ICD 10 international classification of dental diseases codes. Dystopia of the tooth. Coding in ICD - C

An orthodontist makes such a diagnosis with code K07.3 according to ICD-10 (International Classification of Diseases, 10th revision) if the tooth has erupted with an inclination or displacement, or has completely appeared outside the dental arch. This mainly happens to the lower eighth molars, incisors and canines.

A companion to dystopia can be other anomalies in the position of the teeth - crowding, displaced or open bite, as well as retention.

Reasons for appearance

• Heredity. If a child inherited, for example, large teeth from his father and a small jaw from his mother, dystopia cannot be avoided. In addition, it can be inherited on its own.
• Atypical formation of dental tissue primordia in the embryo.
• Injuries and bad habits: prolonged use of a pacifier, habit of biting a pencil, etc.
• Early removal of baby teeth.
• Peculiarities of eruption time. For example, if fangs appear late, that is, after 9 years, there may no longer be room for them in the arch.
• Dystopia is often caused by polyodontia (“extra teeth”), macrodentia (abnormally large teeth), partial absence of teeth or a sharp discrepancy between the size of primary and permanent teeth.

Types of dystopia

Depending on how and where the crown is displaced, several types of pathology are distinguished:

• A tilt towards the vestibule of the mouth means that we are talking about the vestibular position of the dystopic tooth, and if, on the contrary, in the depths of the oral cavity, we are talking about the oral position.
• When the body of the tooth is completely located outside the arch and moves forward or backward, the dentist will note in the chart the presence of a mesial or distal position, respectively.
• Is the newbie cutting higher than the rest? – Such an anomaly will be called supraposition. If lower, infra position.
• Rare anomalies are torto- and transposition. In the first case, the tooth rotates around its axis, in the second, it changes places with its neighbor, for example, a canine takes the place of a premolar.

Depending on which tooth is in the wrong position, dystopia of incisors, canines, molars and premolars or “eights” is distinguished.

The eighth molars are the last to appear, and that is why they are associated with greatest risk the occurrence of dystopia.

The bone tissue has already been formed, and often there is no longer room for a newcomer in the dental arch. In addition, any indigenous is preceded by a dairy pioneer who “breaks” the path. The “wise” molar does not have such an assistant, just as there are no neighboring teeth that determine the correct position on the arch.

Possible complications

A dystopic tooth can injure the oral mucosa, tongue and cheeks, resulting in decubital ulcers.

Anomalies in the position of crowns and malocclusion – common reason caries: oral hygiene becomes more complicated; it is difficult to completely remove plaque and food debris from the interdental spaces.

Another complication is problems with diction and chewing food.

Also, inflammation often occurs above the part of the crown that has not yet erupted - pericoronitis. And in the most difficult cases, the “problem” tooth erupts outside the alveolar arch, which, of course, entails not only serious discomfort, but also diseases of other organs.

The method of therapy depends on the condition of the dystopic tooth and its useful load. Sometimes it is enough just to polish the sharp edges and give it a shape that will not injure the mucous membrane.

Most often, when a tooth is in an incorrect position, they resort to orthodontic treatment methods. Braces allow you to cope with serious malocclusions. If there is no room for a tooth, and this is, for example, a canine that is important from the point of view of functionality and aesthetics, then you will have to remove its neighbors and only then begin orthodontic treatment.

Treatment of dystopia with braces

When to remove a dystopic tooth

Removal is not a pleasant procedure, and therefore is always a last resort. It is used in the following cases:

• in the presence of pulpitis, periodontitis or cysts;
• if it is a wisdom tooth complicating the treatment of caries of the seventh molars;
• when the anomaly is accompanied by osteomyelitis or periostitis;
• if surrounding tissues are seriously injured.

If there are no such indications, the dentist will do everything possible to save the dystopic tooth. Note that it is optimal to undergo treatment before the end of growth of the facial skeleton, that is, up to 14-16 years. In this case, you will see results faster, and they will be noticeably better than if you consult a specialist later.

The protocol for the management of patients “Dental Caries” was developed by the Moscow State Medical and Dental University (Kuzmina E.M., Maksimovsky Yu.M., Maly A.Yu., Zheludeva I.V., Smirnova T.A., Bychkova N.V. , Titkina N.A.), Dental Association of Russia (Leontiev V.K., Borovsky E.V., Wagner V.D.), Moscow Medical Academy named after. THEM. Sechenova Roszdrav (Vorobiev P.A., Avksenteva M.V., Lukyantseva D.V.), dental clinic No. 2 of Moscow (Chepovskaya S.G., Kocherov A.M.., Bagdasaryan M.I., Kocherova M.A.).

I. SCOPE OF APPLICATION

The “Dental Caries” patient management protocol is intended for use in the healthcare system Russian Federation.

II. NORMATIVE REFERENCES

- Decree of the Government of the Russian Federation dated November 5, 1997 No. 1387 “On measures to stabilize and develop healthcare and medical science in the Russian Federation” (Collected Legislation of the Russian Federation, 1997, No. 46, Art. 5312).
- Decree of the Government of the Russian Federation dated October 26, 1999 No. 1194 “On approval of the Program of State Guarantees for Providing Citizens of the Russian Federation with Free medical care"(Collected Legislation of the Russian Federation, 1997, No. 46, Art. 5322).
- Nomenclature of works and services in healthcare. Approved by the Ministry of Health and Social Development of Russia on July 12, 2004 - M., 2004. - 211 p.

III. GENERAL PROVISIONS

The “Dental Caries” patient management protocol was developed to solve the following problems:

- establishment of uniform requirements for the procedure for diagnosis and treatment of patients with dental caries;
- unification of the development of basic compulsory programs health insurance and optimization of medical care for patients with dental caries;
- ensuring optimal volumes, accessibility and quality of medical care provided to the patient in a medical institution.

The scope of this protocol is medical and preventive institutions of all levels and organizational and legal forms that provide medical dental care, including specialized departments and offices of any form of ownership.

The strength of evidence scale used in this document is:

A) The evidence is compelling: There is strong evidence for the proposed statement.
B) Relative strength of evidence: There is sufficient evidence to recommend this proposal.
C) There is not enough evidence: The available evidence is insufficient to make a recommendation, but recommendations may be made based on other circumstances.
D) Negative evidence is sufficient: there is sufficient evidence to recommend against the use of this drug, material, method, technology in certain conditions.
E) Strong negative evidence: There is sufficiently convincing evidence to exclude the drug, method, technique from the recommendations.

IV. KEEPING RECORD

The “Dental Caries” Protocol is maintained by the Moscow State Medical and Dental University of Roszdrav. The management system provides for the interaction of the Moscow State Medical and Dental University with all interested organizations.

