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Contents of the topic.

The work of a dentist is multifaced; it is difficult and has its own characteristics. One of them is to perform their professional activities to the dentist a lot of different equipment and specially equipped room - a dental office. It should be a special bright room with total area of not less than 14 m2 for workstation. For each additional workstation is added to an area of not less than 7 m2 and 10 m2 for each additional seat with a universal dental unit. The height of the cabinet must be at least 3 m, and the depth at its sole natural light should not exceed 6 m.

Dentist uses in his work a variety of materials and medicines that can cause adverse health effects of medical personal and patients. That is why, dental office should be equipped with forced ventilation and a sufficient amount - at least 12 m2 per person. The walls and floor office should be easily sanitized. To do so, according to their hygienic water-based paints are painted bright colors or covered with tiles. This is especially important when conducting study amalgams fillings: on the floor and walls should be no gaps where they could accumulate dust contaminated with mercury. Working with the amalgam is allowed only if the cabinet enclosure with exhaust, which directly and prepared amalgam.

The organization provides for a dental office in him the necessary conditions for the dentist and auxiliary medical personnel - nurses and orderlies. Given this, in the dental office should not be anything extra, necessary furniture should be located efficiently. It is necessary that the staff did not make any unnecessary movements and to create favorable conditions for doctors, paramedical staff and for patient well-being.

It is important to a sufficient level of illumination of the working field dentist (5000-10 000 lux) and dental (500 lux). Lighting should be intense enough and do not cause eye strain staff. With the same purpose, the walls and floor are painted in neutral colors. It is advisable to use a neutral light gray, not interfering with the right shades of color discrimination on mucous membranes, skin, blood, teeth and filling materials. Doors and windows in the room are painted enamel or oil paint in white. Door and window hardware should be smooth and easy to clean. Dental office should have natural lighting. Study window is desirable to focus on cross right direction to avoid the significant intensity changes in the workplace due to exposure to direct solar rays finite in other types of orientation, as well as reheating of premises in the summer, in a study, not having the correct orientation of in daylight saving time is recommended to use shading windows with blinds, shutters, ten сomrade and other accessories. Light ratio (the ratio of glazed surface of windows to floor area) should be 1:4 - 1:5. Cabinet shall have a common artificial light provided by fluorescent lamp. For a general fluorescent lighting is recommended to use the lamp with the emission spectrum does not distort colors, for example, fluorescent daylight lamps with color corrected fluorescent tubes or cold natural color. The illumination level of the cabinet using the lumi luminescent lamps should be 500 lux.

The office should maintain a temperature which is optimal for health personnel. It usually ranges from 18-22 ° C. The same temperature needed for optimal mixing, forming and hardening filling materials. When you work a dentist in the air cabinet formed of water-air aerosols containing a lot of all possible pathogens. Therefore, obligatory is used in the study of various apparatuses and devices for circulation and air disinfection. It is necessary condition of the amalgam - presence in the office of the fume cupboard in which it is prepared. In this autonomous mechanical closet rod to provide air velocity of at least 0.7 m / s and bleeding must come from all areas of the cabinet. In the cabinet should be mounted sink tap with a trap for mercury. Amalgam-mixer, eliminating manual steps in the preparation of silver amalgam, should always be in the hood. Dental cabinet should be provided with a forced ventilation system with air exchange 3 times for hour and extract 2 times for hour on the flow, as well as a window. To avoid infection, health personnel should work in special clothing and footwear (medical uniform, change of low-heeled shoes, medical cap); uses of rubber (latex) gloves and face masks. Eyes must be protected by special goggles or transparent shields.

In the doctor's office should be a quartz lamp (desktop or portable), through which air is quartz office. This procedure is usually carried out during the break between shifts or after working hours. In the dental office should be working for doctors, nurses and aid-women. Workplace doctor provides the dental unit, chair, table for drugs and supplies, chair screw. The workplace nurse should include a table for sorting tools, hot-air sterilization cabinet, sterile screw-table and chair. For nurses working table should be used for sorting equipment, a sink for cleaning instruments. In addition, the study should be a wardrobe to store materials and tools, case (A) toxic or cabinet (B) for potent drugs stances and a desk.

