Dental treatment for teenagers. A pediatric dentist: who he is, what is included in his competence, treatment features and basic recommendations Prevention is most important

How long have you been working (Zubrenok Clinic)?

Our children's clinic "Zubrenok" was one of the first clinics in Moscow, which in 2002 began developing specialized care for children and adolescents.

What is the easiest way to find your clinic?

On foot. From metro Chertanovo, Southern exit. Walk down Balaklavsky Avenue, on the opposite side of the metro, towards the Airbus shopping center.
- by car. Turn onto Balaklavsky Prospekt from Varshavskoye Shosse, first floor of a residential building, after the Rus auto parts store. You can park in the store parking lot.
On the clinic’s website in the “Contacts” section there is detailed information on how to reach us on foot from the metro or by car.

Why should parents be present at the first appointment?

Parents must be present at the reception, since only they, being the legal representatives of the child, make the decision on the choice of treatment method; its cost.

Is it possible for the child to come to the first appointment with his grandmother/grandfather/aunt/uncle/nanny, etc.

This is possible if the accompanying person has a notarized power of attorney from both parents stating that it is this accompanying person who will represent the legal interests of the child and make decisions about his treatment.
It is possible, the initial visit is a consultation that does not involve any manipulation. At the next visit, when treatment is to take place, the child’s legal representative must be present (which is confirmed by a passport and birth certificate) so that there is no disagreement about the treatment method. Informed consent for treatment is signed. By law, only a legal representative can do this.

Why do I need to present my passport and birth certificate?

The law obliges us, the service providers, to make sure that the adult with whom the child came is his parent or legal representative.

Who works best with young children?

All doctors at the clinic have special training in child psychology and know how to establish contact with children. All you have to do is choose a convenient day, time and, if desired, the gender of the doctor.

If a child is afraid, how is treatment done?

We have doctors who always try to find an approach to the child, play with him and persuade him to undergo treatment. It may take several visits to the clinic for the child’s acquaintance with the doctor and the clinic to be successful.
If you cannot establish contact with your child or he already has negative experience with dental treatment, then you can try the following options:
- sedation (the child is injected intramuscularly with a drug that relieves fear, anxiety, and tension. The drug is used only for these purposes and is approved by the Russian Ministry of Health). The child is conscious; some children become sleepy; some continue to cry but do not resist treatment. It is impossible to know in advance how the drug will work. The dosage of the drug is selected depending on the weight of the child. The procedure is performed by an anesthesiologist, who first determines the absence of contraindications to the use of the drug, and then monitors the child’s condition during treatment;
- anesthesia (the child is put into a state of sleep using Sevoran gas). The child does not feel pain, does not remember what was done and how; treatment is carried out in a supine position, which allows you to comply with all technological conditions of treatment and complete the entire scope of work: treatment; deletion; prosthetics. If necessary, after teeth are removed, impressions can be taken to make a replacement prosthesis.

Do you have a psychologist?

IN this moment We don't have a psychologist. However, the clinic’s doctors have special training in the field of child psychology and know how to find an approach to any child.

If my child is a little sick, should I bring him to the appointment?

You should not bring your child to the appointment. The child must be completely cured. If a child has a cold, he will be capricious or have difficulty breathing through his nose, which can provoke the urge to vomit. You should not bring a child with herpes, even if several days have passed since its appearance, as a relapse and exacerbation of the disease is possible.

Is there a discount for low-income/large families?

There are no separate discounts. We have a unified discount system for everyone.
There is a cumulative discount, which starts after the first appointment, and weekday discounts: 20% from 9:00 to 15:00 and 10% from 15:00 to 21:00.

Therapy

How much will it cost to treat a baby/permanent tooth?

The cost of tooth treatment depends on its condition. It is impossible to say even approximately, since the cost consists of many parameters that can only be determined by a doctor and only after preliminary diagnosis. You can see the approximate cost of treatment for each diagnosis on our website in the “Prices” section. There are prices for individual manipulations that may be part of the “Treatment of baby/permanent tooth” service.

What anesthesia do you use? How is everything going?

The clinic uses articaine anesthetics in dosages specially selected according to the weight and age of the child; hypoallergenic.
Anesthesia is administered with disposable (individual) syringes (injectors). The injection site is also treated with an anesthetic so that the child does not feel the injection. Anesthetic in the form of a pleasant-tasting and odorless gel. A spray can also be used. The need for one or another pain reliever is determined by the doctor.

What is “manual tooth preparation”? At what age is it indicated and how much does the service cost?

Preparation manually increases the cost of caries treatment by 1,790 rubles. During the work, an individual set of tools and a special gel are used to dissolve carious tissues in order to scrape them out more easily. The procedure takes about 10 – 15 minutes. After which the tooth is filled.
The good thing about the procedure is that there is no noise, vibration, unpleasant odors or sounds, as with traditional boron work. In addition, this procedure is painless, since hand instruments do not touch living tissue, removing only non-viable tissue. The quality of this treatment is similar to that of boron. But in terms of time – longer. There are no age restrictions for this type of cavity treatment. It can be used in any patient who is afraid of pain, the dentist, or in children who come to the doctor for the first time, in order to avoid causing discomfort.