V. GENERAL ISSUES

Dental caries(K02 according to ICD-10) is an infectious pathological process that manifests itself after teething, during which demineralization and softening of the hard tissues of the tooth occur, followed by the formation of a defect in the form of a cavity.

Currently, dental caries is the most common disease of the dental system. The prevalence of caries in our country among adults aged 35 years and older is 98-99%. In the general structure of medical care for patients in dental treatment and prevention institutions, this disease occurs in all age groups of patients. If untimely or improperly treated, dental caries can cause the development of inflammatory diseases of the pulp and periodontium, tooth loss, and the development of purulent-inflammatory diseases of the maxillofacial area. Dental caries are potential foci of intoxication and infectious sensitization of the body.

Indicators of the development of complications of dental caries are significant: in the age group of 35-44 years, the need for fillings and prosthetics is 48% and tooth extraction - 24%.

Untimely treatment of dental caries, as well as tooth extraction as a result of its complications, in turn lead to the appearance of secondary deformation of the dentition and the occurrence of pathology of the temporomandibular joint. Dental caries directly affects the health and quality of life of the patient, causing disturbances in the chewing process up to the final loss of this body function, which affects the digestion process.

In addition, dental caries is often the cause of gastrointestinal diseases.

ETIOLOGY AND PATHOGENESIS

The immediate cause of demineralization of enamel and the formation of a carious lesion are organic acids (mainly lactic acid), which are formed during the fermentation of carbohydrates by plaque microorganisms. Caries is a multifactorial process. Microorganisms of the oral cavity, nature and diet, enamel resistance, quantity and quality of mixed saliva, general condition of the body, exogenous influences on the body, fluoride content in drinking water The occurrence of a focus of enamel demineralization, the course of the process and the possibility of its stabilization are influenced. Initially, carious lesions occur due to frequent consumption of carbohydrates and insufficient oral care. As a result, adhesion and proliferation of cariogenic microorganisms occurs on the surface of the tooth and dental plaque is formed. Further intake of carbohydrates leads to a local change in pH to the acidic side, demineralization and the formation of microdefects in the subsurface layers of enamel. However, if the organic enamel matrix is ​​preserved, then the carious process at the stage of its demineralization can be reversible. The long-term existence of a focus of demineralization leads to the dissolution of the surface, more stable, layer of enamel. Stabilization of this process can be clinically manifested by the formation of a pigmented spot that exists for years.

CLINICAL PICTURE OF DENTAL CARIES

The clinical picture is characterized by diversity and depends on the depth and topography of the carious cavity. A sign of initial caries is a change in the color of the tooth enamel in a limited area and the appearance of a stain; subsequently, a defect develops in the form of a cavity, and the main manifestation of developed caries is the destruction of the hard tissues of the tooth.

As the depth of the carious cavity increases, patients experience increased sensitivity to chemical, temperature and mechanical stimuli. The pain from the irritants is short-lived and quickly goes away after the irritant is removed. There may be no pain response. Carious lesions of chewing teeth cause dysfunction of chewing; patients complain of pain when eating and disturbances in aesthetics.

CLASSIFICATION OF DENTAL CARIES

In the international statistical classification of diseases and health problems of the World Health Organization, tenth revision (ICD-10), caries is included in a separate category.

K02.0 Enamel caries. Stage of "white (chalky) spot" [initial caries]
K02.I Dentin caries
K02.2 Cement caries
K02.3 Suspended dental caries
K02.4 Odontoclasia
K02.8 Other dental caries
K02.9 Dental caries, unspecified

Modified classification of carious lesions by location (according to Black)

Class I - cavities localized in the area of ​​fissures and natural recesses of incisors, canines, molars and premolars.
Class II - cavities located on the contact surface of molars and premolars.
Class III - cavities located on the contact surface of the incisors and canines without breaking the cutting edge.
Class IV - cavities located on the contact surface of the incisors and canines with a violation of the angle of the coronal part of the tooth and its cutting edge.
Class V - cavities located in the cervical region of all groups of teeth.
Class VI - cavities located on the cusps of molars and premolars and the cutting edges of incisors and canines.

The stage of the spot corresponds to the code according to ICD-C K02.0 - “Enamel caries. Stage of “white (matte) spot” [initial caries].” Caries in the spot stage is characterized by changes in color (matte surface) resulting from demineralization, and then in texture (roughness) of the enamel in the absence of a carious cavity, which have not spread beyond the enamel-dentin border.

The stage of dentin caries corresponds to the ICD-C code K02.1 and is characterized by destructive changes in the enamel and dentin with the transition of the enamel-dentin border, but the pulp is covered by a larger or smaller layer of preserved dentin and without signs of hyperemia.

The cement caries stage corresponds to the ICD-C code K02.2 and is characterized by damage to the exposed surface of the tooth root in the cervical region.

The stage of suspended caries corresponds to the ICD-C code K02.3 and is characterized by the presence of a dark pigmented spot within the enamel (focal demineralization of the enamel).

1 ICD-C - International classification of dental diseases based on ICD-10.

GENERAL APPROACHES TO DIAGNOSIS OF DENTAL CARIES

Diagnosis of dental caries is made by collecting anamnesis, clinical examination and additional methods examinations. The main task in diagnosis is to determine the stage of development of the carious process and select the appropriate treatment method. During diagnosis, the localization of caries and the degree of destruction of the crown of the tooth are established. Depending on the diagnosis, a treatment method is chosen.

Diagnostics are carried out for each tooth and are aimed at identifying factors that prevent the immediate start of treatment. Such factors may be:

- presence of intolerance medicines and materials used at this stage of treatment;
- concomitant diseases that complicate treatment;
- inadequate psycho-emotional state of the patient before treatment;
- acute lesions of the oral mucosa and red border of the lips;
- acute inflammatory diseases of organs and tissues of the oral cavity;
- a life-threatening acute condition/disease or exacerbation of a chronic disease (including myocardial infarction, acute cerebrovascular accident), which developed less than 6 months before seeking this dental care;
- diseases of periodontal tissues in the acute stage;
- unsatisfactory hygienic condition of the oral cavity;
- refusal of treatment.

GENERAL APPROACHES TO THE TREATMENT OF DENTAL CARIES

The principles of treating patients with dental caries provide for the simultaneous solution of several problems:

- elimination of factors causing the demineralization process;
- prevention of further development of the pathological carious process;
- preservation and restoration of the anatomical shape of a tooth affected by caries and the functional ability of the entire dental system;
- prevention of development pathological processes and complications;
- improving the quality of life of patients.

Treatment for caries may include:

- elimination of microorganisms from the surface of teeth;
- remineralizing therapy at the “white (chalky) spot” stage;
- fluoridation of hard dental tissues in case of suspended caries;
- preservation, as far as possible, of healthy hard dental tissues, if necessary, excision of pathologically altered tissues with subsequent restoration of the tooth crown;
- issuing recommendations on the timing of re-application.

