How is dental care organized? Organization of dental service and assistance to the population

11.1 Organization of dental care for the urban population

Dental care for the urban population is provided in a variety of institutions or departments, starting with a dental office and ending with an independent specialized dental clinic.

The beginning of this organizational hierarchy is the dental office - the most massive structural unit of the service. The pinnacle of organization and concentration of all its types is an independent specialized dental clinic with departments of therapeutic, surgical and orthopedic dentistry, a department or office of pediatric dentistry, orthodontic, physiotherapy, x-ray rooms and a laboratory.

Such a highly specialized institution with enough highly qualified specialists allows comprehensively solving issues of diagnosis and treatment of patients, making the most of property, equipment, tools and having the opportunity to consult patients with various specialists in one institution.

The capacity of dental clinics varies and is determined by the number of full-time medical posts.

Table number 3. Categories of independent dental clinics and staffing standards for medical personnel (approximate distribution by departments and offices)

The vast majority of patients is treated in the therapeutic department, therefore, from 30 to 15% of the entire medical staff of the polyclinic are directly involved in the treatment of diseases of the oral cavity and teeth. The proportion of dentists-surgeons is 7-8%, dentists-orthopedists - 16-18%.

urgentdental care during the opening hours of the polyclinic it is a duty dentist, and at night - doctors of special emergency dental care centers organized in several polyclinics of the city.

In addition to the budgetary network of dental clinics, self-supporting polyclinics are being opened in the cities, which provide highly qualified dental care to all residents, regardless of age, place of work and residence.

Chief physician of the dental clinic manages all medical and preventive, organizational and methodological, economic and financial activities, controls the implementation of measures aimed at improving the quality and culture of medical service population, analyzes the performance of the institution and individual specialists, appoints and dismisses medical and administrative personnel, imposes disciplinary sanctions on employees for violation labor discipline.

As a manager of loans, he controls the correct use of the budget, is responsible for the sanitary condition and the implementation of fire prevention measures, etc.

Deputy for medical and preventive work is responsible for the quality of examination and treatment of patients, medical expertise, rational use of medicines, equipment, advanced training of medical staff. He solves the issues of hospitalization of patients together with the organizational and methodological office, studies the experience of other dental clinics, and holds production meetings.

Each department is headed manager, which ensures the organization of correct and timely diagnosis, high-quality treatment and disease prevention, appropriate maintenance of medical records, advanced training of doctors and paramedical personnel, preservation and use of equipment, tools and medicines.

Staff standards for medical personnel of dental clinics are determined by decree of the Ministry of Health of Ukraine No. 33 dated 23.02.2000. According to him, in urban dental clinics for adults located in cities with a population of more than 25 thousand people, they are as follows:

1-4 positions of dentists and dentists-surgeons in the amount of 10 thousand people of the adult population of the city where the polyclinic is located;

2.5 positions in total per 10 thousand people of the adult rural population;

2.7 positions in total per 10 thousand people of the adult rural population;

2 positions of dentists-orthopedists, which are self-supporting or special means, are set on the basis of:

1 position per 10 thousand people of the adult population of the city where the polyclinic is located;

0.7 positions per 10 thousand people of the adult rural population;

0.8 positions per 10 thousand people of the adult rural population.

Positions of heads of departments are established:

dental department - 1 position for every 12 positions of dentists and dentists-surgeons, but not more than 3 positions per clinic;

denture department (maintained on self-financing or at the expense of special means) - 1 position per clinic, in which, according to current staffing standards, at least 4 positions of orthopedic dentists are established.

The position of deputy head physician for the medical unit is provided for in the staff of the polyclinic, where there are at least 40 medical positions, taking into account the position of the head physician.

Positions of dentists-surgeons in departments maxillofacial surgery are installed at the rate of 1 per 25 beds. According to the standards for providing the population with hospital beds for certain profiles, beds for dentistry are not provided. They are deployed in large cities in one of the city hospitals in agreement with local health authorities. The position of the head of the surgical dental department is established instead of 0.5 of the position of a doctor if there are less than 60 beds in the department.

To serve patients in hospitals of regional, central city, city hospitals, medical units organize dental offices at the rate of 1 position for 600 beds, in tuberculosis hospitals - 0.5 for every 250 beds, but not less than 0.5 positions in hospitals.

The positions of nurses in medical offices are established at the rate of one position for:

1 position of a dentist-surgeon;

2 positions of dentists and orthodontists;

3 positions of dentists-orthopedists.

In dental offices, where the state provides for 1 position of a dentist, at least 1 position of a nurse is being introduced.

In dental laboratories, which are self-supporting, the number of dental technicians is set depending on the amount of work on prosthetics at the rate of 2-3 positions per orthopedic dentist. The position of a senior dental technician of a dental laboratory is provided for every 10 positions of dental technicians, but not less than 1 position for 3 dental technicians instead of one of them.

The positions of junior nurses are established at the rate of 1 position for 1 position of a dental surgeon, or for 3 positions of dentists of other specialties.

An obligatory structural department of any dental clinic is the registry (with a medical archive), which regulates the flow of patients, carries out accounting and statistical and reference and information activities.

The front desk works in two shifts. Her work should begin in 20-25 minutes. prior to admission of patients. Depending on the capacity of the polyclinic, several registrars may work in one shift in the registry. The registrar fills in the passport part of the medical record of the dental patient, writes out a coupon for an appointment with a doctor, where the date and time of receipt, doctor's name, office number, floor. Medical cards are transferred to the offices. Registrars control the self-registration of patients for an appointment, provide information about the work of others medical institutions cities.

