytes
3) keratinocytes
4) plasma cells
18. IN A SENSITIZED BODY, THE PROBABILITY OF ANTIGENS WITH ANTIBODIES Above
1) blood vessels of the peri-maxillary tissues
2) bone tissue
3) lymphoid tissue
4) periapical tissues
19. TO MAINTAIN EQUILIBRIUM BETWEEN THE FOCUS OF CHRONIC INFECTION AND THE PATIENT'S BODY
1) the system "hypothalamus-pituitary-adrenal cortex"
2) complement
3) humoral immunity
4) interferon
20. LYMPH OUTFLOW FROM THE BOTTOM OF THE ORAL CAVITY IS CARRIED OUT IN
1) superficial and deep parotid lymph nodes
2) deep cervical and chin lymph nodes
3) lymph nodes of the lateral triangle of the neck
4) upper jugular lymph nodes
21. LYMPH OUTFLOW FROM THE TEETH OF THE LOWER JAW IS CARRIED OUT IN
1) parotid lymph nodes and deep cervical
2) lower jugular lymph nodes
3) retropharyngeal lymph nodes
4) submandibular and chin lymph nodes
Appendix 2
TESTS FOR CONTROL
LEVEL OF ASSEMBLY OF THE TOPIC
Choose one of the most correct answer
1. THE BASIC ELEMENTS OF THE SKIN IMMUNE SYSTEM ARE
1) keratinocytes, Langerhans cells, secretory immunoglobulin A
2) B-lymphocytes, T-lymphocytes
3) keratinocytes, B-lymphocytes
4) keratinocytes, Langerhans cells, epidermal T-lymphocytes.
2. THE MUCOSA OF THE ORAL CAVITY HAS ON ITS SURFACE
1) SIgA
2) IgM
3) IgG
4) IgD
3. MICROCIRCULATION OF THE FACIAL SKIN LOCATED ON THE BORDER OF THE PAPER AND RETIDAL LAYERS OF THE DERMIS, CALLED
1) papillary
2) subpapillary
3) dermal
4) subdermal
4. MICROCIRCULATION OF THE FACIAL SKIN LOCATED AT THE BORDER OF THE DERMIS AND THE SUBCUTANEOUS FAT CELL, CALLED
1) papillary
2) subpapillary
3) dermal
4) subdermal
5. THE INTRAINDICINAL VASCULAR CIRCUIT IS CHARACTERIZED
1) the presence of functional arteriovenous shunts - short capillary veto-checks with a muscular membrane
2) the presence of functional arteriovenous shunts - short capillary veto-checks that do not have a muscular membrane
3) a low degree of anastomosis between the same type and different types of vessels
4) the average degree of anastomosis between the same type and different types of vessels
6. INDUCTIVE AREA IN THE IMMUNE SYSTEM OF THE ORAL MUCOSA IS PRESENTED
1) lymphoid tissue
2) nerve tissue
3) directly by the mucous membrane
4) epithelial tissue
7. A PLASMA EXUDATE PASSING THROUGH THE CONNECTING EPITHELIUM AND FILLING THE GINGUAL SLIT IS CALLED
1) saliva
2) gingival fluid
3) mixed saliva
4) oral fluid
8. THE MOST IMPORTANT NON-SPECIFIC FACTOR OF LOCAL IMMUNITY OF THE MUCOSA IS
1) lactoferrin
2) lysozyme
3) complement
4) IgA
9. MOST SENSITIVE TO LYSOCYME
1) gram-negative microorganisms
2) gram-positive microorganisms
3) fungal-bacterial form of anaerobes
4) rickettsia
10. SPECIFIC FACTOR OF ANTIBACTERIAL AND ANTI-VIRUS ORAL PROTECTION ARE
1) lactoferrin
2) lysozyme
3) complement
4) immunoglobulins
11. METHEMOGLOBINEMIA MANIFESTED AS A RESULT OF TOXIC EFFECTS
1) pesticides
2) dioxins
3) radionuclides
4) nitrite
12. AN IMPORTANT ROLE IN MAINTAINING DYNAMIC EQUILIBRIUM BETWEEN THE FOCUS OF CHRONIC ODONTOGENIC INFECTION AND THE PATIENT'S ORGANISM-MOM PLAYS
1) healthy eating
2) connective tissue capsule
3) ecology
4) hypothermia of the body
13. THE REASONS OF EXCERING ODONTOGENIC INFECTION AND DISTRIBUTION OF INFLAMMATORY PROCESS ARE
1) increasing the virulence of microflora due to the outflow of exudate through the root canal tooth-ba
2) increased physical activity
3) climate change
4) insomnia
14. IN A SENSITIZED BODY, DAMAGE TO THE CONNECTION-TISSUE CAPSULE CAN CAUSE DEVELOPMENT
1) an immunopathological reaction of the Artyus-Sakharov type
2) delayed-type hypersensitivity reactions
3) complement-dependent cytotoxic reactions of immediate type
4) immediate hypersensitivity reactions
Topic: “PERIODONTITIS. CLASSIFICATION. ETIOLOGY, PATHOGENESIS, PATHOLOGICAL ANATOMY. CLINIC, DIAGNOSTICS, TREATMENT OF ACUTE PERIODONTITIS "
1. Relevance. Periodontitis is a disease frequently encountered in dental practice and is characterized by a varied clinical course. It is often the cause of the emergence of a focus of chronic odontogenic infection with subsequent sensitization, leading to a violation of immune reactivity, and, therefore, causing the development of purulent-inflammatory diseases of the maxillofacial region and general somatic disorders of the patient's body.
Periodontitis is characterized by a number of common symptoms with other odontogenic inflammatory diseases of the maxillofacial region, at the same time they have their own inherent signs. This circumstance determines the need to use the most evidence-based diagnostic method for their recognition - the differential diagnosis of the disease.
The effectiveness of the treatment of patients with periodontitis is largely determined by its timely diagnosis. Timely and accurate topical diagnosis of the inflammatory process with adequate treatment allows it to be eliminated in a short time.
It is known that any diagnostic method, including differential, is carried out on the basis of the existing classification of the disease. The classification of periodontitis makes it possible to establish and formulate a diagnosis and thereby determine the measures of prevention and therapy.
Timely and targeted therapy of periodontitis in most cases makes it possible to avoid the spread of inflammation to the jaw and the surrounding tissues, to cure the disease and restore the affected periodontium.
All of the above emphasizes the relevance of the topic under study.
2. The purpose of the lesson: to create conditions and assist in mastering theoretical knowledge on classification, etiology, pathogenesis, pathological anatomy, clinic of acute and chronic periodontitis and medical skills in diagnosis, methods of their treatment and timely prevention of complications.
To form professional competencies, the student must know:
- the microflora of the oral cavity;
- immunobiological features of the oral cavity and maxillofacial area;
- the mechanism of development of inflammatory processes;
- pathological anatomy of inflammatory processes;
- structural features of the periodontal;
- blood supply and innervation of the periodontium;
- periodontal function;
- determination of periodontitis;
- classification of periodontitis:
- by origin;
- according to the clinical course;
- by localization.
- etiology of periodontitis;
- pathogenesis of periodontitis;
- pathological anatomy of periodontitis, depending on its forms;
- clinic, diagnosis of acute periodontitis;
- clinic, diagnostics of various forms of chronic periodontitis;
- additional research methods used in the diagnosis of periodontitis;
- X-ray characteristics of various forms of periodontitis;
- differential diagnosis of periodontitis;
- complications of periodontitis;
- prevention of periodontitis.
To form professional competencies, the student must own:
1. OPK-5 (principles of analysis of its activities)
2.OPK-6 (analysis of the results of their own activities, skills in filling out medical documentation, methods of maintaining accounting and reporting documentation)
3. PC-2 (A / 04.7), theoretical knowledge on methods of examination of soft tissue injuries of the maxillofacial region, clinical course, diagnosis, differential diagnosis of injuries of the maxillofacial region;
4. PC-5 (A / 01.7), PC-6 (A / 01.7) skills of examination of patients with soft tissue injuries of the maxillofacial region, diagnosis and treatment of soft tissue injuries of the maxillofacial region.
5. PC-6 (A / 01.7) the ability to determine in patients the main pathological conditions, symptoms, syndromes of dental diseases, nosological forms in accordance with the International Statistical Classification of Diseases and Problems Related to Health.
6. PC-9 (A / 02.7) readiness for the management and treatment of patients with dental diseases on an outpatient basis and in a day hospital.
To form professional competencies, the student must be able to:
- conduct a survey of organs and systems;
- to identify the etiology of periodontitis;
- to appoint a plan of additional examination;
- to evaluate the results of clinical data and additional research methods;
- to carry out differential diagnosis of periodontitis with other odontogenic inflammatory diseases of the maxillofacial region;
- formulate a diagnosis in accordance with the classification;
- to apply knowledge on the etiology and pathogenesis of periodontitis when drawing up a treatment plan;
- to appoint primary and secondary preventive measures.
3. Necessary basic knowledge and skills (knowledge gained in the study of previous disciplines):
- Human Anatomy: Head and Neck Anatomy
Know:
- anatomical terms (Russian and Latin);
- anatomy and topography of the maxillofacial region;
- the relationship of organs with each other; projection of organs on the surface of the body;
- the main stages of development of the maxillofacial region (organogenesis);
- the main options for the structure and possible malformations of the salivary glands;
- the regularities of the structure of the human body as a whole, anatomical and functional relationships of individual parts of the body with each other.
- histology, embryology, cytology - histology of the oral cavity
Know:
- the main patterns of development and life of the human body based on the structural organization of cells, tissues and organs;
- histofunctional features of the tissue elements of the maxillofacial area; methods of their research.
- normal physiology - physiology of the maxillofacial region
Know:
- basic properties and conditions of excitable tissues, understanding of the mechanisms of bioelectric phenomena;
- functional properties and features of the salivary glands and saliva;
- principles of organization and functioning of the central nervous system (CNS);
- the role of proteins, fats, carbohydrates, minerals, vitamins and water in the body;
- physiological features of metabolism and energy in the body, between the body and the external environment;
- concept and classification of pain
- pharmacology
Know:
-classification and basic characteristics of drugs, pharmacodynamics and pharmacokinetics, indications and contraindications for the use of drugs;
- side effects when using drugs;
- general principles for the preparation of prescriptions and the preparation of prescription drug prescriptions.
4. Type of lesson: practical.
5. Duration of the lesson: 4 academic hours.
6. Equipment: multimedia projector, slides, diagrams, tables, sets of test items
Questions on the topic of the lesson:
1. Definition of periodontitis.
2. Classification of periodontitis:
- by origin;
- according to the clinical course;
- by localization.
3. Etiology of periodontitis.
4. Pathogenesis of periodontitis.
5. Pathological anatomy of periodontitis, depending on its forms.
6. Clinic, diagnosis of acute periodontitis.
7. Clinic, diagnostics of various forms of chronic periodontitis.
8. Additional research methods used in the diagnosis of periodontitis.
9. X-ray characteristics of various forms of periodontitis.
10. Differential diagnosis of periodontitis.
11. Complications of periodontitis.
12. Prevention of periodontitis.
Place of self-training: reading room, study room for independent work of students.
Educational and research work of students on this topic:
1. Chronic periodontitis - as a source of body sensitization.
2. Physiotherapy in the treatment of periodontitis.
Appendices to the topic: “Periodontitis. Classification. Etiology, pathogenesis, pathological anatomy. Clinic, diagnosis, treatment of acute periodontitis "
Annex 1
TESTS FOR CONTROL
INITIAL LEVEL OF KNOWLEDGE
Choose one or more correct answers
1. THE PERIODONT IS A COMPLEX ANATOMICAL EDUCATION ... ORIGIN
1) epithelial
2) connective tissue
2. WIDTH OF THE PERIODONTAL SLIT OF THE UPPER JAW TEETH
1) 0.15 - 0.22 mm
2) 0.20 - 0.25 mm
3) 0.25 - 0.30 mm
4) 0.30 - 0.40 mm
3. WIDTH OF THE PERIODONTAL SLIT OF THE LOWER JAW TEETH
1) 0.15 - 0.22 mm
2) 0.20 - 0.25 mm
3) 0.25 - 0.30 mm
4) 0.30 - 0.40 mm
4. THE WIDTH OF THE PERIODONTAL SLIT OF THE TEETH INCREASES
1) in the periapical region
2) in the middle third of the root
3) at the apex of the interalveolar septum
5. IN LOSS OF ANTAGONIST TOOTH, PERIODONTAL SLIT
1) narrows
2) expands
3) does not change
6. THE MAIN COMPONENTS OF THE PERIODONT ARE
1) fibers
2) cellular elements
3) the main substance of connective tissue with blood vessels and nerves
4) lymphatic vessels
7. IMMUNOCOMPETENT CELLS OF THE PERIODONT ARE
1) fibroblasts
2) plasma cells
3) histiocytes
4) mast cells
8. FIBROBLASTS PERFORM THE FUNCTION
1) ensuring a protective reaction and participation in the regulation of the permeability of the main substance of the connective tissue of the periodontium
2) the formation of collagen fibers, in pathology they become macrophages, free to absorb foreign bodies, large bacteria
3) the formation of the basic substance, and in pathological conditions, participation in the regeneration of fibrous structures and the formation of a connective tissue capsule around the focus of inflammation
4) performing a plastic role - building a secondary cellular cement.
9. BLOOD SUPPLY OF THE PERIODONT IN THE LOWER JAW IS CARRIED OUT BY BRANCHES FROM
1) a. alveolaris anterior
2) a. alveolaris posterior
3) a. alveolaris superior
4) a. alveolaris inferior
10. LYMPH VESSELS OF THE LOWER PREMOLAR PERIODONT HAVE ANASTOMOSIS WITH LYMPH VESSELS
1) language
2) the mandibular canal
3) the floor of the mouth
4) submental area
11. THE BASIC FUNCTION OF THE PERIODONT IS
1) barrier
2) reflexogenic
3) support-holding
4) participation in the growth, eruption and change of teeth
12. BARRIER FUNCTION PROVIDED
1) cells - histiocytes
2) plasma cells
3) a circular bundle consisting of three groups of fibers
4) cellular elements: fibroblasts, osteoblasts, cementoblasts
13. REFLEXOGENIC FUNCTION OF PERIODONT
1) is caused by the presence of endings of nerve fibers penetrating the loose connective tissue between the bundles of collagen fibers and transmitting peripheral irritation to the center
2) is carried out due to a large number of sensitive nerve endings, which are a vast field saturated with sensitive nerve endings
3) is carried out due to the development of a network of capillaries and nerves that feed the cement and alveoli
4) is provided by the cells of the reticuloendothelial system - histiocytes, which play a role in the absorption and breakdown of protein molecules
Appendix 2
TESTS FOR CONTROL
LEVEL OF ASSEMBLY OF THE TOPIC
Choose one or more correct answers
1. AGENTS OF PERIODONTITIS -
1) mixed microflora of the oral cavity
2) viruses
3) radiant mushrooms
4) obligate anaerobes
2. PERIODONTITIS OF ORIGIN IS CLASSIFIED ON
1) allergic
2) infectious
3) traumatic
4) medicinal
3. MARGINAL PERIDONTITIS ARISES DUE TO PENETRATION OF INFECTION THROUGH
1) carious cavity
2) the bottom of the gingival pocket
3) opening of the root apex
4) lymph
4. IN ACUTE PURULENT PERIODONTITIS, PATHOLOGOANATOMICALLY DETERMINED
1) severe inflammatory hyperemia, infiltration with polymorphonuclear leukocytes
2) periodontal edema, the formation of diffuse leukocyte infiltrate, the formation of microabscesses, the melting of periodontal tissues
3) replacement of the apical periodont with coarse-fibrous tissue, poor in cells, violation of fiber orientation, areas of resorption of the compact plate of the walls of the alveoli
4) replacement of the apical periodontium with granulation tissue, in which cellular elements (fibroblasts, histiocytes, leukocytes) predominate, deformation of the compact layer of the alveoli, resorption of cement and dentin of the apical part of the root
5. IN CHRONIC FIBROUS PERIODONTIS
1) periodontal edema, the formation of diffuse leukocyte infiltrate, the formation of microabscesses, the melting of periodontal tissues
2) replacement of the apical periodont with coarse-fibrous tissue, poor in cells, violation of fiber orientation, areas of resorption of the compact plate of the walls of the alveoli
3) replacement of the apical periodontium with granulation tissue, in which cellular elements predominate (fibroblasts, histiocytes, leukocytes), deformation of the compact layer of the alveoli, resorption of cement and dentin of the apical part of the root
4) limitation of the focus of granulation tissue of varying degrees of maturity with a dense connective tissue sheath, hypercementosis
6. IN CHRONIC GRANULATING PERIODONTIS OF PATOLOGOAN, TOMICALLY DETERMINED
1) periodontal edema, the formation of diffuse leukocyte infiltrate, the formation of microabscesses, the melting of periodontal tissues
2) replacement of the apical periodont with coarse-fibrous tissue, poor in cells, violation of fiber orientation, areas of resorption of the compact plate of the walls of the alveoli
3) replacement of the apical periodontium with granulation tissue, in which cellular elements predominate (fibroblasts, histiocytes, leukocytes), deformation of the compact layer of the alveoli, resorption of cement and dentin of the apical part of the root
4) limitation of the focus of granulation tissue of varying degrees of maturity with a dense connective tissue sheath, hypercementosis
7. IN CHRONIC GRANULEMATOUS PERIODONTIS OF PATHOLOGOAN TOMICALLY DETERMINED
1) periodontal edema, the formation of diffuse leukocyte infiltrate, the formation of microabscesses, the melting of periodontal tissues
2) replacement of the apical periodont with coarse-fibrous tissue, poor in cells, violation of fiber orientation, areas of resorption of the compact plate of the walls of the alveoli
3) replacement of the apical periodontium with granulation tissue, in which cellular elements predominate (fibroblasts, histiocytes, leukocytes), deformation of the compact layer of the alveoli, resorption of cement and dentin of the apical part of the root
4) limitation of the focus of granulation tissue of varying degrees of maturity with a dense connective tissue sheath, hypercementosis
8. SYMPTOM OF "GREATED" TOOTH IS CHARACTERISTIC FOR
1) acute purulent periodontitis
2) chronic fibrous periodontitis
3) chronic granulating periodontitis
4) chronic granulomatous periodontitis
9. THE SYMPTOM OF VASOPARESIS IS CHARACTERISTIC FOR
1) acute purulent periodontitis
2) chronic fibrous periodontitis
3) chronic granulating periodontitis
4) chronic granulomatous periodontitis
10. METHODS FOR DIAGNOSING ACUTE PURULENT PERIODONTITIS INCLUDE-CHAUT
1) electroodontodiagnostics
2) thermal diagnostics
3) ultrasound diagnostics
4) rheoparadontography
11. A SPECIAL METHOD OF RESEARCH FOR DETERMINING THE FORM OF CHRONIC PERIODONTITIS IS
1) electroodontodiagnostics
2) rheoparodontography
3) radiography
4) rheoplethysmography
12. X-RAY DETERMINED EXPANSION OF THE PERIODONTAL SLIT IN THE REGION OF THE ROOT TOP IS CHARACTERISTIC FOR
1) acute periodontitis
2) chronic fibrous periodontitis
3) chronic granulating periodontitis
4) chronic granulomatous periodontitis
13. X-RAY DETERMINED FOCUS OF BONE TISSUE DESTRUCTION IN THE AREA OF THE ROOT APPER WITH FUZZY BOUNDARIES HARAK-TEREN FOR
1) acute periodontitis
2) chronic fibrous periodontitis
3) chronic granulating periodontitis
4) chronic granulomatous periodontitis
14. X-RAY DETERMINED FOCUS OF BONE TISSUE DESTRUCTION IN THE AREA OF THE ROOT APPER WITH CLEAR BOUNDARIES CHARACTER-REN FOR
1) acute periodontitis
2) chronic fibrous periodontitis
3) chronic granulating periodontitis
4) chronic granulomatous periodontitis
Appendix 3
SITUATION TASKS
TO CONTROL THE LEVEL OF ASSEMBLY OF THE TOPIC
Task 1. Patient L., 25 years old, turned to the dentist with complaints of mild spontaneous pain during the last 24 hours in the area of the lower jaw tooth on the left, intensifying when pressed on it, chewing and taking hot food or water. With prolonged pressure on the tooth, the pain subsides somewhat.
Objectively. The general condition is satisfactory. The face configuration is not changed. Regional lymph nodes on palpation are painless, soft, elastic consistency, not adhered to the surrounding tissues. The opening of the mouth is free.
Locally. There is a carious cavity on the chewing surface of the 3.6 tooth, the crown of the tooth is not changed in color. Probing the carious cavity is painless. With vertical percussion, slight pain is noted. The mucous membrane of the gums in the area of the 3.6 tooth is pale pink in color.
On the sighting intraoral radiograph of the 3.6 tooth, changes in the periapical tissues are not detected.
1. Make a diagnosis, justify it.
2. Determine the tactics of treatment.
Problem 2. Patient S., 27 years old, consulted a dentist with complaints of a sharp, constant pain in the area of the tooth of the upper jaw on the right, which radiates to the eye and temple. The use of cold somewhat reduces the intensity of the pain, heat intensifies it. It notes the feeling of a "grown" tooth, stress or touching it causes a sharp increase in pain. The appearance of pain in the tooth is associated with hypothermia the day before at a public transport stop.
Objectively. The general condition is satisfactory. The face configuration is not changed. The chin lymph nodes on the right are enlarged on palpation to 0.5 x 1.0 cm and are painful. Opening the mouth is free.
Locally. On the chewing surface of 1.6 tooth there is a deep carious cavity, the tooth crown is not changed in color. Probing the carious cavity is painless. With percussion, there is a sharp soreness. The mobility of the I degree is determined. The mucous membrane of the gums in the area of the 1.6 tooth is hyperemic, edematous.
1. Make a diagnosis, justify it.
2. What additional research methods are needed to clarify the diagnosis?
3. Make a treatment plan.
Task 3. Patient D., 20 years old, turned to the dentist with complaints of periodic pain of an unclear nature in the area of the left upper jaw tooth for a month.
The patient associates the occurrence of pain with the manufacture of an artificial crown for the lateral incisor due to its abnormal shape.
Objectively. The general condition is satisfactory. The face configuration is not changed. Regional lymph nodes are not palpable. Opening the mouth is free.
Locally. 2.2 the tooth is covered with a plastic crown, when checking the occlusal relationship with copy paper, the presence of superocclusion was revealed. With percussion of the tooth, soreness is not noted. The mucous membrane of the gums in the area of the 2.2 tooth is pale pink in color.
On the targeted intraoral radiograph in the area of the root apex of the 2.2 tooth, an uneven expansion of the periodontal gap is determined.
1. Determine the etiology of the disease.
2. Make a diagnosis, justify it.
3. Make a treatment plan.
Problem 4. Patient A., 45 years old, turned to a dentist surgeon, complaining of recurring pain in the tooth of the lower jaw on the right when taking solid and hot food.
Medical history. According to the patient, the tooth bothers for a long time, in the past - paroxysmal pain, aggravated by biting. The tooth has not been previously treated.
Objectively. The general condition is satisfactory. The face configuration is not changed. The submandibular lymph nodes on the right are enlarged to 1.0 cm on palpation and are painful. Opening the mouth is free.
Locally. The crown of the 4.6 tooth is completely destroyed. Vertical percussion of the tooth causes insignificant pain. On the gum in the area of the projection of the root apex of the 4.6 tooth from the vestibular side, there is a fistula with scanty purulent discharge. The mucous membrane of the gums in the area of the 4.6 tooth is hyperemic, edematous.
On the sighting intraoral radiograph in the region of the apex of the medial root of the 4.6 tooth, a focus of destruction of bone tissue with indistinct boundaries of 0.4 x 0.6 cm in size is determined.
1. Make a diagnosis, justify it.
Task 5. Patient T., 23 years old, during the examination of the oral cavity on the chewing surface of the 3.5 tooth revealed a deep carious cavity, the crown was destroyed by 1/2. When probing the cavity and percussion of the tooth, pain is not noted. The mobility of the tooth of the 1st degree is determined. The mucous membrane of the gums in the area of the 3.5 tooth is pale pink in color.
On the sighting intraoral radiograph - the root canal of the 3.5 tooth is sealed for 2/3 of the length, in the area of the root apex a focus of bone tissue destruction is determined with clear boundaries measuring 0.5 x 0.5 cm.
1. Make a diagnosis, justify it.
TOPIC: “CHRONIC PERIODONTITIS. CLINIC, DIAGNOSTICS, TREATMENT ".
1. Relevance. Treatment methods for chronic periodontitis are varied. Surgical methods of treatment are used when it is impossible to carry out effective conservative treatment.
These include tooth extraction and operations that preserve the tooth (resection of the apex of the tooth root, replantation of the tooth, amputation of the root of the tooth, hemisection of the tooth, coronary radicular separation of the tooth, etc.).
The most common method at the present time remains the operation of removing a tooth, if possible, tooth-preserving operations are performed, which in many cases make it possible to preserve either the entire tooth or part of it, eliminate further tooth decay, create conditions for the functioning of the tooth in the jaw and use it with further rational prosthetics, as well as to achieve, by preserving the tooth, esthetic patient satisfaction and to sanitize the focus of chronic infection.
The task of the dental surgeon is to choose the correct surgical method for treating chronic periodontitis, taking into account the indications and contraindications to them, adhering to the technique of performing operations, taking into account the topographic and anatomical features of the upper and lower jaws. This will further ensure a favorable outcome of operations and avoid complications during and after operations.