Treatment is carried out for each tooth affected by caries, regardless of the degree of damage and the treatment of other teeth.

When treating dental caries, only those dental materials and medications are used that are approved for use on the territory of the Russian Federation in accordance with the established procedure.

ORGANIZATION OF MEDICAL CARE FOR PATIENTS WITH DENTAL CARIES

Treatment of patients with dental caries is carried out in dental treatment and prevention institutions, as well as in therapeutic dentistry departments and offices of multidisciplinary treatment and prevention institutions. As a rule, treatment is carried out in an outpatient setting.

The list of dental materials and instruments necessary for the work of a doctor is presented in Appendix 1.

Providing assistance to patients with dental caries is carried out mainly by dentists, dental therapists, orthopedic dentists, and dentists. Nursing staff and dental hygienists take part in the process of providing assistance.

VI. CHARACTERISTICS OF REQUIREMENTS

6.1. Patient model

6.1.1 Criteria and features defining the patient model

6.1.2 Procedure for including a patient in the Protocol

6.1.3. Requirements for outpatient diagnostics

6.1.4. Characteristics of algorithms and features of performing diagnostic measures

For this purpose, all patients must undergo anamnesis collection, examination of the oral cavity and teeth, as well as other necessary studies, the results of which are entered into the dental patient’s medical record (form 043/y).

History taking

All teeth are subject to examination; the examination begins with the upper right molars and ends with the lower right molars. All surfaces of each tooth are examined in detail, paying attention to the color, enamel relief, the presence of plaque, the presence of stains and their condition after drying the surface of the teeth, defects.

Pay attention to the presence of white matte spots on the visible surfaces of the teeth, the area, shape of the edges, surface texture, density, symmetry and multiplicity of lesions in order to establish the severity of changes and the speed of development of the process, the dynamics of the disease, as well as differential diagnosis with non-carious lesions. Fluorescent stomatoscopy can be used to confirm the diagnosis.

Thermodiagnostics used to identify pain reactions and clarify the diagnosis.

Percussion used to eliminate caries complications.

Vital staining of hard dental tissues. In cases that are difficult to differentiate from non-carious lesions, the lesion is stained with a 2% solution of methylene blue. Upon receipt negative result carry out appropriate treatment (different patient model).

Oral hygiene indices determined before treatment and after training in oral hygiene for the purpose of control.

6.1.5. Requirements for outpatient treatment

6.1.6 Characteristics of algorithms and features of non-drug care

Non-drug care is aimed at ensuring proper oral hygiene to prevent the development of caries and includes three main components: oral hygiene education, supervised tooth brushing and professional oral and dental hygiene.

In order to develop the patient's oral care skills (brushing teeth) and the most effective removal of soft plaque from the surfaces of the teeth, the patient is taught oral hygiene techniques. Teeth brushing techniques are demonstrated on models.

Oral hygiene products are selected individually. Oral hygiene education helps prevent dental caries (level of evidence B).

Controlled teeth cleaning means brushing that the patient does independently in the presence of a specialist (dentist, dental hygienist) in a dental office or oral hygiene room, in the presence of the necessary hygiene products and visual aids. The purpose of this event is to monitor the effectiveness of the patient’s teeth brushing and correct deficiencies in the teeth brushing technique. Controlled brushing can effectively maintain oral hygiene (level of evidence B).

Professional oral hygiene includes the removal of supra- and subgingival dental plaque from the tooth surface and helps prevent the development of dental caries and inflammatory periodontal diseases (level of evidence A).

First visit

Complete the brushing with circular movements of the toothbrush with the jaws closed, massaging the gums from right to left.

Individual selection of oral hygiene products is carried out taking into account the dental status of the patient (the condition of the hard tissues of the teeth and periodontal tissues, the presence of dental anomalies, removable and non-removable orthodontic and orthopedic structures) ().

Second visit

First visit

Next visit

The patient is instructed to attend a preventive examination with a doctor at least once every six months.

- carry out antiseptic treatment of the oral cavity with an antiseptic solution (0.06% chlorhexide solution, 0.05% potassium permanganate solution);

Grinding of hard dental tissues

Grinding is carried out before starting a course of remineralizing therapy in the presence of rough surfaces.

Sealing the tooth fissure with sealant

To prevent the development of caries, the fissures of the teeth are sealed with a sealant in the presence of deep, narrow (pronounced) fissures.

6.1.7. Requirements for outpatient drug care

6.1.8. Characteristics of algorithms and features of the use of medications

The main methods of treating enamel caries in the spot stage are remineralization therapy and fluoridation (level of evidence B).

Remineralizing therapy

The course of remineralizing therapy consists of 10-15 applications (daily or every other day). Before starting treatment, if there are rough surfaces, they are sanded. Start a course of remineralizing therapy. Before each application, the affected tooth surface is mechanically cleaned of plaque and dried with a stream of air.

Applications of remineralizing agents on the treated tooth surface for 15-20 minutes, changing the tampon every 4-5 minutes. Applications of a 1-2% sodium fluoride solution are carried out every 3rd visit, after application of a remineralizing solution on a cleaned and dried tooth surface for 2-3 minutes.

Fluoride varnish, an analogue of a 1-2% sodium fluoride solution, is applied to the teeth every 3rd visit after application of the remineralizing solution on the dried tooth surface. After application, the patient is not recommended to eat for 2 hours and brush his teeth for 12 hours.

The criterion for the effectiveness of a course of remineralization therapy and fluoridation is a reduction in the size of the focus of demineralization until it disappears, restoration of the shine of the enamel or less intense staining of the focus of demineralization (on a 10-point scale of enamel staining) with a 2% solution of methylene blue.

6.1.9. Requirements for the regime of work, rest, treatment and rehabilitation

Patients with enamel caries in the spot stage should visit a specialist once every six months for observation.

6.1.10. Requirements for patient care and ancillary procedures

6.1.11. Dietary requirements and restrictions

After completing each medical procedure It is recommended not to eat or rinse your mouth for 2 hours. Limit consumption food products and drinks with low pH values ​​(juices, tonic drinks, yoghurts) and rinse your mouth thoroughly after taking them.

Limiting the presence of carbohydrates in the oral cavity (sucking, chewing candies).

6.1.12. Form of informed voluntary consent of the patient when implementing the Protocol

6.1.13. Additional information for the patient and his family members

6.1.14. Rules for changing requirements when implementing the Protocol and terminating the requirements of the Protocol

6.1.15. Possible outcomes and their characteristics

6.1.16. Cost characteristics of the Protocol

6.2. PATIENT MODEL

6.2.1. Criteria and signs defining the patient model

6.2.2. The procedure for including a patient in the Protocol

A patient's condition that meets the diagnostic criteria and signs of a given patient model.

