Danylo Halytskyj Lviv National Medical University

Department of Therapeutic dentistry

recommendations for practical work in conservative dentistry for the IIIrd year students of dental faculty

Lviv-2012

Authors: M. Hysyk, O. Ripetska

Edited by prof. Volodymyr Zubachyk

Reviews: assist. assist. prof. L. Chervinska, assist. prof. N. Krupnyk, assist. prof. O. Matvijchuk

Computer printing by Oxana Zamoiyska

Danylo Halytskyj Lviv National Medical University,

Lviv-2012

Методичні рекомендації обговорені та схвалені на засіданні профільної методичної комісії зі стоматологічних дисциплін (протокол №___ від „____” ______2012 року).

Contens

Page
Structure of practical medical training for the 3-year students of the Dentistry Faculty 2011-2012 acord. year …………………………………………………. / 5
Principles of occupational health service and professional hazard in dental practice ……………… / 7
Individual protective means ………………………... / 9
The list of practical skills for the Final module control from thematic module No1 ………………… / 13
Students’ self-study during the practical training …... / 14
Dental caries ………………………………………... / 19
Pulpitis ……………………………………………… / 19
Apical Periodontitis ………………………………… / 20

International classification of the diseases, 1998 …...

/ 22
Diseases of oral cavity, salivary glands and jaws (K00-K14) ………………………………………….. / 22

List of topics for research during practical training ...

/ 32

Record ………………………………………………

/ 33

Example of the diary ………………………………..

/ 43

Summary report of the carried out work in Odontology and Endodontics ……………………….

/ 46
Example of the characteristics...... / 48
References...... / 49

Practical training for students of higher medical educational establishment of the III-IV levels of accreditation is an important link in the training of doctor and an integral part of education. Teaching process and practical training are closely interrelated.

The programme of practical training for the 3-year students of institutions of higher medical education of the III-IV levels of accreditation is worked out on speciality „Dentistry” 7.110101 following the recommendations of the educational- and qualified characteristic (EQC) as well as vocational programme (VP) of specialists’ training approved by the Ministry of Health Care of Ukraine (Order No239 dated from 16.04.2003) and curriculum approved by the ministry of Health Care of Ukraine (Order No414 dated from 23.07.2007).

The goals of the practical training for the 3-year students of Dentistry Faculty are in:

-  strengthening knowledge and practical skills;

-  extending and improvement of the students academic and professionally – oriented experience;

-  the ability to cope professionally with the working conditions during the students practical training in medical institutions;

-  familiarizing with the peculiarities of the physician’s work both in municipal (city) and regional medical establishments;

-  becoming familiar with the organization of the medical, prophylactic work; with the principles of ethic and medical deontology; with the skills of samitary- and elucidative work;

-  investigating the ways of health care organization within the tasks, envisaged by the educational and professional programme in specialists’ training on „Dentistry”.

The organization of education is carried out in accordance with the modular credit transfer system and modular rating assessment system according to the Regulations of the Ministry of Health Care of Ukraine (Order No414 dated from 23.07.2007). The extent of practical training for the 3-year students includes: 3,5 credits, equal to 105 hours, including 45 hours for self-study.

Structure of practical medical training for the 3-year students of the Dentistry Faculty 2011-2012 acord. year

Structure of practical training / Number of hours / Forms of control / Unit/Chair
Total number of hours ECTS credits / Classroom activities (practical classes) / Self-education
Module 1. Thematic module 1. Medical practice in therapeutic dentistry / 105 hours
3,5 credits / 60 hours / 45 hours / current / therapeutic Dentistry

The programme of practical training is presented by 1 module. According to the curriculum and syllabus, the students of the Dentistry Faculty do their practical training executing the functions of dental auxiliary/chair side assistant. The duration of their practical training, is 2 weeks. The institution of higher medical education and the bases of practical training conclude a bilateral agreement as to the forthcoming medical practice and its schedule (the document should be signed by 2 parties/sides with 2-month interval preceeding the beginning of the medical practice).