The registrar positions are calculated according to the principle of 1 registrar for every 5 positions of doctors who receive appointments, but not less than 1 position per shift.

To save time, an examination room is organized in the clinic, the dentist of which provides a reasonable referral of patients to other rooms, and if necessary, provides emergency care.

The therapeutic department has rooms for the treatment of diseases of the teeth, periodontium and oral mucosa. Large polyclinics may have 2 therapeutic departments.

Office space therapeutic dentistry when installing one chair in it, it must have an area of ​​\u200b\u200bat least 14 square meters. m. For each additional seat you need to allocate at least 7 square meters. m. The doctors of the department of therapeutic dentistry work in 2 shifts according to the schedule. The most effective was the provision of therapeutic dental care on a precinct-territorial basis.

In view of the patient's right to choose a doctor, outpatient appointments are carried out according to the principle of free appointment, and according to the precinct-territorial principle, only dispensary work is carried out.

The dentist is appointed by the chief physician of the clinic. In his daily work subordinate to the department, deputy head physician for the medical unit and head physician. Orders of the doctor are obligatory for the middle and junior staff of the department within the limits of their functional duties.

The dentist must:

ensure effective and high-quality provision of dental care to patients;

render emergency care in cases anaphylactic shock, collapse, loss of consciousness and other emergency conditions;

take part in medical examinations of the population;

conduct an examination of temporary disability;

conduct dispensary observation of certain contingents;

systematically improve their professional level, using modern diagnostic methods, treatment and prevention of dental diseases;

constantly take care of improving the professional theoretical skills of middle and junior staff;

to carry out sanitary and educational work among the population;

Adhere to workplace safety rules.

The dentist is responsible for:

non-fulfillment of the production plan and poor-quality treatment of patients;

the occurrence of complications after treatment due to his fault;

poor quality and untimely maintenance of the necessary medical records;

irrational use of medical and diagnostic equipment that is available, tools and other medical equipment.

The results of medical examinations, data of observation of patients during outpatient appointments allow to allocate dispensary groups for further registration, observation and treatment.

D1– healthy and practically healthy persons who do not have dental diseases, periodontal disease and malocclusion. This also includes patients who have a compensated form of caries, mucosal diseases associated with unhygienic maintenance of the oral cavity and patients after traumatic injury. teeth jaw system. They are sanitized once a year.

D 2- persons who have subcompensated numerous caries, dental fluorosis, increased fragility, gingivitis, periodontitis, leukoplakia, neuralgia trigeminal nerve, after surgical interventions and dentoalveolar injuries, those that have inflammatory processes (osteomyelitis, odontogenic lymphadenitis, etc.), are on orthodontic treatment, etc. They are inspected and sanitized at least 2 times a year.

D3- persons with sub- and decompensated forms of caries, generalized periodontal disease and periodontitis, diseases of the marginal periodontium caused by diseases of the internal organs (periodontal syndrome), as well as those who require complex dental treatment with a severe course of the disease, with chronic recurrent aphthous stomatitis, etc. d. This group is examined and sanitized 3 times a year or more.

Surgical Dental Department provided only in large dental clinics if there are 6 or more dental surgeons in the staff of the clinic.

The structure of such a department includes: operating room, preoperative room, sterilization room and rooms for temporary stay of patients after surgery. The area of ​​the surgical department with one dental chair is 23 sq.m. for each subsequent chair - +7 sq.m.

Category II-V dental clinics have only a surgical room.

AT last years into structure surgical departments dental clinics included offices rehabilitation treatment and rehabilitation. This makes it possible to ensure continuity in the outpatient and inpatient treatment of patients, increase its effectiveness and reduce the duration of temporary disability.

The main responsibilities of the surgeon-stomatologist of the polyclinic are:

reception of primary and secondary patients, diagnosis of diseases, provision of emergency and planned surgical care;

advisory assistance to patients;

referral of patients for consultation to specialized institutions and hospital treatment;

conducting examinations in the oral cavity;

clinical examination of patients according to profiles;

examination of temporary disability;

medical rehabilitation at the stage of post-treatment of patients with injuries, inflammatory processes fabrics maxillofacial area.

Dental orthopedic care is one of the foundations of tertiary prevention. Without orthopedic intervention, it is impossible to consider dental patients cured, because. almost all of them have damage to the dentoalveolar apparatus.

The relevance of orthopedic dental care for child's body confirmed scientific observations, which show that among children preschool age 20-25% have various disorders in the development of the jaw system, and 5-7% of them require emergency orthopedic care.

Orthopedic care is provided in departments or offices of dental clinics. Doctors orthopedic department provide medical care to adults and children in the absence of children's dental institutions.

For orthopedic treatment, contingents of patients are formed by self-referral for help, as well as by patients referred by dentists of other specialties.

The activities of the orthopedic department are supported by self-supporting or special means. Free or preferential treatment is used by participants in the liquidation of the Chernobyl accident, war and labor invalids and persons who are equated to them, pensioners, children.

The orthopedic department includes rooms for receiving patients, a dental laboratory and a foundry.

The doctor on duty examines the patient and selects the design of the necessary prosthesis. If the patient needs oral sanitation, he is referred to a therapist or surgeon who treats and prepares for prosthetics.

The orthopedic surgeon takes an impression after processing the teeth under the prostheses and through nurse passes it on to the production manager. The manager determines the period of the intermediate stage of manufacturing the prosthesis and appoints the patient for the next visit. Depending on the organization of the work of dental technicians, orthopedic care can be provided in three forms:

individual - when the dental technician completely manufactures the denture himself;

brigade - when there is a distribution by type of prosthesis;

phased - when there is a distribution of operations on one prosthesis.