All of the above determines the relevance of this topic.
2. The purpose of the lesson: to create conditions and assist in mastering the choice of methods of surgical treatment of chronic periodontitis of various groups of teeth, taking into account the indications and contraindications to them and the medical skills of their implementation.
To form professional competencies, the student must know:
- features of the anatomical structure of the upper and lower jaws;
- dental anatomy;
- blood supply and innervation of the upper and lower jaws;
- X-ray diagnostics of chronic periodontitis;
- methods of pain relief of the upper and lower jaw;
- surgical methods for the treatment of chronic periodontitis;
- indications and contraindications for surgical treatment of chronic periodontitis;
- the main stages of operations and tools used in operations;
- complications during and after operations, their prevention and treatment.
To form professional competencies, the student must own:
1. OPK-5 (principles of analysis of its activities)
2.OPK-6 (analysis of the results of their own activities, skills in filling out medical documentation, methods of maintaining accounting and reporting documentation)
3. PC-2 (A / 04.7), theoretical knowledge on methods of examination of soft tissue injuries of the maxillofacial region, clinical course, diagnosis, differential diagnosis of injuries of the maxillofacial region;
4. PC-5 (A / 01.7), PC-6 (A / 01.7) skills of examination of patients with soft tissue injuries of the maxillofacial region, diagnosis and treatment of soft tissue injuries of the maxillofacial region.
5. PC-6 (A / 01.7) the ability to determine in patients the main pathological conditions, symptoms, syndromes of dental diseases, nosological forms in accordance with the International Statistical Classification of Diseases and Problems Related to Health.
6. PC-9 (A / 02.7) readiness for the management and treatment of patients with dental diseases on an outpatient basis and in a day hospital.
To form professional competencies, the student must be able to:
- conduct a survey of organs and systems;
- to diagnose various forms of periodontitis;
- describe the radiological picture of various forms of chronic periodontitis;
- to carry out differential diagnostics of chronic periodontitis;
- to formulate a diagnosis in accordance with the modern classification;
- choose the right method and tactics for the surgical treatment of chronic periodontitis of various groups of teeth;
- to carry out surgical methods of treatment of chronic periodontitis on the phantom.
3. Necessary basic knowledge and skills (knowledge gained in the study of previous disciplines):
- Human Anatomy: Head and Neck Anatomy
Know:
- anatomical terms (Russian and Latin);
- anatomy and topography of the maxillofacial region;
- the relationship of organs with each other; projection of organs on the surface of the body;
- the main stages of development of the maxillofacial region (organogenesis);
- the main options for the structure and possible malformations of the salivary glands;
- the regularities of the structure of the human body as a whole, anatomical and functional relationships of individual parts of the body with each other.
- histology, embryology, cytology - histology of the oral cavity
Know:
- the main patterns of development and life of the human body based on the structural organization of cells, tissues and organs;
- histofunctional features of the tissue elements of the maxillofacial area; methods of their research.
- normal physiology - physiology of the maxillofacial region
Know:
- basic properties and conditions of excitable tissues, understanding of the mechanisms of bioelectric phenomena;
- functional properties and features of the salivary glands and saliva;
- principles of organization and functioning of the central nervous system (CNS);
- the role of proteins, fats, carbohydrates, minerals, vitamins and water in the body;
- physiological features of metabolism and energy in the body, between the body and the external environment;
- concept and classification of pain
- pharmacology
Know:
-classification and basic characteristics of drugs, pharmacodynamics and pharmacokinetics, indications and contraindications for the use of drugs;
- side effects when using drugs;
- general principles for the preparation of prescriptions and the preparation of prescription drug prescriptions.
4. Type of lesson: practical.
5. Duration of the lesson: 4 academic hours.
6. Equipment: multimedia projector, slides, diagrams, tables, sets of test items
Questions on the topic of the lesson:
1. Surgical methods for the treatment of chronic periodontitis.
2. Indications and contraindications for the operation of the root apex resection, the method of carrying out.
3. Indications and contraindications for tooth replantation surgery, method of carrying out.
4. Indications and contraindications for the operation of tooth root amputation, method of carrying out.
5. Indications and contraindications for the operation of tooth hemisection, method of carrying out.
6. Indications and contraindications for the operation of coronal-radicular tooth separation, the method of carrying out.
7. Possible complications during tooth-preserving operations and their prevention.
Place of self-training: reading room, study room for independent work of students.
Educational and research work of students on this topic:
1. Osteoplastic materials used in the surgical treatment of chronic periodontitis.
2. Possible complications during surgical treatment of chronic periodontitis, their prevention.
Appendices to the topic: “Chronic periodontitis. Clinic, diagnostics, treatment "
Annex 1
TESTS FOR CONTROL
INITIAL LEVEL OF KNOWLEDGE
Choose one or more correct answers
1. CLINICAL CHRONIC PERIODONTITIS IS DIVIDED INTO
1) purulent
2) fibrous
3) granulomatous
4) granulating
2. THE PRESENCE OF A SCAR ON THE MUCOSA IN THE PROJECTION OF THE TOP OF THE TOOTH ROOT IS CHARACTERISTIC FOR
1) chronic fibrous periodontitis
2) chronic pulpitis
3) chronic granulomatous periodontitis
4) history of chronic granulating periodontitis
3. FORM OF CHRONIC PERIODONTITIS CHARACTERIZED BY AN ACTIVE CURRENT -
1) fibrous
2) granulomatous
3) granulating
4) purulent
4. THE LEADING METHOD OF RESEARCH FOR DETERMINING THE FORM OF CHRONIC PERIODONTITIS IS
1) EDI
2) clinical
3) cytological
4) radiological
5. EXPANSION OF THE PERIODONTAL SLIT IN THE AREA OF THE TOP OF THE ROOT OF THE TOOTH ON AN X-RAY DETERMINED AT
1) acute periodontitis
2) chronic fibrous periodontitis
3) chronic granulating periodontitis
4) chronic granulomatous periodontitis
6. THE FOCUS OF BONE TISSUE DESTRUCTION IN THE AREA OF THE TOP OF THE ROOT OF A TOOTH WITH FUZZY BOUNDARIES IS DETERMINED ON AN X-RAY
1) acute periodontitis
2) chronic fibrous periodontitis
3) chronic granulating periodontitis
4) chronic granulomatous periodontitis
7. FOCUS OF BONE TISSUE DESTRUCTION IN THE AREA OF THE TOP OF THE ROOT OF A TOOTH WITH CLEAR BOUNDARIES IS DETERMINED ON AN X-RAY
1) acute periodontitis
2) chronic fibrous periodontitis
3) chronic granulating periodontitis
4) chronic granulomatous periodontitis
8. ON THE X-RAY DEGREE IN CHRONIC GRANULEMATOUS PERIO-DONTITIS, THE APICAL GRANULEM IS LOCALIZED
1) on the side of the tooth root
2) on the side of the apex of the tooth root
3) at the apex of the tooth root
4) in the region of furcation of channels
9. ON THE X-RAY FOR CHRONIC GRANULOMATOUS PERIO-DONTITIS, LATERAL GRANULEM IS LOCALIZED
1) on the side of the tooth root
2) on the side of the apex of the tooth root
3) at the apex of the tooth root
4) in the region of furcation of channels
10. ON THE X-RAY DEGREE WITH CHRONIC GRANULEMATOUS PERIO-DONTITIS, THE APICOLATERAL GRANULA IS LOCALIZED
1) on the side of the tooth root
2) on the side of the apex of the tooth root
3) at the apex of the tooth root
4) in the region of furcation of channels
11. ON THE X-RAY DEGREE WITH CHRONIC GRANULEMATOUS PERIO-DONTITIS INTERROOT GRANULA IS LOCALIZED
1) on the side of the tooth root
2) on the side of the apex of the tooth root
3) at the apex of the tooth root
4) in the region of furcation of channels
12. THE ANESTHESIA ZONE IN PALATINAL ANESTHESIA INCLUDES THE MUCOSA OF THE ALVEOLAR PROCESS ON THE SIDE OF ANESTHETICS ON THE SIDE OF THE PALATINAL SIDE FROM THE THIRD MOLAR TO
1) the middle of the canine crown
2) the middle of the crown of the central incisor
3) the first premolar
4) second premolar
13. THE ANESTHESIA ZONE DURING CUTTING ANESTHESIA INCLUDES THE MUCOSE-STAFF OF THE ALVEOLAR PROCESS FROM THE CANINE TO
1) central incisor
2) canine
3) second premolar
4) third molar
14. IN THE AREA OF ANESTHESIA IN MANDIBULAR ANESTHESIA INCLUDES THE MUCOSA OF THE ALVEOLAR PROCESS FROM THE LANGUAGE SIDE OF THE LOWER JAW FROM THE THIRD MOLAR TO
1) the first molar
2) the first premolar
3) canine
4) central incisor
15. IN THE AREA OF ANESTHESIA IN TORUSAL ANESTHESIA INCLUDES THE SLIDAYS OF THE ALVEOLAR PROCESS OF THE LOWER
JAWS ON THE SIDE OF PAIN WITH
1) the vestibular side of the lower jaw
2) the vestibular side of the upper jaw
3) the vestibular and palatal sides of the upper jaw
4) the vestibular and lingual sides of the lower jaw
16. THE FIRST PREMOLAR OF THE UPPER JAW HAS
1) one root
2) two roots: buccal and palatine
3) two roots: medial and distal
4) three roots: palatine, mesio-buccal and distal-buccal
17. THE SECOND PREMOLAR OF THE UPPER JAW HAS
1) one root
2) two roots: buccal and palatine
3) two roots: medial and distal
4) three roots: palatine, mesio-buccal and distal-buccal
18. THE FIRST AND SECOND MOLARS OF THE UPPER JAW HAVE
1) two roots: buccal and palatine
2) two roots: medial and distal
3) three roots: palatine, mesio-buccal and distal-buccal
4) three roots: buccal, medial-palatine and distal-palatal
19. THE LOWER JAW PREMOLARS HAVE
1) one root
2) two roots: buccal and lingual
3) two roots: medial and distal
4) three roots: lingual, mesio-buccal and distal-buccal
20. FIRST AND SECOND MOLARS OF THE LOWER JAW HAVE
1) two roots: buccal and lingual
2) two roots: medial and distal
3) three roots: lingual, mesio-buccal and distal-buccal
4) four roots: 2 medial and 2 distal
21. PLACE IN THE CORRECT SEQUENCE OF TEETH EXTRACTIONS WITH TONGS
1) closing the forceps (fixation)
2) extraction of the tooth from the socket (traction)
3) applying forceps
4) dislocation of the tooth (luxation or rotation)
5) advancing the cheeks of the forceps under the gum
22. THE SCALING OF GRANULATIONS FROM A HOLE IS CALLED
1) osteotomy
2) excision
3) curettage
4) hemostasis
23. REMOVE
1) teeth with preserved crown
2) the roots of the teeth
24. TONGS WITH DIFFERENT CHEEKS REMOVE
1) teeth with preserved crown
2) the roots of the teeth
25. STRAIGHT TONGS WITH DIFFERENT CHEEKS REMOVE
1) incisors, canines of the upper jaw
2) premolars of the upper jaw
3) molars of the upper jaw
4) incisors, canines of the lower jaw
26. S-SHAPED TONGS WITH DIFFERENT CHEEKS WITHOUT SPIKES, REMOVE
1) molars of the upper jaw
2) molars of the lower jaw
3) premolars of the upper jaw
4) the third molars of the lower jaw
27. REMOVE
1) premolars of the upper jaw
2) the premolars of the lower jaw
3) molars of the upper jaw
4) molars of the lower jaw
28. REMOVE
1) incisors, canines of the lower jaw
2) the premolars of the lower jaw
3) premolars of the upper jaw
4) third molars of the upper jaw
29. BEAR FORCE WITH DIFFERENT CHEEKS AND SHI-PAMI REMOVE
1) premolars of the upper jaw
2) molars of the upper jaw
3) molars of the lower jaw
4) third molars of the upper jaw
30. ON THE LOWER JAW WITH A CORNER ELEVATOR REMOVE
1) incisors
2) fangs
3) premolars
4) the roots of the teeth
Appendix 2
TEST PROBLEMS
TO CONTROL THE LEVEL OF ASSEMBLY OF THE TOPIC
Choose one or more correct answers
1. DENTAL-SAVING OPERATIONS ARE RELATED TO
1) resection of the apex of the tooth root, replantation of the tooth
2) amputation of the tooth root, hemisection of the tooth
3) tooth implantation
4) coronal-radicular tooth separation
2. GENERAL (RELATIVE) CONTRAINDICATIONS TO SURGICAL TREATMENT OF CHRONIC PERIODONTITIS ARE
1) hypovitaminosis (C- avitaminosis)
2) pathological periodontal pockets in periodontal disease
3) acute glomerulonephritis
4) acute radiation sickness
3. LOCAL CONTRAINDICATIONS FOR DENTAL CONSERVATION OPERATIONS ARE
1) acute inflammatory processes in the oral cavity and periodontium
2) the mobility of the causal tooth of the II-III degree
3) underfilling of the root canal
4) poor oral hygiene
4. SURGICAL METHOD OF TREATMENT OF CHRONIC PERIODONTITIS, AT WHICH EXTRACT OF 1/3 OF THE ROOT OF THE TOOTH AND REMOVAL OF PATHO-LOGICALLY CHANGED TISSUES ADJACENT TO IT IS
1) resection of the apex of the tooth root
2) amputation of the tooth root
3) hemisection of the tooth
4) coronal-radicular tooth separation
5. INDICATIONS FOR CARRYING OUT RESECTION OF THE TOOTH ROOT TOP
1) the presence of a peri-root cyst, when the apex of the root protrudes into the lumen of the cyst for more than 3/4 of the length of the root
2) underfilling of no more than 1/3 of the root canal due to anatomical obstacles (bending, narrowing, denticles, obliteration of the tooth canal)
3) the presence of bone pockets in the area of one of the roots of the premolar or molar
4) complications as a result of endodontic therapy (perforation of the root wall in its upper third, breakage in the canal of root needles and pulpextractors, excessive removal of filling material into the apical region)
6. LOCAL CONTRAINDICATIONS FOR CARRYING OUT VER-HUSHKA RESECTION OF THE TOOTH ROOT ARE
1) acute and exacerbated chronic periodontitis
2) damage to the root apex during the extraction of a nearby impacted tooth
3) involvement in the pathological process of more than 1/3 of the apex of the tooth with cysts
4) apicolateral and lateral granulomas
7. POSSIBLE COMPLICATIONS DURING RESECTION OF THE TOP OF THE TOOTH ROOT
1) damage to the alveolar nerves and blood vessels
2) fracture of the tooth root
3) perforation of the floor of the maxillary sinus and nasal cavity
4) fracture of the upper jaw
8. TOOTH REPLANTATION IS
1) transplantation of a tooth into another dental alveolus
2) tooth transplant from one person to another
3) removing a tooth and returning it to its own hole
4) installation of an implant with subsequent restoration of the defect in the dentition
9. INDICATIONS FOR DELAYED DENTAL REPLANTATION ARE
1) failure or impossibility of conservative treatment of chronic periodon-tititis
2) complete dislocation of an intact tooth
3) erroneous tooth extraction
4) acute or exacerbated chronic periodontitis
10. POSITION THE STAGES OF ONE-TIME TOOTH REPLANTATION IN THE ORDER OF CARRYING OUT THERAPEUTIC MANIPULATIONS
1) preparation of the tooth socket for replantation
2) fixation of the tooth
3) preparing the tooth for replantation
4) replantation of the tooth
5) tooth extraction
11. TYPE OF FUSION OF A REPLANTED TOOTH IN WHICH OCCURRENCE-DIT REPLACEMENT OF THE PERIODONTAL SLIT WITH BONE TISSUE
1) periodontal
2) fibrous
3) osteoid
4) mixed
12. SURGICAL METHOD FOR TREATMENT OF CHRONIC PERIODONTITIS IN WHICH ONE OF THE ROOTS OF A MULTI-ROOTED TOOTH IS EXTRACTED WITH THE PRESERVATION OF ITS CROWN PART
1) resection of the apex of the tooth root
2) amputation of the tooth root
3) hemisection of the tooth
4) coronal-radicular tooth separation
13. INDICATIONS FOR DENTAL ROOT AMPUTATION ARE
1) the presence of deep, more than 1/2 and 3/4 of the root length, intraosseous pockets in the area of one of the two buccal roots or the palatine root of the upper molar
2) significant destruction of bone tissue at one of the roots of a multi-rooted tooth
3) the presence of a peri-root cyst, when the apex of one root protrudes into the lumen of the cyst by more than 3/4 of the root length
4) the presence of accrete roots that cannot be separated
14. LOCAL CONTRAINDICATIONS FOR TOOTH ROOT AMPUTATION ARE
1) peri-root cysts, in the cavity of which are the tops of the roots of the teeth
2) significant resorption of bone tissue at all roots of the tooth
3) the presence of accreted roots that cannot be separated
4) pronounced hypercementosis of the removed root
15. SURGICAL METHOD FOR TREATMENT OF CHRONIC PERIODONTITIS IN WHICH ONE OF THE ROOTS IS PRODUCED TOGETHER WITH THE CROWN PART LAYING TO IT IN MULTI-ROOTED TEETH IS
1) resection of the apex of the tooth root
2) amputation of the tooth root
3) hemisection of the tooth
4) coronal-radicular tooth separation
16. INDICATIONS FOR HEMISECTION OF THE TOOTH ARE
1) the presence of deep, more than 1/2 and 3/4 of the root length, intraosseous pockets in the area of one of the roots of the lower molar
2) damage and loss of bone in the furcation area and exposure of one of the roots
3) fracture of the tooth root, vertical split of the tooth
4) impassable root canals of teeth to be preserved
17. LOCAL CONTRAINDICATIONS FOR HEMISECTION OF THE TOOTH ARE
1) acute radiation sickness
2) impassable root canals of teeth to be preserved
3) the close location of the bifurcation to the apex of the roots
4) the alleged ineffectiveness of conservative treatment of the remaining root canals
18. SURGICAL METHOD OF TREATMENT OF CHRONIC PERIODONTITIS, AT WHICH A MULTI-ROOT TOOTH IS DISCOVERED IN THE AREA OF BIFURCATION WITH THE FOLLOWING CURETATION OF THE INTERROOT AREA OF THE SURGICAL REGION AND FAR LARGE
1) resection of the apex of the tooth root
2) amputation of the tooth root
3) hemisection of the tooth
4) coronal-radicular tooth separation
19. INDICATIONS FOR CORONO-RADICULAR SEPARATION OF THE TOOTH IS
1) cervical caries of one of the roots
2) acute or exacerbated chronic periodontitis
3) fracture of the tooth root, vertical split of the tooth
4) perforation of the bottom of the pulp chamber with rarefaction of the apex of the interroot septum
20. LOCAL CONTRAINDICATIONS FOR CROWN-RADICULAR SEPARATION OF THE TOOTH ARE
1) pathological processes in the area of the inter-root septum, the elimination of which can lead to exposure of more than 1/3 of the length of the roots
2) the close location of the bifurcation to the apex of the roots
3) lesion of the periodontium in the area of bifurcation with lysis of the apex of the inter-root septum
4) the presence of additional tubules connecting the tooth cavity with the periodontium in the bifurcation area
Appendix 3
SITUATION TASKS
TO CONTROL THE LEVEL OF ASSEMBLY OF THE TOPIC
Task 1. X-ray control of the endodontic treatment result for chronic granulating periodontitis of tooth 1.2 revealed that due to the anatomical curvature of the root in the upper third, root perforation occurred with excessive removal of the filling material into the periapical focus of bone tissue destruction.
1. Determine the method of surgical treatment.
2. List all indications for the selected method.
Task 2. A 20-year-old patient consulted a dental surgeon with complaints of a tooth loss in the upper jaw on the right. According to the patient's words, the tooth was "knocked out" during a street fight the night before, and he sought medical help the next morning. The lost tooth, on the advice of his mother, was stored in a glass of milk in a refrigerator. The patient wants to save the tooth.
Objectively. The general condition is satisfactory. The face configuration has not been changed. Regional lymph nodes are not palpable.
Locally. The crown of the 1.1 tooth is intact. The well of the 1.1 tooth is filled with a blood clot. The mucous membrane of the gums around the hole of the 1.1 tooth is hyperemic, edematous.
1. Make a diagnosis.
2. Determine the method of surgical treatment.
3. List the stages of the selected operation.
Task 3. A 22-year-old patient consulted a dentist with complaints of pain in the area of the upper jaw tooth on the right, a feeling of a "grown" tooth, and the appearance of swelling of the gums.
According to the patient, the tooth was treated a year ago for complicated caries. The patient wants to save the tooth.
Objectively. The general condition is satisfactory. The face configuration has not been changed. Regional lymph nodes are not palpable.
Locally. 1.1 tooth under the filling. With percussion, there is a sharp soreness. The mucous membrane of the gums in the area of the 1.1 tooth is hyperemic, edematous.
A sighting X-ray shows that the root canal of the 1.1 tooth is sealed 2/3 of its length; periapical destruction of bone tissue around the root with clear boundaries 0.7 x 0.8 cm in size is determined.
1. Make a diagnosis.
2. Determine the method of surgical treatment.
3. List the stages of the selected operation.
Task 4. A 36-year-old patient consulted a dentist-surgeon with complaints of aching pain in the left upper jaw tooth. The pains bother for a month.
Locally: 2.6 tooth under filling, previously treated for complicated caries. With percussion, slight soreness is noted. The mucous membrane in the area of the 2.6 tooth is hyperemic and edematous.
On the sighting radiograph of 2.6 teeth - the palatine and distal buccal root canals are sealed throughout, the medial buccal canal is sealed for 2/3 of the length. Around the medial buccal root, a focus of bone tissue destruction with indistinct boundaries measuring 0.3 x 0.5 cm is determined.
1. Make a diagnosis.
2. Determine the method of surgical treatment.
3. List local contraindications for the selected operation.
Task 5. A 45-year-old patient consulted a dentist - orthopedist for the purpose of prosthetics of the lower jaw teeth on the right. During the examination, a dental formula was established:
n n
7 6 5 4 3 2 1 1 2 3 4 5 6 7
7 6 5 4 3 2 1 1 2 3 4 5 6 7
with o o p
The expediency of making a bridge has been determined. On the sighting X-ray of the 4.6 tooth, the medial canal is obliterated, in the region of the apex of the medial root, a focus of bone tissue destruction with indistinct boundaries measuring 0.3 x 0.7 cm is determined.
1. Make a diagnosis.
2. Determine the method of surgical treatment.
3. Describe the technique of the operation.
Task 6. A 29-year-old patient consulted a dentist surgeon with complaints of recurrent pain when biting on a tooth in the lower jaw on the left. Pain appeared 2 months ago.
Objectively: 3.6 tooth under the filling, discolored. On the sighting X-ray of the 3.6 tooth, the canals are obturated with a radiopaque mass throughout, in the area of the bifurcation, a focus of bone tissue destruction with clear boundaries 0.7 x 0.5 cm in size is determined.
1. Make a diagnosis.
2. Determine the method of surgical treatment.
3. Describe the technique for carrying out one of the methods of the selected operation.
Task 7. During endodontic treatment of the 3.6 tooth, the bottom of the tooth cavity was perforated.
1. Determine the method of surgical treatment.
2. Describe the methodology for carrying out the selected operation.
Answers to situational tasks
to control the level of mastering the topic
Objective 1.
1. Resection of the root apex of the 1.2 tooth.
2. Indications for performing a root apex resection are:
- chronic granulating and granulomatous periodontitis, when conservative methods fail to eliminate the chronic inflammatory process in the periodontium;
- underfilling of the root canal due to anatomical obstacles (bending, narrowing, denticles, obliteration of the tooth canal);
- complications as a result of endodontic therapy (perforation of the root wall in its upper third, breakage of root needles and pulpextractors in the canal, excessive removal of filling material into the apical region);
- peri-root cysts, in the cavity of which are the tops of the roots of the teeth;
- damage to the root apex during the removal of a nearby impacted tooth;
- removal of bone sequesters during the treatment of chronic osteomyelitis, when the root apex is in the lesion;
- the presence of bridges, when pin teeth are used as a support and there is bone destruction in the apex area;
- the presence of a sinus tract, defective regeneration of bone tissue in the area of the peri-apical focus after properly performed endodontic treatment;
- taking a biopsy material for differential diagnosis of tumors of the jaws of odontogenic origin.
Objective 2.
1. Complete dislocation of the 1.1 tooth.
2. One-stage replantation of a 1.1 tooth.
3. 1) Preparing the well for replantation.
2) Preparing the tooth for replantation.
3) Tooth replantation.
4) Fixation of the tooth.
Objective 3.
1. Exacerbation of chronic granulomatous periodontitis of the 1.1 tooth.
2. Delayed replantation of the 1.1 tooth.
3. 1) Tooth extraction.
2) Preparing the tooth for replantation.
3) Preparing the well for replantation.
4) Tooth replantation.
5) Fixation of the tooth.
Task 4.
1. Chronic granulating periodontitis 2.6 tooth.
2. Amputation of the slow buccal root of the 2.6 tooth at the level of 2/3 of the length.
3. Local contraindications for root amputation include:
- acute inflammatory processes in the oral cavity and periodontium;
- significant resorption of bone tissue at all roots;
- the presence of accreted roots that are not amenable to separation;
- impassable root canals of teeth to be preserved;
- pronounced hypercementosis of the removed root;
- with the supposed ineffectiveness of conservative treatment of the remaining root canals;
- mobility of the tooth II-III stage;
- poor level of oral hygiene.