What method is used to treat caries in the clinic?

If we mean filling a cavity by the term “treatment”, then first the cavity is cleaned using one of the following methods: ultrasound/air-kinetic method (without boron; a jet of air under pressure and a special powder)/manual method (special tools and gel for dissolving carious tissues )/burs. Doctors use special burs that can wear off when the treatment reaches the level of healthy tissue. These are disposable burs. They can only remove dead (caries) tissue. All these methods are used to avoid damaging healthy tooth tissue.
Then the cavity is filled. The filling material is selected depending on the condition of the child’s dental tissues. The doctor determines this and first tells the parent what determines the choice of material.
It is correct to understand by “treatment” the elimination of the cause of caries - systemic disease body. For this purpose, the clinic employs a pediatrician who helps to establish the cause of metabolic disorders in the child’s body.

What material do doctors work with?

The materials used for filling teeth are imported; photopolymerizable and more. The choice of materials is made by the doctor depending on the condition of the child’s dental tissues, since they perform a therapeutic function.

What is the guarantee for the seal?

Guarantee on the seal from 3 to 6 months; extended every 3 to 6 months during the entire period of observation of the child in the clinic. The condition for extending the warranty is the completion of treatment with an individual course of prevention; repeating the course of prophylaxis after 3/6 months (according to indications).
The duration of the primary guarantee depends on the activity of caries in the child - the number carious cavities. For multiple caries – this is 3 months; at small quantity carious cavities and good hygiene – 6 months; if there is only one filling and hygiene is good – 1 year.
Repeating preventive courses is aimed at strengthening tooth enamel; improved hygiene; inactivation of cariogenic flora (microbes that cause caries); improving oral health (which indirectly affects the child’s overall health). If you follow the preventive program, there is no need to re-treat your teeth; redo fillings and treat new caries. The treatment guarantee can last throughout childhood.

How much does restoration cost? front tooth?

Within 10,000 rubles (including isolation of the working field with a rubber dam; necessary anesthesia, etc.). But only the doctor can determine the final cost of the work and only after its completion. During the consultation, the doctor will draw up a treatment plan and a preliminary estimate; will agree it with you, and will also indicate what options (both increasing and decreasing the cost) are possible during the course of treatment.

Do you use general anesthesia/general anesthesia?

Yes. Our clinic has an anesthesia department equipped with the most modern anesthesiological equipment. Experienced anesthesiologists and resuscitators work; there is a rehabilitation ward ( day hospital), where the child recovers under the supervision of a pediatrician and other medical staff. It is possible for parents to be present in the rehabilitation room. On our website in the “Services/Treatment under Anesthesia” section or in the “Patients/Video” section there is a film that will help answer many of your questions.

Surgery

How much does it cost to remove a baby/permanent tooth and what does it depend on?

Removing a baby tooth costs from 1,520 rubles; permanent – ​​from 2770 rub. Cost depends on the type and amount of pain relief needed; difficulty of removal (which is associated with the condition of the tooth and its anatomical features). A variety of medicinal “inserts” into the socket (after removal) with an analgesic effect may be required; hemostatic; anti-inflammatory (the choice is always individual and is made by the doctor depending on the need). In our clinic, this procedure is performed by certified dental surgeons.

At what age should a child have a transection of the shortened frenulum of the tongue? Why is this being done?

Dissection of the frenulum of the tongue is done in the maternity hospital, when the child cannot clasp the nipple of the mother's breast. This leads to nervousness of the child, as he quickly gets tired when sucking and does not gain the required weight.
If, for some reason, this manipulation was not done in the maternity hospital, it must be carried out in the first weeks of life. In our clinic, pediatric dentists are skilled in this procedure, which is quick and painless for babies.

Is there any warranty period?

None of the surgical procedures in pediatric dentistry provides a warranty period - the procedure is performed simultaneously and does not require repeated intervention. If required repeat consultation Doctors, it will be carried out. In general, the clinic’s rules for providing services include patronage by medical workers of their patients - until complete recovery.

Hygiene

Why do you need to visit a hygienist if your child’s teeth are fine?

It is necessary to visit a hygienist - a specialist in the field of dental prevention - regardless of whether there are problems with teeth or not. This must be done every six months, and possibly more often (on the recommendation of a doctor). Plaque accumulates daily on a child’s teeth, which over time turns into dense dental deposits that cannot be cleaned with a toothbrush. Under this plaque, the process of softening the enamel and the appearance of caries occurs. Therefore, it is necessary to regularly remove plaque, diagnose tooth enamel and hidden caries so that the teeth are healthy and do not have to be treated in the future.

How much does an initial visit with a hygienist cost?

4200 rub. It includes diagnostics of the quality of cleaning (visual for the child and parent); training in hygiene rules and rules for monitoring its implementation; professional hygiene mouth (a brush and a special paste, which is selected depending on the condition of the teeth or a sandblasting machine (for older children - teenagers); laser diagnostics of initial caries and its hidden forms; consultation on the selection of hygiene products (paste, rinse aid, brushes); consultation on healthy nutrition.