In each regional, city and district dental clinic (department), an orthodontist is organized for the treatment and prevention of malocclusion and jaw deformities in children. The positions of orthodontists are distinguished from the positions of children's dentists. With a standard of 5.0 doctors per 10 thousand of the child population, 0.5 positions are allocated for orthodontics.

The positions of dental technicians for servicing the work of orthodontists are set at the rate of 1:1.

Surgical dental inpatient departments are organized in regional and large city hospitals. The number of beds in them depends on the population that lives there and on the use of a hospital as a clinical base for universities.

An independent department is created if it has from 40 to 60 beds. For inpatient treatment of patients with pathology of the maxillofacial region in small settlements, specialized beds are deployed in one of the surgical departments of a city or district hospital with the consent of local health authorities. According to the standard standards, there are 25 beds per one dentist-surgeon in the hospital.

Organization of dental care for the urban population

Dental care for the urban population is provided in a variety of institutions or departments, starting with a dental office and ending with an independent specialized dental clinic.

The beginning of this organizational hierarchy is the dental office - the most massive structural unit of the service. The pinnacle of organization and concentration of all its types is independent specialized dental clinic with departments of therapeutic, surgical and orthopedic dentistry, department or office of pediatric dentistry, orthodontic, physiotherapy, x-ray rooms and a laboratory.

Such a highly specialized institution with a sufficient number of highly qualified specialists makes it possible to comprehensively address the issues of diagnosing and treating patients, to make the most of property, equipment, tools, and to be able to consult patients with various specialists in one institution.

The capacity of dental clinics varies and is determined by the number of full-time medical posts.

Table number 3. Categories of independent dental clinics and staffing standards for medical personnel (approximate distribution by departments and offices)

The vast majority of patients is treated in the therapeutic department, therefore, from 30 to 15% of the entire medical staff of the polyclinic are directly involved in the treatment of diseases of the oral cavity and teeth. The proportion of dentists-surgeons is 7-8%, dentists-orthopedists - 16-18%.

Emergency Dental Care during the opening hours of the polyclinic it is a duty dentist, and at night - doctors of special emergency dental care centers organized in several polyclinics of the city.

In addition to the budgetary network of dental clinics, self-supporting polyclinics are being opened in the cities, which provide highly qualified dental care to all residents, regardless of age, place of work and residence.

Chief physician of the dental clinic manages all medical and preventive, organizational and methodological, economic and financial activities, controls the implementation of measures aimed at improving the quality and culture of medical care for the population, analyzes the performance of the institution and individual specialists, appoints and dismisses medical and administrative personnel, imposes disciplinary sanctions on employees for violation of labor discipline.

As a manager of loans, he controls the correct use of the budget, is responsible for the sanitary condition and the implementation of fire prevention measures, etc.

Deputy for medical and preventive work is responsible for the quality of examination and treatment of patients, medical expertise, rational use of medicines, equipment, advanced training of medical staff. He solves the issues of hospitalization of patients together with the organizational and methodological office, studies the experience of other dental clinics, and holds production meetings.

Each department is headed manager, which ensures the organization of correct and timely diagnostics, high-quality treatment and prevention of diseases, appropriate maintenance of medical records, advanced training of doctors and nursing staff, preservation and use of equipment, tools and medicines.

Staff standards for medical personnel of dental clinics are determined by decree of the Ministry of Health of Ukraine No. 33 dated 23.02.2000. According to him, in urban dental clinics for adults located in cities with a population of more than 25 thousand people, they are as follows:

· 1-4 positions of dentists and dentists-surgeons in the amount of 10 thousand people of the adult population of the city where the polyclinic is located;

· 2.5 positions in total per 10 thousand people of the adult rural population;

· 2.7 positions in total per 10 thousand people of the adult rural population;

2 positions of dentists-orthopedists, which are self-supporting or on special funds, are established on the basis of:

· 1 position per 10,000 adults in the city where the polyclinic is located;

· 0.7 positions per 10 thousand people of the adult rural population;

· 0.8 positions per 10 thousand people of the adult rural population.

Positions of heads of departments are established:

dental department - 1 position for every 12 positions of dentists and dentists-surgeons, but not more than 3 positions per clinic;

· Prosthodontic department (maintained on self-financing or at the expense of special means) - 1 position per polyclinic, in which, according to the current staffing standards, at least 4 positions of orthopedic dentists are established.

The position of deputy head physician for the medical unit is provided for in the staff of the polyclinic, where there are at least 40 medical positions, taking into account the position of the head physician.

The positions of dentists-surgeons in the departments of maxillofacial surgery are established at the rate of 1 per 25 beds. According to the standards for providing the population with hospital beds for certain profiles, beds for dentistry are not provided. They are deployed in large cities in one of the city hospitals in agreement with local health authorities. The position of the head of the surgical dental department is established instead of 0.5 of the position of a doctor if there are less than 60 beds in the department.

To serve patients in hospitals of regional, central city, city hospitals, medical units organize dental offices at the rate of 1 position for 600 beds, in tuberculosis hospitals - 0.5 for every 250 beds, but not less than 0.5 positions in hospitals.

The positions of nurses in medical offices are established at the rate of one position for:

1 position of a dentist-surgeon;

2 positions of dentists and orthodontists;

· 3 positions of dentists-orthopedists.