Out-patient departments of the regional municipal (urban) and district hospitals; stomatological polyclinics and private clinics. May serve as well – suited bases for practical training. The succession of the practical training may be determined by the institution of higher medical education individually and may be changed in case of need. The students’ practical training is a form of their self-independent work. The quality of the above work is supervised and by both the Head (manager) of the bases of practical training and the university teacher – employee of the Department of Therapeutic Dentistry. The administration (authorities) of the institution of Medical education is responsible for the organization and supervision of the students’ medical practice. Highly specialized, narrow purpose departments are responsible for the educational and methodical realization and for completing the programme of practical training.

The general organization of medical practice at the university and its control is accomplished by the Head of the Department of Medical practice. Rector of the University authorizes the experienced university subject teachers (who are engaged in the teaching process on therapeutic dentistry) to execute the functions of managers (supervisors of practical training).

The forms of control and assessment system meet both the requirements of practical medical training programme and assessment criteria should be done by specially trained assessors in accordance with the modular credit transfer system and modular rating assessment system approved by the Regulations of the Ministry of Health Care of Ukraine (2005, 2009). The final modular control of practical medical practice is carried out after its completion by the university teachers.

The aim of the practical medical practice is to:

-  gain and consolidate the experience defined by the programme of vocational education for specialists’ training on „Dentistry”;

-  interview and examine patients as well as the analyzing the obtained results;

-  plan the schemes of odontological patients depending on the peculiarities of the clinical course of a disease;

-  analyze the results of the laboratory tests and instrumental investigations;

-  determine the main pathological symptoms in dental caries, pulpitis and periodontitis;

-  carry out the diferential diagnosis and make a preliminary diagnosis of the noncaries destruction of the dental hard tissue;

-  carry out the differential diagnosis of the main disease of both the teeth and the oral cavity, methods of diagnosis and rendering the urgent medical (dental aid);

-  gain practice in moral-deontological principles of medical specialist and principles of professional subordination.

Principles of occupational health service and professional hazard in dental practice

Dental room is a workplace of a dentist Dental health team (dentists and dental auxiliary) while rendering aid to dental patients are at high potential risk to their health to be infected by inside – hospital infection.

Cross infection is a major occupational hazard in dental practice. Cross-contamination can occur by direct contact with microorganisms indirect contact with contaminated objects droplet transmission and inhalation of airborne pathogene. Both dental health care workers and dental patients may be exposed to a great variety of microorganisms via oral or respiratory secretions, blood etc. These microorganisms may be: human immunodeficiency virus (HIV), viral hepatitis (B, C), herpes simplex virus, infection, of the upper respiratory tract, tuberculosis (TB), staphylococci, streptococci, infections, grippe, adenovirus, syphilis, candidosis, etc.

Efforts to present the spread of inside – hospital infection and to protect both dental health team and patients should include improved surveillance, risk assessment, evaluation of measures to prevent exposure and studies of prophylaxis. It is necessary to maintain hygiene in the dental room and to follow – the sanitary and disinfectant regimen. Such may lead to development of safer and more effective devices, work practices and personal protective equipment.

Every dental patient on his/her first visit must be provided with a patient’s dental record (form No043/0). The dentist is to fill in all significant data about the dental patient: family case history (past infectious diseases) and present case history.

Despite taking accurate medical history, it may not be known if a patient is carrying an infectious and dangerous virus. Most patients are asymptomatic and, therefore not identifiable. Thus, it is reasonable to assume that every patient is a potential bacilli-carrier. That is why, it is obligatory for the dentist as well as for dental health team to use individual protective means: face shields, or surgical marks, disposable gloves disposable needle, puncture – proof containers, protective eyewear, etc.

Individual protective means

Individual protective means include:

-  protective clothes;

-  gloves;

-  mask;

-  glasses or shields.

Protective clothes. Medical gowns, caps, spare (changeable) footwear are to protect the skin and the dentist’s outer-clothes from blood, saliva, pus and other substance of biological and non-biological origin. In case the working clothes become dirty due to the blood or some other biological substances, a complete chemical treatment should be done.

The sanitary clothing should be kept in personal cabinets, separately from other clothes. Dentists and medical personnel are forbidden to eat, to smoke or to be outside the dental clinic if they wear the sanitary working clothes.