Task 5.
1. Chronic granulating periodontitis of the 4.6 tooth.
2. Hemisection of the 4.6 tooth.
3. Before the hemisection of the tooth, endodontic treatment of the remaining root, instrumental and drug treatment of the canals and their filling are performed. If necessary, the remaining tooth fragment is reinforced with a clasp wire pin.
The operation is performed under local conduction and infiltration anesthesia. According to indications, sedative preparation is prescribed.
With the help of a fissure diamond bur or a diamond disc, used for separating teeth in orthopedic dentistry, and a turbine drill, the crown of the tooth is cut into two halves.
When working with burs, discs, the surgical field must be cooled by irrigation with isotonic sodium chloride solution from a syringe or fizdispenser (a tip with an antiseptic or sterile isotonic solution).
Then the affected root with the adjacent crown is removed with forceps or an elevator. The interroot septum, as well as the bone tissue surrounding the remaining segment of the tooth, is preserved. After removing the affected tooth fragment, the overhanging edges in the bifurcation area are smoothed out and the hole curettage is performed.
2-3 weeks after the surgery, the patient is given orthopedic treatment.
Task 6.
1. Chronic granulating periodontitis of the 3.6 tooth.
2. Crown-radicular separation of the 3.6 tooth with detachment of the muco-periosteal lapel.
3. A trapezoidal or angular incision of the mucous membrane and periosteum is made to the bone of the alveolar part of the lower jaw from the vestibular surface. The mucoperiosteal flap is peeled off with a raspator. In the projection area of the pathological focus with a spherical bur, trepanation of the bone wall of the alveoli is performed, after which the opening is expanded with a fissure bur to the required size.
Curettage of the area of the inter-root pathological focus is carried out. They are washed with antiseptic solutions (3% hydrogen peroxide solution, 0.06% chlorhexidine solution, etc.), filled with osteoplastic material ("Osteodent", "Collost", "Collapan", "Osteomatrix", "Bioplant" , "Combiplant", etc.). The muco-periosteal flap is returned to its place and fixed with a polyamide thread or catgut.
Task 7.
1. Corona-radicular separation of the 3.6 tooth without detachment of the muco-periosteal lacrimal region.
2. Wash with antiseptic solutions (3% hydrogen peroxide solution, 0.06% chlorhexidine solution, etc.) and apply a protective bandage. Fragments of the tooth are fixed with the adjacent teeth with a ligature wire splint. In the future, crowns are made for each of the roots, which are soldered to each other.
TOPIC: "SURGICAL TREATMENT OF PERIODONTAL DISEASES"
1. Relevance. According to WHO (1983), more than 80% of the world's population is affected by periodontal disease. The prevalence of periodontal diseases in various regions of our country ranges from 85 to 98%, and among them inflammatory diseases - gingivitis and periodontitis - occupy a special place, they account for more than 90% of cases.
The occurrence and course of inflammatory periodontal diseases are influenced by many general and local factors. These include: microbial factor, accumulation of soft and hard dental deposits, shortened frenum of the lips, shallow vestibule of the oral cavity, anomalies and deformations of the dentition, uneven distribution of chewing load, improperly made fillings and prostheses, etc. In this regard, the treatment of inflammatory periodontal diseases should be complex, include surgical methods aimed not only at eliminating the pathological focus and etiological factors, but also restoring the bone tissue of the alveolar part of the jaw. In connection with the above, study of the topic “General principles of periodontal surgery (curettage, gingivotomy, gingivectomy). Surgical methods of treating periodontitis using tissue movement and osteoplastic materials ”for students of the Faculty of Dentistry is mandatory.
2. The purpose of the lesson: to familiarize students with surgical methods of treatment of inflammatory periodontal diseases, to teach to determine the indications and contraindications for their use and to teach the skills of conducting.
To form professional competencies, the student must know:
- anatomical and physiological features of periodontal tissues;
- methods for examining tissues and organs of the oral cavity;
- methods of examining a patient by organs and systems;
- methods for examining periodontal tissues;
- classification of periodontal diseases;
- age characteristics of periodontal tissues;
- methods of conservative treatment of periodontal diseases;
- the basics of pharmacotherapy;
- clinic for gingivitis and periodontitis;
- indications for the use of gingivotomy and gingivectomy;
- indications for closed and open curettage;
- indications for patchwork operations;
- methods of frenulotomy and frenulectomy;
- the operation of deepening the vestibule of the oral cavity;
- osteoplastic materials in periodontology.
To form professional competencies, the student must own:
1. OPK-5 (principles of analysis of its activities)
2.OPK-6 (analysis of the results of their own activities, skills in filling out medical documentation, methods of maintaining accounting and reporting documentation)
3. PC-2 (A / 04.7), theoretical knowledge on methods of examination of soft tissue injuries of the maxillofacial region, clinical course, diagnosis, differential diagnosis of injuries of the maxillofacial region;
4. PC-5 (A / 01.7), PC-6 (A / 01.7) skills of examination of patients with soft tissue injuries of the maxillofacial region, diagnosis and treatment of soft tissue injuries of the maxillofacial region.
5. PC-6 (A / 01.7) the ability to determine in patients the main pathological conditions, symptoms, syndromes of dental diseases, nosological forms in accordance with the International Statistical Classification of Diseases and Problems Related to Health.
6. PC-9 (A / 02.7) readiness for the management and treatment of patients with dental diseases on an outpatient basis and in a day hospital.
To form professional competencies, a student must be able to:
- to examine patients with periodontal diseases;
- draw up a plan for an additional examination before carrying out
surgical treatment of periodontal diseases;
- to evaluate the results of clinical and laboratory-instrumental data;
- to formulate a diagnosis in accordance with modern classifications;
- to determine the indications and contraindications for the use of various types of periodontal surgery;
- draw up a comprehensive treatment plan;
- to appoint primary and secondary preventive measures for
prevent the development of complications.
3. Necessary basic knowledge and skills (knowledge gained in the study of previous disciplines):
- Human Anatomy: Head and Neck Anatomy
Know:
- anatomical terms (Russian and Latin);
- anatomy and topography of the maxillofacial region;
- the relationship of organs with each other; projection of organs on the surface of the body;
- the main stages of development of the maxillofacial region (organogenesis);
- the main options for the structure and possible malformations of the salivary glands;
- the regularities of the structure of the human body as a whole, anatomical and functional relationships of individual parts of the body with each other.
- histology, embryology, cytology - histology of the oral cavity
Know:
- the main patterns of development and life of the human body based on the structural organization of cells, tissues and organs;
- histofunctional features of the tissue elements of the maxillofacial area; methods of their research.
- normal physiology - physiology of the maxillofacial region
Know:
- basic properties and conditions of excitable tissues, understanding of the mechanisms of bioelectric phenomena;
- functional properties and features of the salivary glands and saliva;
- principles of organization and functioning of the central nervous system (CNS);
- the role of proteins, fats, carbohydrates, minerals, vitamins and water in the body;
- physiological features of metabolism and energy in the body, between the body and the external environment;
- concept and classification of pain
- pharmacology
Know:
-classification and basic characteristics of drugs, pharmacodynamics and pharmacokinetics, indications and contraindications for the use of drugs;
- side effects when using drugs;
- general principles for the preparation of prescriptions and the preparation of prescription drug prescriptions.
4. Type of lesson: practical.
5. Duration of the lesson: 4 academic hours.
6. Equipment multimedia projector, slides, diagrams, tables, sets of test items
Questions to control the initial level of knowledge:
1. Methods of examination of the patient by organs and systems.
2. Anatomical and functional features of the maxillofacial region.
3. Methods for examining periodontal tissues.
4. Immunobiological features of the tissues of the maxillofacial region.
5. Age features of periodontal tissues
6. Classification of periodontal diseases.
7. Methods of conservative treatment of inflammatory periodontal diseases.
8. Rules for rational oral hygiene.
7.5.1 Questions to control the development of the topic of the lesson:
1. Indications and contraindications for surgical treatment of parodont diseases.
2. Preoperative preparation of patients.
3. Types of surgical interventions for periodontal diseases.
4. The procedure and timing of periodontal surgery.
5. The choice of methods of anesthesia in the surgical treatment of inflammatory periodontal diseases.
6. Open and closed curettage, indications, methods of carrying out.
7. Gingivotomy, indications, methods of carrying out.
8. Gingivectomy, indications, methods of carrying out.
9. Patchwork operations, indications, methods of carrying out, modifications.
10. Lip frenum plasty, indications, methods of carrying out.
11. Vestibuloplasty, indications, methods of carrying out.
12. Postoperative management of patients after surgical treatment of periodontal diseases.
Place of self-training: reading room, study room for independent work of students, patient rooms, functional diagnostics rooms, etc.
Educational and research work of students on this topic:
1. Microbiocenosis of the oral cavity in chronic generalized periodontitis.
2. Osteoplastic materials in periodontal surgery.
Appendices to the topic of the lesson: "Surgical treatment of periodontal diseases"
Annex 1
TEST PROBLEMS
TO CONTROL THE BASELINE LEVEL OF KNOWLEDGE
In the following test items, choose one correct answer.
1. INDEX ALLOWS INFLAMMATION OF THE GUM
1) KPU
2) KPI
3) Fedorova-Volodkina
4) PMA
5) KPU + kp
2. BLOOD SUPPLY OF PERIODONTAL TISSUES CAN BE ESTIMATED WITH THE HELP
1) computed tomography
2) rheography
3) fistulography
4) contrast radiography
5) polarography
3. APPLICATION OF DENSITOMETRY ALLOWS TO DETECT
1) the presence of foci of osteoporosis
2) disturbances in the conduction of nerve fibers
3) disorders of mucosal permeability
4) violations of tissue trophism
5) the presence of toxic substances in the tissues
4. PERIODONTAL POCKET DEPTH IS DETERMINED
1) probing
2) visually
3) radiographically
4) ultrasound examination
5) according to the degree of exposure of the roots of the teeth
5. IN PERIODONTIS, THE FOLLOWING TYPE OF CO-STI RESORPTION DOMINATES
1) mixed
2) horizontal
3) vertical
4) diffuse
5) focal
6. IN PERIODONTOSIS, THE FOLLOWING TYPE OF CO-STI RESORPTION DOMINATES
1) mixed
2) horizontal
3) vertical
4) diffuse
5) focal
7. MOBILITY OF TEETH ALREADY IN THE EARLY STAGES OF XA-RAKTERN'S DISEASE FOR
1) periodontitis
2) periodontal disease
3) gingivitis
8. INDICATION FOR SURGICAL TREATMENT OF PERIODON-TITUS IS
1) bleeding gums
2) profuse purulent discharge
3) exposing the necks of the teeth
4) the presence of periodontal pockets
5) the presence of subgingival calculus
9. CONTRAINDICATION TO SURGICAL TREATMENT OF PERIODONTITIS IS THE PRESENCE
1) periodontal pockets up to 1/2 root length
2) bone pockets
3) slight tooth mobility
4) purulent discharge
5) subgingival calculus
10. CONTRAINDICATION TO SURGICAL TREATMENT OF PERIODONTITIS IS
1) shortened lip frenulum
2) shallow vestibule of the oral cavity
3) hypertension
4) tooth mobility of the 2nd degree
5) ARVI
Appendix 2
TEST PROBLEMS
FOR CONTROL OF THE LEVEL OF DEVELOPMENT OF THE TOPIC
In the following test items, choose one correct answer.
1. HYPERTROPHIC GYNHIVITIS IS AN INDICATION FOR CARRYING OUT
1) gingivotomy
2) gingivectomy
3) closed curettage
4) open curettage
5) flap surgery
2. PERIODONTAL ABSCESS IS AN INDICATION FOR CARRYING OUT
1) gingivotomy
2) gingivectomy
3) closed curettage
4) open curettage
5) flap surgery
3. THE PRESENCE OF PERIODONTAL POCKETS WITH A DEPTH OF 3-4 mm IS AN INDICATION FOR CARRYING OUT
1) gingivotomy
2) gingivectomy
3) closed curettage
4) open curettage
5) flap surgery
4. THE PRESENCE OF PERIODONTAL POCKETS WITH A DEPTH OF 4-5 mm IS AN INDICATION FOR CARRYING OUT
1) gingivotomy
2) gingivectomy
3) closed curettage
4) open curettage
5) flap surgery
5. THE PRESENCE OF PERIODONTAL POCKETS UP TO 7MM IN THE FRONTAL TEETH IS AN INDICATION FOR CARRYING OUT
1) gingivotomy
2) gingivectomy
3) closed curettage
4) open curettage
5) flap surgery
6. PERFORMANCE OF FLAP OPERATION IN PERIODONTITIS SUBSUMABLE-ET REMOVAL
1) hard dental plaque
2) granulation tissue
3) ingrown epithelium
4) circular tooth ligament
5) softened bone
7. CONDUCTING AN OPEN CURETAGE OF PERIODONTAL POCKETS IN ONE VISIT IS POSSIBLE IN THE REGION
1) only 1 tooth
2) no more than 2 teeth
3) no more than 4-6 teeth
4) half of the jaw
5) the entire jaw
8. THE OPTIMAL ANTISEPTIC DRUG USED IN PERIODONTOLOGICAL SURGERY IS A SOLUTION
1) furacilin
2) potassium permanganate
3) chlorhexidine
4) dioxidine
5) hydrogen peroxide
9. WHEN CARRYING OUT THE OPERATION ON VIDMAN-NEUMAN GINGUAL EDGE
1) tighten and fix in the area of the anatomical neck of the tooth with a pressure bandage
2) tighten and fix in the area of the anatomical neck of the tooth with sutures through the interdental spaces
3) excised and fixed with a pressure bandage
4) excised and fixed with sutures through the interdental spaces
5) excised and fixed with sutures to the periosteum
10. CUTTING OPEN CURETEGE IS CONDUCTED
1) horizontally along the tops of the interdental papillae
2) horizontally at the level of the bottom of periodontal pockets
3) vertically in the center of the tooth crown
4) vertically through the interdental papillae
Appendix 3
SITUATION TASKS
FOR CONTROL OF THE LEVEL OF DEVELOPMENT OF THE TOPIC
Task 1. The patient complains of pain, swelling of the gums in the frontal part of the lower jaw, bleeding when brushing teeth. The examination revealed the mobility of the incisors in the lower jaw of the II degree, the necks were bare, periodontal pockets 5-6 mm deep, supra- and subgingival hard dental deposits were identified, and purulent discharge from under the gingival margin. The frenum of the lower lip is shortened. Radiographically determined bone pockets up to 1/3 - 1/2 of the length of the roots in the area of the incisors of the lower jaw.
1. Make a diagnosis.
2. Make a treatment plan.
Task 2. The patient complained of bleeding, soreness of the gums. When examining the oral cavity, swelling, hyperemia of the gingival margin in the area of all teeth, abundant soft dental deposits, tooth mobility of 1 degree, periodontal pockets up to 3 mm deep are determined.
1. Make a preliminary diagnosis?
2. Make a plan for the examination and treatment of the patient.
Task 3. Patient A. Appealed with complaints of an aesthetic defect - exposure of the roots of the teeth, from the anamnesis - the development of the disease is gradual, over several years, no painful sensations. Examination of the oral cavity revealed a uniform recession of the gingival margin in the area of all teeth up to 1/3 of the root length, the mucous membrane was without inflammation, the mobility of the teeth was insignificant, and the oral hygiene was satisfactory.
1. Make a preliminary diagnosis.
2. Make a plan for the examination and treatment of the patient.
Task 4. When examining patient P., bleeding of the gums, mobility of the teeth of the 2nd degree, hyperesthesia of the necks of the teeth, the presence of periodontal pockets with a depth of 3-4 mm, mainly in the region of the anterior teeth, are determined. Make a diagnosis, make a comprehensive plan for the examination and treatment of the patient.
Task 5. Patient R. complained of recurrent pain, suppuration from under the gums in the area of 46.47 teeth. Examination revealed: 46.74 teeth under a single filling on the chewing surfaces, the mucous membrane in this area is hyperemic, edematous. When probing the area of the interdental space, a periodontal pocket with a depth of up to 10 mm is determined. On the sighting X-ray, bone resorption is determined between 46.47 teeth to the apex of the roots, the bone tissue in the bifurcation area is preserved. Make a comprehensive treatment plan for the patient.
Task 6. Patient Sh. Addressed with complaints of pain, edema, swelling of the gums in the area of 16.17 teeth. On examination, a round infiltrate is determined on the alveolar ridge in the area of the interdental space measuring 1x1.5 cm with fluctuation in the center, the mucous membrane is hyperemic, edematous, palpation is sharply painful. Percussion of the teeth is slightly painful, mobility is 1 degree. Make a plan for the examination and treatment of the patient.
TOPIC: “WAYS OF SPREADING OF ODONTOGENIC INFECTION. CAUSES OF EXCERING CHRONIC ODONTOGENIC INFECTION. PERI-LEFT JAWS. CLASSIFICATION, ETIOLOGY AND PATHOGENESIS. ACUTE ODONTOGENIC PERIOSTITIS OF JAWS. PATHOLOGICAL ANATOMY. CLINIC, DIAGNOSTICS, DIFFERENTIAL DIAGNOSTICS, TREATMENT "
1. Relevance. Acute odontogenic periostitis of the jaws develops as a result of the penetration of infection under the periosteum from the inflammatory focus in the periapical tissues, as well as with difficult teething and suppuration of the contents of the radicular cyst.
Acute odontogenic periostitis of the jaws has a serous and purulent form. Each form has a certain duration and features of the clinical course. Odontogenic periostitis can also occur in the chronic stage.
For the correct diagnosis and treatment of odontogenic periostitis of the jaws at each stage and form, it is necessary to know their characteristic clinical symptoms of the disease, radiological and morphological manifestations.
In turn, acute odontogenic periostitis of the jaws can be complicated by osteomyelitis of the jaws, abscess or phlegmon of the maxillofacial region.
The knowledge gained during the study of this topic will allow a graduate of the Faculty of Dentistry to carry out the prevention of periostitis, correctly diagnose and differentiate it with other diseases, timely prescribe adequate treatment and avoid complications.
2. The purpose of the lesson: to create conditions and assist students in mastering theoretical knowledge on etiology, pathogenesis, pathological anatomy, classification and clinic of odontogenic periostitis and medical skills in diagnosis, differential diagnosis, methods of its treatment and timely prevention of complications.
To form professional competencies, the student must know:
˗ Anatomy, blood supply and innervation of the upper and lower jaws.
˗ Anatomical and topographic features of the upper and lower jaws.
˗ Anatomy of teeth.
˗ The concept of the periosteum.
˗ Signs of inflammation.
˗ Indicators of blood in inflammatory processes.
˗ Pathomorphological changes that occur in tissues during inflammatory processes.
Medicinal substances included in the complex of anti-inflammatory therapy.
˗ Medicinal substances that correct local and systemic immunity.
˗ Clinical manifestations of jaw periostitis (various forms and localizations).
˗ Diagnostics and differential diagnosis of odontogenic periostitis with other diseases.
˗ Principles of treatment of patients with odontogenic periostitis.
˗ Indications for the preservation and removal of the "causal" tooth with periostitis of the jaws.
˗ Possible complications of odontogenic periostitis of the jaws.
˗ Prevention of odontogenic periostitis of the jaws.
˗ Examination of the disability of patients with odontogenic periostitis of the jaws.
To form professional competencies, the student must own:
1. OPK-5 (principles of analysis of its activities)
2.OPK-6 (analysis of the results of their own activities, skills in filling out medical documentation, methods of maintaining accounting and reporting documentation)
3. PC-2 (A / 04.7), theoretical knowledge on methods of examination of soft tissue injuries of the maxillofacial region, clinical course, diagnosis, differential diagnosis of injuries of the maxillofacial region;
4. PC-5 (A / 01.7), PC-6 (A / 01.7) skills of examination of patients with soft tissue injuries of the maxillofacial region, diagnosis and treatment of soft tissue injuries of the maxillofacial region.
5. PC-6 (A / 01.7) the ability to determine in patients the main pathological conditions, symptoms, syndromes of dental diseases, nosological forms in accordance with the International Statistical Classification of Diseases and Problems Related to Health.
6. PC-9 (A / 02.7) readiness for the management and treatment of patients with dental diseases on an outpatient basis and in a day hospital.
To form professional competencies, a student must be able to:
˗ Take anamnesis, examine the patient by organs and systems.
˗ To determine additional research methods for odontogenic periostitis of the jaws.
˗ Assess the results of clinical and laboratory-instrumental research methods.
˗ Conduct differential diagnosis of odontogenic periostitis of the jaws with other diseases that have common symptoms with it.
˗ Formulate a diagnosis in accordance with modern classification.
˗ To treat a patient with odontogenic periostitis of the jaws.
˗ Determine the indications for the extraction and preservation of teeth that are the source of infection.
˗ Conduct an examination of the disability of a patient with odontogenic periostitis of the jaws.
˗ To carry out the prevention of complications of odontogenic periostitis of the jaws.
3. Type of lesson: practical
4. Duration of the lesson: 4 academic hours.
5. Equipment: diagrams, tables, test tasks, situational tasks, X-ray images, negatoscope, multimedia projector
Questions on the topic of the lesson:
1. Definition of periostitis.
2. Etiology of acute odontogenic periostitis of the jaws.
3. Classification of acute odontogenic periostitis of the jaws.
4. Pathogenesis of acute odontogenic periostitis of the jaws.
5. Clinical signs of acute odontogenic periostitis of the jaws.
6. Features of the clinic, diagnosis, differential diagnosis and treatment of acute odontogenic periostitis of the upper jaw with localization in the hard palate.
7. Features of the clinic, diagnosis, differential diagnosis and treatment of retromolar periostitis.
8. Diagnostics and differential diagnosis of acute odontogenic periostitis of the jaws.
9. Complex treatment of a patient with acute odontogenic periostitis of the jaws.
10. Indications for the preservation and removal of "causal" teeth in case of odontogenic periostitis of the jaws.
11. Reasons for the development of chronic odontogenic periostitis.
12. Clinic of odontogenic periostitis in the chronic stage: simple and ossifying (rearing).
13. Diagnostics and differential diagnostics of odontogenic periostitis in the chronic stage.
14. Treatment of a patient with odontogenic periostitis of the jaws in the chronic stage.
15. Physical factors used in the treatment of acute and chronic odontogenic periostitis of the jaws.
16. Complications of odontogenic periostitis of the jaws and their prevention.
17. Examination of the disability of patients with odontogenic periostitis of the jaws.
18. Prevention of odontogenic periostitis of the jaws.
Place of self-training: reading room, study room for independent work of students.
Educational and research work of students on this topic:
1. Rationale for the use of antibiotic therapy in the treatment of acute odontogenic periostitis of the jaws.
2. Pathogenesis of periostitis of the lower jaw with difficult eruption of the third lower molars.
Appendices to the topic: “Ways of spreading odontogenic infection. Causes of exacerbation of chronic odontogenic infection. Periostitis of the jaws. Classification, etiology and pathogenesis. Acute odontogenic periostitis of the jaws. Pathological anatomy. Clinic, diagnostics, differential diagnostics, treatment "
Annex 1
TESTS FOR CONTROL
INITIAL LEVEL OF KNOWLEDGE
Choose one correct answer.
1. PERIOST IS
1) a dense connective tissue plate that covers the entire surface of the bone, with the exception of its articular ends
2) formation of connective tissue, the terminal structure of the striated muscles, with the help of which they attach to the bones
3) a wide plate formed from dense collagen and elastic fibers
4) solid (bearing) component of the endoskeleton of a living organism
2. INFLAMMATION IS
1) complex local vascular - mesenchymal reaction to tissue damage caused by the action of various kinds of agents
2) irreversible changes in the vital activity of the body, the onset of autolytic processes
3) a qualitatively changed reaction of the body to the action of substances of an antigenic nature, which leads to a variety of disorders in the body
4) persistent abrupt change in the hereditary apparatus of the cell, not associated with the usual recombination of genetic material
3. ANATOMICAL FEATURE OF THE UPPER JAW IS
1) thin compact plate
2) dense compact plate
3) no compact plate
4) thick compact plate
4. ANATOMICAL FEATURE OF THE LOWER JAW IS
1) thick compact plate
2) no compact plate
3) dense compact plate
4) thin compact plate
5. WHEN REMOVING THE FIRST LOWER MOLAR ANESTHESIA IS EFFECTIVE
1) torusal
2) mandibular
3) lingual nerve
4) mental
6. THE TEETH OF THE LOWER JAW INERVATE
1) I branch of the trigeminal nerve
2) II branch of the trigeminal nerve
3) III branch of the trigeminal nerve
4) facial nerve
7. THE UPPER JAW MOLARS ARE INERVATED
1) I branch of the trigeminal nerve
2) the upper anterior alveolar plexus
3) the upper posterior alveolar plexus
4) the upper middle alveolar plexus
8. IN CONDUCTIVE ANESTHESIA, SENSITIVITY BLOCK IS OBSERVED
1) tactile
2) painful
3) temperature
4) gustatory
9. DURATION OF EFFECTIVE ANESTHESIA WITH LIDOCAINE IN CONDUCTOR ANESTHESIA IS
1) 15-20 minutes
2) more than 30 minutes
3) less than 30 minutes
4) 6 hours
10. OBLIGATE NON-PORO-FORMING BACTERIA ARE RELATED TO
1) proteus, Escherichia coli
2) bacteroids, fusobacteria
3) staphylococci, streptococci
4) pneumococci
11. ANTI-HISTAMINE DRUG IS NOT
1) diazolin
2) tavegil
3) amoxycycline
4) claritin
12. DRUG WITH OSTEOTROPIC EFFECT
1) azithromycin
2) cetirizine
3) ampicillin
4) penicillin
13. ANTIFUNGAL DRUG IS NOT
1) nystatin
2) levorin
3) valocardin
4) natamycin
14. DURING THE INFLAMMATORY PROCESS, THE QUANTITY INCREASES
1) erythrocytes
2) platelets
3) leukocytes
4) hemoglobin
Appendix 2
TESTS FOR CONTROL
LEVEL OF ASSEMBLY OF THE TOPIC
Choose one correct answer.