6.2.3. Requirements for outpatient diagnostics

6.2.4. Characteristics of algorithms and features of performing diagnostic measures

History taking

When collecting anamnesis, they find out the presence of complaints of pain from irritants, an allergic history, the presence somatic diseases. They purposefully identify complaints of pain and discomfort in the area of ​​a specific tooth, food getting stuck, how long ago they appeared, when the patient paid attention to them. Special attention pay attention to clarifying the nature of the complaints, whether they, in the patient’s opinion, are always associated with a specific irritant. They find out the patient’s profession, whether the patient takes proper hygienic care of the oral cavity, and the time of his last visit to the dentist.

When examining the oral cavity, the condition of the dentition is assessed, paying attention to the presence of fillings, the degree of their adherence, the presence of defects in the hard tissues of the teeth, and the number of teeth removed. The intensity of caries is determined (KPU index - caries, filling, removed), hygiene index. Pay attention to the condition of the oral mucosa, its color, moisture, and the presence of pathological changes. All teeth are subject to examination; the examination begins with the upper right molars and ends with the lower right molars.

They examine all surfaces of each tooth, pay attention to the color, enamel relief, the presence of plaque, the presence of stains and their condition after drying the surface of the teeth, defects.

Pay attention to the fact that probing is carried out without strong pressure. Pay attention to the presence of stains on the visible surfaces of the teeth, the presence of stains and their condition after drying the surface of the teeth, the area, shape of the edges, surface texture, density, symmetry and multiplicity of lesions in order to establish the severity of the disease and the speed of development of the process, the dynamics of the disease, and also differential diagnosis with non-carious lesions. When probing an identified carious cavity, attention is paid to its shape, location, size, depth, the presence of softened dentin, changes in its color, soreness or, conversely, lack of pain sensitivity. The approximal surfaces of the tooth are especially carefully examined. Thermal diagnostics are carried out. To confirm the diagnosis, in the presence of a cavity on the contact surface and in the absence of pulp sensitivity, radiography is performed.

When performing electroodontometry, pulp sensitivity indicators for dentin caries are recorded in the range from 2 to 10 μA.

6.2.5. Requirements for outpatient treatment

6.2.6. Characteristics of algorithms and features of non-drug care

Non-drug assistance is aimed at preventing the development of the carious process and includes three main components: ensuring proper oral hygiene, filling the carious defect and, if necessary, prosthetics.

Treatment of caries, regardless of the location of the carious cavity, includes: premedication (if necessary), anesthesia, opening of the carious cavity, removal of softened and pigmented dentin, shaping, finishing, washing and filling the cavity (as indicated) or prosthetics with inlays, crowns or veneers.

Indications for prosthetics are:

Damage to the hard tissues of the coronal part of the tooth after preparation: for the group of chewing teeth, the index of destruction of the occlusal surface of the tooth (IROPD) > 0.4 indicates the manufacture of inlays, IROPD > 0.6 - the production of artificial crowns is indicated, IROPD > 0.8 - the use of pin structures is indicated followed by the production of crowns;
- prevention of the development of deformations of the dental system in the presence of adjacent teeth with fillings that replenish more? chewing surface.

Main goals of treatment:

Stopping the pathological process;
- restoration of the anatomical shape and function of the tooth;
- prevention of the development of complications, including prevention of the development of the Popov-Godon phenomenon in the area of ​​antagonist teeth;
- restoration of aesthetics of the dentition.

Treatment of dentin caries with fillings and, if necessary, prosthetics allows for compensation of function and stabilization of the process (level of evidence A).

Algorithm for teaching oral hygiene

First visit

The doctor or dental hygienist determines the hygiene index, then demonstrates to the patient the technique of brushing teeth with a toothbrush and dental floss, using dental models, or other demonstration tools.

Teeth brushing begins with an area in the area of ​​the upper right chewing teeth, sequentially moving from segment to segment. The teeth on the lower jaw are cleaned in the same order.

Pay attention to the fact that the working part of the toothbrush should be positioned at an angle of 45° to the tooth, making cleaning movements from gum to tooth, while simultaneously removing plaque from the teeth and gums. Clean the chewing surfaces of the teeth with horizontal (reciprocating) movements so that the fibers of the brush penetrate deep into the fissures and interdental spaces. Clean the vestibular surface of the front teeth of the upper and lower jaws with the same movements as molars and premolars. When cleaning the oral surface, place the brush handle perpendicular to the occlusal plane of the teeth, while the fibers should be at an acute angle to the teeth and capture not only the teeth, but also the gums.

Complete the cleaning with circular movements of the toothbrush with the jaws closed, massaging the gums from right to left.

Cleaning duration is 3 minutes.

For high-quality cleaning of the contact surfaces of teeth, it is necessary to use dental floss.

Second visit

In order to consolidate the acquired skills, controlled teeth brushing is carried out.

Controlled teeth brushing algorithm

First visit

Treatment of the patient's teeth with a staining agent, determination of the hygienic index, demonstration to the patient using a mirror of the areas of greatest accumulation of plaque.
- The patient brushes his teeth in his usual manner.
- Repeated determination of the hygiene index, assessment of the effectiveness of tooth brushing (comparing the hygiene index indicators before and after brushing), showing the patient, using a mirror, stained areas where plaque was not removed during brushing.
- Demonstration of the correct technique for brushing teeth on models, recommendations to the patient for correcting deficiencies hygiene care for the oral cavity, the use of dental floss and additional hygiene products (special toothbrushes, dental brushes, monotuft brushes, irrigators - according to indications).

Next visit

Determination of the hygiene index, with a satisfactory level of oral hygiene - repeating the procedure.

Stages of professional hygiene:

Teaching the patient individual oral hygiene;
- removal of supra- and subgingival dental plaque;
- polishing of tooth surfaces, including root surfaces;
- elimination of factors contributing to the accumulation of plaque;
- applications of remineralizing and fluoride-containing agents (except for areas with high fluoride content in drinking water);
- patient motivation for the prevention and treatment of dental diseases. The procedure is carried out in one visit.
- When removing supra- and subgingival dental deposits (tartar, dense and soft plaque), a number of conditions must be observed:
- removal of tartar is carried out with application anesthesia;

- isolate the teeth being treated from saliva;
- pay attention that the hand holding the instrument must be fixed on the patient’s chin or adjacent teeth, the terminal rod of the instrument is located parallel to the axis of the tooth, the main movements - lever-like and scraping - must be smooth and not traumatic.

In the field of metal-ceramic, ceramic, composite restorations, implants (when processing the latter, plastic tools are used), a manual method of removing dental plaque is used.

Ultrasound machines should not be used on patients with respiratory, infectious diseases, as well as in patients with a pacemaker.