Gloves. Latex gloves prove to be the effective protection of dentist’s skin from the contact with the damaged surface of the oral mucosa, blood, pus and liquid from the patient’s mouth. Latex gloves are valid for one occasion only. It is forbidden to use them twicely for another patient even if they underwent a thorough disinfection. It should be emphasized that disinfectants and detergents may damage the gloves and as a result they may lose their protective power.

As a role, latex and vinyl gloves are used on examining and treatment of patients. The rubber gloves should be used while working with disinfectants and detergents. A thorough hygienic cleaning of hands should precede the use of new pair of rubber gloves.

Masks. The protective face masks and respirators serve as reliable shield for the skin and oral mucous membranes of the dentists from blood, liquid from the mouth of a patient. Non-disposable protective masks are used only for one patient. 4-stratal masks are to be replaced for the new ones every 4 hours.

Glasses, shields (protective screens). The dentist must take all necessary precautionary measures in order to protect himself from the patient’s blood and liquid from the oral cavity. Protective glasses and face shields (screens) serve a reliable barrier for the upper part of the dentist’s face. The disinfecting cleansing of the protective glasses and shields should be done each time before a visit of the next patient. For this purpose a serviette, soaked with a – 70% – alcohol solution or disinfectant solution will do the best. Hands should be scrubbed and washed between patients in a disinfectant solution before glowing. Any cuts and abrasions on the dentist’s skin should be covered with waterproof dressings. Disposable rubber gloves should be worn routinely. It should be kept in mind that disposable articles are for single use only and should be discarded appropriately.

The students must know: principles of Health care Legislation of Ukraine the ways of organization of medical work in therapeutic dentistry department; modern classification of diseases; clinical, laboratory and instrumental diagnostics of diseases tactics of treatment of the main diseases in outpatient conditions and indications for hospitalization of patients; contingents of patients that need dispensary’s supervision.

The student must be able to: see patients, make a diagnosis and render medical aid in outpatient department, elicit the necessity of prophylactic medical examination and define to what group should the patient be referred, give recommendations as to the next examination and treatment; administer an adequate psychotherapy, give advices as to the diet, regime and occupation, physical culture, body hardening, rest, hygiene, etc., direct a patient to the physiotherapeutic unit for treatment.

During the practical training the students as dentist’s assistant must be able to:

-  render medical aid to patients in time and professionally;

-  be attentive to patient’s complaints;

-  examine a patient thoroughly in order to make a precise diagnosis and administer a proper treatment;

-  to perform the necessary medical manipulations (interventions) under the supervision of a dentist (curator) of the practical training.

Student’s while doing (undergoing) the practical training must:

-  be informed preliminarily by the Head of the Department of Practical Training as to the duration of practical training and the list of documents required for dental practice, etc.;

-  submit a direction from a dean’s office to be allowed to undergo the practical training;

-  come to the base of practical training at the right time;

-  fulfil his/her work quota envisaged by both the programme of practical training and instructions of the curators;

-  learn and keep strictly to the labour safety measures, accident prevention and sanitary-and-hygienic standards;

-  keep to the established order and regulations in the clinic;

-  keep a diary of practical training and other documents stipulated by the programme of practical training;

-  pass the summative (final) module control in time.

Educational-and-scientific work of students (ESRW)

The educational-and-scientific work of the 3-year students of the Dentistry Faculty during their practical training is an important form of top-quality and effectiveness of cognitive, creative process that estimates the quality of the dentist’s everyday work.

The students’ educational-and-scientific research work favours the deeper perception of a discipline (subject), assists in developing the skills in analyzing and summarizing the results obtained during the examination of a patient; stimulates the ability to well-reasoned and logical conclusion in making the clinical diagnosis and in prognosing the further, course of a disease.

A great number of questions the students come across while taking care of patients as well as the working indices of the department are special preferences in determining the theme of the ESRW. ESRW may include: stage-by-stage, epicrisis, abstracts, reports at the clinical conferences.

The demands to the ESRW are as follows: the aim, the main task, materials and methods and methods of investigations, obtained results, discussion, conclusions, a list of reference literature.