In dental offices, where the state provides for 1 position of a dentist, at least 1 position of a nurse is being introduced.

In dental laboratories, which are self-supporting, the number of dental technicians is set depending on the amount of work on prosthetics at the rate of 2-3 positions per orthopedic dentist. The position of a senior dental technician of a dental laboratory is provided for every 10 positions of dental technicians, but not less than 1 position for 3 dental technicians instead of one of them.

The positions of junior nurses are established at the rate of 1 position for 1 position of a dental surgeon, or for 3 positions of dentists of other specialties.

An obligatory structural department of any dental clinic is the registry (with a medical archive), which regulates the flow of patients, carries out accounting and statistical and reference and information activities.

The front desk works in two shifts. Her work should begin in 20-25 minutes. prior to admission of patients. Depending on the capacity of the polyclinic, several registrars may work in one shift in the registry. The registrar fills in the passport part of the dental patient's medical record, writes out a coupon for an appointment with a doctor, which indicates the date and time of the appointment, the doctor's name, room number, floor. Medical cards are transferred to the offices. Registrars supervise self-registration of patients for admission, provide information about the work of other medical institutions of the city.

The registrar positions are calculated according to the principle of 1 registrar for every 5 positions of doctors who receive appointments, but not less than 1 position per shift.

To save time, an examination room is organized in the clinic, the dentist of which provides a reasonable referral of patients to other rooms, and if necessary, provides emergency care.

The therapeutic department has rooms for the treatment of diseases of the teeth, periodontium and oral mucosa. Large polyclinics may have 2 therapeutic departments.

The room of the cabinet of therapeutic dentistry, when installing one chair in it, must have an area of ​​​​at least 14 square meters. m. For each additional seat you need to allocate at least 7 square meters. m. The doctors of the department of therapeutic dentistry work in 2 shifts according to the schedule. The most effective was the provision of therapeutic dental care on a precinct-territorial basis.

In view of the patient's right to choose a doctor, outpatient appointment are carried out according to the principle of free registration, and according to the precinct-territorial principle, only dispensary work is carried out.

The dentist is appointed by the chief physician of the clinic. In his daily work, he reports to the head. department, deputy head physician for the medical unit and head physician. Orders of the doctor are obligatory for the middle and junior staff of the department within the limits of their functional duties.

The dentist must:

Provide effective and high-quality dental care to patients;

provide emergency care in cases of anaphylactic shock, collapse, loss of consciousness and other emergency conditions;

take part in medical examinations of the population;

Conduct an examination of temporary disability;

Conduct dispensary observation of certain contingents;

systematically improve their professional level, using modern methods of diagnosis, treatment and prevention dental diseases;

· constantly take care of improving the professional theoretical skills of middle and junior staff;

to carry out sanitary and educational work among the population;

Adhere to workplace safety regulations.

The dentist is responsible for:

Failure to meet production plan poor quality treatment sick;

the occurrence of complications after treatment due to his fault;

Poor quality and untimely maintenance of the necessary medical documentation;

· irrational use of medical and diagnostic equipment, which is available, tools and other medical equipment.

The results of medical examinations, data of observation of patients during outpatient appointments allow to allocate dispensary groups for further registration, observation and treatment.

D1– healthy and practically healthy persons who do not have dental diseases, periodontal disease and malocclusion. This also includes patients who have a compensated form of caries, mucosal diseases associated with unhygienic maintenance of the oral cavity and patients after traumatic injury dental system. They are sanitized once a year.

D 2- persons who have subcompensated multiple caries, dental fluorosis, increased fragility, gingivitis, periodontitis, leukoplakia, trigeminal neuralgia, after surgical interventions and dentoalveolar injuries, those that have inflammatory processes (osteomyelitis, odontogenic lymphadenitis, etc.), are on orthodontic treatment, etc. They are inspected and sanitized at least 2 times a year.

D3- persons with sub- and decompensated forms of caries, generalized periodontal disease and periodontitis, diseases of the marginal periodontium caused by diseases of the internal organs (periodontal syndrome), as well as those who require a comprehensive dental treatment with a severe course of the disease, with chronic relapsing aphthous stomatitis etc. This group is examined and sanitized 3 times a year or more.

Surgical Dental Department provided only in large dental clinics if there are 6 or more dental surgeons in the staff of the clinic.

The structure of such a department includes: operating room, preoperative room, sterilization room and rooms for temporary stay of patients after surgery. The area of ​​the surgical department with one dental chair is 23 sq.m. for each subsequent chair - +7 sq.m.

Category II-V dental clinics have only a surgical room.

In recent years, the structure of the surgical departments of dental clinics has included rooms for restorative treatment and rehabilitation. This makes it possible to ensure continuity in the outpatient and inpatient treatment of patients, increase its effectiveness and reduce the duration of temporary disability.

The main responsibilities of the surgeon-stomatologist of the polyclinic are:

reception of primary and secondary patients, diagnosis of diseases, provision of emergency and planned surgical care;

consultative assistance to patients;

referral of patients for consultation to specialized institutions and for inpatient treatment;

Carrying out examinations in the oral cavity;

Prophylactic medical examination of patients according to profiles;

examination of temporary disability;

· Conducting medical rehabilitation at the stage of post-treatment of patients with injuries, inflammatory processes in the tissues of the maxillofacial region.

Dental orthopedic care is one of the foundations of tertiary prevention. Without orthopedic intervention, it is impossible to consider dental patients cured, because. almost all of them have damage to the dentoalveolar apparatus.