Plates for one jaw cost from 13920 to 16420 rubles. After consulting an orthodontist and deciding on treatment using plates, you must make a 100% prepayment, since the plates are manufactured in the laboratory. Their production begins only after an advance payment has been made.

And we also have metal , ceramic And lingual braces.

Why not a fixed fee for braces?

In our clinic, advance payments are not made for the entire period of treatment, since it proceeds differently for everyone and pre-paid manipulations may not be necessary. This allows parents to control their expenses.
The cost of the braces system is fixed in the price list and changes only when the price list is changed again due to an increase in the purchase prices of braces, of which all visitors are notified through the site in advance. The remaining manipulations are very individual, and we do not see the need for advance payments.

What is myofunctional therapy? In what case is it indicated?

The main goal of myofunctional therapy is the prevention and correction of impaired muscle functions, elimination of bad myofunctional habits, elimination of crowding of teeth and correction of occlusion.
You can read more detailed information on our website in the “Services/Myofunctional Therapy” section.

Is there any guarantee period for orthodontic treatment?

The warranty period is established after the end of the retention period of one year. This issue is also discussed in detail during a consultation with an orthodontist, since orthodontic treatment there are some nuances.

Parents often wonder: where to treat the teeth of their children who are already 10 - 18 years old: at a pediatric dentist or at an adult dentist who treats the parents themselves? It seems that the children are adults, and their teeth are already the same as those of adults...

Reasons why teenagers should be treated by a pediatric dentist.

Photo: dental treatment with a rubber dam The tooth is isolated from the oral cavity, from saliva and tongue using a rubber dam. It is convenient for both the doctor and the patient, as it allows the patient to partially cover their mouth to rest during treatment without compromising quality.

• By law, only a doctor with a dentistry certificate childhood"has the right to treat children and adolescents under 18 years of age;
• Children's teeth are different from adult teeth. Both dairy and permanent teeth for a child and a teenager - young, new. The unformed enamel of such teeth is more susceptible to the carious process, which, while occurring unnoticed by the child and parents, is very quickly complicated by inflammation of the nerve of the tooth (pulpitis).
• How smaller child, the more difficult it is for him to comply with the dentist’s requirements: open his mouth wide, lie motionless in the dental chair, endure various manipulations in the oral cavity (but sometimes a child wants to touch and see what is being done in his mouth). These features require the dentist to have patience and the ability to manage the child’s behavior.
• Young teeth, especially molars, are partially covered with mucous membrane for a long time after eruption, which creates significant difficulties in isolating the surgical field from saliva. In such a situation, the use of special isolating devices, such as a rubber dam, is required. A rubber dam is a special curtain made of latex that allows you to effectively treat a tooth. Carrying out such manipulations on young molars as sealing and placing a filling without isolation with a rubber dam is not possible.
• A pediatric dentist knows the peculiarities of dental development in childhood and adolescence. Often adult therapists do not know how to treat teeth whose eruption is not complete, the root system of which is not formed. This, in turn, is fraught with excessive preparation of healthy tooth tissue and poor quality of treatment; As a result, the teeth do not complete their formation. SUCH TEETH ARE BADLY RESISTANT TO STRAIN AND CARIES;

The legislative framework

FUNDAMENTAL DOCUMENTS

For the successful functioning of the pediatric dentistry service, it is necessary to comply with the requirements of the Laws of the Russian Federation, orders and instructions for providing medical, including dental, care to children.

To the general laws regulating health protection and organization medical care population of the Russian Federation include:

BASICS OF LEGISLATION OF THE RUSSIAN FEDERATION
ABOUT PROTECTING THE HEALTH OF CITIZENS
(approved by the Supreme Court of the Russian Federation on July 22, 1993 N 5487-1) (as amended on September 28, 2010)

(edited) Federal laws dated March 2, 1998 N 30-FZ,
dated December 20, 1999 N 214-FZ, dated December 2, 2000 N 139-FZ,
dated January 10, 2003 N 15-FZ, dated February 27, 2003 N 29-FZ,
dated June 30, 2003 N 86-FZ, dated June 29, 2004 N 58-FZ,
dated August 22, 2004 N 122-FZ (as amended on December 29, 2004), dated December 1, 2004 N 151-FZ,
dated 03/07/2005 N 15-FZ, dated 12/21/2005 N 170-FZ,
dated December 31, 2005 N 199-FZ, dated February 2, 2006 N 23-FZ,
dated December 29, 2006 N 258-FZ (as amended on October 18, 2007), dated July 24, 2007 N 214-FZ,
dated October 18, 2007 N 230-FZ, dated July 23, 2008 N 160-FZ,
dated 08.11.2008 N 203-FZ, dated 25.12.2008 N 281-FZ,
dated December 30, 2008 N 309-FZ, dated July 24, 2009 N 213-FZ,
dated November 25, 2009 N 267-FZ, dated December 27, 2009 N 365-FZ,
dated July 27, 2010 N 192-FZ, dated September 28, 2010 N 243-FZ,
as amended by Decree of the President of the Russian Federation dated December 24, 1993 N 2288)

The fundamentals of the legislation of the Russian Federation on protecting the health of citizens are a fundamental document and regulate the relations of citizens, government bodies and management, economic entities, subjects of state, municipal and private healthcare systems in the field of protecting the health of citizens. Appendix No. 1.

