УПБГМУ: Methodical recommendations for students

Course categories:

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.

	Classification of inflammatory diseases of the maxillofacial region. Etiology and pathogenesis of odontogenic inflammatory diseases.
	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
	Periodontitis. Classification. Etiology, pathogenesis, pathological anatomy. Clinic, diagnosis, treatment of acute periodontitis
	Chronic periodontitis. Clinic, diagnostics, treatment.
	Surgical treatment of periodontal diseases
	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.
	Diseases of teething. Causes. Clinic, diagnostics, treatment. Difficulty erupting the third lower molar. Clinic, diagnostics. Complications with difficult teething of wisdom teeth, treatment.
	Odontogenic osteomyelitis of the jaws. Classification. Etiology. Modern concepts of pathogenesis. Pathological anatomy. Acute stage of jaw osteomyelitis. Clinic, diagnostics, differential diagnostics. Treatment.
	Subacute and chronic stages of odontogenic osteomyelitis of the jaws. Clinic, diagnostics, differential diagnostics, treatment.
	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.
	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;

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)

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

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

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)

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

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)

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)

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)

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)

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

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)

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)

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)

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

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

RECOMMENDED REFERENCES

Main:

1. Surgical dentistry / Ed. T.G. Robustova. - 2nd ed., Rev. and add. - M .: "Medicine", 2003. - 623 p.

Additional:

1. Bernadsky Yu. I. Fundamentals of maxillofacial surgery and surgical dentistry. - 3rd ed., Rev. and add. - M .: Medical literature, 2007 .-- 416 p.

2. Biology of the oral cavity. Borovskiy E.V., Leontiev V.K. M. - Medical book, N.-Novgorod, Ed. - NGMA 2001 .-- 304 p.

3. Inflammatory diseases of the maxillofacial region and neck. Ed. A.G. Shargo-rodsky - M .: Medicine, 1994.

4. Purulent maxillofacial surgery. Bernadsky Yu.N., Kiev, 1983.

5. Diseases of the mucous membrane of the mouth and lips: Textbook / L.A. Tsvetkova, S. D. Arutyunov, L. V. Petrova, Yu. N. Pearl. - 2nd ed., Rev. and add. - M .: MED-press-inform, 2006 .-- 208 p.

6. Lukyanenko VI Osteomyelitis of the jaws, their prevention and treatment. L., 1968 .-- 268 p.

7. Microbiology of the oral cavity (third edition). Tsarev V.V., Davydova M.M. UMO MZRF 2008 50 p.

8. Mukovozov IN Differential diagnosis of surgical diseases of the maxillofacial area. - M .: "MEDpress", 2002. - 224 p.

9. Fundamentals of maxillofacial surgery: textbook, A.A. Timofeev. - M .: LLC "Medical Information Agency", 2007. - 696 p.

10. Increase M.G., Lysenkov N.K., Bushkovich V.I. Human anatomy. - 11th ed., Rev. and add. - SPb .: Hippocrates, 2002 .-- S. 470 - 472.

11. Rational pharmacotherapy in dentistry: Ruk. for practicing doctors / G.M. Barer, E.V. Zoryan, V.S. Agapov, V.V. Afanasyev and others; Under total. ed. G.M. Barrera, E.V. Zoryan. - M .: Litera, 2006 .-- 568 p.

12. Guidelines for Maxillofacial Surgery and Surgical Dentistry, A.A. Timofeev, Kiev, 2002.

13. Strukov A.I., Serov V.V. Pathological Anatomy: Textbook. - 4th ed., Stereotyped. - M .: Medicine, 1995 .-- S. 134 - 141.

14. Timofeev A.A. Fundamentals of Maxillofacial Surgery: Textbook. - M .: LLC "Medical Information Agency", 2007. - 696 p.

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