1. PERIOSTITIS IS
1) infectious-allergic, purulent-necrotic process that develops in the bone
2) a disease characterized by the spread of the inflammatory process from the periodontal to the periosteum of the alveolar process and the body of the jaw
3) an inflammatory process that affects periodontal tissue and spreads to adjacent bone structures
4) inflammatory process in the jaw bone tissue
2. THE CAUSE OF ACUTE ODONTOGENIC PERIOSTITIS OF THE LOWER JAW MOST OFTEN ARE
1) incisors
2) fangs
3) premolars
4) molars
3. PAIN IN ACUTE SERIOUS PERIOSTITIS IS CHARACTERIZED AS
1) acute irradiating, aggravated by biting and percussion of the tooth
2) acute irradiating, paroxysmal, aggravated at night
3) pain in the jaw and in the causative tooth, aggravated by biting
4) pain in several teeth, the percussion of the "causal" tooth is sharply painful, and next to those standing it is painless
4. IN ACUTE PURULENT ODONTOGENIC PERIOSTITIS IN THE BLOOD
1) no changes
2) leukocytosis, neutrophilic shift to the left, increased ESR
3) leukocytosis, neutrophilic shift to the right, increased ESR
4) leukopenia, eosinopenia, lymphocytosis, basophilia
5. TREATMENT OF A PATIENT WITH ACUTE PURULENT ODONTOGENIC PERYOSTITIS INCLUDES
1) removal or treatment of the causative tooth (according to indications), prescribing medication
2) removal or treatment of the causative tooth, opening of the subperiosteal abscess, medical treatment
3) treatment of the causative tooth, opening of the subperiosteal abscess, drug treatment
4) periostotomy
6. DIFFERENT CHRONIC PERIOSTITIS
1) hyperplastic and hyperostous
2) purulent, hyperplastic and hyperostous
3) simple, ossifying, referencing
4) purulent, destructive, hyperostous
7. ACUTE PERIOSTITIS OF THE UPPER JAW SHOULD BE DIFFERENTIATED WITH
1) trismus
2) acute sialodochitis
3) acute osteomyelitis
4) chronic sinusitis
8. IN ACUTE REGIONAL LYMPHONOSIS
1) not changed
2) mobile, slightly painful, slightly enlarged, soft on palpation
3) painful, enlarged, elastic consistency, mobile
4) painless, enlarged, dense, inactive, soldered to the surrounding tissues
9. THE REASON FOR THE DEVELOPMENT OF ODONTOGENOUS PERIOSTITIS IS
1) contusion of soft tissues of the face
2) exacerbation of chronic pulpitis
3) exacerbation of chronic sinusitis
4) exacerbation of chronic periodontitis
10. DURING PERIOSIS, THE PURULENT PROCESS IS LOCATED UNDER
1) skin
2) muscle
3) periosteum
4) bone
11. "CAUSAL" SINGLE-ROOT TOOTH IN ACUTE SERIOUS PERIOSTITIS SHOULD BE SEALED
1) on the day of treatment
2) after antiseptic treatment of the root canal
3) after a course of physical treatments
4) after the inflammation subsides
12.TYPICAL OPERATIONAL ACCESS IN THE TREATMENT OF PERIOSTITIS CONCLUDED IN THE SECTION
1) mucous membrane along the transitional fold
2) the mucous membrane along the pterygo-mandibular fold
3) mucosa and periosteum for the entire length of the infiltrate along its most bulging part
4) in the submandibular region along the edge of the lower jaw
13. PERIOSTITIS BY THE NATURE OF INFLAMMATION IS
1) fibrous
2) serous
3) fibrinous
4) granulating
14. RE-FORMED BONE AFTER TREATMENT IS SUBJECT TO REVERSE DEVELOPMENT IN PERIOSTITIS
1) acute purulent
2) simple chronic
3) ossifying chronic
4) refractory chronic
15. TREATMENT OF RAREFICING PERIOSTITIS CONSISTS IN
1) the appointment of electrophoresis with 1 - 2% potassium iodide solution
2) removal of the causative tooth, the appointment of electrophoresis with 1 - 2% potassium iodide solution
3) removal of the causative tooth, excision of the proliferatively changed part of the periosteum, removal of the newly formed bone, prescribing medications and physical methods of treatment
4) removal or treatment of the causative tooth, opening of the subperiosteal abscess, prescribing medications
16. AFTER PERIOSTOTOMY, WOUND DRAINING IS CONDUCTED
1) after 2 hours
2) after opening a purulent focus
3) the next day
4) after the inflammation subsides
17. PARESTHESIA OF THE LOWER LIP ARISES WHEN LOCALIZATION OF THE PERIOSTI-TA IN THE REGION
1) incisors
2) canine
3) premolars
4) molars
18. SUBSCRIBLE ABSCESS IN THE SOLID SKY IS OPENED
1) cross cut
2) a lunar cut
3) a linear incision at the border of the hard and soft palate
4) by excision of a small area of the mucous membrane of a triangular shape, parallel to the midline of the palate
Appendix 3
SITUATION TASKS
TO CONTROL THE LEVEL OF ASSEMBLY OF THE TOPIC
Task 1. Patient K., 28 years old, turned to a dentist surgeon, complaining of malaise, an increase in body temperature up to 38.0 ° C, pain in the lower jaw on the left, swelling in the cheek area on the left.
Medical history. The onset of the disease is associated with the appearance about 3 days ago of pain in the 3.8 tooth and painful swelling in the left cheek area 2 days ago. On the next day, the swelling increased in size, the pain intensified, notes the deterioration of the general condition.
Objectively. The general condition is relatively satisfactory. Body temperature 38.0 ° C.
Local status. The configuration of the face was changed due to collateral edema of the soft tissues of the lower part of the buccal region on the left. The color of the skin above it is not changed, it is gathered in a fold. In the submandibular region, on the left, a single painful movable lymph node measuring 1.0 × 1.0 cm is palpated. Opening of the mouth is limited to 2.5 cm due to pain. The tongue is covered with a whitish coating.
In the 3.8 tooth there is a deep carious cavity filled with food debris, with percussion of the tooth, pain is noted, mobility of the I degree is determined. 3.7 the tooth is intact, with percussion, there is a slight soreness. The mucous membrane of the gums in the area of 3.7, 3.8 teeth is hyperemic, edematous from the vestibular side of the alveolar process. The transitional fold in the area of 3.7, 3.8 teeth is edematous, hyperemic. The mucous membrane of the retromolar region on the left is hyperemic, edematous, palpation is sharply painful. The mucous membrane in the area of the wing-jaw fold on the left is slightly hyperaemic. On the orthopantomogram, a focus of bone tissue destruction of 0.5 × 0.7 cm is determined in the area of the apex of the roots of the 3.8 tooth with indistinct boundaries.
1. Make a clinical diagnosis.
2. Make a treatment plan.
Task 2. Patient N., 70 years old, came to the dental clinic at the place of residence, accompanied by her granddaughter, patient N., with complaints of malaise, fever up to 37.5 ° C, pain in the lower jaw on the right, swelling -A bone in the cheek area on the right.
Medical history. According to the granddaughter, the onset of the disease is associated with the onset of pain in the 4.6 tooth about 2 days ago and painful swelling in the cheek area on the right. In the next day, the swelling increased in size.
Objectively. The general condition is relatively satisfactory. Body temperature 37.5 ° C.
Local status. The configuration of the face was changed due to collateral edema of the soft tissues of the buccal region on the right. The color of the skin above it is not changed, it is gathered in a fold. In the submandibular region on the left, a single painful movable lymph node measuring 1.0 × 1.0 cm is palpated. The mouth is opened in full. The tongue is covered with a whitish coating.
4.6 tooth is destroyed by 2/3, its percussion causes soreness, I degree mobility is noted. 4.5 tooth is missing. 4.7 tooth under the crown, with percussion, there is a slight soreness. The mucous membrane in the area of 4.6, 4.7 teeth from the vestibular side of the alveolar process and along the transitional fold is edematous, hyperemic, bulges out in the form of a roller, palpation of which is sharply painful.
1. Make a preliminary diagnosis.
2. What method of diagnostic examination still needs to be done?
3. Make a treatment plan.
Task 3. Patient V., 32 years old, came to the dental clinic at the place of residence, patient V., 32 years old, with complaints of pain in the lower jaw on the left, an increase in body temperature to 37.0 chin area.
Medical history. The onset of the disease is associated with the appearance of pain in the 3.3 tooth about a day ago. The previous evening there was a swelling in the chin area, after which the pain in the tooth decreased. According to the patient, 3.3 tooth a week ago was treated for complicated caries.
Objectively. The general condition is satisfactory. Body temperature 37.0 ° C.
Local status. The configuration of the face was changed due to collateral edema of the soft tissues of the chin region. The skin above it is not changed in color, it is difficult to fold into a fold.
3.3 tooth under filling, its percussion causes pain. 3.2, 3.4 teeth under the filling, with percussion they are slightly painful. The mucous membrane of the gums and the transitional fold of the alveolar process from the vestibular side in the area of 3.2, 3.3, 3.4 teeth is edematous, hyperemic, smoothed, palpation of this area is sharply painful.
On a sighting intraoral radiograph, the root canal 3. 3 teeth are filled all the way to the root apex. Expansion of the periodontal gap is observed in the area of the root apex of tooth 3.3.
1. Make a clinical diagnosis.
2. Make a treatment plan.
Task 4. Patient M., 40 years old, came to the dental clinic at the place of residence to the surgeon - stomatologist, complaining of headache, sleep disturbance, increased body temperature to 37.0 ° C, pain in the upper jaw on the left, swelling in the suborbital region on the left.
Medical history. According to the patient, the onset of the disease is associated with the fact that he had had the flu a week ago, after which pain appeared in 2.4 tooth, and two days later - painful swelling in the infraorbital region on the left.
Objectively. The general condition is satisfactory. Body temperature 37.0 ° C.
Local status. The configuration of the face was changed due to collateral edema of the soft tissues of the infraorbital region on the left. The color of the skin above it is not changed, it is gathered into a fold. In the submandibular region on the left, a single painful movable lymph node measuring 0.5 × 0.5 cm is palpated. The mouth is opened in full.
2.4 tooth under an artificial crown, its percussion causes soreness. 2.3, 2.5 teeth under the filling, with percussion, there is a slight soreness. The mucous membrane of the gums and the transitional fold on the left in the area of 2.3, 2.4, 2.5 teeth from the vestibular side are edematous, hyperemic. The transitional fold is smoothed, palpation of this area is painful.
1. Make a preliminary diagnosis.
2. What method of diagnostic examination should be carried out?
3. Make a treatment plan.
Problem 5. Patient A., 68 years old, came to the dental clinic at the place of residence to the surgeon - stomatologist, complaining of headache, sleep disturbance, fever up to 37.0 ° C, pain in the upper jaw on the right ...
Medical history. According to the patient, about three days ago, a swelling appeared in the area of the hard palate on the right, two days before that, pain in the 1.2 tooth was noted.
Anamnesis of life. Of the transferred and concomitant diseases, he notes - ARVI, type II diabetes mellitus, chronic gastritis.
Objectively. The general condition is satisfactory. Body temperature 37.0 ° C.
Local status. The face configuration has not been changed. The skin is of a physiological color. Regional lymph nodes are not palpable. Opening the mouth is free.
0 0 R 0 0 0 0 R 0
Dental formula: 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8
8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8
C C R 0
The crown part of the 1.2 tooth is completely destroyed, the percussion of the tooth causes pain, and the mobility of the II degree is noted. The mucous membrane of the gums from the vestibular side and the transitional fold at the level of 1.1, 1.2, 1.3 teeth is pale pink, moist. The mucous membrane in the area of the hard palate at the level of the above teeth is hyperemic, edematous, there is a round infiltration with clear boundaries, measuring 1.5 × 1.5 cm with softening in the center, palpation of this area is sharply painful.
On the sighting intraoral X-ray, a focus of bone tissue destruction of 0.8 × 0.8 cm in the area of the root apex of a 1.2 tooth with indistinct boundaries is determined.
1. Make a clinical diagnosis.
2. Determine the fate of the "causal" tooth.
3. Describe the surgical technique.
TOPIC: "TEETHING DISEASES. CAUSES. CLINIC, DIAGNOSTICS, TREATMENT. HARD CUTTING OF THE THIRD BOTTOM MOLAR. CLINIC, DIAGNOSTICS. COMPLICATIONS WITH DIFFICULT TEETHING WISDOM, TREATMENT "
1. Relevance. Anthropometric studies have shown that in phylogeny, due to a decrease in the chewing load of a modern person, the size of the lower jaw decreases. Also, a decrease in the size of the jaw can also occur in ontogenesis as a result of various past diseases (lack of vitamins, jaw trauma, hormonal disorders).
And since in a modern person the number and size of teeth have not decreased, in such cases, teething diseases (dystopia and retention) develop, as well as difficult eruption of the third lower molar. At the same time, teething diseases are rarely observed in people living in conditions of low civilization and eating the same rough animal and plant foods.
In 1 - 3% of the population, at present, third molars during embryogenesis are not laid at all. From 3 - 5% of the population do not experience difficulties associated with the eruption of these teeth. The rest may develop crowded teeth, pericoronitis, etc.
With difficult eruption of the third lower molar, complications such as retromolar periostitis, osteomyelitis, lymphadenitis, abscesses and phlegmon may develop.
In connection with the above, knowledge of the causes, clinical manifestations of teething diseases and difficult eruption of the third lower molar, additional examination methods, the ability to conduct differential diagnostics will allow the student to diagnose these diseases in a timely manner and prescribe treatment, thereby avoiding all kinds of complications.
2. The purpose of the lesson:
1) create conditions and assist students in mastering theoretical knowledge on etiology, pathogenesis, pathological anatomy, classification and clinic of teething diseases, medical skills in diagnosis, differential diagnosis, methods of their treatment and timely prevention of complications;
2) create conditions and assist students in mastering theoretical knowledge on etiology, pathogenesis, pathological anatomy, classification and clinic of difficult eruption of the third lower molar, medical skills in diagnostics, differential diagnosis, methods of its treatment and timely prevention of complications.
To form professional competencies, the student must know:
˗ Phylogenesis and ontogenesis of the maxillofacial region.
˗ The timing of the laying of tooth germs, as well as the timing, order of eruption and change of milk teeth.
˗ Timing and order of eruption of permanent teeth.
˗ Endogenous and exogenous factors affecting teething.
˗ Etiopathogenetic significance of early extraction of milk teeth for the development of teething diseases.
˗ Types of teething diseases.
˗ Methods of treatment of teething diseases and indications for them.
˗ Types of retention. Clinic.
˗ Types of dystopias. Clinic.
˗ The role of trauma in the growth zones of the jaws for the development of teething diseases.
˗ Additional research methods for teething diseases.
˗ Reasons for lack of space for the eruption of the third lower molar.
˗ Etiopathogenesis of the inflammatory process with difficult teething.
˗ Classification of pericoronitis.
˗ Features of the clinic of various forms of pericoronitis
˗ Diagnostics and differential diagnostics of pericoronitis.
˗ Treatment of various forms of pericoronitis and indications for them.
˗ Complications of pericoronitis.
To form professional competencies, the student must own:
1. OPK-5 (principles of analysis of its activities)
2.OPK-6 (analysis of the results of their own activities, skills in filling out medical documentation, methods of maintaining accounting and reporting documentation)
3. PC-2 (A / 04.7), theoretical knowledge on methods of examination of soft tissue injuries of the maxillofacial region, clinical course, diagnosis, differential diagnosis of injuries of the maxillofacial region;
4. PC-5 (A / 01.7), PC-6 (A / 01.7) skills of examination of patients with soft tissue injuries of the maxillofacial region, diagnosis and treatment of soft tissue injuries of the maxillofacial region.
5. PC-6 (A / 01.7) the ability to determine in patients the main pathological conditions, symptoms, syndromes of dental diseases, nosological forms in accordance with the International Statistical Classification of Diseases and Problems Related to Health.
6. PC-9 (A / 02.7) readiness for the management and treatment of patients with dental diseases on an outpatient basis and in a day hospital.
To form professional competencies, a student must be able to:
˗ Take anamnesis, examine the patient.
˗ Assign additional research methods for teething diseases.
˗ Evaluate the results of clinical and complementary research methods.
˗ Conduct differential diagnosis of teething diseases with other diseases that have common symptoms.
˗ Formulate a diagnosis in accordance with modern classification.
˗ Determine the indications for the extraction and preservation of teeth in teething diseases.
˗ Provide treatment for teething diseases.
˗ Conduct an examination of the disability of a patient with teething diseases.
˗ Carry out prevention of complications of teething diseases.
˗ Prescribe additional research methods in case of difficult eruption of the third lower molar.
˗ Evaluate the results of clinical and complementary research methods.
˗ To carry out differential diagnosis of difficult eruption of the third lower molar with other diseases that have common symptoms.
˗ Formulate a diagnosis in accordance with modern classification.
˗ Determine the indications for the extraction and preservation of teeth with difficult eruption of the third lower molar.
˗ Treat the eruption of the third lower molar.
˗ Conduct an examination of the disability of a patient with a difficult eruption of the third lower molar.
˗ To carry out the prevention of complications of difficult eruption of the third lower molar.
3. Necessary basic knowledge and skills (knowledge gained in the study of previous disciplines):
- Human Anatomy: Head and Neck Anatomy
Know:
- anatomical terms (Russian and Latin);
- anatomy and topography of the maxillofacial region;
- the relationship of organs with each other; projection of organs on the surface of the body;
- the main stages of development of the maxillofacial region (organogenesis);
- the main options for the structure and possible malformations of the salivary glands;
- the regularities of the structure of the human body as a whole, anatomical and functional relationships of individual parts of the body with each other.
- histology, embryology, cytology - histology of the oral cavity
Know:
- the main patterns of development and life of the human body based on the structural organization of cells, tissues and organs;
- histofunctional features of the tissue elements of the maxillofacial area; methods of their research.
- normal physiology - physiology of the maxillofacial region
Know:
- basic properties and conditions of excitable tissues, understanding of the mechanisms of bioelectric phenomena;
- functional properties and features of the salivary glands and saliva;
- principles of organization and functioning of the central nervous system (CNS);
- the role of proteins, fats, carbohydrates, minerals, vitamins and water in the body;
- physiological features of metabolism and energy in the body, between the body and the external environment;
- concept and classification of pain
- pharmacology
Know:
-classification and basic characteristics of drugs, pharmacodynamics and pharmacokinetics, indications and contraindications for the use of drugs;
- side effects when using drugs;
- general principles for the preparation of prescriptions and the preparation of prescription drug prescriptions.
4. Type of lesson: practical.
5. Duration of the lesson: 4 academic hours.
6. Equipment: multimedia projector, slides, diagrams, tables, sets of test items
Questions on the topic of the lesson:
1. Definition of teething diseases.
2. Classification of teething diseases.
3. Etiology of teething diseases.
4. Pathogenesis of teething diseases.
5. Clinical manifestations of tooth retention.
6. Clinical manifestations of teeth half-retention.
7. Clinical manifestations of dental dystopia.
8. Features of diagnosis, differential diagnosis of teething diseases.
9. Complex treatment for teething diseases.
10. Examination of the disability of patients with teething disease.
11. Indications for the preservation and extraction of teeth in teething diseases.
12. Physical factors used in the treatment of teething diseases.
13. Etiology of difficult teething (perekoronita).
14. Pathogenesis of pericoronitis.
15. Classification of pericoronites.
16. Features of the clinic of various forms of pericoronitis.
17. Diagnostics and differential diagnostics of pericoronitis.
18. Treatment of various forms of pericoronitis and indications for them.
19. Complications of pericoronitis.
20. Examination of the disability of patients with difficult teething.
Place of self-training: reading room, study room for independent work of students.
Educational and research work of students on this topic:
1. Methods of surgical treatment of teeth dystopia in the upper and lower jaws.
2. The choice of a surgical method for the treatment of difficult eruption of the lower third molar, depending on its location.
Appendices to the topic: “Diseases of teething. Causes. Clinic, diagnostics, treatment. Difficulty erupting the third lower molar. Clinic, diagnostics. Complications with difficult teething of wisdom teeth, treatment "
Annex 1
TESTS FOR CONTROL
INITIAL LEVEL OF KNOWLEDGE
Choose one of the most correct answers.
1. PERMANENT TEETH FORMATION AND FORMATION STARTS WITH
1) 1st month of embryonic life
2) 3rd month of embryonic life
3) 5th month of embryonic life
4) 7th month of embryonic life
2. THE FOLLICULE OF THE PERMANENT THIRD MOLAR IS IMPLEMENTED IN
1) 4 years
25 years
36 years
4) 20 years old
3. THIRD LOWER MOLAR REMOVE
1) straight tongs
2) bayonet forceps
3) Limberg crochet
4) bayonet elevator
4. THE THIRD LOWER MOTOR TOOTH HAS
1) 1 root
2) 2 roots
3) 3 roots
4) often the number of roots can be variable
5. IN THE PROCESS OF THE PHILOGENESIS OF THE JAW OF A MODERN HUMAN
1) increased
2) decreased
3) have not changed
4) no such studies have been conducted
6. THE NUMBER OF TEETH IN PERMANENT BITE IS IN NORMAL
1) 10
2) 20
3) 26
4) 32
7. POSSIBLE COMPLICATION DURING REMOVAL OF THE THIRD MOLAR OF THE LOWER JAW -
1) alveolitis
2) the formation of exostosis
3) fracture of the lower jaw
4) perforation of the maxillary sinus
8. WHEN REMOVING THE THIRD LOWER MOLAR, USE ANESTHESIA
1) torusal
2) tuberous
3) buccal nerve
4) lingual nerve
9. WHEN REMOVING THE FRONTAL GROUP OF THE UPPER JAW TEETH, ANESTHESIA IS APPLIED
1) infiltration and incisal
2) infiltration and palatal
3) according to Bersha - Dubov
4) by Weisbram
10. WHEN REMOVING PREMOLARS ON THE LOWER JAW, APPLY ANE-STESIA
1) mental
2) according to Vaysblat
3) according to Vishnevsky
4) infraorbital
11. THIRD MOLARS OF THE UPPER JAW REMOVE WITH TONGS
1) S - shaped with a thorn
2) S - shaped with converging cheeks
3) bayonet with converging cheeks
4) bayonet with non-converging rounded cheeks
Appendix 2
TESTS FOR CONTROL
LEVEL OF ASSEMBLY OF THE TOPIC
Choose one of the most correct answer
1. EXTRACTION OF A DISTRICTED TOOTH IS CARRIED OUT UNDER
1) application of anesthesia
2) electrosleep
3) acupuncture
4) conduction anesthesia
2. INDICATION FOR RETINATED TOOTH EXTRACTION SERVICES
1) TMJ dysfunction
2) the development of inflammatory complications
3) wedge-shaped defect
4) periodontal disease
3. LOCAL COMPLICATION OF DIFFICULT EXTRACTION OF THE THIRD MOLAR OF THE LOWER JAW IS
1) neuralgia
2) microstomy
3) pericoronitis
4) xerostomia
4. AT THE CORRECT POSITION OF THE THIRD LOWER MOLAR AND THE KATA-RAL PERICORONITE
1) tooth extraction
2) sequestrectomy
3) excision of the hood
4) incision along the transition fold
5. TOOTH RETENTION IS
1) incomplete eruption of a tooth through the jaw bone tissue or mucous membrane
2) timely eruption of the formed permanent tooth
3) delay in the eruption of a normally formed permanent tooth
4) incorrect position in the dentition of the erupted tooth or its abnormal location in the jaw
6. IN MEDIALLY - OBJECTED POSITION OF THE LOWER THIRD MOLAR
1) the axis of the tooth is perpendicular to the axis of the second molar
2) the axis of the tooth is parallel to the axis of the second molar
3) the axis of the wisdom tooth is inclined at an acute angle to the axis of the second molar
4) the axis of the wisdom tooth is inclined at an acute angle to the front edge of the lower jaw branch
7. THE HALF OF WASSMUND IS
1) rarefaction of the bone around the apex of the root of the lunar tooth
2) the shadow of a dense formation with sharply delineated boundaries
3) rarefaction of the bone around the apex of the tooth root
4) rarefaction of the bone behind the distal root of the third lower molar of a semilunar shape with a width of about 3.0 mm with indistinct boundaries
8. X-RAY METHOD OF RESEARCH, APPLIED FOR HARD CUTTING OF THE THIRD LOWER MOLAR, -
1) computed tomography
2) angiography
3) orthopantomography
4) sialography
9. ROOT IN THE UNFORMED TOP STAGE ON THE X-RAY GRAM
1) of normal length with a pointed apex, a narrow apical foramen
2) normal length with a pointed apex, wide apical foramen
3) shorter than normal length, narrow root canal
4) shorter than normal length, the root canal is wide, widens at the root apex
10. TEETH ANOMALIES ARE
1) tortoanomaly
2) retention
3) supernumerary teeth
4) microdentia
11. VESTIBULO-ORAL POSITION OF THE TEETH IS THE RESULT
1) carious destruction of tooth crowns
2) lowering the occlusal height
3) lack of space in the dentition
4) TMJ dysfunction
12. IN DYSTOPY OF THE THIRD LOWER MOLAR, OPERATIONAL ACCESS IS IN THE SECTION
1) along the transitional fold from the lingual side
2) along the transitional fold from the vestibular side
3) from the middle of the second molar down to the transitional fold from the vestibular side
4) from the middle of the first molar down to the transitional fold from the vestibular side
13. PERICORONAROTOMY IS
1) excision of the hood
2) dissection of the hood
3) convergence of the edges of the hole
4) opening the inflammatory focus with periostitis
14. FOR NORMAL CUTTING OF THE LOWER THIRD MOLAR, IT IS NECESSARY THAT THE DISTANCE FROM THE HARD EDGE OF THE SECOND LOWER MOLAR TO THE FORWARD EDGE OF THE LOWER JAW BRANCH IS NOT LESS
1) 5 mm
2) 10 mm
3) 15 mm
4) 20 mm
15. PERICORONIT IS
1) subperiosteal inflammation
2) inflammation of the bone of the lower jaw
3) sluggish inflammation in the subcutaneous tissue
4) inflammation of the soft tissues surrounding the crown of the tooth during its incomplete and difficult eruption
16. PHYSIOLOGICAL STANDARD OF THE PERIODONTAL FISSION ON THE DISTAL SIDE OF THE CROWN OF THE THIRD LOWER MOLAR IS CONSIDERED
1) 1 mm
2) 2 mm
3) 3 mm
4) 4 mm
17. RESORPTION OF BONE TISSUE BEHIND THE DISTAL CROWN OF THE THIRD LOWER MOLAR ARISES AS A RESULT
1) the presence of a hood
2) caries
3) lack of space in the jaw
4) chronic inflammatory process
18. IN THE CLASSIFICATION OF PERICORONITIS, FORMS DETERMINE
1) catarrhal, purulent
2) fibrous, granulating, granulomatous
3) simple, ossifying, refining
4) serous, purulent
Appendix 3
SITUATION TASKS
TO CONTROL THE LEVEL OF ASSEMBLY OF THE TOPIC
Task 1. Patient L., 22 years old, turned to a dentist surgeon with complaints of trauma to the tongue with a 3.5 tooth.