Concept for the development of healthcare in the Russian Federation until 2020

The concept provides that one of the priorities of state policy should be the preservation and strengthening of public health based on the formation healthy image life and improving the availability and quality of medical care. The objectives of the concept include: creating conditions, opportunities and motivation for the population to lead a healthy lifestyle; improving the system of organizing medical care; specifying state guarantees for the provision of free medical care to citizens; informatization of healthcare, etc. The full text of the document is given in Appendix No. 2.

THE FEDERAL LAW
ABOUT PERSONAL DATA
dated July 27, 2006 No. 152-FZ

(as amended by Federal Laws of November 25, 2009 N 266-FZ,
dated December 27, 2009 N 363-FZ, dated June 28, 2010 N 123-FZ,
dated July 27, 2010 N 204-FZ, dated July 27, 2010 N 227-FZ,
dated November 29, 2010 N 313-FZ)

The law regulates the relations between citizens and government bodies, legal and individuals related to the processing of personal data. The law is aimed at ensuring the protection of the rights and freedoms of man and citizen when processing his personal data, including the protection of the rights to privacy, personal and family secrets. The full text of the document is given in Appendix No. 3.

dated December 31, 2006 N 905

"On approval of the Administrative Regulations of the Federal Service for Surveillance in Healthcare and social development for the performance of the state function of monitoring compliance with quality standards of medical care." The order regulates the procedure for checking compliance with quality standards of medical care in state and non-state organizations providing medical care to the population. The full text of the document is given in Appendix No. 4.

Resolution of the Chief State Sanitary Doctor of the Russian Federation dated July 7, 2009 N 48
"On approval of SanPiN 2.1.3.2524-09"

New sanitary norms and rules regulate sanitary and hygienic requirements for dental medical organizations and determine the features of organizing dental care for children. The text of the document is given in Appendix No. 5.

Decree of the Government of the Russian Federation No. 913 of December 5, 2008
"On the Program of State Guarantees for Providing Free Medical Care to Citizens of the Russian Federation for 2009"

The resolution guarantees citizens the receipt of free primary health care, emergency and specialized medical care. The full text of the document is given in Appendix No. 6.

Order of the USSR Ministry of Health
dated April 22, 1988 N 318
"On sectoral statistical reporting of institutions, enterprises and organizations of the USSR Ministry of Health"
(as amended by the Order of the USSR Ministry of Health
dated 04/17/1989 N 250)

The order regulates the preparation statistical reporting using approved forms of accounting and reporting documentation. For operational management, heads of healthcare institutions are given the opportunity to establish intra-institutional reporting submitted structural divisions. The full text of the document is given in Appendix No. 7.

Order of the USSR Ministry of Health dated 04.10.80 N 1030
"On approval of forms of primary medical documentation of healthcare institutions"

The order approves the forms of primary medical documentation, which are also used in pediatric dentistry: a medical record of a dental patient (form 043/y), a control card of dispensary observation (form 030/y), etc.

According to Appendix No. 5 to the order of the USSR Ministry of Health dated January 25, 1988 No. 50, the “List of daily records of the work of a dentist ...” (form 037/u-88) and “Summary record sheet for the work of a dentist..." (form 039-2/у-88). Forms "Daily Work Record Sheet" dentist..." (form 0.37/у), "Diary of the work of a dentist" (form 0.39/2у), "Recording journal preventive examinations oral cavity (form 0.49/у) are excluded from the “List of forms of primary medical documentation” of dental institutions.

Decree of the Government of the Russian Federation
dated March 21, 2007 No. 172
About the federal target program "Children of Russia" for 2007-2010.

The program has a subroutine " Healthy generation", which is aimed at improving the health of children and includes measures to promote a healthy lifestyle. The full text of the document is given in Appendix No. 9.

FUNDAMENTAL DOCUMENTS ON PEDIATRIC DENTISTRY

Order of the USSR Ministry of Health of June 12, 1984 N 670
"On measures to further improve dental care for the population"
(as amended December 9, 1996)

The order prescribes:

• introduction of the position of pediatric dentist,
• security further development networks of dental clinics, departments and offices, contacting Special attention for the organization of dental clinics, primarily for children;
• ensuring the organization of dental offices in all higher and secondary educational institutions with a student population of 800 or more;
• implementation of a comprehensive program for the prevention of dental caries and periodontal diseases.
• providing routine sanitation of the oral cavity for children and adolescents;
• implementation modern methods local and general anesthesia.

The full text of the document is given in Appendix No. 10.

Order of the Ministry of Health and Social Development of the Russian Federation
dated April 14, 2006 N 289
"On measures to further improve dental care for children in the Russian Federation"

Fundamental document on pediatric dentistry, regulating the organization of activities, structure and staffing standards medical personnel children's dental clinic, the procedure for organizing the activities of the dental office of educational institutions, organizing the activities of a pediatric dentist, etc. The full text of the document is given in Appendix No. 11.