Treatment of dental diseases and that most of the stomatological manipulations are not possible without using special equipment (drills), require significant time to implement them, and often painful to sufficient. Therefore, necessary for treatment is a convenient accommodation of patients, as well as giving them the relevant provisions to comply with medical dental procedures. For this purpose, special dental chairs can change the height and position of the backrest, which allows the patient to give any desired location, convenient for him and the work of a dentist. To fix the patient's head in position, the right to treatment, a chair equipped with a headrest.

The necessary equipment to treat patients in dental offices is usually linked in universal dental units. The complete set includes a drill, sometimes two or three, with varying speed of a hog, a chair to accommodate the patient, the lighting device (lamp Dental), a gun for water and air, the spittoon. Additionally it can be mounted a number of different devices and special equipment: elektro-diagnostical devices, diathermy-coagulant, saliva ejectors, vacuum cleaner, etc. In addition to the dental unit in the cabinet must be both diagnostic and treatment equipment: X-ray dental devices, vital testers, apex locators, dental light detectors, intraoral camera, endodontic microscope, ultrasonic scalers, photopolymer lamps, amalgam-mixers, equipment for electrophoresis (Depophoresis) etc. When you equip the modern dental units, these types of equipment may be included in the universal dental unit. Such an integration of different devices in one unit generates up to convenience for the dentist and expands the range of his professional activities. An important component of the dental unit is a versatile light source that provides light intensity oral cavity of about 10,000 lux. Given such a high intensity light operating margins, it is necessary to provide sufficient illumination and dentistry in general, to avoid dentist eyestrain. Modern design of dental fixtures provide a narrow beam directed "cold" (without a significant amount of infrared light) light, which does not irritate the patient's perspective. To make it easier to operate, the doctor and nurses use special chairs and furniture. For example, stacked cabinets for medical supplies, tools, security seals, wound dressings and other materials; table dentist for placement of tools, instruments and devices during operation. It can be equipped with wheels for easy movement and drawers. Dentist and his assistants are working while sitting on special chairs.

The work is impossible without a dentist's drill, which is employed to preparation of cavities and tooth decay. Developed many designs drills: electric, pneumatic, turbine, standing, hanging, combined, stationary, and portable, etc. Despite the variety of designs, they should provide some speed and mechanical force during rotation of boron for preparation of hard tissue of teeth. It is generally accepted division drills based on the rotation speed of boron on low speed (rotational speed - 1000 to 10 000-30 000 rpm for 1 min) and high-speed, the so-called round drill (rotational speed of boron - 100 000-500 000 rpm 1 min.) Typically, these two types of drills, regardless of their design, always include a complete set of universal dental units. Created a wide variety of designs drills driven by electric motors and torque transmission with flexible or rigid hose of various designs. They are also used mikroelectric engine and air motor in the so-called sleeveless drill, in which due to the small size of the engine handpiece is attached directly to them. Torque is transferred to the motor from working instrument with a flexible or rigid hose. One end of the sleeve attach to electric motor, and another - to dental handpiece. Flexible hose transmits rotary motion through a flexible shaft that allows it to bend in all directions. To equip a high-speed electric machine (up to 30 000 rpm in 1 min) using hard sleeve. Usually it consists of multiple knees to the rollers, which stretched cord. Today increasingly use drill mikroelectric engine directly, without sleeves, joined to the tip. In recent years increasingly used pneumatic-hydraulic micromotors, which are actuated by compressed air. They are connected with the installation of a flexible hose through which air enters the compressor.

Turbine drill usually consists of a compressor for compressed air and special tips, which are mounted in miniature turbines. The compressed air passes through a nozzle with high velocity (10,000 - 500,000 rpm) rotates the turbine and fortified in her forest. The combination of these two types of drills allows for quick and relatively painless to perform various stages of preparation and processing of teeth, to avoid thermal burn during dissection of the pulp provides water-cooled bur. Portable drill usually sleeveless, with a miniature electric motor and arranged in small suitcases. Dental chairs are designed for easy placement of the patient in the desired position for the dentist during dental procedures. They can move up and down, back them if necessary can be attached to a horizontal position, the headrest allows you to make necessary the patient's head position. In the current chair of changing their place with the help of electric motors.

Modern chairs for the patients are provided with the software device that provides change their position. Chairs are made taking into account the anatomical shape of the body and consists of seats, bent at the knee at an angle of 120, descending back, adjustable head restraint. Backrest and head restraint chairs are designed so that during treatment, they could accommodate foot and dental assistants. Position the patient's seats is controlled by foot pedal or manual control.