Objectively. The general condition is satisfactory.
Local status. The face configuration has not been changed. The skin is of a physiological color. In the submandibular region on the left, a single painful movable lymph node measuring 1.0 × 1.0 cm is palpated. The mouth is opened in full.
There is a narrowing of the dental arches of the upper and lower jaws, crowding of the frontal group of the teeth of the lower jaw. The 3.5 tooth is located outside the dentition, has a lingual-to-soy arrangement. From the medial - approximal surface of the crown, there is a deep carious cavity filled with food debris; no pain is noted during probing and percussion. The mucous membrane of the gums is pale pink, moist, shiny.
Tongue coated white. On the left lateral surface of the tongue, there is a rounded ulcer measuring 0.4 × 0.4 cm. The bottom of the ulcer is soft and covered with fibrin, the palpation is painful.
1. Make a preliminary diagnosis.
2. Make a treatment plan.
Task 2. Patient I., 26 years old, turned to the dentist surgeon, with complaints of weakness, constant pain behind the 3.7 tooth, aggravated by chewing, pain when swallowing, bad breath, restriction of opening the mouth, irradiation pain in the left ear, swelling of the cheek on the left.
Anamnesis of life. Has been suffering from chronic tonsillitis for 10 years.
Medical history. The pain bothers about 5 days.
Objectively. The general condition is relatively satisfactory. Body temperature 38.0 ° C.
Local status. The configuration of the face was changed due to collateral edema of the soft tissues of the lower part of the buccal region on the left. Physiological color of the skin. In the submandibular region, on the left, a single painful movable lymph node measuring 1.0 × 1.0 cm is palpable.The opening of the mouth is limited to 3.0 cm due to pain and inflammatory muscle contracture.
The crown of the 3.8 tooth is covered with a hyperemic, edematous mucous membrane, with pressure on which purulent discharge and soreness are noted. The mucous membrane of the pterygoid-mandibular fold, the anterior palatine arch on the left and the lower arch of the vestibule of the mouth at the level of 3.8 tooth is hyperemic, edematous.
On the orthopantomogram, a vertically located 3.8 tooth is determined. Its roots are fully formed. Behind the distal root of tooth 3.8, there is an expansion of the periodontal lunate fissure (Vasmund half moon) with a width of about 3.0 mm.
1. Make a clinical diagnosis.
2. Make a treatment plan.
3. With what other diseases should this disease be differentiated?
Task 3. Patient D., 24 years old, turned to a dentist surgeon with complaints of soreness of the mucous membrane in the region of a partially erupted 4.8 tooth.
Medical history. According to the patient, the patient has been ill for about two days.
Objectively. The general condition is satisfactory. Body temperature 36.6 ° C.
Local status. The face configuration has not been changed. The skin is of a physiological color. In the submandibular region, a single painful movable lymph node 0.5 × 0.5 cm in size is palpated on the right. The mouth is opened in full. Tongue coated white.
The 4.8 tooth was partially erupted by the medial tubercles. The rest of the coronal part is covered with a hyperemic mucous membrane (hood), there is no edema, there is no discharge from under it, its palpation causes pain.
P S P 0
Dental formula: 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8
8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8
0 P C 0
On the orthopantomogram, an incompletely erupted 4.8 tooth is determined, which has a vertical position. The roots of the 4.8 tooth are fully formed.
1. Make a clinical diagnosis.
2. Make a treatment plan.
3. Determine the cause of the disease. Schedule preventive measures.
Task 4. Patient L., 20 years old, turned to a dentist surgeon for a preventive examination.
Objectively. The general condition is satisfactory. Body temperature 36.6 ° C.
Local status. The face configuration has not been changed. The skin is of a physiological color. Regional lymph nodes are not palpable. Opening the mouth in full.
0 P P P0
Dental formula: 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8
8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8
0 K P 0
On the orthopantomogram, an unerupted 2.8 tooth is determined, which has a medial - oblique location, with formed roots, completely surrounded in the bone tissue of the upper jaw on the left. The thickness of the bone tissue from the distal tubercles of the 2.8 tooth to the alveolar edge of the jaw is 1.0 mm. The 2.8 tooth with medial tubercles rests on the roots of the 2.7 tooth from the distal side.
1. Make a clinical diagnosis.
2. What is the doctor's tactics in relation to 2.8 teeth?
Task 5. Patient S., 50 years old, turned to a dentist surgeon, complaining of a painful aching character in the lower jaw on the right during a meal, a periodic feeling of numbness in this area.
Medical history. The onset of the disease is associated with the performed removable prosthetics of the lower jaw three months after the removal of the roots of 4.4, 4.6 teeth.
Objectively. The general condition is satisfactory. Body temperature 36.6 ° C.
Local status. The face configuration has not been changed. The skin is of a physiological color. Regional lymph nodes are not palpable. Opening the mouth in full.
Terminal defects of the dentition of the lower jaw were restored with a clasp prosthesis that meets medical and technological requirements. The occlusion on the artificial teeth is not disturbed. The mucous membrane of the oral cavity and prosthetic bed without pathological changes. The edentulous areas of the alveolar part of the lower jaw are uniformly moderately atrophied.
On the orthopantomogram, an unerupted 4.5 tooth is determined, which has a distal - oblique location, with formed, accrete roots, completely located in the thickness of the body of the lower jaw on the right. The roots of the 4.5 tooth are projected onto the inferior alveolar canal on the right.
1. Make a clinical diagnosis.
2. What is the tactic for 4.5 teeth?
TOPIC: "ODONTOGENIC OSTEOMYELITIS OF JAWS. CLASSIFICATION. ETIOLOGY. MODERN CONCEPTS OF PATHOGENESIS. PATHOLOGICAL ANATOMY. ACUTE STAGE OF OSTEOMYELITIS OF CHE-LUSTEY. CLINIC, DIAGNOSTICS, DIFFERENTIAL
DIAGNOSTICS. TREATMENT"
1. Relevance. In the modern view, osteomyelitis of the jaws is an infectious-allergic purulent-necrotic process of all bone structures (cancellous bone, cortical plate, periosteum, bone) with the involvement of the bone marrow and surrounding soft tissues. Osteomyelitis of the jaws in more than 80% of cases have odontogenic origin.
A purulent-necrotic process in osteomyelitis can be located on the upper or lower jaw, be localized only in the area of the alveolar process of the jaw, or spread to its body, covering a small area (area of 2-3 teeth), half of the jaw, or the entire jaw.
Odontogenic osteomyelitis of the jaws in its course passes through certain stages (acute, subacute and chronic), characterized by general nonspecific symptoms and many local symptoms, which make up the clinic of odontogenic osteomyelitis, according to the stages of its course.
Clinical symptoms in acute odontogenic osteomyelitis of the jaws depend on age, immunoreactivity, concomitant diseases, type of body reaction, virulence of infection, localization and prevalence of the pathological process.
The acute stage of odontogenic osteomyelitis of the jaws has a definite clinic, which differs from the clinic of the subacute and chronic stages, but is similar in many respects to other acute inflammatory diseases
maxillofacial area. Therefore, the differential diagnosis of acute odontogenic osteomyelitis of the jaws seems to be very important in practical terms.
In order to correctly formulate the diagnosis, it is also very important to know the existing classifications, drawn up taking into account modern ideas about the etiology and pathogenesis of jaw osteomyelitis. All this will allow you to choose the right treatment tactics at the pre-hospital, hospital, post-hospital stages and avoid all possible complications.
All of the above emphasizes the relevance of the topic under study.
2. The purpose of the lesson: to create conditions and assist in the acquisition of theoretical knowledge on classification, etiology, modern understanding of the pathogenesis and pathological anatomy of jaw osteomyelitis; knowledge of the clinical symptoms of acute odontogenic osteomyelitis of the jaws and medical skills for the diagnosis, complex treatment of patients with odontogenic osteomyelitis of the jaws in the acute stage and timely prevention of complications.
To form professional competencies, the student must know:
- the microflora of the oral cavity;
- immunobiological features of the oral cavity and maxillofacial area;
- features of the anatomical structure of the upper and lower jaws;
- blood supply and innervation of the jaws;
- localization of regional lymph nodes and pathways of lymph drainage from the jaws;
- the mechanism of development of inflammatory processes;
- pathological anatomy of inflammatory processes in bone tissue;
- pathophysiological manifestations of inflammation;
- definition of odontogenic osteomyelitis of the jaws;
- the etiology of odontogenic osteomyelitis of the jaws;
- pathogenesis of odontogenic osteomyelitis of the jaws;
- pathological anatomy of odontogenic osteomyelitis of the jaws (in acute, subacute and chronic stages);
- classification of odontogenic osteomyelitis of the jaws
- by origin
- according to the clinical course
- by prevalence, etc .;
- clinic of odontogenic osteomyelitis of the jaws in the acute stage;
- diagnosis of odontogenic osteomyelitis of the jaws in the acute stage;
- additional research methods used in the diagnosis of odontogenic osteomyelitis of the jaws in the acute stage;
- differential diagnosis of odontogenic osteomyelitis of the jaws in the acute stage;
- principles of treatment of patients with odontogenic osteomyelitis of the jaws in the acute stage;
- methods of surgical treatment of odontogenic osteomyelitis of the jaws in the acute stage;
- the principles of antibacterial effects on the course of the inflammatory process;
- principles and means of detoxification of the body;
- principles and means of immunocorrective influence;
- indications and contraindications for the appointment of physical methods of treatment for odontogenic osteomyelitis of the jaws in the acute stage;
- examination of the disability of patients with odontogenic osteomyelitis of the jaws in the acute stage;
- prevention of odontogenic osteomyelitis of the jaws in the acute stage.
To form professional competencies, the student must own:
1. OPK-5 (principles of analysis of its activities)
2.OPK-6 (analysis of the results of their own activities, skills in filling out medical documentation, methods of maintaining accounting and reporting documentation)
3. PC-2 (A / 04.7), theoretical knowledge on methods of examination of injuries of soft tissues of the maxillofacial region, clinical course, diagnosis, differential diagnosis of injuries of the maxillofacial region;
4. PC-5 (A / 01.7), PC-6 (A / 01.7) skills of examination of patients with soft tissue injuries of the maxillofacial region, diagnosis and treatment of soft tissue injuries of the maxillofacial region.
5. PC-6 (A / 01.7) the ability to determine in patients the main pathological conditions, symptoms, syndromes of dental diseases, nosological forms in accordance with the International Statistical Classification of Diseases and Problems Related to Health.
6. PC-9 (A / 02.7) readiness for the management and treatment of patients with dental diseases on an outpatient basis and in a day hospital.
To form professional competencies, the student must be able to:
- conduct a survey of organs and systems;
- to identify the etiology of odontogenic osteomyelitis of the jaws;
- to appoint a plan of additional examination;
- to evaluate the results of clinical and laboratory-instrumental data;
- to carry out differential diagnosis of odontogenic osteomyelitis of the jaws in the acute stage;
- to formulate a diagnosis in accordance with the modern classification;
- apply knowledge on the etiology and pathogenesis of odontogenic osteomyelitis of the jaws when drawing up a treatment plan;
- to prescribe complex treatment for patients with odontogenic osteomyelitis of the jaws in the acute stage with various types of inflammatory reaction;
- to carry out on the phantom surgical methods of treating patients with odontogenic osteomyelitis of the jaws in the acute stage;
- to carry out an examination of the disability of patients with odontogenic osteomyelitis of the jaws in the acute stage;
- to appoint primary and secondary preventive measures.
3. Necessary basic knowledge and skills (knowledge gained in the study of previous disciplines):
- Human Anatomy: Head and Neck Anatomy
Know:
- anatomical terms (Russian and Latin);
- anatomy and topography of the maxillofacial region;
- the relationship of organs with each other; projection of organs on the surface of the body;
- the main stages of development of the maxillofacial region (organogenesis);
- the main options for the structure and possible malformations of the salivary glands;
- the regularities of the structure of the human body as a whole, anatomical and functional relationships of individual parts of the body with each other.
- histology, embryology, cytology - histology of the oral cavity
Know:
- the main patterns of development and life of the human body based on the structural organization of cells, tissues and organs;
- histofunctional features of the tissue elements of the maxillofacial area; methods of their research.
- normal physiology - physiology of the maxillofacial region
Know:
- basic properties and conditions of excitable tissues, understanding of the mechanisms of bioelectric phenomena;
- functional properties and features of the salivary glands and saliva;
- principles of organization and functioning of the central nervous system (CNS);
- the role of proteins, fats, carbohydrates, minerals, vitamins and water in the body;
- physiological features of metabolism and energy in the body, between the body and the external environment;
- concept and classification of pain
- pharmacology
Know:
-classification and basic characteristics of drugs, pharmacodynamics and pharmacokinetics, indications and contraindications for the use of drugs;
- side effects when using drugs;
- general principles for the preparation of prescriptions and the preparation of prescription drug prescriptions.
4. Type of lesson: practical.
5. Duration of the lesson: 4 academic hours.
6. Equipment: multimedia projector, slides, diagrams, tables, sets of test items
Questions on the topic of the lesson:
1. Definition of odontogenic osteomyelitis of the jaws.
2. Classification of osteomyelitis of the jaws.
3. Predisposing factors for the development of odontogenic osteomyelitis of the jaws.
4. Theories of the pathogenesis of odontogenic osteomyelitis of the jaws.
5. Pathological anatomy of odontogenic osteomyelitis of the jaws (according to the stages of the clinical course).
6. Clinic of odontogenic osteomyelitis of the jaws in the acute stage.
7. Diagnosis of odontogenic osteomyelitis of the jaws in the acute stage.
8. Differential diagnosis of odontogenic osteomyelitis of the jaws in the acute stage.
9. Treatment of patients with odontogenic osteomyelitis of the jaws in the acute stage.
10. Examination of the disability of patients with odontogenic osteomyelitis of the jaws in the acute stage.
11. Prevention of acute odontogenic osteomyelitis of the jaws.
Place of self-training: reading room, study room for independent work of students.
Educational and research work of students on this topic:
1. Antibiotic therapy in the treatment of patients with odontogenic osteomyelitis of the jaws in the acute stage.
2. The role and mechanism of action of vitamins on the course of the inflammatory process.
“Odontogenic osteomyelitis of the jaws. Classification. Etiology. Modern concepts of pathogenesis. Pathological anatomy. Acute stage of jaw osteomyelitis. Clinic, diagnostics, differential diagnostics. Treatment"
Annex 1
TESTS FOR CONTROL
INITIAL LEVEL OF KNOWLEDGE
Choose one or more correct answers
1. THE ANATOMICAL FEATURES OF THE UPPER JAW ARE
1) a small amount of spongy substance
2) a significant amount of spongy substance
3) thin compact plate, the presence of many holes
4) dense compact plate
2. ANATOMICAL FEATURES OF THE LOWER JAW ARE
1) a small amount of spongy substance
2) a significant amount of spongy substance
3) thin compact plate, the presence of many holes
4) dense compact plate
3. BLOOD SUPPLY OF THE JAWS IS PERFORMED
1) superficial temporal artery
2) branches of the maxillary artery
3) facial artery
4) lingual artery
4. THE TEETH OF JAWS ARE INERVATED
1) the hypoglossal nerve
2) facial nerve
3) the vagus nerve
4) branches of the trigeminal nerve
5. THE MIDDLE UPPER ALVEOLAR BRANCH INSERTS THE TEETH OF THE UPPER JAW
1) incisors
2) fangs
3) premolars
4) molars
6. TO DISCONNECT THE REAR UPPER ALVEOLAR BRANCHES, ANESTHESIA IS PERFORMED
1) incisor
2) palatinal
3) infraorbital
4) tuberous
7. NERVES ARE RELATED TO SENSITIVE FIBERS OF THE NERVES
1) palatine
2) buccal
3) lingual
4) lower alveolar
8.To turn off the sensory fibers of the mandibular non-moat, anesthesia is performed in the mandibular roller
1) P. M. Egorov
2) M. M. Weisbrem
3) Bershe
4) S.N. Vaysblat
9. MOTOR FIBERS OF THE LOWER MANDAL NERVE INERVATE MUSCLES
1) chewable
2) mimic
3) the floor of the mouth
4) language
10. MUSCLES LIFTING THE LOWER JAW ARE RELATED TO
1) chewable
2) temporal
3) lateral and medial pterygoid
4) buccal
11. IN INFLAMMATORY CONTRACT OF THE LOWER JAW, PERFORM ANESTHESIA ON
1) Dubov
2) M. M. Weisbrem
3) Bershe
4) S.N. Vaysblat
12. FROM THE CUTTERS AND CANCES OF THE JAWS, THE LYMPH FLOWS INTO ... LYMPH NODES
1) facial
2) buccal
3) submandibular
4) chin
13. FROM THE PREMOLARS AND MOLARS OF THE LOWER JAW LYMPH FLOWS INTO ... LYMPH NODES
1) facial
2) buccal
3) submandibular
4) chin
14. THE TYPES OF INFLAMMATORY REACTIONS OF THE BODY ARE
1) anaphylaxis
2) normergy
3) hypoergy
4) hyperergy
15. LOCAL, INTEGRATED, VASCULO-MESENCHIMAL REACTION IN RESPONSE TO DAMAGE IS
1) necrosis
2) adaptation
3) inflammation
4) thrombosis
16. INFLAMMATION HAS THE FOLLOWING PHASES
1) alteration
2) exudation
3) proliferation
4) reparation
17. IN THE ALTERATION PHASE
1) release of inflammatory mediators of humoral and cellular origin
2) emigration of blood cells
3) the formation of exudate and inflammatory cell infiltrate
4) multiplication of local cellular components in the focus of inflammation
18. THE MAIN COMPONENTS OF THE EXUDATION PHASE ARE
1) release of inflammatory mediators of humoral and cellular origin
2) change in blood flow
3) emigration of blood cells and phagocytosis
4) the formation of exudate and inflammatory cell infiltrate
19. THE PROLIFERATION PHASE IS CHARACTERIZED
1) the release of inflammatory mediators of humoral and cellular origin
2) phagocytosis
3) the formation of exudate and inflammatory cell infiltrate
4) multiplication of local cellular components in the focus of inflammation
Set correspondence
20. SYMPTOM OF INFLAMMATION CAUSE
1) rubor (redness) a) the exit of fluid from the lumen of the vessels
2) dorol (pain) in tissue
3) calor (fever) b) vasodilation
4) tumor (swelling) c) increased blood flow velocity, inflammatory hyperemia
d) irritation of pain receptors by inflammatory mediators and compression
Appendix 2
TESTS FOR CONTROL
LEVEL OF ASSEMBLY OF THE TOPIC
Choose one or more correct answers
1. OSTEOMYELITIS IS
1) putrefactive necrotic process of all bone structures
2) an infectious-allergic, purulent-necrotic process of all bone structures with the involvement of the bone marrow and surrounding soft tissues
3) acute purulent inflammation of the periosteum of the alveolar process or the body of the jaw
4) diffuse purulent inflammation of the cellulose
2. The causative agents of odontogenic osteomyelitis of the jaws are
1) golden and white staphylococci, streptococci
2) rod-shaped bacteria in combination with putrefactive
3) viruses
4) radiant mushrooms
3. Infection in the jaw with odontogenic osteomyelitis PRONIC-ET VIA
1) apical and marginal periodontium
2) inflamed oral mucosa
3) the resulting gap in the fracture of the jaw
4) lymph nodes
4. FOR THE DEVELOPMENT OF ODONTOGENOUS OSTEOMYELITIS OF THE JAWS ARE DEFINITELY IMPORTANT
1) congenital and acquired immunity disorders
2) anatomical features of the jaws
3) blood circulation
4) lymphatic system
5. IN THE ACUTE PURULENT STAGE OF ODONTOGENOUS OSTEOMYELITIS OF THE CHELI-STEY, PATANATOMICALLY DETERMINED
1) edema and hyperemia of certain areas of the bone marrow
2) foci of purulent infiltration of the bone marrow, vascular thrombosis with their subsequent purulent fusion, bone necrosis
3) the proliferation of vascular-rich granulation tissue in the circumference of the dead bone areas, the onset of sequestration, the neoplasm of bone tissue
4) delimitation of inflammatory foci, rejection of sequesters, neoplasm of bone tissue
6. IN THE SUB-STAGE OF ODONTOGENOUS OSTEOMYELITIS OF THE JAWS PA-TOLOGO-ANATOMICALLY DETERMINED
1) edema and hyperemia of certain areas of the bone marrow
2) foci of purulent infiltration of the bone marrow, vascular thrombosis with their subsequent purulent fusion, bone necrosis
3) the proliferation of vascular-rich granulation tissue in the circumference of the dead bone areas, the onset of sequestration, the neoplasm of bone tissue
4) delimitation of inflammatory foci, rejection of sequesters, neoplasm of bone tissue
7. IN THE CHRONIC STAGE OF ODONTOGENOUS OSTEOMYELITIS OF THE JAWS, PATHOLOGICAL-ANATOMICALLY DETERMINED
1) edema and hyperemia of certain areas of the bone marrow
2) foci of purulent infiltration of the bone marrow, vascular thrombosis with their subsequent purulent fusion, bone necrosis
3) the proliferation of vascular-rich granulation tissue in the circumference of the dead bone areas, the onset of sequestration, the neoplasm of bone tissue
4) delimitation of inflammatory foci, rejection of sequesters, neoplasm of bone tissue
8. CLINICALLY ODONTOGENOUS OSTEOMYELITIS OF JAWS IS CLASSIFIED ON
1) acute, chronic
2) acute, subacute, chronic
3) primary chronic
4) chronic in the stage of exacerbation
9. Chronic odontogenic osteomyelitis of the jaws
1) sequestering
2) re-refining
3) purulent
4) hyperplastic
10. SEQUESTERING FORM OF CHRONIC ODONTOGENOUS OSTEO-MYELITIS OF JAWS IS A FORM WITH DOMINATION OF PROCESSES
1) productive
2) destructive
3) destructive-productive
11. NESTED FORM OF CHRONIC ODONTOGENOUS OSTEOMYELITIS OF JAWS IS A FORM WITH DOMINATION OF PROCESSES
1) productive
2) destructive
3) destructive-productive
12. HYPEROSTOUS FORM OF CHRONIC ODONTOGENOUS OSTEOMY-LITA OF THE JAWS - THIS IS A FORM WITH THE PREVENTION OF PROCESSES
1) productive
2) destructive
3) destructive-productive
13. WITH LIMITED ODONTOGENIC OSTEOMYELITIS OF JAWS, PATHOLOGICAL PROCESS
1) covers half or all of the jaw
2) localized within the alveolar process
3) localized in the area of the body or the angle of the jaw
14. IN FOCAL ODONTOGENIC OSTEOMYELITIS OF JAWS, PATHOLOGICAL PROCESS
1) covers half or all of the jaw
2) localized within the alveolar process
3) localized in the area of the jaw body or jaw angle
15. IN DIFFUSE ODONTOGENIC OSTEOMYELITIS OF JAWS, PATHOLOGICAL PROCESS
1) covers half or all of the jaw
2) localized within the alveolar process
3) localized in the area of the jaw body or jaw angle
16. DURING EXTERNAL EXAMINATION OF A PATIENT WITH ACUTE PURULENT ODONTOGENOUS OSTEOMYELITIS OF THE JAW FACE CONFIGURATION
1) not changed
2) is changed due to collateral edema of soft tissues, the skin over it is not changed in color, it is easily taken into a fold
3) is changed due to pronounced collateral edema and infiltration of soft tissues, the skin over it is hyperemic, tense, shiny, does not fold into the fold
4) is changed due to inflammatory infiltration of soft tissues, the skin over it has a bluish tint
17. IN ACUTE PURULENT ODONTOGENIC OSTEOMYELITIS OF THE JAW RE-HYONARY LYMPH NODES
1) not palpable
2) on palpation painless, soft, elastic consistency, not soldered to the surrounding tissues
3) enlarged and painful, palpable throughout the entire process of the disease
4) enlarged and painful, palpable only at the beginning of the process
18. IN THE ACUTE PURULENT STAGE OF ODONTOGENOUS OSTEOMYELITIS OF THE HUMAN BEAM, THE MUCOSA IS CHARACTERIZED
1) slight swelling and hyperemia of the gums in the area of the causative tooth
2) severe swelling and hyperemia of the gums on one side of the jaw
3) severe swelling and hyperemia of the gums on both sides of the jaw
4) no changes in the area of the causative tooth
19. IN ACUTE PURULENT ODONTOGENIC OSTEOMYELITIS OF THE JAW, MOBILITY IS REMAINED
1) I-II degree of the causative tooth
2) II- III degree of the causative tooth
3) II-III degree of the causative and adjacent tooth
4) II-III degree of causal and row of teeth
20. HYPOESTHESIA OF THE SOFT TISSUE OF THE AFFECTED AREA OF THE JAW IN ACUTE ODONTOGENIC OSTEOMYELITIS - A SYMPTOM
1) Brudzinsky
2) loads
3) Vincent
4) vasoparesis
21. AT X-RAY EXAMINATION OF JAW IN THE ACUTE STAGE OF ODONTOGENOUS OSTEOMYELITIS
1) foci of destruction of bone tissue without clear boundaries
2) only changes characterizing the previous odontogenic pathological process
3) against the background of destruction of bone tissue, shadows of various sizes and shapes
4) foci of osteosclerosis
22. DIFFERENTIAL DIAGNOSTICS OF ACUTE ODONTOGENOUS JAW OSTEOMYELITIS MUST BE CARRIED OUT WITH
1) abscesses and phlegmon
2) a festering odontogenic cyst
3) trigeminal neuralgia
4) acute (or exacerbated chronic) periodontitis
23. COMPREHENSIVE TREATMENT OF ACUTE ODONTOGENOUS OSTEOMYELITIS OF THE JAW INCLUDES
1) surgical intervention
2) drug therapy
3) herbal medicine
4) physical methods
24. SURGICAL TREATMENT FOR ACUTE ODONTOGENIC OSTEOMIELI-THOSE JAWS INCLUDE IN
1) removal of the causative tooth
2) periostotomy in the area of the causative tooth, drainage
3) removal of the causative tooth, wide periostotomy of the jaw on one side of the alveolar process, drainage
4) removal of the causative tooth, wide periostotomy of the jaw on both sides of the alveolar process, drainage
25. OSTEOPERFORATION OF THE JAW IN THE TREATMENT OF THE ACUTE PHASE OF ODONTOGENIC OSTEOMYELITIS IS CONDUCTED FOR A PURPOSE
1) evacuation of pus
2) prevention of pathological jaw fracture
3) carrying out intraosseous lavage
4) formation of access to sequestration
26. THE MEDICINAL TREATMENT OF A PATIENT WITH ACUTE ODONTOGENIC JAW OSTEOMYELITIS INCLUDES THERAPY
1) anti-inflammatory
2) desensitizing
3) hypotensive
4) detoxification
27. FOR ANTI-INFLAMMATORY THERAPY OF ACUTE ODONTOGENIC OSTEOMYELITIS OF THE JAW IS USED
1) broad-spectrum antibiotics with osteotropic action
2) sulfonamides
3) nitrofuran preparations
4) hypoglycemic agents
28. FROM PHYSICAL METHODS FOR TREATMENT OF ACUTE ODONTOGENOUS JAW OSTEOMYELITIS IS USED
1) hyperbaric oxygenation
2) electrophoresis
3) massage
4) ultraviolet irradiation
29. WITH AN ADVERSE COURSE OF ACUTE ODONTOGENIC OSTEOMY-LITIS JAWS MAY BE COMPLICATED
1) phlegmons
2) cicatricial contracture
3) sepsis
4) thrombosis
Appendix 3
SITUATION TASKS
TO CONTROL THE LEVEL OF ASSEMBLY OF THE TOPIC
Task 1. Patient R.,
24 years old, with complaints of constant aching pains in the upper jaw on the left, radiating to the temporal region, swelling of the left half of the face, weakness.