The relevance of orthopedic dental care for the child's body is confirmed by scientific observations, which show that among preschool children, 20-25% have various violations in the development of the jaw system, with 5-7% of them requiring emergency orthopedic care.

Orthopedic care is provided in departments or offices of dental clinics. Doctors of the orthopedic department provide medical care to adults and children in cases where there are no children's dental institutions.

For orthopedic treatment contingents of patients are formed due to self-referral for help, as well as due to patients referred by dentists of other specialties.

The activities of the orthopedic department are supported by self-supporting or special means. Free or preferential treatment is used by participants in the liquidation of the Chernobyl accident, war and labor invalids and persons who are equated to them, pensioners, children.

The orthopedic department includes rooms for receiving patients, dental laboratory and foundry.

The doctor on duty examines the patient and selects the design of the necessary prosthesis. If the patient needs oral sanitation, he is referred to a therapist or surgeon who treats and prepares for prosthetics.

The orthopedic doctor takes an impression after processing the teeth for prostheses and passes it through the nurse to the production manager. The manager determines the period of the intermediate stage of manufacturing the prosthesis and appoints the patient for the next visit. Depending on the organization of the work of dental technicians, orthopedic care can be provided in three forms:

individual - when the dental technician completely manufactures the denture himself;

Brigadier - when there is a distribution according to the type of prosthesis;

Staged - when there is a distribution of operations on one prosthesis.

In each regional, city and district dental clinic (department), an orthodontist is organized for the treatment and prevention of malocclusion and jaw deformities in children. The positions of orthodontists are distinguished from the positions of children's dentists. With a standard of 5.0 doctors per 10 thousand of the child population, 0.5 positions are allocated for orthodontics.

The positions of dental technicians for servicing the work of orthodontists are set at the rate of 1:1.

Surgical dental inpatient departments are organized in regional and large city hospitals. The number of beds in them depends on the population that lives there and on the use of a hospital as a clinical base for universities.

An independent department is created if it has from 40 to 60 beds. For inpatient treatment of patients with pathology of the maxillofacial region in small settlements, specialized beds are deployed in one of the surgical departments of a city or district hospital with the consent of local health authorities. According to the standard standards, there are 25 beds per one dentist-surgeon in the hospital.

The main features of the organization of dental care for residents of the village include:
. stages in the provision of dental care;
. the need to develop mobile types of dental care (therapeutic, orthopedic, surgical, orthodontic, etc.);
. the seasonal nature of the way of life of the villagers and the difficulties of transport links between settlements.

Dental care for residents of rural areas, as a rule, is organized on the basis of functioning medical facilities at all stages of provision medical care villagers.

At the first stage of organizing medical care for the rural population, dental care is provided to patients in FAPs, which must be equipped with the necessary tools, medicines and consumables. Using analgesic and anti-inflammatory drugs, the FAP assistant must stop or reduce acute toothache, remove a tooth of the third degree of mobility, thereby preventing odontogenic inflammation.

In district, district hospitals, outpatient clinics, centers of general medical (family) practice, a stomatological (dental) office is organized. The tasks of such an office include providing the population with qualified dental care in the treatment and prevention of diseases of the oral cavity, teeth, as well as regular planned sanitation of the oral cavity for children attending preschool and school institutions, sanitation of pregnant women, patients who are on dispensary records with socially significant diseases.

A dentist (dentist) periodically (according to the schedule) visits the FAPs, which are part of the complex therapeutic area, for treatment preventive work among the attached population.

The organization of the work of dental (dental) offices is largely determined by the seasonal nature of the way of life of the villagers, the difficulties of transport communication between settlements. Taking into account these features, work schedules for dental (dentistry) offices are drawn up, which are communicated to the population in a timely manner.

The organizational and methodological management of these offices is carried out by the district dentist, who is appointed from among the heads of the district dental clinics (dental departments of the central district hospitals).

In individual entities Russian Federation Outreach forms of providing dental care to residents of rural settlements have become widespread. They are organized on the basis of specially equipped vehicles (cross-country), assigned to the central district or district hospitals. The use of such mobile dental units makes it possible to provide dental care to residents of remote villages.

At the second stage of organizing medical care for the rural population, an independent district dental clinic or dental department is created in the structure of the Central District Hospital, the tasks of which are in many respects similar to those of the city dental clinic.

At the third stage, dental care is provided to rural residents, including in the regional (regional, district, republican) dental clinic, the main tasks of which are:
. provision of highly qualified dental care to residents municipal districts regions (territories, districts, republics);
. organizational and methodological management of dental clinics (departments, offices) operating at the first two stages of organizing medical care for rural residents;
. development and implementation control targeted programs on the prevention of dental diseases in the population of the region (territory, district, republic);

Organization and control of statistical accounting and reporting of the activities of dental clinics (departments, offices);
. study and dissemination modern technologies prevention, diagnosis and treatment of dental diseases;
. organization of advanced training of dentists and paramedical personnel.

The indicator of the average number of treated teeth per day per 1 dentist (dentist) characterizes the load on a mixed dental appointment. The recommended value of this indicator is 7-8 cured teeth per day.

The indicator of the average number of extracted teeth per day per 1 dentist also serves as a characteristic of the load at a mixed dental appointment. The recommended value of this indicator is 2-3 extracted tooth(temporary and permanent bite) per day.

The last two indicators are also used to calculate an indicator that characterizes the quality of dental care - the ratio of the number of treated teeth to those removed.