To remove plaque and polish smooth surfaces of teeth, it is recommended to use rubber caps, chewing surfaces - rotating brushes, contact surfaces - floss and abrasive strips. The polishing paste should be used from coarse to fine. Fluoride-containing polishing pastes are not recommended for use before certain procedures (fissure sealing, teeth whitening). When processing implant surfaces, fine polishing pastes and rubber caps should be used.

It is necessary to eliminate factors that contribute to the accumulation of plaque: remove overhanging edges of fillings, re-polish fillings.

The frequency of professional oral hygiene depends on the patient’s dental status (oral hygiene, intensity of dental caries, condition of periodontal tissues, presence of fixed orthodontic appliances and dental implants). The minimum frequency of professional hygiene is 2 times a year.

In case of dentin caries, filling is carried out in one visit. After diagnostic studies and making a decision on treatment, treatment begins at the same appointment.

It is possible to place a temporary filling (bandage) if it is impossible to place a permanent filling on the first visit or to confirm the diagnosis.

Anesthesia;
- “opening” of the carious cavity;


- excision of enamel devoid of underlying dentin (according to indications);
- cavity formation;
- cavity finishing.

It is necessary to pay attention to the processing of the edges of the cavity to create a high-quality marginal seal of the filling and prevent chipping of the enamel and filling material.

When filling with composite materials, gentle preparation of cavities is allowed (level of evidence B).

Features of preparation and filling of cavities

Class I cavities

One should strive to preserve the cusps on the occlusal surface as much as possible; for this, before preparation, areas of enamel that bear occlusal load are identified using articulating paper. The tubercles are removed partially or completely if the slope of the tuberosity is damaged at 1/2 of its length. If possible, preparation is carried out within the contours of natural fissures. If necessary, use the method of “preventive expansion” according to Black. The use of this method helps prevent caries relapse. This type of preparation is recommended primarily for materials that do not have good adhesion to tooth tissue (amalgam) and are retained in the cavity due to mechanical retention. When expanding the cavity to prevent secondary caries, it is necessary to pay attention to maintaining the maximum possible thickness of dentin at the bottom of the cavity.

Class II cavities

Before starting the preparation, the types of access are determined. The cavity is formed. The quality of removal of affected tissue is checked using a probe and a caries detector.

When filling, it is necessary to use matrix systems, matrices, and interdental wedges. In case of extensive destruction of the crown part of the tooth, it is necessary to use a matrix holder. It is necessary to carry out anesthesia, since the application of a matrix holder or insertion of a wedge is painful for the patient.

A correctly formed contact surface of a tooth can in no case be flat - it must have a shape close to spherical. The contact zone between the teeth should be located in the equator area and slightly higher - as in intact teeth. You should not model the contact point at the level of the marginal ridges of the teeth: in this case, in addition to food getting stuck in the interdental space, chips of the material from which the filling is made are possible. As a rule, this error is associated with the use of a flat matrix that does not have a convex contour in the equator region.

The formation of the contact slope of the marginal ridge is carried out using abrasive strips (strips) or discs. The presence of a slope of the edge ridge prevents the material from chipping in this area and food getting stuck.

Attention should be paid to the formation of tight contact between the filling and the adjacent tooth, preventing excessive introduction of material into the area of ​​the gingival wall of the cavity (creating an “overhanging edge”), ensuring optimal fit of the material to the gingival wall.

Class III cavities

When preparing, it is important to determine the optimal access. Direct access is possible if there is no adjacent tooth or if there is a prepared cavity on the adjacent contact surface of the adjacent tooth. Lingual and palatal approaches are preferred, as this allows preserving the vestibular enamel surface and providing a higher functional aesthetic level of tooth restoration. During preparation, the contact wall of the cavity is excised with an enamel knife or bur, having previously protected the intact adjacent tooth with a metal matrix. A cavity is formed by removing enamel devoid of underlying dentin, and the edges are treated with finishing burs. It is allowed to preserve vestibular enamel, devoid of underlying dentin, if it does not have cracks or signs of mineralization.

Class IV cavities

Features of the preparation of a class IV cavity are a wide rebate, the formation in some cases of an additional platform on the lingual or palatal surface, and gentle preparation of tooth tissue during the formation of the gingival wall of the cavity in the event of the carious process spreading below the gum level. When preparing, it is preferable to create a retention form, since the adhesion of composite materials is often insufficient.

When filling, pay attention to correct formation contact point.

When filling with composite materials, restoration of the incisal edge should be carried out in two stages:

Formation of the lingual and palatal fragments of the incisal edge. The first illumination is carried out through the enamel or a previously applied composite on the vestibular side;
- formation of the vestibular fragment of the cutting edge; illumination is carried out through a hardened lingual or palatal fragment.

Class V cavities

Before starting the preparation, it is necessary to determine the depth of the process under the gum; if necessary, the patient is referred for correction (excision) of the mucous membrane of the gingival margin to open the surgical field and remove the area of ​​hypertrophied gum. In this case, treatment is carried out in 2 or more visits, because after the intervention the cavity is closed with a temporary filling; cement or oil dentin is used as a material for the temporary filling until the tissues of the gingival margin heal. Then filling is carried out.

The shape of the cavity should be round. If the cavity is very small, gentle preparation with ball-shaped burs without creating retention zones is acceptable.

To fill defects that are noticeable when smiling, you should choose a material with sufficient aesthetic characteristics. In patients with poor oral hygiene, it is recommended to use glass ionomer (polyalkenate) cements, which provide long-term fluoridation of tooth tissues after filling and have acceptable aesthetic characteristics. In elderly and elderly patients, especially with xerostomia, amalgam or glass ionomers should be used. It is also possible to use compomers that have the advantages of glass ionomers and high aesthetics. Composite materials are indicated for filling defects in cases where the aesthetics of the smile is very important.

Class VI cavities

The characteristics of these cavities require gentle removal of the affected tissue. Burs should be used that are only slightly larger than the diameter of the cavity. It is acceptable to refuse anesthesia, especially if the cavity depth is insignificant. It is possible to preserve enamel devoid of underlying dentin, which is associated with a fairly large thickness of the enamel layer, especially in the area of ​​the molar cusps ().

Algorithm and features of inlay manufacturing

Indications for the manufacture of inlays for dentin caries are cavities of classes I and II according to Black. Inlays can be made from metals, ceramics and composite materials. Inlays allow you to restore the anatomical shape and function of the tooth, prevent the development of the pathological process, and ensure the aesthetics of the dentition.

Contraindications to the use of inlays for dentin caries are tooth surfaces that are inaccessible for the formation of cavities for inlays and teeth with defective, fragile enamel.

The question of the method of treatment with an inlay or a crown for dentin caries can be decided only after removing all necrotic tissue.