Anamnesis of the disease: considers himself ill for 3 days, when pain appeared in the tooth of the upper jaw on the left, and then swelling of the face. I did not go to the doctor, I took ketonal in tablets.
Objectively. The general condition is satisfactory. Body temperature 37.3 ° C. Visible skin is pale pink.
Locally. The configuration of the face is changed due to collateral edema of the soft tissues of the suborbital and buccal regions on the left, the skin over it is hyperemic, collected in a fold. The submandibular lymph nodes on the left are enlarged to 2.0 cm, painful on palpation, elastic consistency, not soldered to the surrounding tissues. Opening the mouth in full.
2.5 tooth under the filling, the crown of the 2.6 tooth is completely destroyed, the mobility of 2.4, 2.5, 2.6 teeth of I - II degrees is determined. On percussion, soreness of 2.4, 2.6 teeth and mild soreness of 2.5 teeth are noted. The mucous membrane of the gums in the area of 2.4, 2.5, 2.6 teeth is hyperemic, edematous from the vestibular and palatal sides.
On the sighting intraoral radiograph of 2.4, 2.5 teeth of the upper jaw in the area of the root apex of the 2.5 tooth, destruction of bone tissue with fuzzy boundaries 0.3 x 0.7 cm in size is determined.
1. Formulate the diagnosis in accordance with the generally accepted classification, justify it.
2. Determine the cause of the disease.
Task 2. Patient S., 33 years old, consulted a dental surgeon with complaints of pain in the lower jaw, swelling of the face, numbness of the lower lip and chin on the right, increased body temperature to 38 ° C, chills, weakness, headache. pain.
Medical history: considers himself sick for 4 days. The disease is associated with the appearance of aching pain in the tooth of the lower jaw on the right after suffering an acute respiratory viral infection, aggravated by biting. He did not seek medical help.
Objectively. General condition of moderate severity. Body temperature 38.3 ° C. The visible skin is pale, moist.
Locally. The configuration of the face was changed due to swelling of the soft tissues of the submandibular region on the right. On palpation of the body of the lower jaw on the right, a dense painful infiltrate is determined, the skin over it is stretched, shiny, and is not taken into a fold. Mouth opening is limited to 3.0 cm due to pain. Determined by a decrease in skin sensitivity in the lower lip and chin on the right.
4.6 tooth under the filling, changed in color, mobility of the III degree is determined, with percussion, soreness is noted. Intact 4.5, 4.7 teeth have mobility of I-II degrees and are moderately painful with percussion. The mucous membrane of the gums from the vestibular and lingual sides in the area of 4.5, 4.6, 4.7 teeth is hyperemic, edematous, there is a smoothness of the transitional fold in the area of 4.5, 4.6, 4.7 teeth on the vestibular side of the alveolar process of the jaw. On palpation, purulent discharge from under the gingival edge of the above teeth is noted.
1. Formulate the diagnosis in accordance with the generally accepted classification.
2. Make a treatment plan.
Task 3. Patient D., 36 years old, was referred for a consultation with a maxillofacial surgeon. Disturbed by aching pains in the lower jaw, swelling of the face on the right, an increase in body temperature up to 38.0 ° C, chills,
weakness.
Medical history: sick for 5 days. On the 3rd day after the onset of the disease, he applied for medical help to a dental clinic, where 4.5 tooth was removed.
Objectively. General condition of moderate severity. Body temperature 38.5 ° C. The visible skin is pale, moist.
Locally. A slight swelling of the soft tissues in the near- and submandibular regions is determined, their palpation is slightly painful. The body of the lower jaw is thickened. The submandibular nodes on the right are enlarged to 1.5 x 1.5 cm, painful and mobile on palpation. Opening the mouth in full.
Dental formula:
p about p
7 6 5 4 3 2 1 1 2 3 4 5 6 7
7 6 5 4 3 2 1 1 2 3 4 5 6 7
o o o o o
Pus is released from the hole of the previously removed 4.5 tooth. The mucous membrane of the gums in the area of the hole from the vestibular and lingual sides is hyperemic, edematous, the transitional fold is infiltrated, painful.
1. Formulate the diagnosis in accordance with the generally accepted classification.
2. Determine the cause of the disease.
3. Describe the pathological changes at this stage of the disease.
Task 4. Patient V., 43 years old, turned to an appointment with a dental surgeon, complaining of the impossibility of chewing food due to severe pain and mobility of the lower jaw teeth on the right, difficulty swallowing, numbness of the lower lip, high body temperature in the evenings, sleep disturbance, general weakness.
Medical history: considers himself ill for the third day. At first, the pain was localized in the previously treated first large molar on the right, then gradually spread to adjacent healthy teeth and swelling of the gums around them appeared. I didn’t go to the doctor, I performed intraoral baths at home.
Objectively. General condition of moderate severity. Body temperature 38.8 ° C. The visible skin is gray, puffy.
Locally. The configuration of the face is changed due to swelling of the soft tissues of the lower half of the buccal and submandibular regions on the right, the skin above it is tense, shiny, and does not fold into a fold. Opening the mouth within 4 cm. Determined by a decrease in skin sensitivity in the lower lip on the right. Palpation of the submandibular lymph nodes on the right is impossible due to the presence of an infiltrate.
4.6 tooth under the filling, discolored. 4.4, 4.5, 4.6, 4.7,4.8 teeth have mobility of I-II degrees, with percussion, their soreness is noted. The mucous membrane of the gums in the area of 4.4, 4.5, 4.6, 4.7, 4.8 teeth from the vestibular and lingual sides is hyperemic, edematous, on palpation, purulent discharge from under the gingival pocket of the 4.6 tooth is noted. The junctional fold is smoothed in the area of 4.4, 4.5, 4.6, 4.7, 4.8 teeth from the vestibular side, tenderness is noted on palpation.
1. Formulate the diagnosis in accordance with the generally accepted classification.
1. Determine the type of inflammatory response in this patient by clinical manifestations.
2. How can the disease of this patient be complicated?
Task 5. Patient P., 59 years old, applied to a dental clinic with complaints of aching pain in the lower jaw, bad breath, numbness of the lower lip and chin on the left.
Medical history: considers himself ill for about two weeks. The onset of the disease is associated with the destroyed 3.7 tooth.
Objectively. The general condition is satisfactory. Visible skin of physiological color.
Locally. The configuration of the face was changed due to a slight swelling of the soft tissues in the submandibular region on the left. On palpation, the body of the jaw is thickened. Determined by a decrease in skin sensitivity in the lower lip and chin on the left. The submandibular lymph nodes on the left are enlarged to 1.5 x 1.5 cm on palpation, painful, mobile. Opening the mouth up to 4.5 cm.
3.7 tooth is destroyed by 1/2, has mobility of II - III degree, with percussion it is painful. The mobility of I - II degrees of 3.5, 3.6, 3.8 teeth and mild soreness during percussion are determined. The mucous membrane of the gums in the area of 3.6, 3.7, 3.8 teeth from the vestibular and lingual sides is hyperemic and edematous. The transitional fold is smoothed in the region of 3.6, 3.7, 3.8 teeth from the vestibular side, pain is noted on palpation.
1. Formulate the diagnosis in accordance with the generally accepted classification.
2. What additional research methods are needed to clarify the diagnosis?
3.With what diseases is it necessary to carry out differential
diagnosis in this case??
TOPIC: “SUBCUTE AND CHRONIC STAGES OF ODONTOGENIC OSTEOMYELITIS OF JAWS. CLINIC, DIAGNOSTICS, DIFFEREN-CIAL DIAGNOSTICS, TREATMENT "
1. Relevance. The possibility of the transition of acute odontogenic osteomyelitis to the sub-stream or chronic stage may depend on the quality of treatment, the characteristics of the microflora, the localization of the pathological process, nonspecific and specific factors of anti-infectious protection, concomitant diseases, etc. These factors are reflected in various types of inflammatory reaction - normal, hyperergic, hypergic, and anergic. For the correct diagnosis of odontogenic osteomyelitis at each stage, it is necessary to know the characteristic clinical symptoms of the disease, the features of the course of pathological processes with similar clinical, radiological and morphological structures and their differential diagnosis. At the same time, in the chronic stage of odontogenic osteomyelitis, proliferative (productive or hyperplastic forms) processes may prevail over destructive ones (rearing and sequestering forms). Each of these forms leads to significant deformities and other complications.
The knowledge gained during the study of this topic will allow a graduate of the Faculty of Dentistry to diagnose subacute and chronic odontogenic osteomyelitis of the jaws in a timely manner and prescribe treatment, thereby avoiding all sorts of their complications, as well as effectively carry out rehabilitation measures and prophylaxis.
2. The purpose of the lesson: to create conditions and assist students in mastering theoretical knowledge on etiology, pathogenesis, pathological anatomy and clinic of advanced and chronic odontogenic osteomyelitis of the jaws, to teach students to diagnose, differential diagnosis, adequate methods of their treatment and timely prevention complications.
˗ To form professional competencies, the student must know:
˗ Anatomy, blood supply and innervation of the jaws.
˗ Anatomical and physiological features of the upper and lower jaws.
˗ Etiology of odontogenic osteomyelitis of the jaws.
˗ Pathogenesis of odontogenic osteomyelitis of the jaws.
˗ Classification of odontogenic osteomyelitis of the jaws.
˗ Blood indices at different stages of inflammatory processes.
˗ Clinic of the subacute stage of odontogenic osteomyelitis of the jaws.
˗ Additional research methods in the subacute stage of odontogenic osteomyelitis of the jaws.
˗ Differential diagnosis of the subacute stage of odontogenic osteomyelitis of the jaws.
˗ Complex treatment of a patient with a subacute stage of odontogenic osteomyelitis of the jaws.
˗ Forms of chronic odontogenic osteomyelitis of the jaws.
˗ Clinic of various forms of chronic odontogenic osteomyelitis of the jaws.
˗ Additional research methods for chronic odontogenic osteomyelitis of the jaws.
˗ X-ray diagnostics of chronic odontogenic osteomyelitis of the jaws.
˗ Differential diagnosis of chronic odontogenic osteomyelitis of the jaws.
˗ Complex treatment of a patient with chronic odontogenic osteomyelitis of the jaws.
˗ Indications for surgical treatment of chronic odontogenic osteo-myelitis of the jaws.
˗ Surgical methods for the treatment of chronic odontogenic osteomyelitis of the jaws.
˗ Medicinal substances included in the complex of anti-inflammatory therapy.
˗ Medicinal substances that correct local and systemic immunity.
˗ Examination of the disability of patients with odontogenic osteomyelitis of the jaws.
˗ Prevention of chronic odontogenic osteomyelitis of the jaws.
To form professional competencies, the student must own:
1. OPK-5 (principles of analysis of its activities)
2.OPK-6 (analysis of the results of their own activities, skills in filling out medical documentation, methods of maintaining accounting and reporting documentation)
3. PC-2 (A / 04.7), theoretical knowledge on methods of examination of soft tissue injuries of the maxillofacial region, clinical course, diagnosis, differential diagnosis of injuries of the maxillofacial region;
4. PC-5 (A / 01.7), PC-6 (A / 01.7) skills of examination of patients with soft tissue injuries of the maxillofacial region, diagnosis and treatment of soft tissue injuries of the maxillofacial region.
5. PC-6 (A / 01.7) the ability to determine in patients the main pathological conditions, symptoms, syndromes of dental diseases, nosological forms in accordance with the International Statistical Classification of Diseases and Problems Related to Health.
6. PC-9 (A / 02.7) readiness for the management and treatment of patients with dental diseases on an outpatient basis and in a day hospital.
To form professional competencies, a student must be able to:
˗ Take anamnesis, examine the patient by organs and systems.
˗ To determine additional research methods for a patient with jaw osteomyelitis in subacute and chronic stages.
˗ Assess the results of clinical and laboratory-instrumental research methods.
˗ Describe the radiograph of the osteomyelitis of the jaws in the subacute and chronic stages.
˗ To carry out differential diagnosis of subacute and chronic odontogenic osteomyelitis of the jaws with other diseases that have common symptoms.
˗ Formulate a diagnosis in accordance with modern classification.
˗ Prescribe treatment for a patient with osteomyelitis of the jaws in the subacute and chronic stages.
˗ Conduct an examination of the disability of a patient with osteomyelitis of the jaws in the subacute and chronic stages.
˗ To carry out prevention of complications of osteomyelitis of the jaws in the subacute and chronic stages.
3. Necessary basic knowledge and skills (knowledge gained in the study of previous disciplines):
- Human Anatomy: Head and Neck Anatomy
Know:
- anatomical terms (Russian and Latin);
- anatomy and topography of the maxillofacial region;
- the relationship of organs with each other; projection of organs on the surface of the body;
- the main stages of development of the maxillofacial region (organogenesis);
- the main options for the structure and possible malformations of the salivary glands;
- the regularities of the structure of the human body as a whole, anatomical and functional relationships of individual parts of the body with each other.
- histology, embryology, cytology - histology of the oral cavity
Know:
- the main patterns of development and life of the human body based on the structural organization of cells, tissues and organs;
- histofunctional features of the tissue elements of the maxillofacial area; methods of their research.
- normal physiology - physiology of the maxillofacial region
Know:
- basic properties and conditions of excitable tissues, understanding of the mechanisms of bioelectric phenomena;
- functional properties and features of the salivary glands and saliva;
- principles of organization and functioning of the central nervous system (CNS);
- the role of proteins, fats, carbohydrates, minerals, vitamins and water in the body;
- physiological features of metabolism and energy in the body, between the body and the external environment;
- concept and classification of pain
- pharmacology
Know:
-classification and basic characteristics of drugs, pharmacodynamics and pharmacokinetics, indications and contraindications for the use of drugs;
- side effects when using drugs;
- general principles for the preparation of prescriptions and the preparation of prescription drug prescriptions.
4. Type of lesson: practical.
5. Duration of the lesson: 4 academic hours.
6. Equipment: multimedia projector, slides, diagrams, tables, sets of test items
Questions on the topic of the lesson:
1. Reasons for the transition of odontogenic osteomyelitis from the acute stage to the subacute and chronic.
2. Pathological anatomy of jaw osteomyelitis in the subacute stage.
3. Pathological anatomy of osteomyelitis of the jaws in the chronic stage.
4. Clinical picture, diagnosis and treatment of a patient with osteomyelitis of the jaws in the subacute stage.
5. Clinical picture, diagnosis and treatment of odontogenic osteomyelitis of the jaws in the chronic stage with a predominance of productive (hyperplastic) processes.
6. Clinical picture, diagnosis and treatment of odontogenic osteomyelitis of the jaws in the chronic stage with a predominance of destructive processes.
7. Clinical picture, diagnosis and treatment of productive and destructive forms of odontogenic osteomyelitis of the jaws.
8. Features of the X-ray picture of jaw osteomyelitis in the subacute and chronic stages.
9. Differential diagnosis of odontogenic osteomyelitis of the jaws in the subacute and chronic stages.
10. Complex treatment of a patient with osteomyelitis of the jaws in the subacute and chronic stages.
11. Indications for surgical treatment of chronic odontogenic osteomyelitis of the jaws.
12. Surgical methods of treatment of patients with chronic odontogenic osteomyelitis of the jaws.
13. Physical factors in the treatment of jaw osteomyelitis in the subacute and chronic stages.
14. Complications of odontogenic osteomyelitis of the jaws and their prevention.
15. Examination of the disability of patients with odontogenic osteomyelitis of the jaws.
Place of self-training: reading room, study room for independent work of students.
Educational and research work of students on this topic:
1. Optimization of reparative bone regeneration in residual cavities.
2. Modern drugs used in the complex treatment of patients with chronic odontogenic osteomyelitis of the jaws.
Appendices to the topic: “Subacute and chronic stages of odontogenic osteomyelitis of the jaws. Clinic, diagnostics, differential diagnostics, treatment "
Annex 1
TESTS FOR CONTROL
INITIAL LEVEL OF KNOWLEDGE
Choose one correct answer.
1. INVERVES THE BONE AND SUPERIOR OF THE UPPER JAW AT THE LEVEL OF PREMOLARS
1) buccal nerve
2) facial nerve
3) upper middle alveolar plexus
4) nasopalatine nerve
2. INVERVES THE TEETH OF THE LOWER JAW
1) maxillary nerve
2) buccal nerve
3) the inferior lunar nerve
4) superior posterior alveolar plexus
3. THE LEVEL OF CA IONS IN THE BODY IS DETERMINED
1) general urine analysis
2) a general blood test
3) urine analysis according to Nechiporenko
4) biochemical blood test
4. INCREASED CONTENT OF CA IONS IN BLOOD PROCESS INDICATOR IN JAW
1) destructive
2) reparative
3) metaplastic
4) productive
5. PURULENT INFLAMMATORY PROCESSES IN THE MAXILLOFACIAL REGION ARISE AS A RESULT OF THE ACTION OF BACTERIA
1) aerobic, facultative and anaerobic
2) only aerobic
3) only optional
4) only aerobic and optional
6. DENTAL PERCUSSION EVALUATES CONDITION
1) pulp
2) periodontal
3) periosteum
4) bones
7. WHEN DETERMINING THE MOBILITY OF TEETH, ISOLATE
1) two degrees of mobility
2) three degrees of mobility
3) four degrees of mobility
4) five degrees of mobility
8. OSTEOTROPIC ACTION POSSESSES
1) azithromycin
2) oxacillin
3) kanamycin
4) methyluracil
9. NORMAL TYPE OF INFLAMMATION IS OBSERVED WHEN
1) low level of immunity, pronounced sensitization of the body and significant virulence of microflora
2) sufficient tension of immunity, low level of sensitization of the body and high virulence of microflora
3) low level of immunity and sensitization of the body, poorly expressed virulence of microflora
4) low level of immunity, pronounced sensitization of the body and poorly expressed virulence of microflora
10. OSTEOMYELITIS IS
1) an inflammatory process that affects the periodontal tissue and spreads to the adjacent bone structures
2) a dystrophic process that affects the periodontal tissue and spreads to the adjacent bone structures
3) infectious - allergic, purulent - necrotic process that develops in the bone under the influence of external or internal factors
4) inflammatory process in the jaw bone tissue
11. ODONTOGENOUS OSTEOMYELITIS OF THE JAWS
1) the presence of foci of hemorrhage
2) proliferation of fibrous tissue from the focus of inflammation
3) the presence of bone ossification with symptoms of hyperostosis
4) foci of purulent infiltration of the bone marrow and foci of osteonecrosis
Appendix 2
TESTS FOR CONTROL
LEVEL OF ASSEMBLY OF THE TOPIC
Choose one correct answer.
1) THE REASON FOR THE DEVELOPMENT OF CHRONIC ODONTOGENOUS OSTEOMIELI-TA OF JAWS IS
1) jaw fracture
2) the presence of a "causal" tooth
3) tuberculosis
4) chronic lymphadenitis
2) DIAGNOSIS OF CHRONIC ODONTOGENOUS OSTEOMYELITIS OF CHELU-STAY STATE ON THE BASIS
1) patient complaints
2) interviewing the patient
3) clinical data
4) clinical and radiological picture
3) THE COMPLEX OF TREATMENT OF A PATIENT WITH CHRONIC ODONTOGENIC OSTEOMYELITIS OF JAWS INCLUDES
1) cryotherapy
2) HBO - therapy
3) autohemotherapy
4) immunotherapy
4) SEQUESTREECTOMY IN CHRONIC ODONTOGENOUS OSTEOMY-LITIS OF JAWS IS SHOWN IN THE PERIOD
1) after physiotherapy
2) formation of sequestration
3) formed sequestration
4) after antibiotic therapy
5) A REMOTE LOCAL COMPLICATION OF CHRONIC ODONTO-GENE OSTEOMYELITIS OF THE JAWS MAY BE
1) sialoadenitis
2) xerostomia
3) deformation of the jaw
4) paralysis of the facial nerve
6. PRIMARY - CHRONIC ODONTOGENIC OSTEOMYELITIS OF JAWS PROCEEDED
1) with a temperature reaction, with the formation of fistulas and extensive destruction of bone tissue
2) with minor destruction of bone tissue
3) with the formation of fistulas and the usual purulent discharge
4) without a temperature reaction, without the formation of fistulas, with a slight destruction of bone tissue
7. THE FIRST X-RAY SIGNS OF DESTRUCTIVE ODONTO-GENIC JAW OSTEOMYELITIS MANIFEST ON
1) 25th day
2) 20th day
3) 14th day
4) 7th day
8. LOCAL COMPLICATION OF CHRONIC ODONTOGENOUS OSTEOMY-LITA JAW CAN BE
1) exophthalmos
2) pathological fracture
3) neuralgia
4) anuresis
9. FOR STIMULATION OF THE BODY'S REACTIVITY IN TREATMENT OF CHRONIC OSTEOMYELITIS OF THE JAW USE
1) Fuzidin
2) Korglikon
3) Levomikol
4) Methyluracil
10. THE VOLUME OF BONE TISSUE IN ODONTOGENIC OSTEO-MYELITIS OF JAWS IS AFFECTED
1) the sex of the patient
2) topographic and anatomical features of the jaws
3) the functional state of the local immune systems of the body
4) the level of immunological reactivity of the body and the level of sensitization of the body
11. DURING THE PERIOD OF FORMATION OF SEQUESTERS, TREATMENT
1) medication
2) aimed at increasing immunity
3) direction to fight infection, preserve microcirculation, reduce vascular permeability
4) symptomatic
12. IN CHRONIC ODONTOGENOUS OSTEOMYELITIS OF JAWS, PAIN PRESENTS COMPLAINTS
1) sharp pain in the jaw
2) thickening of the bone or the presence of slightly painful swelling
3) high body temperature
4) double vision
13. BEFORE CARRYING OUT SEQUESTRECTOMY ON THE UPPER JAW IN THE REGION OF MOLARS, IT IS NECESSARY TO PREPARE IN ADVANCE
1) Vankevich bus
2) mouthguard that increases the bite
3) protective plate
4) Weber bus
14. THE PURPOSE OF SUBSTITUTION OF BIOLOGICAL TRANSPLANT POSTSEQUE-STRAL CAVITY OF THE JAW IS INSERTED IN
1) increasing the biomechanical strength of the operated jaw
2) an increase in bone calcium
3) achieving a cosmetic effect
4) optimizing bone regeneration
Appendix 3
SITUATION TASKS
TO CONTROL THE LEVEL OF ASSEMBLY OF THE TOPIC
Task 1. Patient R., 35 years old, was admitted to the department of maxillofacial surgery, with complaints of increased body temperature, swelling of the cheek on the left and the presence of a fistula with purulent discharge in this area, aching pain in the jaw on the left, tooth mobility and an unpleasant odor from mouth.