Dental care quality indicators

The indicator of the ratio of the number of cured teeth to those removed characterizes the level of sanitary culture of the population, the introduction of modern medical technologies and has specific features for children and adults. This indicator is calculated as the ratio of cured teeth to the number of teeth removed. The recommended value of this indicator for the child population is 800:1 (for permanent teeth), the adult population - 3:1.

The indicator of the proportion of complicated caries characterizes the level of sanitary culture of the population, the availability of dental care, the qualifications of specialists and the provision of dental organizations with the necessary material resources. This indicator is calculated as a percentage of the number of teeth treated for pulpitis, periodontitis to total number cured teeth, and its value should not exceed 15%.

The indicator of the proportion of complications after tooth extraction characterizes the level of professional training of dentists (dentists), the provision of dental organizations with the necessary medicines and consumables. In their work, dentists (dentists) should not allow such complications, however, in the current practice, the proportion of complications after tooth extraction remains at the level of 1.0%.

Rice. 13.2. Dynamics of population provision with dentists and dentists in the Russian Federation (1998-2008)

Indicators of clinical examination of patients with a dental profile

The indicator of the proportion of sanitized persons characterizes the completeness of sanitation of patients with diseases of the oral cavity, identified during medical examinations, during which it is necessary to strive for 100% sanitation of patients in need of dental care.

The Kollegov index characterizes the level of work on the prevention and treatment of children in organized groups of oral diseases. Given the need for sanitation of all children in organized groups in need of dental care, the value of this indicator should tend to 1.0.

O.P. Shchepin, V.A. Medic

PURPOSE OF THE LESSON: to know state of the art dental care, the structure, tasks and organization of the city dental clinic, master the methodology for calculating and evaluating general and special indicators of the clinic, use the information received to analyze and plan the activities of the institution.

LESSON METHODOLOGY: Students independently prepare for a practical lesson using the recommended literature and do individual homework. The teacher checks the correctness of the execution within 10 minutes. homework and indicates the mistakes made, checks the degree of preparation using testing and oral questioning. Then the students independently, according to the annual report of the medical institution, calculate the main indicators of the polyclinic's activity. Analyze the obtained data and formulate a conclusion. At the end of the lesson, the teacher checks independent work students.

TEST QUESTIONS:

1. What types of medical institutions provide outpatient dental care to the population?

2. What are the main tasks of the dental clinic.

3. What is the structure and organization of work of the city dental clinic?

4. What is the organization of work of the polyclinic registry?

5. What are functional responsibilities a dentist?

6. How is dispensary observation of patients of the city dental clinic organized?

7. What is the anti-epidemic work in the dental clinic?

8. What are the main types of documentation used by dentists?

9. What are the general and special indicators activities of the dental clinic. What is the method of their calculation and evaluation?

Dental care is a type of specialized medical care provided for diseases and injuries of the teeth, jaws and other organs of the oral cavity and maxillofacial region. Dental care includes therapeutic, orthopedic and surgical dentistry and is one of the most popular types of specialized medical care. The bulk of dental care (more than 90%) is provided in outpatient settings. Outpatient dental care is provided by:

In specialized state and municipal dental clinics (for adults and children);

In dental departments (offices) that are part of other public institutions healthcare: territorial polyclinics, medical units, dispensaries, women's clinics;

In dental offices deployed in non-medical organizations: preschool and school institutions, higher and secondary specialized educational institutions;

In private dental organizations, institutions, offices.

The dental clinic is the main medical and preventive institution in the system of outpatient dental care, whose activities are aimed at the prevention of dental diseases, timely detection and treatment of patients with diseases of the maxillofacial region. The work here is based mainly on the precinct principle, and the leader should be dispensary method.

Depending on the number of medical positions, polyclinics are divided into categories.

As part of the dental clinic in the department of orthopedic and orthodontic dentistry As a rule, a dental (denture) laboratory is deployed, in which complex technological processes associated with the manufacture of dentures are carried out, which differ significantly from each other: casting, stamping, soldering, grinding, polishing, polymerization and artistic modeling. In addition, mobile dental offices equipped with special vehicles can be created in the regional (regional) dental clinic.

The main tasks of the city dental clinic:

Providing highly qualified and specialized dental care in the clinic and at home.

Organization and implementation of measures for the prevention of diseases of the maxillofacial region - medical examination of the population, sanitary and educational work, propaganda healthy lifestyle life, anti-epidemic measures.

Holding rehabilitation treatment pathologies of the maxillofacial region and, above all, dental prosthetics and orthodontic treatment.

High-quality conduct of clinical and expert work - examination of temporary disability and timely detection of signs of permanent disability.

Timely hospitalization of persons in need of inpatient treatment.

Compliance with successive ties with other health facilities.

The main tasks of a dentist are to provide qualified medical and diagnostic care on an outpatient basis to patients with diseases of the teeth and oral cavity, living in the area of ​​​​the clinic, as well as workers and employees of attached enterprises. The dentist in his work reports directly to the deputy chief physician for medical affairs, and in his absence, to the chief physician of the polyclinic.

Functional duties of a dentist:

1. Conduct outpatient appointments according to the schedule approved by the administration of the polyclinic, regulating the flow of visitors through the rational distribution of repeat patients.

2. Provide qualified and timely examination and treatment of patients with diseases of the teeth and oral cavity.

3. Carry out preventive examinations and sanitation of the oral cavity among patients who are under dispensary observation in the clinic.