The inlays are made over several visits.

First visit

During the first visit, the cavity is formed. The cavity under the inlay is formed after removing necrotic and pigmented tissues affected by caries. It must meet the following requirements:

Be box-shaped;
- the bottom and walls of the cavity must withstand chewing pressure;
- the shape of the cavity must ensure that the insert is kept from moving in any direction;
- for an accurate marginal fit that ensures sealing, a bevel (rebate) should be formed within the enamel at an angle of 45° (in the manufacture of solid-cast inlays).

Cavity preparation is carried out under local anesthesia.

After the cavity is formed, the inlay is modeled in the oral cavity or an impression is taken.

When modeling a wax model, inlays pay attention to the accuracy of fitting the wax model according to the bite, taking into account not only central occlusion, but also all movements of the lower jaw, to exclude the possibility of the formation of retention areas, and to giving the external surfaces of the wax model the correct anatomical shape. When modeling an inlay in a class II cavity, matrices are used to prevent damage to the interdental gingival papilla.

When making inlays using the indirect method, impressions are taken. Taking an impression after odontopreparation at the same appointment is possible in the absence of damage to the marginal periodontium. Silicone two-layer and alginate impression compounds and standard impression trays are used. It is recommended that the edges of the trays be edged with a narrow strip of adhesive tape before taking impressions for better retention of the impression material. It is advisable to use special glue to fix silicone impressions on the spoon. After the trays are removed from the mouth, the quality of the impressions is checked.

When making ceramic or composite inlays, color determination is carried out.

After modeling the inlay or taking impressions for its manufacture, the prepared tooth cavity is closed with a temporary filling.

Next visit

After making the inlay, the inlay is fitted in the dental laboratory. Pay attention to the accuracy of the marginal fit, the absence of gaps, occlusal contacts with antagonist teeth, approximal contacts, and the color of the inlay. If necessary, make corrections.

When making a solid-cast inlay, after polishing it, and when making ceramic or composite inlays, after glazing, the inlay is fixed with permanent cement.

The patient is instructed on the rules for using the insert and indicated the need for regular visits to the doctor once every six months.

Algorithm and features of manufacturing microprostheses (veneers)

For the purposes of this protocol, veneers should be understood as facet veneers made on the anterior teeth of the upper jaw. Features of making veneers:

Veneers are installed only on the front teeth in order to restore the aesthetics of the dentition;
- veneers are made from dental ceramics or composite materials;
- when making veneers, preparation of tooth tissue is carried out only within the enamel, while pigmented areas are sanded off;
- veneers are made with or without overlapping the cutting edge of the tooth.

First visit

When the decision is made to make a veneer, treatment begins at the same appointment.

Preparation for preparation

Tooth preparation for veneer is performed under local anesthesia.

When preparing, you should pay special attention to the depth: 0.3-0.7 mm of hard tissue is ground off. Before starting the main preparation, it is advisable to retract the gums and mark the depth of preparation using a special marking bur (disc) measuring 0.3-0.5 mm. It is necessary to pay attention to maintaining approximal contacts and avoid preparation in the cervical area.

An impression of the prepared tooth is taken at the same appointment. Silicone two-layer and alginate impression compounds and standard impression trays are used. It is recommended that the edges of the trays be edged with a narrow strip of adhesive tape before taking impressions for better retention of the impression material. It is advisable to use special glue to fix silicone impressions on the spoon. After removing the spoons from the oral cavity, the quality of the impressions is checked (accuracy of displaying the anatomical relief, absence of holes, etc.).

To fix the correct relationship of the dentition in the position of central occlusion, plaster or silicone blocks are used. The color of the veneer is determined.

The prepared teeth are covered with temporary veneers made of composite material or plastic, which are fixed with temporary calcium-containing cement.

Next visit

Application and fitting of veneer

Particular attention must be paid to the accuracy of the fit of the edges of the veneer to hard tissues tooth, check that there are no gaps between the veneer and the tooth. Pay attention to approximal contacts and occlusal contacts with antagonist teeth. Contacts are especially carefully adjusted during sagittal and transversal movements of the lower jaw. If necessary, correction is carried out.

The veneer is fixed with permanent cement or composite material for dual-curing cementation. Pay attention to the color of the cement matching the color of the veneer. The patient is instructed on the rules for using veneers and is instructed to regularly visit the doctor once every six months.

Algorithm and features of manufacturing a solid-cast crown

The indication for making crowns is significant damage to the occlusal or cutting surfaces of the teeth while the vital pulp is preserved. Crowns are made on teeth after treatment of dentin caries with filling. Solid crowns for dentin caries are made for any teeth to restore the anatomical shape and function, as well as to prevent further tooth destruction. Crowns are made over several visits.

Features of manufacturing solid crowns:

When replacing molars, it is recommended to use solid crown or crowns with a metal occlusal surface;
- when making a solid-cast metal-ceramic crown, an oral garland is modeled (a metal edging along the edge of the crown);
- plastic (ceramic if required) veneering is performed in the area of ​​the front teeth on the upper jaw only up to the 5th tooth inclusive and on the lower jaw up to the 4th tooth inclusive, then - as needed;
- when making crowns for antagonist teeth, a certain sequence must be followed:

• the first stage is the simultaneous production of temporary aligners for the teeth of both jaws to be prosthetized with maximum restoration of occlusal relationships and mandatory determination of the height of the lower part of the face; these aligners should reproduce the design of future crowns as accurately as possible;
• first, permanent crowns are made for the teeth of the upper jaw;
• After fixing the crowns on the teeth of the upper jaw, permanent crowns are made on the teeth of the lower jaw.

First visit

Preparation for preparation

To determine the viability of the pulp of prosthetic teeth, electroodontometry is performed before therapeutic measures. Before starting the preparation, impressions are taken to make temporary plastic crowns (aligners).

Preparing teeth for crowns

The type of preparation is selected depending on the type of future crowns and the group affiliation of the prosthetic teeth. When preparing several teeth, special attention should be paid to the parallelism of the clinical axes of the tooth stumps after preparation.

In the case of using the gum retraction method, when taking an impression, attention is paid to the somatic status of the patient. If there is a history cardiovascular diseases(coronary heart disease, angina pectoris, arterial hypertension, heart rhythm disturbances) auxiliary products containing catecholamines (including threads impregnated with such compounds) should not be used for gum retraction.

To prevent the development inflammatory processes in the tissues of the marginal periodontium after preparation, anti-inflammatory regenerative therapy is prescribed (rinsing the mouth with tincture of oak bark, as well as infusions of chamomile, sage, etc., if necessary, applications oil solution vitamin A or other agents that stimulate epithelialization).