Medical history. According to the patient, a month ago there was an acute pain in the 3.6 tooth. I did not go to the doctor, I treated myself, the pain was relieved by taking painkillers, I applied a heating pad to the lower jaw on the left in the projection of the 3.6 tooth. After a while, there was a swelling of the cheeks and pain in the lower jaw on the left. In the future, the appearance of a fistula in this area with purulent discharge from it and a decrease in the swelling of the cheek is noted.
Objectively. The general condition is relatively satisfactory, the body temperature is 37.3 ° C.
Local status. The configuration of the face was changed due to swelling of the soft tissues of the buccal region on the left. The skin above it is slightly hyperemic, gathers in a fold, palpation is moderately painful. In this area, a fistula with a diameter of about 2.0 × 2.0 mm with scanty purulent discharge is determined. In the submandibular region, on the left, a single slightly painful movable lymph node 0.5 × 0.5 cm in size with an elastic-elastic consistency is palpated. Mouth opening is limited to 4.5 cm due to pain.
In the oral cavity: the crown of the 3.6 tooth is partially destroyed, with percussion, moderate pain is noted, mobility of the II degree is determined, 3.5, 3.7 teeth are absent, 3.4 tooth is under an artificial metal crown, when it is percussed, painlessness is noted, mobility of the I degree is determined. Gums, mucous membrane, transitional fold in the area of 3.4, 3.5, 3.6 teeth are moderately hyperemic, edematous, palpation is slightly painful. From under the gums in the area of the 3.6 tooth, a scanty purulent discharge is determined. The tongue is covered with a whitish coating.
On the general X-ray of the lower jaw in the lateral projection on the left in the area of the lower jaw body, a focus of bone tissue destruction 1.0 × 1.5 cm of irregular shape, without clear boundaries, is determined. On the edge of the jaw, there is an uneven density, thickness and width of a wavy shadow.
1. Make a clinical diagnosis.
2. What disease could have preceded this pathological condition?
Task 2. Patient D., 40 years old, turned to the polyclinic at the place of residence, with complaints of periodic aching pain in the upper jaw on the right, the presence of a fistula in the infraorbital region on the right.
Medical history. According to the patient, he has been ill for about three months. The onset of the disease is associated with the 1.5 tooth, which was treated for complicated caries.
Objectively. The condition is relatively satisfactory, the body temperature is 36.9 ° C.
Local status. The face configuration has been slightly changed. The skin in the infraorbital region on the right is somewhat thinned and taut. In the same area, a fistula with a diameter of about 2.0 × 2.0 mm is determined, with scanty purulent discharge and bulging lush, easily bleeding granulations. On palpation, the upper jaw on the right is slightly painful and thickened. In the submandibular region on the right, a single weakly painful movable lymph node 0.5 × 0.5 cm in size with an elastic consistency is palpated. Opening the mouth up to 4.0 cm.
In the oral cavity: 1.5 tooth under the filling, with percussion, moderate pain is noted, mobility of the II degree is determined. 1.3, 1.4, 1.6 teeth are intact, their percussion is slightly painful, there is a grade I pathological mobility. The gums, mucous membrane and transitional fold in the area of 1.3, 1.4, 1.5, 1.6 teeth are moderately hyperemic, edematous, in places slightly cyanotic, loose, moderately painful on palpation, from under the gums in the area of the 1.5 tooth there is a scanty purulent discharge. On palpation of the alveolar process on the side of the lesion, its thickening is noted. When probing the fistula, the roughness of the bone is determined.
On the orthopantomogram, destruction of the bone tissue of the upper jaw on the right in the projection of 1.4, 1.5, 1.6 teeth is determined, against its background small foci of resorption 0.3 × 0.4 cm, of various shapes, with indistinct edges stand out. The root canals of the 1.5 tooth are filled 2/3 of their length.
1. Make a clinical diagnosis.
2. Determine the further location of the patient and the type of treatment.
Task 3. Patient I., 18 years old, turned to the polyclinic at the place of residence, complaining of aching pains in the lower jaw on the left.
Anamnesis of life. According to the patient, she was sick for a year, when the first aching pains appeared in the 3.6 tooth, which was at the beginning pulp and filled. The treatment had no effect, the pain did not stop and the 3.6 tooth was removed. Aching pains persisted. Gradually, swelling appeared in the area of the body of the lower jaw on the left.
Objectively. The general condition is satisfactory, the body temperature is 36.8 ° C.
Local status. The configuration of the face was changed due to deformation of the left half of the lower jaw. The color of the skin above it is not changed, it is gathered in a fold. A single, moderately painful, mobile, submandibular lymph node on the left with a size of 0.5 × 0.5 cm is palpated. On palpation of the left half of the lower jaw, a thickening is determined. The mouth opening is limited to 4.0 cm.
In the oral cavity: 3.6 tooth - missing. 3.5, 3.7 teeth are intact, their percussion is slightly painful, their pathological mobility of the 1st degree is noted. The gums, mucous membrane and transitional fold in the area of 3.5, 3.6, 3.7 teeth are slightly hyperemic, edematous, in places slightly cyanotic, moderately painful on palpation.
On the plain radiograph of the lower jaw in the left lateral projection in the area of 3.5, 3.7 teeth, a large number of small and medium foci of destruction with a diameter of 0.5 to 0.8 cm, layering on top of each other, of different shapes, with indistinct edges, is determined. The cortical plate along the edge of the body is destroyed, the periosteum is thickened.
General blood and urine tests - no significant changes.
1. Make a clinical diagnosis.
2. Make a plan for further treatment of the patient.
Task 4. Patient B., 50 years old, came to the emergency room, complaining of weakness, fever, aching pain in the lower jaw and swelling of the cheek on the right, tooth mobility, bad breath, the presence of a fistula in the cheek on the right ...
Medical history. According to the patient, she has been sick for about two months. The onset of the disease is associated with the 4.6 tooth, which was treated for complicated caries.
Objectively. The condition is relatively satisfactory, the body temperature is 37.8 ° C.
Local status. The configuration of the face was changed due to swelling of the soft tissues of the buccal region on the right. The skin in this area is hyperemic, edematous, painful on palpation, a healed fistula drawn inward is determined. On palpation, the lower jaw on the right is painful and thickened. In the submandibular region on the right, two moderately painful movable lymph nodes measuring 1.0 × 1.0 cm of elastic consistency are palpated.
In the oral cavity: 4.6 tooth under the filling, with percussion, there is a sharp soreness, the mobility of the II degree is determined. 4.4 tooth is missing. 4.5, 4.7 teeth under a metal crown, with percussion, moderate pain is noted. The mucous membrane and the transitional fold in the area of 4.5, 4.6, 4.7 teeth are hyperemic, edematous, loose, painful on palpation, from under the gums in the area of the 4.6 tooth there is a scanty purulent discharge.
On the orthopantomogram, destruction of the bone tissue of the lower jaw on the right in the projection of 4.5, 4.6, 4.7 teeth is determined, against its background dense foci of resorption are distinguished, of various shapes, with indistinct edges and an intense shadow of 0.6 × 1.0 cm in size. The root canals of the 4.6 tooth are sealed all over.
1. Make a clinical diagnosis.
2. With what diseases can this pathological condition be differentiated?
Task 5. The patient was given a clinical diagnosis: "Chronic odontogenic osteomyelitis of the alveolar part of the lower jaw to the left of 2.4 teeth in the sequestration stage."
Determine the type of treatment and describe the methodology.
TOPIC: "ODONTOGENIC MAXILLARY SINUSITIS. PATHOGENESIS. CLASSIFICATION. CLINIC, DIAGNOSTICS, DIFFERENTIAL DIAGNOSTICS. TREATMENT. Perforation and fistula of the maxillary sinus. CLINIC, DIAGNOSTICS.
DOCTOR'S TACTICS FOR PERFORATION OF THE MAXILLARY SINUS "
1. Relevance. Odontogenic sinusitis is, according to various sources, from 3% to 7% of the total number of surgical dental diseases. The number of patients with odontogenic sinusitis, despite the expansion of knowledge and understanding of this disease, does not decrease. Late diagnosis of acute sinusitis, late treatment of patients, differential - diagnostic errors in the recognition of rhinogenic and odontogenic forms, incorrect tactics of the surgeon - dentist in case of sinus floor perforation lead to chronicity of the disease, which is often accompanied by various local and general complications. According to the literature, only 40% - 60% of patients with odontogenic sinusitis recover.
The knowledge gained during the study of this topic will allow a graduate of the Faculty of Dentistry to purposefully conduct all the necessary studies to identify odontogenic sinusitis, its differential diagnosis with other diseases, diagnostics of perforations and fistulas of the maxillary sinus, timely prescribe treatment, avoid complications and effectively carry out rehabilitation Events.
2. The purpose of the lesson: to create conditions and assist students in mastering theoretical knowledge on etiology, pathogenesis, classification, clinic of odontogenic sinusitis, as well as perforations and fistulas of the maxillary sinus, to teach students to carry out diagnostics, differential diagnosis of these diseases, to compose treatment plan for patients; to carry out the prevention of odontogenic sinusitis, perforations and fistulas of the maxillary sinus.
To form professional competencies, the student must know:
˗ Anatomy, blood supply, innervation and variants of the structure of the upper jaw.
˗ Physiological significance of the maxillary sinus.
˗ Histology of the mucous membrane of the maxillary sinus.
˗ Anatomical and topographic features of the maxillary sinus and the ratio of the tops of the roots of the teeth to its bottom.
˗ The concept of sinusitis.
˗ Signs of inflammation.
˗ Clinical signs of acute odontogenic sinusitis.
˗ Clinical signs of chronic odontogenic sinusitis.
˗ Pathomorphological changes in the sinus with various forms of inflammation.
˗ Additional research methods used in the diagnosis of various forms of sinusitis.
˗ Indicators of blood in inflammatory processes.
˗ General principles of treatment of patients with various forms of odontogenic sinusitis.
˗ Medicinal substances included in the complex of anti-inflammatory therapy.
˗ Medicinal substances that correct local and systemic immunity.
˗ Indications and methods of surgical treatment of odontogenic sinusitis.
˗ Anatomical prerequisites for the occurrence of perforation of the floor of the maxillary sinus.
˗ Pathological processes that cause perforation of the maxillary sinus.
˗ Iatrogenic causes leading to perforation of the floor of the maxillary sinus.
˗ Clinical signs of maxillary sinus perforation.
˗ Tactics of the doctor for perforation of the maxillary sinus.
˗ Morphological definition of fistula.
˗ Factors causing the development of a fistula.
˗ Diagnostics of the fistula of the maxillary sinus.
˗ Treatment of patients with sinus fistulas.
˗ Prevention of odontogenic sinusitis, fistulas and maxillary sinus perforations.
To form professional competencies, the student must own:
1. OPK-5 (principles of analysis of its activities)
2.OPK-6 (analysis of the results of their own activities, skills in filling out medical documentation, methods of maintaining accounting and reporting documentation)
3. PC-2 (A / 04.7), theoretical knowledge on methods of examination of soft tissue injuries of the maxillofacial region, clinical course, diagnosis, differential diagnosis of injuries of the maxillofacial region;
4. PC-5 (A / 01.7), PC-6 (A / 01.7) skills of examination of patients with soft tissue injuries of the maxillofacial region, diagnosis and treatment of soft tissue injuries of the maxillofacial region.
5. PC-6 (A / 01.7) the ability to determine in patients the main pathological conditions, symptoms, syndromes of dental diseases, nosological forms in accordance with the International Statistical Classification of Diseases and Problems Related to Health.
6. PC-9 (A / 02.7) readiness for the management and treatment of patients with dental diseases on an outpatient basis and in a day hospital.
To form professional competencies, a student must be able to:
˗ Take anamnesis, examine the patient by organs and systems.
˗ Determine additional research methods for odontogenic sinusitis.
˗ Assess the results of clinical and laboratory-instrumental research methods.
˗ To carry out differential diagnosis of odontogenic sinusitis with other diseases that have common symptoms.
˗ Formulate a diagnosis in accordance with modern classification.
˗ Draw up a treatment plan for patients with odontogenic sinusitis.
˗ Recognize maxillary sinus floor perforation.
˗ Choose treatment tactics for maxillary sinus floor perforation, taking into account the clinical situation.
˗ Conduct examination of patients with sinus floor fistulas.
˗ Carry out preoperative sanitation of the maxillary sinus.
˗ Conduct an examination of the disability of a patient with odontogenic sinusitis.
˗ To carry out the prevention of complications of odontogenic sinusitis.
3. Necessary basic knowledge and skills (knowledge gained in the study of previous disciplines):
- Human Anatomy: Head and Neck Anatomy
Know:
- anatomical terms (Russian and Latin);
- anatomy and topography of the maxillofacial region;
- the relationship of organs with each other; projection of organs on the surface of the body;
- the main stages of development of the maxillofacial region (organogenesis);
- the main options for the structure and possible malformations of the salivary glands;
- the regularities of the structure of the human body as a whole, anatomical and functional relationships of individual parts of the body with each other.
- histology, embryology, cytology - histology of the oral cavity
Know:
- the main patterns of development and life of the human body based on the structural organization of cells, tissues and organs;
- histofunctional features of the tissue elements of the maxillofacial area; methods of their research.
- normal physiology - physiology of the maxillofacial region
Know:
- basic properties and conditions of excitable tissues, understanding of the mechanisms of bioelectric phenomena;
- functional properties and features of the salivary glands and saliva;
- principles of organization and functioning of the central nervous system (CNS);
- the role of proteins, fats, carbohydrates, minerals, vitamins and water in the body;
- physiological features of metabolism and energy in the body, between the body and the external environment;
- concept and classification of pain
- pharmacology
Know:
-classification and basic characteristics of drugs, pharmacodynamics and pharmacokinetics, indications and contraindications for the use of drugs;
- side effects when using drugs;
- general principles for the preparation of prescriptions and the preparation of prescription drug prescriptions.
4. Type of lesson: practical.
5. Duration of the lesson: 4 academic hours.
6. Equipment: multimedia projector, slides, diagrams, tables, sets of test items
Questions on the topic of the lesson:
1. Etiology of odontogenic sinusitis.
2. Classification of odontogenic sinusitis.
3. Pathogenesis of odontogenic sinusitis.
4. Clinical signs of acute odontogenic sinusitis.
5. Additional research methods for acute odontogenic sinusitis.
6. Differential diagnosis of acute odontogenic sinusitis.
7. Complex treatment of a patient with acute odontogenic sinusitis.
8. The reasons contributing to the development of chronic odontogenic sinusitis.
9. Clinical signs of chronic odontogenic sinusitis.
10. X-ray diagnostics of odontogenic sinusitis in the chronic stage.
11. Additional research methods for chronic odontogenic sinusitis.
12. Differential diagnosis of chronic odontogenic sinusitis.
13. Indications for surgical treatment of chronic odontogenic sinusitis.
14. Surgical methods for the treatment of chronic odontogenic sinusitis.
15. Clinical signs of exacerbation of chronic odontogenic sinusitis.
16. Differential diagnosis of chronic odontogenic sinusitis in the acute stage.
17. Complex treatment of a patient with chronic odontogenic sinusitis in the acute stage.
18. Physical factors used in the treatment of odontogenic sinusitis.
19. Complications of odontogenic sinusitis and ways of their prevention.
20. Examination of the disability of patients with odontogenic sinusitis.
21. Anatomical prerequisites for the occurrence of perforation of the floor of the maxillary sinus during the removal of the lateral group of teeth.
22. Pathological processes causing perforation of the maxillary groove-chi.
23. Iatrogenic causes leading to perforation of the floor of the maxillary sinus.
24. Features of the clinic, diagnosis, differential diagnosis, prophylaxis, doctor's tactics and treatment of maxillary sinus perforations.
25. Morphological definition of a fistula.
26. Factors causing the development of a fistula.
27. Features of the clinic, diagnosis, differential diagnosis, prophylaxis, doctor's tactics and treatment of sinus fistulas.
28. New methods of treatment of patients with odontogenic sinusitis, fistulas and perforations of the maxillary sinus.
29. Examination of the disability of patients with inflammatory diseases of the maxillary sinus.
Place of self-training: reading room, study room for independent work of students.
Educational and research work of students on this topic:
1. Modern methods of treatment of odontogenic sinusitis.
2. Ways of spread of infection from the maxillary sinus and the possibility of developing intracranial complications.
Appendices to the topic: “Odontogenic maxillary sinusitis. Pathogenesis. Classification. Clinic, diagnostics, differential diagnostics. Treatment. Perforation and fistula of the maxillary sinus. Clinic, diagnostics.
Doctor's tactics for perforation of the maxillary sinus "
Annex 1
TESTS FOR CONTROL
INITIAL LEVEL OF KNOWLEDGE
Choose one correct answer.
1. The maxillary sinus in the human embryo appears to be
1) at the end of the 2nd and beginning of the 3rd month of fetal life
2) at the end of the 4th and beginning of the 5th month of fetal life
3) at the end of the 6th and beginning of the 7th month of fetal life
4) at the end of the 8th and beginning of the 9th month of fetal life
2. In an adult, the volume of the maxillary sinus in the environment is
1) 5 - 6 cm
2) 7 - 8 cm
3) 8 - 9 cm
4) 10 - 12 cm
3. THE PNEUMATIC TYPE OF THE UPPER JAW IS
1) an overdeveloped sinus, when it can spread even to the processes of the maxillary bone
2) small size of the maxillary sinus
3) a moderately developed sinus, without spreading to the processes of the maxillary bone
4) underdevelopment of the maxillary sinus
4. The maxillary sinus of an adult is lined with ... EPITHELIUM
1) cubic
2) cylindrical
3) multi-layer atrial
4) flat keratinizing
5. INFORMATIVE METHOD OF X-RAY EXAMINATION OF THE MAXILLARY SINCE IS
1) plain radiography of the bones of the facial skeleton in the nasal projection
2) plain radiography of the bones of the facial skeleton in the naso-chin projection
3) plain radiography of the bones of the facial skeleton in a direct projection
4) plain radiography of the bones of the facial skeleton in lateral projection
6. THE NATURAL JOINT OF THE MAXILLARY SAUNA WITH THE NASULAR IS LOCATED IN
1) upper nose stroke
2) middle nasal passage
3) lower nasal passage
4) different areas (individually)
7. WHEN STUDYING X-RAYS, IT SHOULD BE COMPARED WITH
1) orbits
2) nasal cavity
3) oral cavity
4) trellis labyrinth
8. CONTRAST X-RAY EXAMINATION OF THE CAPACULAR SINO IS CONDUCTED WITH THE APPLICATION
1) urotrasta
2) cardiotrast
3) iodolipol
4) verografina
9. POLYP IS
1) the proliferation of the epithelium together with the cells of the underlying connective tissue, which is based on productive inflammation
2) tumor of glandular organs and mucous membranes, lined with prismatic epithelium
3) an extensive focus of necrosis, surrounded by a cellular infiltrate of lymphocytes, plasmocytes and epithelioid cells
4) a nodule consisting mainly of macrophages, lymphocytes and plasma cells
10. THE FRONT-EXTERNAL WALL OF THE maxillary sinus is LOCATED BETWEEN
1) the lower orbital edge and the alveolar process of the upper jaw
2) pterygopalatine and infratemporal fossa
3) the lower and middle nasal passages
4) sphenoid and frontal sinuses
11. The posterior-outer wall of the maxillary sinus is
1) Turkish saddle
2) maxillary tubercle
3) frontal tubercle
4) upper jaw
12. The medial wall of the maxillary sinus is
1) ethmoid bone
2) the lateral wall of the nasal cavity
3) canine fossa
4) lower orbital fissure
13. The bottom of the maxillary sinus forms
1) the upper surface of the alveolar process along the length from the first premolar to the tubercle of the upper jaw
2) the upper surface of the alveolar process along the length from the first incisor to the tubercle of the upper jaw
3) the upper surface of the alveolar process from the first molar to the tubercle of the upper jaw
4) the upper surface of the alveolar process from the first molar to the third molar of the lower jaw
14. THE UPPER WALL OF THE maxillary sinus is
1) the medial wall of the orbit
2) the outer wall of the orbit
3) the lower wall of the orbit
4) the upper wall of the orbit
Appendix 2
TESTS FOR CONTROL
LEVEL OF ASSEMBLY OF THE TOPIC
Choose one correct answer
1. MOST OFTEN PERFORATION OF THE BOTTOM OF THE maxillary sinus occurs when removing
1) the incisors of the upper jaw
2) incisors and canines of the upper jaw
3) premolars and molars of the upper jaw
4) the canines of the upper jaw
2. A SIGN OF PERFORATION OF THE MAXILLARY SINVE BOTTOM IS-IS
1) crepitus of soft tissues
2) bleeding from the hole
3) fracture of the alveolar bone
4) discharge from the hole of blood with air bubbles
3. IN THE PERFORATION OF THE BOTTOM OF THE MAXILLARY SINCE AFTER EXTRACTION OF THE TOOTH AND THE PRESENCE OF INFLAMMATORY EFFECTS IN IT IS NECESSARY
1) sanitize the oral cavity
2) prescribe physiotherapy
3) suture the wound
4) rinse the sinus with an antiseptic solution
4. IN THE PERFORATION OF THE BOTTOM OF THE MAXILLARY SINCE AFTER EXTRACTION OF THE TOOTH AND NO INFLAMMATORY EFFECTS IN IT IS NECESSARY
1) to carry out sinusitis
2) close the perforation with a flap from the cheek
3) rinse the sinus with an antiseptic
4) dynamic observation
5. AT THE FORMED ODONTOGENIC FISTULA OF THE MAXILLARY SINUS, TREATMENT IS SHOWN
1) sinusitis with simultaneous plastic fistula
2) sinusitis
3) excision of the fistula
4) physiotherapy
6.To eliminate the communication of the maxillary sinus from the oral cavity, use tissue
1) Filatov stem
2) buccal mucosa
3) the mucous membrane of the upper lip
4) the mucous membrane of the tongue
7. EARLY LOCAL COMPLICATION AFTER RADICAL HAYMOROTO MI AND PLASTIC FISTULATION IS
1) trismus
2) nosebleeds
3) deformation of the zygomatic region
4) paresis of the marginal branch of the facial nerve
8. EARLY LOCAL COMPLICATION AFTER RADICAL HAYMOROTO MI AND PLASTIC FISTULATION IS
1) seam divergence
2) narrowing of the jaw
3) arthritis of the temporomandibular joint
4) xerostomia
9. TO ACCELERATE EPITHELIZATION OF THE WOUND AFTER PLASTIC FISTULATION OF THE UPPER-CAVIAR SINK IS LOCALLY APPOINTED
1) massage
2) laser therapy
3) acupuncture
4) cryotherapy
10. The puncture of the maxillary sinus is carried out through
1) upper nasal passage
2) middle nasal passage
3) lower nasal passage
4) the protruding part of the mucous membrane of the nasal cavity
11. WHEN CARRYING OUT THE PUNCTION OF THE MAXILLARY SINK, IT IS NECESSARY TO STEP BACK FROM THE FRONT EDGE OF THE LOWER NASULAR SINK ON
1) 1.0 - 1.5 cm
2) 2.0 - 2.5 cm
3) 3.0 - 3.5 cm
4) 4.0 - 4.5 cm
12. IN ACUTE ODONTOGENOUS CATARAL GAYMORITIS, TREATMENT CONSISTS IN
1) removal of the causative tooth
2) removal of the causative tooth, the appointment of vasoconstrictor and physiotherapeutic agents
3) sinusitis
4) the appointment of vasoconstrictor agents
13. IN CHRONIC POLYNOSIS ODONTOGENIC GAYMORITIS, TREATMENT CONSISTS IN
1) removal of the causative tooth, the appointment of symptomatic remedies
2) puncture of the maxillary sinus and removal of the causative tooth
3) removal of the causative tooth, sinusitis
4) sinusitis with the treatment of the causative tooth.