Decision of the board of the Ministry of Health of the Russian Federation
dated October 21, 2003
"On improving dental care for children in the Russian Federation"
(protocol No. 14)

The decision of the board states that improving the quality of dental care for children is one of the most important tasks of the maternal and child health service of the Ministry of Health of the Russian Federation, government bodies and health care institutions of the constituent entities Russian Federation. It is recommended to refine the model of the territorial comprehensive program "Pediatric Dentistry", develop clinical protocols“Management of children suffering from dental diseases”, preparation of additions to the accounting and reporting documentation of the activities of medical institutions and forms of federal state statistical observation on the provision of dental care to children. It is recommended that the heads of healthcare authorities of the constituent entities of the Russian Federation, together with educational authorities, continue to develop a network of school dental offices, develop and adopt territorial programs “Pediatric Dentistry” based on the program model recommended by the Ministry of Health of Russia. The full text of the document is given in Appendix No. 12.

Order of the Ministry of Health of the Russian Federation of December 30, 2003 N 620
"On approval of protocols for the management of children suffering from dental diseases"

The protocols provide schemes for the management of children in accordance with the diagnosis of diseases according to ICD-10 and the nosological form of the disease. Necessary for children with specific dental diseases are indicated. diagnostic measures(procedures, frequency), therapeutic measures, average follow-up periods for complicated and uncomplicated diseases in hospitals and clinics, evaluation criteria. The full text of the document is given in Appendix No. 13.

Job description of a pediatric dentist
Tatarnikov M.A. "Collection of job descriptions for healthcare workers, state sanitary and epidemiological supervision and pharmacy institutions." INFRA-M, 2004. 604 p.

The job description defines job responsibilities, rights and responsibilities of a pediatric dentist. It is indicated that a person with a higher education degree is appointed to the position of pediatric dentist. medical education, who has completed postgraduate training or specialization in the specialty "Pediatric Dentistry". A pediatric dentist must have a wide range of knowledge on health care legislation and regulatory documents in pediatric dentistry, organization of dental care for children, etiology and pathogenesis, clinic, diagnosis, prevention and treatment dental diseases, rehabilitation and medical examination of children.

Methodological recommendations for organizing the activities of medical workers providing medical care to students in educational institutions
(approved by the Ministry of Health and Social Development of the Russian Federation on January 15, 2008 N 207-BC)

The recommendations contain provisions on the organization of activities of a pediatric dentist (regulation III), a dental hygienist (regulation IV), nurse pediatric dentist (position V) performing medical support students in educational institution. The provisions deal primarily with the responsibilities medical workers dental profile. The full text of the document is given in Appendix No. 15.

Order of the Ministry of Health and Social Development of the Russian Federation of April 21, 2008 N 183n
"On conducting medical examinations of orphans and children in difficult life situations staying in inpatient institutions in 2008-2010"
(as amended on November 1, 2008 No. 618n)

The order approves the procedure for conducting clinical examination of orphans and children in difficult situations in 2008 - 2010 life situation, registration and reporting forms of medical examination. Requires monitoring of the implementation of treatment preventive measures, annual analysis of the results of clinical examination. Pediatric dentists should participate in the medical examination of children of all age groups. The full text of the document is given in Appendix No. 16.

Methodological recommendations "Hygienic requirements for limiting radiation doses of children during X-ray examinations" (approved by the Deputy Chief State Sanitary Doctor of the Russian Federation dated April 27, 2007 N 0100/4443-07-34)

The recommendations contain a section “Dentistry”, which explains the specific indications for X-ray examination at various types dental treatment for children. The text of the document is given in Appendix No. 17.

Order of the Ministry of Health and Medical Industry of the Russian Federation
dated March 14, 1995 N 60
"On approval of instructions for conducting preventive examinations of children of preschool and school age based on medical and economic standards"

According to the instructions, a dentist must examine a child before entering a preschool institution, a year before entering school, immediately before entering school, etc. It should be noted that these recommendations do not meet modern dental requirements. The full text of the document is given in Appendix No. 18.

Order of the Ministry of Health and Social Development of the Russian Federation
dated July 7, 2009 N 415n
"On approval of qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare"

The order provides for the need for pediatric dentists to receive higher professional education in the specialty "060105 Dentistry", postgraduate professional education in the specialty "Dentistry" or "Dentistry" general practice", additional education in clinical residency or courses professional retraining in the specialty "Pediatric Dentistry". At least once every 5 years throughout his entire career, a pediatric dentist must receive additional professional education at advanced training courses. The text of the document is given in Appendix No. 19.

Order of the USSR Ministry of Health and State. USSR Committee on Public Education
dated August 11, 1988 No. 639/271
"On measures to improve the prevention of dental diseases in organized children's groups."