Work chairs. The dentist and his assistant moved to 5 wheels have a smooth, soft seat and adjustable backrest. Their height is adjusted depending on the growth of working. Office chairs are also rotated, so that your spine free from hazardous working curves. Working in the sitting position a person spends 27% less energy than the same work while standing.

Operating position of specialists. In the treatment (the basic concept of 1 / 1) assistant and dentist, sitting opposite each other. The dentist is in the position 9 hours (at an abstract clock face), while an assistant, depending on the work performed, is set to 1-3 hours. The dentist and the assistant put their jobs closer to you. Used, both mobile professionals a table in the center, in front of the patient. This ensures optimum performance movement. It is very important for safe and reliable service is a convenient and relaxed working posture. Height of the chair adjusted so that the leg is settled on the floor. The angle between the femur and tibia must be 105 degrees. The dentist and assistant stir near the patient to bend forward is not much at work. The legs are placed so that the left leg is located between the helper slightly spread legs dentist. Dentist chair sets the patient in a comfortable position, so often the little helper growth is difficult to find the optimum position. Both professionals must choose a compromise solution in view of increasing stress of a dentist performing the treatment in the sitting position for a longer period than his assistant.

The position of the patient during treatment. Waiting in the chair treatment, the patient can take a semi-sitting or accumbency. During treatment, he should be placed in a chair in the supine position. Of course, the position of chair will be different depending on where the treatment is carried out - on the upper or lower jaw. You can not force the patient to bend his body strong. At the top - the position of the chair before taking the patient (back and seat bottom tilt of about 120o). At the bottom - without changing the position of the patient chair is set to "work" position for choose the correct working posture assistant dentist recommended to sit naturally and easily, without straining or stooping.

Upper jaw. In carrying out therapeutic interventions on the upper jaw chair tilted back so that the patient's head and feet were on the same level. Tucked under the shoulders of the patient's pillow, you can achieve a favorable treatment for the head position at which the doctor gets a good review of the chewing surfaces of the upper teeth.

Lower jaw. In the treatment of mandible teeth in the patient chair is only slightly tilted back, his head bowed to his chest. Thanks to this state of dentition of the mandible is nearly horizontal. Position the patient's seats can be changed, providing a comfortable working position as a doctor and his assistant. Since the dental chair are tilted slightly back. For a more comfortable working posture and physician assistant must sit with legs spread slightly, this lead to more sustainable situation? The doctor may take a position directly behind the patient's head in "10 to 12 hours" in the abstract dial. Assistant - "from 2 to 5 hours' close to the patient and thus has a good review of the mouth, the optimal distance to the tools, instruments conveys the doctor and the patient does not see the toolbox.

To enhance the rotational use of working tools stomatological tips. Industry mainly produces two types: straight and angular. They provide a rotational speed of boron up to 30 000 rpm in 1 min. Tips usually consist of a rotating (fixed) and fixed (locating) parts.

The main instruments for dissection teeth are dental drills. They dissect a cavity in various stages of caries, pulpitis and periodontitis. There are drills for conventional, high-speed and turbine commenced, for the latter they are made of special hard alloys. To distinguish normal drills for direct and angular tip

To remove dental plaque are special tools to handle length of 10-12 cm and a working part of a crescent-shaped hooks, blades, and drill bits. They can be assembled into kits, which consist of four or more instruments. These tools can be quite different shapes depending on the treatment of teeth which group they are intended, and the type of dental plaque (subgingival). Rounding out the handling and cleaning the tooth surface from residues of dental plaque with special polish, brushes, and cups.

In addition to universal dental unit in the dental office can be (but not necessarily) and other instruments and apparatus, which uses for diagnosis, treatment and preparation of filling materials. Widely used for various devices elektrodiagnostics of dental diseases: ML-2M, EOM-3, IVN-1. With their help, stimulating different strengths of electric shock pain receptors pulp or periodontal, we can determine their status, which allows us to refine the diagnosis of dental disease. The principle of the apparatus is the same; they differ only by constructional features.

For pain of hard tissues of teeth with dissection instruments are used for elektroanesthetization. Active electrode apparatus attached to the tip of a drill, and passive - to the earlobe, the strength of the electric current is determined individually for each patient.