4. Render out of turn emergency assistance patients with acute toothache, as well as war and labor veterans.

5. Provide proper conduct examination of temporary disability.

6. Refer patients, if indicated, to additional types studies (laboratory, x-ray, functional, etc.).

7. Timely present patients with unidentified forms of diseases or those who are ill for a long time for a consultation with other specialist doctors of the polyclinic and CEC.

8. Advise patients on the referral of other specialists of the institution, including at home.

9. Carry out, in accordance with the indications, timely hospitalization of patients.

10. Follow the principles of deontology in your work.

11. Monitor and manage the work of the paramedical staff of the dental office.

12. Systematically improve their professional skills by studying the relevant literature, participating in conferences and seminars.

13. Participate in the promotion of sanitary and hygienic knowledge among the population on the prevention of diseases of the teeth and oral cavity.

14. News medical records dental patients, a diary of the work of a dentist, a sheet of daily records of the work of a dentist, a journal of records preventive examinations oral cavity, etc.

The dentist has the right:

Make proposals to the administration of the polyclinic on improving the organization of preventive dental care for the population, the organization and conditions of their work and the work of the paramedical staff of the dental office;

Participate in meetings on the organization of dental care;

Prescribe and cancel any medical treatment preventive actions based on the condition of the patient;

Receive information necessary for the performance of official duties;

Enhance your skills with continuing education courses in due course.

The dentist is responsible both for poor-quality work and erroneous actions, as well as for inaction and failure to make decisions that fall within the scope of his duties and competence, in accordance with applicable law.

An important part of the dentist's work is preventive activity. Disease prevention is a system of medical and non-medical measures aimed at preventing deviations in health status, slowing down the progression of diseases and reducing them. adverse effects. In dentistry, it is customary to subdivide preventive measures into primary, secondary and tertiary prevention.

Primary prevention: complex general events to improve human health in combination with special ones aimed at preventing dental caries, periodontal diseases, dental anomalies (sanitary and educational work, balanced diet, water fluoridation, elimination of occupational hazards).

Secondary prevention - a set of measures to timely treatment caries and its complications, periodontal disease and dentoalveolar anomalies. The main organizational method secondary prevention is the planned provision of dental care (planned sanitation).

Tertiary prevention is the restoration of the lost function of the dentition as a result of tooth loss.

With the aim of active prevention dental caries and other common dental diseases, clinics carry out planned rehabilitation teeth and oral cavity to decreed groups of the population (children and adolescents in organized groups, students, industrial workers, pregnant women, etc.)

Planned rehabilitation methods:

Centralized - provides for examination, diagnosis of diseases and all types of treatment in a dental clinic. This method allows you to carry out high-quality medical and preventive work, since the clinic has a modern special equipment, materials and medicines, the best diagnostic capabilities.

Decentralized - planned sanitation is carried out in existing dental offices at enterprises, organizations and educational institutions if the number of employees is not less than 2000 people and if the number of students is not less than 1500 people.

Brigadier (visiting) - a team of 3-4 doctors, 1 nurse and 1 nurse is formed in the dental clinic to provide dental care to rural residents, children in preschool institutions, and the elderly. This method uses specially equipped transport.

The assessment of the work of a dentist is carried out by the deputy chief physician of the polyclinic for the medical unit based on the results of work for the quarter (year) based on the qualitative and quantitative indicators of his work, his compliance with the requirements of fundamental official documents, labor discipline rules, moral and ethical standards, social activity. To record the work of doctors dental profile a system is used based on measuring the amount of work in conventional units of labor input (UET). Labor accounting according to the UET is aimed at raising the interest of doctors in the final results of their own work, stimulating their productivity growth and developing a preventive focus in their work. For 1 UET, the amount of work of a doctor is taken, which is necessary for applying a filling with an average caries. Labor costs increase when performing more complex types of work. So, when applying a filling with deep caries the doctor performs 1.5 UET, in the treatment of pulpitis of a single-root tooth in one visit 4.0 UET (two-root tooth - 5.0 UET, three-root tooth - 6.0). Treatment of periodontitis of a single-rooted tooth in one visit is estimated at 3.5 UET, a two-root tooth - 4.5 UET, a three-root tooth - 5.5 UET.

A doctor with a six-day working week must perform 21 conventional units of labor intensity per working day, with a five-day working week - 25 UET. The norm of annual workload per 1 doctor is 5500 UET.

The use of the principle of conventional units of labor intensity (LUT) provides for the following opportunities for intensifying the activities of dental institutions, taking into account budget financing and financing under compulsory medical insurance programs:

1. reduction in the number of visits to the patient for the provision of dental care, which, in turn, provides each patient with savings in his personal and working time spent on receiving this care, in the amount of 30% to 60% by reducing travel time, registration , waiting for reception; providing more assistance in one visit: treatment of 2-3 teeth for caries in one visit, treatment of pulpitis - in one visit, etc.;

2. saving the doctor's working time by reducing the time spent on unproductive elements of the labor process (calling the patient, preparing the workplace, preparing operating field, work with documentation, etc.);

3. reduction in the number of such auxiliary elements of the labor process as the selection of tools necessary for the performance of work, its sterilization (reduction in the number of directions of tools for sterilization from 2-5 times, according to the number of visits, to 1);

4. increase in the number of seals applied per shift, from 6 (according to standards oriented to assessment by visits) to 10-12 due to rational use real working time of dentists.

5. increase in the overall labor productivity of dentists by 15-20%, and in some regions by 25%.