The order is valid and has not lost its meaning at the present time. The order provides:

• develop and approve republican regional programs for the prevention of dental diseases in organized children's groups;
• organize training for nursing staff at dental clinics and departments preschool institutions and schools implementation of measures comprehensive prevention dental diseases in organized children's groups;
• oblige the heads of preschool, boarding institutions and schools to provide conditions for sanitation of the oral cavity and the prevention of dental diseases in children during the school year;
• oblige the pediatric service to actively participate in the organization of the prevention of dental diseases in children" to ensure continuity of work with the dental service;
• provide in regions with reduced content fluoride in drinking water regulatory intake of endogenous fluoride preparations in organized children's groups
• it is recommended to review the regulatory and technological documentation for products baby food to further reduce sugar, expand the production of baby food products with reduced sugar content, strengthen sanitary educational work, meet the need for dental equipment, instruments and materials in schools, boarding institutions, sanatoriums, develop and approve new learning programs schools on hygiene and prevention (at the rate of 3 hours per year in grades 1-3 and 1 hour per year in grades 4-10), supplement the curriculum with issues of oral hygiene and prevention of dental diseases, make it the responsibility of educators to carry out daily hygiene activities oral care from 2-3 years of age and a number of other activities.

The full text of the document is given in Appendix No. 20.

Orders of the Ministry of Health, instructions, guidelines on problems of dental care for the population often include sections aimed at improving dental care for children.

Order of the Ministry of Health and Medical Industry of the Russian Federation dated August 6, 1996 N 312
"On the organization of work of dental institutions in new economic conditions"

The order prescribes budgetary financing of dental institutions taking into account the labor intensity of the dentist’s work, expressed in conventional units (CUT), and the work actually performed by him; compensate for expenses that are not restored by the budget or the Compulsory Medical Insurance Fund through self-supporting activities during working hours; maintain separate records and accumulation of property acquired as a result of self-accounting activities; maintain statistical and financial records separately by funding source; include dental care for the population in the territorial compulsory health insurance program. The full text of the document is given in Appendix No. 21.

Order of the Ministry of Health and Social Development of the Russian Federation of April 16, 2008 N 176n
"On the nomenclature of specialties for specialists with secondary medical and pharmaceutical education in the healthcare sector of the Russian Federation"

The nomenclature of specialties includes: dentistry, orthopedic dentistry and preventive dentistry. The full text of the document is given in Appendix No. 22.

Order of the Ministry of Health and Social Development of the Russian Federation
dated April 23, 2009 N 210n
"On the nomenclature of specialties of specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare of the Russian Federation"

The order approves the nomenclature of specialist specialties, including the dental profile: the specialty upon graduation is “Dentistry”, the main specialty is “General Dentistry”, the specialty requiring additional training is “Pediatric Dentistry”. The text of the document is given in Appendix No. 23.

Order of the USSR Ministry of Health
dated January 25, 1988 No. 50
"On the transition to a new labor accounting system for dental doctors and improving the form of organizing dental appointments."

The order introduced a new system for recording the work of doctors, which is based on measuring the volume of their work in conventional units of labor intensity (CLU) and is aimed at intensifying the work of a doctor. UET standards for dentists and dentists, accounting and reporting documentation dentist and instructions for filling it out.

Order of the Ministry of Health of the Russian Federation
dated October 2, 1997 N 289
"On improving the labor accounting system for dental doctors"

The order allows the heads of healthcare management bodies of the constituent entities of the Russian Federation to develop and approve conventional units of accounting for the labor intensity of work (UET) of dentists and dentists for all types of work using new technologies for their production, not provided for by the order of the USSR Ministry of Health dated January 25, 1988 N 50 " About the transition to new system accounting for the work of dental doctors and improving the form of organizing dental appointments." The text of the document is given in Appendix No. 25.

RESOLUTION of the XII Congress of the Russian Dental Association
Moscow, September 9, 2009

The resolution includes recommendations on the widespread introduction of therapeutic and preventive dental measures into the work of school dental offices; ensuring financing of preventive measures within the framework of compulsory medical insurance; integrating a modern model for the functioning of dental offices into the school health care system; about the development federal program prevention of dental diseases for children with disabilities; complex of preventive measures for children living in rural areas and sparsely populated cities of the Russian Federation; on the widespread involvement of nursing staff, in particular dental hygienists, in the implementation of preventive measures, etc. The full text of the document is given in Appendix No. 26.

Some international documents are also of interest:

Convention on the Rights of the Child
Adopted unanimously by the UN General Assembly on November 20, 1989 and is open for signature, ratification and accession.
Came into force on September 2, 1990 in accordance with Article 49.
Ratified by the Supreme Soviet of the USSR on June 13, 1990.
Came into force for the Russian Federation on September 15, 1990.

According to the convention, a child is every human being under the age of 18. The Convention aims to respect and ensure all the rights of every child, without any discrimination, regardless of race, colour, sex, language, religion, political or other opinion, national, ethnic or social origin, property, state of health or birth of the child , his parents or legal guardians or any other circumstances. IN Appendix No. 27 The full text of the UN Convention on the Rights of the Child is provided.

European Charter of Patients' Rights
Presented in Brussels on November 15, 2002.

Contains coverage of the basic rights of patients to: preventive measures, access to health care, information, consent, freedom of choice, privacy and confidentiality, respect for the patient's time, adherence to quality standards, safety, innovation, avoiding suffering and pain whenever possible, individualized treatment, filing a complaint, compensation. Assumes the rights of patients to civic activity, participation in the formation of health policy, etc. The full text of the document is given in

06-10-2009

The developers of the document hope that the new rules will ensure the safety of patients and doctors, and first of all, children.