Next visit

Taking impressions

When making solid crowns, it is recommended to make an appointment with the patient the next day or one day after preparation to take a working two-layer impression of the prepared teeth and an impression of the antagonist teeth, if they were not taken on the first visit.

Silicone two-layer and alginate impression compounds and standard impression trays are used. It is recommended that the edges of the trays be edged with a narrow strip of adhesive tape before taking impressions for better retention of the impression material. It is advisable to use special glue to fix silicone impressions on the spoon. After removing the spoons from the oral cavity, the quality of the impressions is checked (display of anatomical relief, absence of pores).

In the case of using the gum retraction method, when taking impressions, attention is paid to the somatic status of the patient. If you have a history of cardiovascular diseases (coronary heart disease, angina pectoris, arterial hypertension, heart rhythm disturbances), auxiliary products containing catecholamines (including threads impregnated with such compounds) should not be used for gum retraction.

Next visit

Application and fitting of a solid crown frame. No earlier than 3 days after preparation, to exclude traumatic (thermal) damage to the pulp, repeated electrical odontometry is performed (possibly at the next visit).

Particular attention should be paid to the accuracy of the frame fit in the cervical area (marginal fit). Check that there is no gap between the crown wall and the tooth stump. Pay attention to the correspondence of the contour of the edge of the supporting crown to the contours of the gingival edge, to the degree of immersion of the edge of the crown into the gingival crevice, approximal contacts, occlusal contacts with antagonist teeth. If necessary, correction is carried out. If veneering is not provided, the solid crown is polished and fixed with temporary or permanent cement. To fix crowns, temporary and permanent calcium-containing cements should be used. Before fixing the crown with permanent cement, electroodontometry is performed to exclude inflammatory processes in the dental pulp. If there are signs of pulp damage, the issue of pulp removal is resolved.

If ceramic or plastic cladding is provided, the color of the cladding is selected.

Crowns with veneering on the upper jaw are made up to the 5th tooth inclusive, on the lower jaw - up to the 4th inclusive. The veneers of the chewing surfaces of the lateral teeth are not shown.

Next visit

Application and fitting of the finished solid crown with veneer

Particular attention should be paid to the accuracy of the fit of the crown in the cervical area (marginal fit). Check that there is no gap between the crown wall and the tooth stump. Pay attention to the correspondence of the contour of the crown edge to the contours of the gingival edge, on

the degree of immersion of the crown edge into the gingival crevice, approximal contacts, occlusal contacts with antagonist teeth.

If necessary, correction is carried out. When using a metal-plastic crown after polishing, and when using a metal-ceramic crown - after glazing, fixation is carried out with temporary (for 2-3 weeks) or permanent cement. To fix crowns, temporary and permanent calcium-containing cements should be used. When fixing with temporary cement, special attention must be paid to removing cement residues from the interdental spaces.

Next visit

Fixation with permanent cement

When fixing with permanent cement, special attention must be paid to removing cement residues from the interdental spaces. The patient is instructed on the rules for using the crown and is instructed to regularly visit the doctor once every six months.

Algorithm and features of manufacturing a stamped crown

When properly manufactured, a stamped crown fully restores the anatomical shape of the tooth and prevents the development of complications.

First visit

After diagnostic studies, the necessary preparatory treatment measures and a decision on prosthetics, treatment begins at the same appointment. Crowns are made on teeth after treatment of dentin caries with filling.

Preparation for preparation

To determine the vitality of the pulp of supporting teeth, electroodontometry is performed before the start of all treatment measures.

Before starting the preparation, impressions are taken to make temporary plastic crowns (cannulas). If it is impossible to make temporary mouthguards due to the small volume of preparation, fluoride varnishes are used to protect the prepared teeth.

Tooth preparation

When preparing, you should pay attention to the parallelism of the walls of the prepared tooth (cylinder shape). When preparing several teeth, you should pay attention to the parallelism of the clinical axes of the tooth stumps after preparation. Tooth preparation is carried out under local anesthesia.

Taking an impression of prepared teeth at the same appointment is possible if there is no damage to the marginal periodontium during preparation. In the manufacture of stamped crowns, alginate impression compounds and standard impression trays are used. It is recommended that the edges of the trays be edged with a narrow strip of adhesive tape before taking impressions for better retention of the impression material. After the spoons are removed from the mouth, quality control is carried out.

To fix the correct relationship of the dentition in the position of central occlusion, plaster or silicone blocks are used. If it is necessary to determine the central relationship of the jaws, wax bases with occlusal ridges are made. When temporary mouth guards are made, they are fitted and, if necessary, re-positioned and fixed with temporary cement.

To prevent the development of inflammatory processes in the marginal periodontal tissues associated with trauma during preparation, anti-inflammatory regenerative therapy is prescribed (rinsing the mouth with an infusion of oak bark, chamomile, sage, and, if necessary, applications with an oil solution of vitamin A or other means that stimulate epithelialization).

Next visit

Impressions are taken if they were not received on the first visit.

Alginate impression materials and standard impression trays are used. It is recommended that the edges of the trays be edged with a narrow strip of adhesive tape before taking impressions for better retention of the impression material. After removing the spoons from the oral cavity, the quality of the impressions is checked (display of anatomical relief, absence of pores).

Next visit

Next visit

Fitting and fitting of stamped crowns

Particular attention should be paid to the accuracy of the fit of the dirk in the cervical area (marginal fit). Check that there is no crown pressure on the marginal periodontal tissue. Pay attention to the correspondence of the contour of the edge of the supporting crown to the contours of the gingival edge, the degree of immersion of the edge of the crown into the gingival crevice (maximum 0.3-0.5 mm), approximal contacts, occlusal contacts with antagonist teeth.

If necessary, correction is carried out. When using combined stamped crowns (according to Belkin), after fitting the crown, an impression of the tooth stump is obtained using wax poured inside the crown. Determine the color of the plastic cladding. Crowns with veneering on the upper jaw are made up to the 5th tooth inclusive, on the lower jaw - up to the 4th inclusive. The lining of the chewing surfaces of the lateral teeth is not shown in principle. After polishing, fixation is performed with permanent cement.

Before fixing the crown with permanent cement, electrical odontometry is performed to identify inflammatory processes in the dental pulp. To fix the crowns, it is necessary to use permanent calcium-containing cements. If there are signs of pulp damage, the issue of pulp removal is resolved.

The patient is instructed on the rules for using crowns and is advised of the need for regular visits to the doctor once every six months.

Algorithm and features of manufacturing an all-ceramic crown

The indication for the manufacture of all-ceramic crowns is significant damage to the occlusal or cutting surfaces of the teeth with preserved vital pulp. Crowns are made on teeth after treatment of dentin caries with filling.

All-ceramic crowns for dentin caries can be made for any teeth to restore the anatomical shape and function, as well as to prevent further tooth decay. Crowns are made over several visits.