Performance indicators of the dental clinic

1. Security of the population with dental outpatient care:

Number of occupied medical positions of dentists in the clinic? 10000

Population in the area of ​​operation of the polyclinic

The standard is 5.0 per 10,000 adults and 5.0 per 10,000 children

2. Staffing of doctors - dentists

Number of occupational positions of dentists? 100

Number of full-time medical positions of dentists

Norm - 100%

3. Average number of visits to dentists per inhabitant per year:

The number of all visits of the residents of the district to dentists

Population in the area of ​​operation of the polyclinic

The average number of visits per 1 adult to dentists is 1.9; for 1 child - 1.4; in total - 1.79.

4. The average number of ULs produced by one doctor per day:

The total number of conventional units of labor intensity generated for the reporting period

Number of working days in the period? number of occupied medical positions

A doctor with a six-day working week must perform 21 conventional units of labor intensity per working day, with a five-day working week - 25 UET

5. Share of initial visits

Number of initial visits to the dental clinic? 100

Number of all visits made to the dental clinic

The average number of first visits is about 45%

6. The ratio of cured and extracted teeth

Total teeth filled

Removed permanent occlusion teeth

In the context of the use of modern technologies is

7. The proportion of those who were sanitized out of those who applied to the polyclinic

Number of sanitized by negotiability? 100

Total number of admitted primary patients

Must be at least 55-60%

8. The proportion of those in need of sanitation, among those examined in planned

The number of those in need of sanitation among those examined? 100

The total number of those examined in a planned manner

On average reaches 70%

9. The proportion of sanitation for preventive work

Number of sanitized out of those identified during planned sanitation? 100

The number of those in need of sanitation among those examined

This figure should be close to 100%.

TASK FOR INDEPENDENT WORK:

Task number 1.

According to the annual report of the medical institution, calculate the performance indicators of the dental clinic. Analyze the data obtained and draw a conclusion about the features of the organization of the work of the dental clinic.

Lisitsyn Yu.P. Public health and healthcare. M, 2002.

Lisitsyn Yu.P. Social hygiene (medicine) and healthcare organization. Kazan, 1999. -p. 321-339

Yuriev V.K., Kutsenko G.I. Public health and healthcare. S-P, 2000. - p. 399-415.

Public health and healthcare. Ed. V.A. Minyaeva, N.I. Vishnyakova M. "MEDpress-inform", 2002. - p. 296-312.

Features of the organization of dental care for the children's population are determined, first of all, high level dental morbidity in childhood and adolescence: more than 80% of children suffer from dental caries, 95% - periodontal disease.

Outpatient dental care for children is provided by the following dental institutions:
. children's dental clinics;
. children's dental departments(offices) of institutions of the general medical network;
. dental offices of educational institutions.

Children's dental clinics as independent healthcare facilities are organized in large cities with a child population of at least 60-70 thousand people. In cities with a child population of up to 20 thousand, dental care is provided in children's departments (offices) of dental clinics for adults.

The main tasks of the children's dental clinic include:
. ensuring a high-quality diagnostic and treatment process based on the standards of medical care for children suffering from dental diseases;
. organizing and carrying out in a planned manner preventive examinations and sanitation of the oral cavity of children in institutions of preschool, primary general, basic general, secondary (complete) general, special education, primary and secondary vocational education;

Providing emergency dental (surgical) care to sick children with acute diseases and injuries of the maxillofacial region;
. carrying out dispensary observation of children with pathology of the dentoalveolar system with an assessment of the level of dental health of children;
. referral in the prescribed manner of sick children for inpatient treatment in specialized dental departments;

Carrying out complex orthodontic treatment of children with dentoalveolar and facial anomalies;
. analysis of dental morbidity in children and development of measures to reduce and eliminate the causes that contribute to the occurrence of diseases and their complications;
. introduction of modern methods of prevention, diagnosis and treatment of dental diseases of the maxillofacial region in children;

Carrying out sanitary and educational work among the population, including with the involvement of nursing staff of medical institutions, teaching staff of schools and preschool institutions, parents, using all media (print, television, radio broadcasting, visual agitation, etc.);

Equipping the structural divisions of the polyclinic with medical equipment, tools, as well as medicines and consumables in accordance with the list of equipment and tools;
. keeping records and compiling medical reports in the prescribed manner.

There are certain requirements for the structure of a children's dental clinic; the presence of at least 2-3 offices of an orthodontist, an office of a psychologist, a game room. In the event that dental care for children is provided in a department that is part of the structure of a dental clinic for adults, then mandatory conditions includes the presence of a separate entrance for children and at least two rooms (surgical, therapeutic).

One of the features of the organization of the work of children's dental clinics is the widespread use of the planned sanitation method.

The main figure in the children's dental clinic is a pediatric dentist who received a higher professional education in the specialty "dentistry" and completed an internship in the specialty "stomatologist" general practice” or clinical residency in the specialty “pediatric dentistry”.

Specialized assistance is provided by dentists-specialists (therapist, surgeon, orthopedist, orthodontist) who have undergone professional retraining in pediatric dentistry in accordance with the requirements of the educational standard, standard program and curriculum approved in accordance with the established procedure and received a certificate of a specialist in the relevant specialty. In addition, dental care for children can be provided by dentists.

The main task of a pediatric dentist is to carry out preventive, diagnostic, therapeutic and sanitary-educational work aimed at the optimal development of the dental system of children. To do this, he carries out planned sanitation of the oral cavity of children, medical examinations in need of constant dynamic monitoring.

AT necessary cases provides emergency dental care to children on an outpatient basis, in accordance with the established procedure, directs children with pathology of the maxillofacial region for inpatient treatment in specialized dental departments, etc.

O.P. Shchepin, V.A. Medic