It is no longer possible to treat children in dental offices for adults. Medical institutions are required to equip separate blocks for minors with their own reception area and bathroom.

It is not profitable to treat children
However, according to Murmansk experts, the new sanitary rules worsen the situation in pediatric dentistry. Today, doctors and heads of medical institutions have no motivation to provide dental care to children. It is much easier for a doctor to treat an adult at a paid appointment than to persuade a child not to be afraid of the dentist’s instrument.

Moreover, due to the lack of a clear regulatory framework Insurance companies Medical institutions only pay for the “adult” work of doctors if they have a diploma as a general dentist.

— That’s why today only pediatric dentists (there are 6 of them in the city) and dentists work with children old school with secondary specialized education. But there are also few of them, and many of them are already over 60,” notes the city’s chief dentist, Emma Tolmacheva. - On the other hand, adolescents aged 15-17 years, who are legally considered children and therefore are treated in pediatric dentistry, can be treated in adult clinics. After all, boys and girls are already physiologically formed. For example, two-meter tall athletes, students, working people or even young mothers come to us. And they are served together with the kids. These guys already have a passport and the right to sign consent for medical intervention. So why not relieve the workload of our pediatric dentists by transferring teenagers to adult clinics?

By the way, now many people may not accept children paid clinics cities - most of them will not equip a separate office for children.

Change patients and gloves
The new document also stipulates a number of requirements for the location of the clinics themselves, the decoration of their premises, equipment, microclimate and lighting. For example, if there are several dental chairs in one office, they must be separated by opaque partitions at least one and a half meters high. According to experts, this part of the rules is feasible for newly built clinics. But not for those who work for many years in adapted premises.

In addition, in dental clinics, each employee must have at least three sets of sanitary clothing, and the doctor must use new ones for each patient. latex gloves. Also, while treating a patient, the dentist should not take notes, touch the phone, or eat or use cosmetics in the workplace.

Mushrooms relieve toothache
Most Murmansk residents try to get free dental care not in private clinics, where prices are quite high, but in regular clinics at their place of residence. To get to the doctor, patients have to “catch” numbers sometimes for several days. As doctors joke, they can catch their breath only two months a year - in August and September, when Murmansk residents are busy harvesting mushrooms and berries.

“To solve the problem of queues now, we would have to at least double the number of doctors,” notes Emma Tolmacheva. “Under current conditions, this is unrealistic.” In addition, today doctors, when treating adult patients, have to deal with the consequences of imperfect technologies of the 80s and 90s. In addition, public dental clinics bear social responsibility by participating in the preferential dental prosthetics program. Thus, over 8 months of 2009, 5,852 residents of Murmansk have already received such assistance in the amount of 43.8 million rubles. These are war and labor veterans, home front workers, disabled people, rehabilitated people, as well as ordinary pensioners.

When should you go to the dentist for the first time? Is dental fluoridation effective? Do baby teeth need to be treated? Answered these and other questions for us dentist, head of children's dental department medical clinic"Aquus", and simply the favorite dentist of many small Nizhny Novgorod residents - Evgenia Olegovna Panasenko.

1. Evgenia Olegovna, tell me, at what age should the first visit to the dentist take place? How will the baby’s first teeth appear or at the first complaints? When should you check your tongue frenulum?

The very first reason for a visit to a pediatric dentist should be to check the frenulum of the tongue. This is usually checked immediately after birth in maternity hospitals or at one of the first appointments with a pediatrician. If this does not happen, then the parents themselves need to take the initiative and pay attention to this point - with a short frenulum, the tongue simply does not rise up and this can prevent the child from latching normally.

Dissection of the frenulum of the tongue is best performed up to 3 months, since during this period it is a thin film without any blood vessels and nerves. From 3 months, the risk of bleeding increases due to the interweaving of blood vessels, so many clinics make a dissection already under general anesthesia. It is better to avoid this and do the dissection in time.

If the frenulum does not interfere with the child’s feeding, then the next moment when this defect may appear is the age when the child begins to speak, since short bridle disrupts pronunciation sounds r, l, sh. In this case, the frenulum is cut already at the age of 6, when the jaw changes and permanent teeth appear.

The next dental examination should be done when the four upper central incisors emerge to see the quality of the teeth. It is approximately, 1.5 - 2 years.

2. Evgenia Olegovna, what are the most basic reasons for the development of caries in baby teeth? A common situation is that your teeth have just come out, you look, and there are already black spots on them. What is the reason?

One of the first causes of caries may be improper formation of teeth during pregnancy and, as a result, “bad enamel”. It is immediately visible - it is either bright white or yellow.

Night feedings, even if it's breast milk, no matter how strange it may sound. Most often, a child’s teeth appear during the period breastfeeding, the baby gets the breast when he wants, and especially at night, because mommy wants to sleep. And I’m not at all against breastfeeding, but mothers should know that frequent night feedings cause the same harm to tooth enamel as night supplements with juice, tea, or anything other than water. A pathogenic flora develops in the child’s mouth, creating an acidic environment that very quickly “eats” more weak enamel children's teeth. The situation is especially aggravated if mommy eats carbohydrate foods at night.