14. THE MOST CHARACTERISTIC X-RAY PICTURE OF ACUTE ODONTOGENOUS HAYMORITIS IS
1) fuzziness of the walls of the maxillary sinus, a decrease in its size
2) homogeneous shading of her sinus
3) dome-shaped shading of the lower 2/3 sinus
4) uneven shading of the sinus, "defect" of one of the walls
15. CHANGE OF VOICE TONE IN PATIENTS WITH ODONTOGENOUS HAYMORITIS OCCURS FROM - FOR
1) violations of external respiration
2) violations of the resonator function of the maxillary sinus
3) edema of the vocal cords
4) narrowing of the lumen of the larynx
16. FEELING OF "HEAVY" IN THE REGION OF THE UPPER JAW IN PATIENTS WITH ODONTOGENIC HAYMORITIS IS CONDITIONED
1) irritation of nerve endings, accumulated exudate
2) an increase in the mass of the upper jaw
3) impaired lymph circulation of the upper jaw
4) violation of venous outflow from the sinus
17. INCREASE IN BODY TEMPERATURE IN PATIENTS WITH ODONTOGENIC HEIMO-RITA IS OCCURRING FROM - FOR
1) breathing disorders
2) violations of the central mechanisms of thermoregulation
3) disorders of cellular metabolism
4) intoxication of the body
18. AFTER THE PUNCTURE AND SHUNTING THE UPPERMANDAL SINOUS SHOULD BE RINSED OUT
1) 3% hydrogen peroxide solution
2) 0.02% furacilin solution
3) alcohol
4) 10% formalin solution
19.For the maxillary sinus puncture, use
1) Kulikovsky's needle
2) trocar
3) trepan
4) a needle 30 mm long
20. THE IMMEDIATE COMPLICATION OF THE PUNCTURE OF THE MAXILLARY SINUS IS
1) violation of the sense of smell
2) subcutaneous emphysema
3) diplopia
4) Vincent's symptom
21. PREFERRED ANALYSIS FOR RADICAL HYMOROTOMY
1) application
2) intradural
3) infiltration
4) general
22. POSTOPERATIVE POST-OPERATIVE CASUAL FLUSHING IS PERFORMED
1) after removing the turunda
2) before extracting the turunda
3) for 5 - 6 days
4) constantly
23. TRADITIONAL DROPS IN THE NOSE AT TREATMENT OF ODONTOGENIC GAIMO-RITA ACT
1) anti-inflammatory
2) antihistamine
3) vasoconstrictor
4) antifungal
24. APPLICATION OF VASCULAR DROPS WITH ODONTOGENIC GAYMORITIS, IMPROVEMENTS
1) outflow of exudate
2) external respiration
3) sleep
4) appetite
Appendix 3
SITUATION TASKS
TO CONTROL THE LEVEL OF ASSEMBLY OF THE TOPIC
Task 1. Patient V., 25 years old, was admitted to the Department of Maxillofacial Surgery, with complaints of weakness, fever, pain and a feeling of heaviness, spreading to the left half of the head, congestion of the left half of the nose, making breathing difficult ...
Medical history. For the first time, signs of the disease appeared 3 days ago. 2 days before, in the clinic at the place of residence, due to exacerbation of chronic granulating periodontitis, a 2.6 tooth was removed.
Objectively. General condition of moderate severity. Body temperature 38.5 ° C.
Local status. The configuration of the face was changed due to the edema of the soft tissues of the buccal region on the left, the skin of the physiological coloration. Palpation of the anterior sinus wall causes pain. With rhinoscopy, insignificant edema and hyperemia of the middle nasal passage on the left are determined. In the submandibular region on the left, a single painful movable lymph node measuring 0.5 × 0.5 cm is palpated. The mouth is opened in full.
The hole of the 2.6 tooth under the thrombus, the gums and the mucous membrane of the oral cavity from the vestibular side of the alveolar process in this area are slightly hyperemic, edematous.
On the plain radiograph of the bones of the facial skeleton and the skull in the naso-chin projection, a violation of the pneumatization of the left maxillary sinus is determined.
1. Make a clinical diagnosis.
2. Determine the type of treatment.
Task 2. Patient P., 30 years old, was admitted to the department of maxillofacial surgery, with complaints of headache, a feeling of heaviness in the upper jaw on the left, periodically appearing discharge from the nasal passage on the left.
Medical history. Signs of the disease appeared 3 years ago, disturbed by a feeling of heaviness in the upper jaw on the left, discharge from the left nasal passage. He was treated on an outpatient basis by an ENT doctor at the place of residence. Two weeks ago, pain and a feeling of heaviness reappeared in the upper jaw area on the left. The dentist recommended surgical treatment in the Department of Maxillofacial Surgery of the City Clinical Hospital No. 21.
Objectively. The general condition is satisfactory. Body temperature 36.6 ° C.
Local status. The configuration of the face is not changed, the skin is physiological.
Palpation and percussion in the area of the projection of the anterior wall of the maxillary sinus on the left are moderately painful. With rhinoscopy, slight edema and hyperemia of the middle nasal passage on the left are determined. Opening the mouth up to 4.0 cm, free, painless.
2.7 tooth under the filling, with percussion, there is a slight soreness. The gums and mucous membrane of the oral cavity from the vestibular side of the alveolar process in the area of 2.6, 2.7, 2.8 teeth are slightly hyperemic, edematous.
On the plain radiograph of the paranasal sinuses, total shading of the left maxillary sinus is determined. On the intramouth aiming radiograph of a 2.7 tooth in the region of the apexes of the buccal roots, a focus of bone tissue destruction with fuzzy boundaries, 0.8 × 0.5 cm in size, is determined.
1. Make a preliminary diagnosis.
2. Determine the type of treatment.
Task 3. Patient N., 40 years old, came to the emergency room of the hospital, complaining of malaise, fever, pain, feeling of heaviness in the right half of the face, spread of pain to the right half of the head, congestion of the right half of the nose, difficulty breathing and weakening of the sense of smell, purulent discharge from the nose.
Medical history. According to the patient, the patient has been ill for 7 days.
Objectively. General condition of moderate severity. Body temperature 38.5 ° C.
Local status. The configuration of the face was changed by swelling of the soft tissues of the infraorbital region and the lower eyelid on the right. The skin is of a physiological color. Palpation in the area of the projection of the anterior wall of the maxillary sinus is painful. With anterior rhinoscopy, edema and hyperemia of the middle nasal passage on the left are determined. In the submandibular region on the left, a single painful movable lymph node measuring 1.0 × 1.0 cm is palpated.
The crown of the 1.5 tooth is destroyed by 1/3, its percussion causes soreness, the mobility of the I degree is noted. 1.4, 1.6 teeth are missing. The gums and mucous membrane on the vestibular side of the alveolar process in the area of 1.4, 1.5, 1.6 teeth are smoothed, hyperemic, edematous.
On the general radiograph of the bones of the facial skeleton in the naso-chin projection, total shading of the right maxillary sinus is determined. On the intraoral X-ray image of a 1.5 tooth in the area of the root apex, a focus of bone tissue destruction with indistinct boundaries, 0.7 × 0.7 cm in size, is determined.
1. Make a clinical diagnosis.
2. What is the doctor's tactics regarding the "causal" tooth?
Task 4. Patient A., 35 years old, turned to a dentist-surgeon at the local dental clinic with complaints of a feeling of heaviness in the upper jaw on the right, recurrent discharge from the nasal passage, headaches, nasal congestion.
Medical history. According to the patient, the above symptoms are noted about 3 years after filling the 1.6 tooth of the upper jaw on the right.
Objectively. The general condition is satisfactory, the body temperature is 36.6 ° C.
Local status. The configuration of the face is not changed, the skin is physiological. Palpation and percussion in the anterior wall of the maxillary sinus on the right is moderately painful. Regional lymph nodes are not palpable. Opening the mouth in full.
1.6 tooth - under filling, discolored, its percussion causes moderate pain. The gums and mucous membrane on the vestibular side of the alveolar process in the region of the 1.6 tooth are pale pink, moist, shiny.
On the orthopantomogram, subtotal shading of the right maxillary sinus is determined, in the center of which an intense shadow of an irregular shape of 4.0-5.0 mm is visualized. On the intraoral sighting radiograph: 1.6 tooth is under the filling, the root canals are sealed throughout with the removal of the filling material by the apex of the root canals.
1. Make a preliminary diagnosis.
2. Determine the further site of the patient's treatment.
3. Make a treatment plan.
Task 5. Patient M., 55 years old, was admitted to the Department of Maxillofacial Surgery, with complaints of a feeling of heaviness in the maxillary sinus on the left, periodically appearing discharge from the nasal passage and the presence of a fistula in the oral cavity.
Medical history. According to the patient, two years ago in a dental clinic at the place of residence, a 2.5 tooth was removed, after which a message arose with the maxillary sinus. Outpatient treatment had no effect; a referral was given to hospitalization in the Department of Maxillofacial Surgery.
Anamnesis of life. From chronic pathology notes type 2 diabetes mellitus, 10 years ago he had an acute myocardial infarction.
Objectively. The general condition is satisfactory, the body temperature is 36.6 ° C.
Local status. The configuration of the face is not changed, the skin is physiological. Regional lymph nodes are not palpable.
In the area of the hole of the 2.5 tooth, a fistulous message with a diameter of about 0.2 cm is determined. In its circumference, the mucosa is moderately hyperemic, edematous, slightly painful on palpation.
Dental formula
00000000 00 0 00
8765432112345678
000 0 0 000
On the orthopantomogram, total shading of the left maxillary sinus is determined.
1. Make a clinical diagnosis.
2. Determine the type of treatment.
THEME: “ABSCESSES AND PHLEGMONS OF THE MAXILLOFACIAL REGION. ETIOLOGY, PATHOGENESIS, PATHOLOGICAL ANATOMY. CLASSIFICATION. CLINICAL SYMPTOMS CHARACTERISTIC FOR ABSCESSES AND PHLEGMONS OF THE MAXILLOFACIAL REGION "
1. Relevance. According to the literature, patients with abscesses and phlegmons of the maxillofacial region and neck account for 30 - 70% of the total number of patients in maxillofacial hospitals and 10-20% of all visits for surgical help to dental offices and clinics. The main reason for the development of pyoinflammatory diseases of the maxillofacial region is chronic odontogenic foci of infection. Sensitization of the body, a decrease in specific and nonspecific reactivity leads to an exacerbation of the existing chronic odontogenic infection with the development of abscesses and phlegmon. The structural features of the maxillofacial region and neck determine the severity of the clinical course and the high risk of developing complications such as sepsis, cavernous sinus thrombosis, mediastinitis, which are often fatal.
In connection with the above, knowledge of the etiology, pathogenesis, pathological anatomy, clinical manifestations, taking into account the reactivity of the body, will allow graduates of the Faculty of Dentistry to diagnose in a timely manner, carry out adequate treatment and prevent the development of complications, systematically carry out the prevention of abscesses and phlegmon of the face and neck.
The purpose of the lesson. To create conditions and promote the mastery of students and theoretical knowledge on classification, etiology, pathogenesis, pathological anatomy, the clinic of abscesses and phlegmons of the maxillofacial region and neck, the skills of diagnosing differential diagnosis and assessing the type of reactivity.
To form professional competencies, the student must know:
˗ anatomy of the maxillofacial region;
˗ physiological and immunobiological features of organs and tissues of the maxillofacial region;
˗ features of the topographic anatomy of cellular spaces, which determine the development and spread of odontogenic infection;
˗ general characteristics and phases of the inflammatory process;
˗ types of immune reactions of the body;
˗ methods of examination of the patient by organs and systems;
˗ basic and additional research methods for inflammatory processes in the maxillofacial region;
˗ etiology of abscesses and phlegmon of the face and neck;
˗ pathological anatomy of abscesses and phlegmon of the face and neck;
˗ morphological differences between abscesses and phlegmon;
˗ pathogenesis of abscesses and phlegmon of the face and neck;
˗ classification of abscesses and phlegmons of the maxillofacial area;
˗ the main clinical symptoms characteristic of abscesses and phlegmons of the maxillofacial area;
˗ characteristic functional disorders in abscesses and phlegmon of the maxillofacial region;
˗ principles of differential diagnosis of abscesses and phlegmon.
To form professional competencies, the student must own:
1. OPK-5 (principles of analysis of its activities)
2.OPK-6 (analysis of the results of their own activities, skills in filling out medical documentation, methods of maintaining accounting and reporting documentation)
3. PC-2 (A / 04.7), theoretical knowledge on methods of examination of soft tissue injuries of the maxillofacial region, clinical course, diagnosis, differential diagnosis of injuries of the maxillofacial region;
4. PC-5 (A / 01.7), PC-6 (A / 01.7) skills of examination of patients with soft tissue injuries of the maxillofacial region, diagnosis and treatment of soft tissue injuries of the maxillofacial region.
5. PC-6 (A / 01.7) the ability to determine in patients the main pathological conditions, symptoms, syndromes of dental diseases, nosological forms in accordance with the International Statistical Classification of Diseases and Problems Related to Health.
6. PC-9 (A / 02.7) readiness for the management and treatment of patients with dental diseases on an outpatient basis and in a day hospital.
To form professional competencies, a student must be able to:
˗ examine patients with abscesses and phlegmons of the maxillofacial area;
˗ determine the source of infection in case of odontogenic abscesses and phlegmon;
˗ draw up a plan for additional examination;
˗ evaluate the results of basic and additional research methods;
˗ formulate a diagnosis in accordance with modern classifications;
˗ to assess the immunological reactivity of the body with phlegmon of the face and neck;
˗ carry out differential diagnostics of abscesses and phlegmon.
3. Type of lesson: practical lesson.
4. Duration of the lesson: 8 academic hours.
5. Equipment:
5.1. Didactic material (films and videos, multimedia atlases and situational tasks, business games, phantoms, radiographs, simulators, etc.);
5.2. TCO (computers, video dual, multimedia projectors, etc.)
Questions on the topic of the lesson:
1. Statistics of abscesses and phlegmons of the face and neck.
2. Classification of abscesses and phlegmons of the face and neck.
3. Etiology of abscesses and phlegmon of the face and neck.
4. Pathological anatomy of abscesses and phlegmon of the face and neck.
5. Pathogenesis of abscesses and phlegmons of the face and neck.
6. Types of immunological reactivity of the body with phlegmon of the face and neck.
7. Basic and additional methods of examination for abscesses and phlegmon of the maxillofacial area.
8. Typical functional disorders in abscesses and phlegmon of the maxillofacial region.
9. The main clinical symptoms of abscesses and phlegmon of the face and neck.
10. Principles of differential diagnosis for abscesses and phlegmon of the face and neck.
Place of self-training: reading room, study room for independent work of students, patient rooms, functional diagnostics rooms, etc.
Educational and research work of students on this topic:
1. The reactivity of the organism. Reactivity types. Changes in the body's immunological reactivity with abscesses and phlegmon of the maxillofacial region.
2. Immunity. Types of immunity.
3. Influence of the body's immunological reactivity on the development and clinical course of abscesses and phlegmons of the maxillofacial region.
4. Specific and non-specific defense mechanisms in the oral cavity.
Appendices to the topic: “Abscesses and phlegmon of the maxillofacial region. Etiology, pathogenesis, pathological anatomy. Classification. Clinical symptoms characteristic of abscesses and phlegmon of the maxillofacial region "
Annex 1
TESTS FOR CONTROL
INITIAL LEVEL OF KNOWLEDGE
Choose one or more correct answers.
1. IMMUNITY IS ABILITY
1) special cells of body fluids to recognize, bind and neutralize substances and structures originating from other organisms or having lost their resemblance to the cells of their own body
2) the immune system to reject foreign bodies
3) blood cells provide protection for the body and destroy bacterial cells that come from the external environment
4) some cells to destroy bacterial cells that come from the external environment
5) the body to protect itself from living beings and substances that carry signs of genetically alien information
2. ONE OF THE MAIN SIGNS OF ACUTE INFLAMMATION IS
1) cyanosis
2) increased blood pressure
3) increased heart rate
4) temperature rise
5) constriction of the pupils
3. ONE OF THE SIGNS OF ACUTE INFLAMMATION IS
1) hyperemia
2) cyanosis
3) acromegaly
4) lowering blood pressure
5) deformation of bone tissue
4. LOCAL MANIFESTATIONS OF ACUTE INFLAMMATION ARE
1) fever, leukocytosis, accelerated ESR
2) pain, fever, organ dysfunction
3) headache, sleep disturbance, loss of appetite
4) pain, hyperemia, edema, local hyperthermia, dysfunction
5) hypoalbuminemia, hypergammaglobulinemia
5. THE CONDITIONAL PHYSIOLOGICAL RATE OF OPENING THE MOUTH IS
1) 3-3.5cm
2) 4.5-5 cm
3) 3 fingers of the subject
4) 3 fingers of the doctor
5) 4 fingers of the subject
6. SIGNS OF GENERAL INTOXICATION OF THE BODY ARE
1) weakness
2) bradycardia
3) increased body temperature
4) an increase in the number of red blood cells
5) constriction of the pupil
7. ADDITIONAL RESEARCH METHODS ARE
1) collection of anamnesis of the disease
2) palpation
3) radiography
4) percussion
5) ultrasound
8. THE CONCENTRATION OF SUGAR IN THE PERIPHERAL BLOOD IS CONSIDERED HIGHER WITH THE INDICATORS ABOVE
1) 7.2 mmol / l
2) 2.2 mmol / l
3) 10 mmol / l
4) 3.2 mmol / l
5) 6.0 mmol / l
9. LYMPH NODES OF THE MAXILLOFACIAL REGION IN NORMAL
1) rounded, painless on palpation, 1x1 cm in size, mobile
2) rounded, painful on palpation, 1x1 cm in size, mobile
3) not determined by palpation
4) rounded, 1x1 cm in size, painless on palpation, motionless
5) round or oval, up to 1.0 cm in size, dense on palpation, painless
10. THE LEUKOCYTE FORMULA IS CALLED PERCENTAGE
1) certain types of leukocytes
2) leukocytes and erythrocytes
3) leukocytes, platelets and erythrocytes
4) leukocytes and platelets
5) basophils and erythrocytes
11. Erythrocyte sedimentation rate in men is normal when the display is not higher
1) 2 mm / h
2) 10 mm / h
3) 12 mm / h
4) 15 mm / h
5) 17 mm / h
12. CLINICALLY INFLAMMATORY INFILTRATE DIFFERENT FROM SOFT TISSUE Edema
1) density
2) functional disorders
3) color
4) the presence of crepitus
5) pronounced pain on palpation
13. THE REACTIVITY OF THE BODY IS
1) the body's response to a stimulus
2) the property of the body as a whole to react with changes in the vital activity of organs and systems to the effects of the environment
3) the body's defensive reaction to the action of a pathogenic stimulus
4) the body's resistance to disease-causing effects
5) nonspecific resistance of the organism
14. THE RELATIVE AMOUNT OF EOSINOPHILS IN THE PERIPHERAL BLOOD IS CONSIDERED INCREASED WITH THE INDICATORS ABOVE
1) 15%
2) 5%
3) 10%
4) 20%
5) 25%
15. BLOOD SHAPED ELEMENTS PARTICIPATING IN INFLAMMATION PATHOGENESIS
1) erythrocytes
2) platelets
3) leukocytes
4) albumin
5) interleukins
16. HYPERERGIC TYPE OF INFLAMMATION DEVELOPS WHEN
1) low level of immunity, pronounced sensitization of the body and significant virulence of microflora
2) a sufficient level of immunity, a low level of sensitization of the body and a high virulence of microflora
3) low level of immunity and sensitization of the body, poorly expressed virulence of microflora
4) low level of immunity, pronounced sensitization of the body and poorly expressed virulence of microflora
5) a sufficient level of immunity, high sensitization of the body, pronounced virulence of microflora
17. HYPERGIC TYPE OF INFLAMMATION IS OBSERVED AT
1) low level of immunity, pronounced sensitization of the body and significant virulence of microflora
2) sufficient tension of immunity, low level of sensitization of the body and high virulence of microflora
3) low level of immunity and sensitization of the body, poorly expressed virulence of microflora
4) low level of immunity, pronounced sensitization of the body and poorly expressed virulence of microflora
5) immunodeficiency state, weak sensitization of the body and pronounced virulence of microflora
18. WHEN THE BODY TEMPERATURE IS INCREASED BY 10 S, THE HEART RATE INCREASES BY
1) 18-20 per minute
2) 6-7 per minute
3) 8-10 per minute
4) 50 - 60 per minute
5) 30 - 40 per minute.
19. CELLULAR SPACES LOCATED ABOUT THE UPPER CHILLER
1) buccal
2) zygomatic
3) temporal
4) pterygo-jaw
5) infraorbital
20. CELLULAR SPACES LOCATED ABOUT THE LOWER JAW
1) sublingual
2) zygomatic
3) temporal
4) submental
5) buccal
Appendix 2
TESTS FOR CONTROL
LEVEL OF DEVELOPMENT OF THE TOPIC
Choose one or more correct answers.
1. WITH PHLEGMONS OF THE MAXILLOFACIAL REGION, FACE ASIM-METRIC IS OBSERVED AT THE EXPENSE
1) collateral edema
2) swelling
3) infiltration
4) deformation
5) hypertrophy of the surrounding tissue
2. The causative agents of abscesses and phlegmon of the maxillofacial region are most often
1) staphylococci
2) actinomycetes
3) gonococci
4) pale treponema
5) Leishmania
3. SOURCES OF INFECTION, MOST OF ALL ARE THE CAUSE OF THE DEVELOPMENT OF ABSCESSES AND FLEGMON OF THE MAXILLOFACIAL REGION
1) otogenic
2) tonsilogenic
3) stomatogenic
4) odontogenic
5) rhinogenic
4. WITH PHLEGMONE OF ONE CELLULAR SPACE OF THE MAXILLOFACIAL REGION GENERAL CONDITION OF THE PATIENT WITH NORMAL TYPE OF BODY REACTIVITY
1) satisfactory
2) moderate
3) heavy
4) extremely hard
5) terminal
5. SURFACES ARE FELEGMONS
1) buccal region
2) eye sockets
3) periopharyngeal space
4) pterygo-palatine fossa
5) submental area
6. IN ACUTE PURULENT LYMPHADENITIS IN THE CASE OF MELTING OF THE LYMPH NODE CAPSULE DEVELOPS
1) odontogenic phlegmon
2) osteophlegmon
3) periostitis
4) adenophlegmon
5) periadenitis
7. DIFFUSED PURULENT INFLAMMATION OF CELLS IN OSTEOMYELITIS OF JAWS IS CALLED
1) osteophlegmon
2) odontogenic phlegmon
3) adenophlegmon
4) periostitis
8. WITH PHLEGMONS OF THE MAXILLOFACIAL REGION, THE NUMBER OF PERIPHERAL BLOOD INCREASES
1) erythrocytes
2) platelets
3) leukocytes
4) hemoglobin
5) eosinophils
9. THE MORPHOLOGICAL DIFFERENCE OF THE ABSCESS FROM PHLEGMONA IS THE PRESENCE
1) fibrous capsule
2) pyogenic membrane
3) serous exudate
4) sinus tract
5) purulent exudate
10. CONCENTRATION OF IMMUNOGLOBULIN M IN BLOOD IN PHLEGMONS OF THE PANOLOFACIAL REGION
1) increases
2) does not change
3) decreases
11. WITH ABSCESSES AND PHLEGMONS OF THE MAXILLOFACIAL REGION, THE FUNCTION IS DISTURBED
1) speech
2) breathing
3) swallowing
4) smell
5) vision
12. AT ABSCESSES AND PHLEGMONS OF THE MAXILLOFACIAL AREA
1) opening the mouth
2) salivation
3) sweating
4) closing the mouth
5) thermoregulation
13. THE DEEP ARE THE PHLEGMONS
1) infraorbital area
2) pterygo-jaw space
3) periopharyngeal space
4) zygomatic region
5) submental area
14. THE MAXIMUM INCREASE IN BLOOD IMMUNOGLOBULIN G CONCENTRATION IN PHLEGMONS OF THE MAXILLOFACIAL REGION IS OBSERVED
1) after opening a purulent focus
2) on the first day of the disease
3) after relief of acute inflammation
4) at the stage of wound epithelialization
15. IN PHLEGMONS OF THE MAXILLOFACIAL REGION, THE IMMUNOGLOBULIN CONTENT IN THE PERIPHERAL BLOOD INCREASES
1M
2) A
3) G
4) E
5) D
16. The pathogens in case of putrefactive-necrotizing phlegmons of the human-facial area are
1) spirochetes
2) clostridia
3) mycobacteria
4) chlamydia
5) Pseudomonas aeruginosa
17. SKIN ABOVE INFILTRATE AT PHLEGMON OF THE MAXILLOFACIAL AREA
1) hyperemic
2) physiological coloration
3) pale
4) pigmented
18.SKIN ABOVE INFILTRATE IN PHLEGMON OF THE MAXILLOFACIAL AREA
1) gathers in the fold
2) does not fold
3) shifts along with the infiltrate
4) necrotic
19. IN PURULOUS-NECROTIC PHLEGMON OF THE MILLOFACIAL AREA, SKIN OVER THE INFILTRATE
1) hyperemic
2) pigmented
3) cyanosis
4) physiological coloration
5) earthy color
20. REGIONAL LYMPH NODES AT PHLEGMONS OF THE MAXILLOFACIAL REGION
1) increase
2) do not change
3) decrease
21. BLOOD COAGULATION AT PHLEGMONS OF THE MAXILLOFACIAL AREA
1) rises
2) does not change
3) decreases
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Additional:
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