Today's universal dental units to be satisfied with small-size dental X-ray apparatus. Respectively equipped (including ionizing effect of x-rays), dental offices are allowed to use them to carry out X-ray examination of the patient (x-rays of teeth, jaws, etc.). Recently developed a special apparatus in which the X-ray image recorded on film is not, and the special sensors in the form of small plates. This allows you to handle obtained image by computer and keep it for a long time.

Given the adverse effects of X-ray radiation on the human body, is used ultrasound diagnostic devices.

Tools that the dentist is working in the mouth the patient must be sterile. For sterilization use special techniques, which include several stages: disinfecting, cleaning pre-sterilization and proper sterilization. Cleaning dental instruments can be carried out by means of special ultrasonic devices.

Sterilization is most often carried out using the Dry Heat sterilization at a temperature of 110-180 ° C dry-air sterilizer cabinets. Dental handpieces and sterilized by boiling in liquid paraffin, some of their design allowed sterilized with steam under pressure (autoclaving). Given the need for sterilization of instruments, which operates a dentist, a dental office should be equipped with lockers for the sterilization. In dental offices are equipped with special facilities, where sterilization is carried out centrally.

In addition to the above-mentioned apparatus of modern dental office can be equipped with many other special instruments and equipment, diagnostic equipment and physical therapy, to in sufficient quantities produced various industrial acceptance. They allow the dentist to facilitate the work and support staff at various stages of diagnosis and treatment of various diseases teeth and mouth.

Preparing for treatment. Before inviting the patient to the office assistant to make sure that the room is cleaned and disinfected properly. The patient should have free access to medical chair: working dentist and assistant chairs pushed to one side, the lamp is turned to the left and upward, so that the patient did not hit his head and right arm (if any) is omitted or tilted upward. The patient must see that it produced a clean, sterile instruments are placed on a tray in front of him.

Factors that significantly affect performance:

- Tools and materials should be prepared earlier and located as close as possible to the place of use;

- An indispensable use of saliva ejectors and vacuum cleaner.

Features of organization periodontalоgical сabinet (offices, departments).

Periodontal cabinet need to equip according to sanitary standards. It should includes a workplace of nurse, dental units, desktop with documentation and card index of dispensarization. Also includes a single dental chair where dental assistants (dental hygienists) conducting a series of medical procedures: removal of dental plaque, determination of hygienic indices, spray irrigation, imposed on the teeth fluoride varnish or medical bandages, teach the patient rules of rational oral hygiene. After treatment session doctor need to give patient a special attraction with recommendations and term of next visit.

Work in the cabinet is carried out by clearly regulated schedule. One day allocated for consultation of the primary patient by group of professionals (physician, surgeon, orthopedist, physiotherapist, etc.) to develop of complex treatment plan. This plan is coordinated with the patient.

In the work of the specialized periodontal cabinet (office) it is desirable to divert one day (or more) for the dispensary services of patients. On this day (days) take patients which need to check inspection, and prescribe preventative or re-treatment. On other days a doctor to do complex routine treatment.

Equipment for periodontal cabinet depends on the number of medical personnel. Besides regular sets of dental tools for the treatment and dental fillings, periodontal cabinets should has special tools: - To remove dental plaque and measure the depth of periodontal pockets; - To curettage of periodontal pockets; - To reconstructive surgery in the case of periodontal diseases; - To functional selective polishing of hard tissue of teeth; - To sharpening tools; - Syringes for injections (traditional carpool, including tuberculin, to sclerosing therapy); - Injection needles (blunt, curved, etc.) - for washing and processing of periodontal pockets; - To take material in biopsy.

Periodontal cabinet, especially office must be equipped with special apparatus to remove dental plaque, various diagnostic and physical therapy apparatus.

Drug treatment of periodontal cabinet (office) is much wider than the usual list of medicines. Except from general medicines, it includes preparations for coloring dental plaque, antiseptic, antibacterial and anti-inflammatory agents, anesthetics, enzymes and inhibitors of proteolysis, plant and immunomodulators, vitamins, various officinal ointments, pastes, composition, bandages and other means.

It is also necessary to have a set of tools for emergency care (for example, in case of anaphylactic shock, asphyxiation, aspiration, etc.).

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