To prevent early development caries, night feedings should be reduced to a minimum, and even better, replaced with water. Under no circumstances should you offer your child juices, teas or other drinks. Only water. If it is not possible to remove feeding, then try to feed the baby reclining and after feeding, wipe the baby’s teeth with a bandage with any paste (just a little), this will prevent microflora from developing.

Of course, not all children have night feedings that cause the development of caries. It must be remembered that all children are different, and if night feedings do not harm one, another may lose teeth because of them.

Food– also one of the main reasons. After all, what do modern children eat: rolls, waffles, breakfast cereals, chips, sweets with soft caramel - refined, soft, sticky, sweet food. Children's diet contains practically no foods that need to be chewed - whole apples, carrots. And this is important for jaw development.

Poor dental hygiene- Very important point. Children should be taught to brush their teeth from early childhood, especially at night. When the baby still cannot brush his teeth on his own, the simplest thing is to wrap a bandage, squeeze out a little toothpaste and wipe the teeth. All these silicone brushes only iron, I don’t believe in them and prefer to use a bandage the old fashioned way, since it has a porous structure.

The causes of caries and poor dental condition can be frequent use antibiotics, anesthesia.

3. Of the currently existing methods for treating caries, which are the most effective? Why are fluoridation and silvering procedures needed?

Silvering- This is a procedure in which I see no point. There is no result from it, except for black teeth and psychological trauma for the child, who will then be teased for these black teeth. The only positive thing is that mom is at least a little reassured that she did something.

Concerning fluoridation. Every children's toothpaste says that it doesn't contain fluoride - what is it written for? For what? Fluoride is a highly toxic substance that tends to accumulate in the body and is harmful to children. In the Nizhny Novgorod region there is no shortage of fluoride, unlike iodine, for example, so our body does not need additional fluoride.

And to be completely honest, how can you believe that they anointed your teeth with some kind of composition and everything became fine? You should always look for the cause and eliminate it, and not smear your teeth with incomprehensible compounds.

I am for sealing- a good old method that has proven its effectiveness. The meaning of this procedure is that a special composition, an analogue of tooth enamel, is applied to the cleaned fissures (grooves on the chewing teeth). By doing this, we seal the tooth and prevent food debris from getting into it. This procedure is done as soon as the 6th teeth erupt. Although, this procedure can also be done for baby teeth.

However, you need to understand that sealing protects teeth only from chewing caries; it is impossible to protect a tooth from contact caries (that which develops between the teeth). Therefore, as soon as you see something strange on your teeth, run to the doctor. Early caries develops very quickly.

4. What are the signs of early caries? Small brown dot– Is this already caries?

Period – this is already caries, and not even early ones. Early caries is a white stripe near the gum, which is slightly brighter in color than the main tone of the tooth. As soon as you see something like this, don’t hesitate, make an appointment with a doctor.

Early caries is very easy to cure; it only takes a few minutes. But our parents are so frightened that they wait until the last minute, when all their teeth already have pulpitis. And treating pulpitis in children is not the same as treating it in adults. At acute pain You can give any dosage of painkiller to an adult, but to a child - a strictly age-specific dose, which is calculated per kg of weight. And if, for example, a child has a toothache for two days, then to freeze the tooth you need adult dosage. No doctor will take responsibility, because reactions can be different, even the most serious.

As a result, it turns out that the mother was afraid that the child would be hurt, she missed time, and when they came to the dentist, normal anesthesia could no longer be administered. It’s better to come right away, especially since in the largest clinics in the city, dental examinations are free! Find time and bring your child for a checkup. This will save you and your child’s money and nerves.

5. Do baby teeth need to be treated? They will still fall out...

First, I would like to dispel the myth that baby teeth do not have nerves. This is wrong. There are nerves and roots, and in general they are the same teeth as permanent teeth, with the only difference being that the roots dissolve over time. And children experience the same pain from a bad tooth as adults.

Now imagine - the fifth, the largest baby tooth, resolves only by the age of 10–11 years. He needs to stand until this age. And if for some reason the tooth had to be removed earlier, then the 6th tooth (already permanent) will take the place of the missing tooth, and when the time comes for the fifth permanent tooth, there is no longer room for it, it goes to the side and is removed. The situation is the same with the upper central incisors - the permanent incisors are larger, so they stand unevenly. Parents come running in panic and ask to remove neighboring teeth. Under no circumstances should this be done! The jaw will grow and the teeth will fall into place. Each tooth has its own function and should fall out when it is supposed to.

6. At what age does the replacement of baby teeth with permanent ones begin?

In girls and boys this occurs in different time. In girls, the lower central incisors begin to erupt at 5-5.5 years old, in boys - at about 6.5. I would like to draw the attention of parents to the fact that in 70% of cases, the central lower incisors change in such a way that permanent teeth appear behind the milk teeth that have not yet fallen out. There is no need to be afraid of this. The reason is that the size permanent teeth larger than those of dairy animals, so it is easier for them to erupt behind their teeth. Then the baby teeth fall out or are removed if necessary, and the permanent teeth fall into place.