Features of manufacturing all-ceramic crowns:

The main feature is the need to prepare a tooth with a circular rectangular shoulder at an angle of 90 degrees.
- When making crowns for antagonist teeth, a certain sequence must be followed:

• The first stage is the simultaneous production of temporary aligners for the teeth of both jaws to be prosthetized with maximum restoration of occlusal relationships and mandatory determination of the height of the lower part of the face. These aligners should reproduce the design of future crowns as accurately as possible;
• Permanent crowns are made one by one for the teeth of the upper jaw;
• after fixing the crowns on the teeth of the upper jaw, permanent crowns are made on the teeth of the lower jaw;
• When the shoulder is located at or below the gingival margin, it is always necessary to apply gingival retraction before taking an impression.

First visit

After diagnostic studies, the necessary preparatory treatment measures and a decision on prosthetics, treatment begins at the same appointment.

Preparation for preparation

To determine the viability of the pulp of prosthetic teeth, electroodontometry is performed before the start of treatment. Before starting the preparation, impressions are taken to make temporary plastic crowns (aligners).

Preparation of teeth for all-ceramic crowns

A preparation with a rectangular circular shoulder at an angle of 90° is always used. When preparing several teeth, special attention should be paid to the parallelism of the clinical axes of the tooth stumps after preparation.

Preparation of teeth with vital pulp is carried out under local anesthesia. Taking an impression of prepared teeth at the same appointment is possible if there is no damage to the marginal periodontium during preparation. Silicone two-layer and alginate impression compounds and standard impression trays are used. It is recommended that the edges of the trays be edged with a narrow strip of adhesive tape before taking an impression for better retention of the impression material. It is advisable to use special glue to fix silicone impressions on the spoon. After the trays are removed from the mouth, the quality of the impressions is checked.

In the case of using the gum retraction method, when taking an impression, attention is paid to the somatic status of the patient. If you have a history of cardiovascular diseases (coronary heart disease, angina pectoris, arterial hypertension, heart rhythm disturbances), auxiliary products containing catecholamines (including threads impregnated with such compounds) should not be used for gum retraction.

To fix the correct relationship of the dentition in the position of central occlusion, plaster or silicone blocks are used. When temporary mouth guards are made, they are fitted and, if necessary, repositioned and fixed with temporary calcium-containing cement.

The color of the future crown is determined.

To prevent the development of inflammatory processes in the tissues of the marginal periodontium after preparation, anti-inflammatory regenerative therapy is prescribed (rinsing the mouth with tincture of oak, chamomile and sage bark, if necessary, applications with an oil solution of vitamin A or other means that stimulate epithelialization).

Next visit

Taking impressions

When making all-ceramic crowns, it is recommended to make an appointment with the patient the next day or one day after preparation to obtain a working two-layer impression from the prepared teeth and an impression from the antagonist teeth, if they were not obtained on the first visit. Silicone two-layer and alginate impression compounds and standard impression trays are used. It is recommended that the edges of the trays be edged with a narrow strip of adhesive tape before taking impressions for better retention of the impression material. It is advisable to use special glue to fix silicone impressions on the spoon. After removing the spoons from the oral cavity, the quality of the impressions is checked (display of anatomical relief, absence of pores).

In the case of using the gum retraction method, when taking impressions, attention is paid to the somatic status of the patient. If you have a history of cardiovascular diseases (coronary heart disease, angina pectoris, arterial hypertension, heart rhythm disturbances), auxiliary products containing catecholamines (including threads impregnated with such compounds) should not be used for gum retraction.

Next visit

Application and fitting of an all-ceramic crown

No earlier than 3 days after preparation, to exclude traumatic (thermal) damage to the pulp, repeated electrical odontometry is performed (possibly at the next visit).

Particular attention must be paid to the accuracy of the fit of the crown to the ledge in the cervical area (marginal fit). Check that there is no gap between the crown wall and the tooth stump. Pay attention to the correspondence of the contour of the edge of the supporting crown to the contours of the edge of the ledge, approximal contacts and occlusal contacts with antagonist teeth. If necessary, correction is carried out.

After glazing, fixation is carried out with temporary (for 2-3 weeks) or permanent cement. To fix crowns, temporary and permanent calcium-containing cements should be used. When fixing with temporary cement, special attention must be paid to removing cement residues from the interdental spaces.

Next visit

Fixation with permanent cement

Before fixing the crown with permanent cement, electroodontometry is performed to exclude inflammatory processes in the dental pulp. If there are signs of pulp damage, the issue of pulp removal is resolved. For vital teeth, permanent calcium-containing cements should be used to secure crowns.

When fixing with permanent cement, pay special attention to removing cement residues from the interdental spaces.

The patient is instructed on the rules for using the crown and is instructed to regularly visit the doctor once every six months.

6.2.7. Requirements for outpatient drug care

6.2.8. Characteristics of algorithms and features of the use of medications

The use of local anti-inflammatory and epithelizing agents is indicated for mechanical trauma of the mucous membrane.

Analgesics, non-steroidal anti-inflammatory drugs, drugs for the treatment of rheumatic diseases and gout

Prescribe rinses or baths with decoctions of one of the drugs: oak bark, chamomile flowers, sage 3-4 times a day for 3-5 days (level of evidence C). Applications to the affected areas with sea buckthorn oil - 2-3 times a day for 10-15 minutes (level of evidence C).

Vitamins

Applications are applied to the affected areas with an oil solution of retinol - 2-3 times a day for 10-15 minutes. 3-5 days (level of evidence C).

Drugs affecting blood

Deproteinized hemodialysate - adhesive paste for the oral cavity - 3-5 times a day on the affected areas for 3-5 days (level of evidence C).

Local anesthetics

6.2.9. Requirements for the regime of work, rest, treatment and rehabilitation

Patients should visit a specialist once every six months for monitoring.

6.2.10. Requirements for patient care and ancillary procedures

6.2.11. Dietary requirements and restrictions

There are no special requirements.

6.2.12. Form of informed voluntary consent of the patient when implementing the Protocol

6.2.13. Additional information for the patient and his family members

6.2.14. Rules for changing requirements when implementing the Protocol and terminating the requirements of the Protocol

If signs are identified during the diagnostic process that require preparatory activities treatment, the patient is transferred to a patient management protocol corresponding to the identified diseases and complications.

If signs of another disease requiring diagnostic and therapeutic measures are identified, along with signs of enamel caries, medical care is provided to the patient in accordance with the requirements:

A) the section of this patient management protocol corresponding to the management of enamel caries;
b) protocol for the management of patients with an identified disease or syndrome.

6.2.15. Possible outcomes and their characteristics

6.2.16. Cost characteristics of the Protocol

Cost characteristics are determined in accordance with the requirements of regulatory documents.

6.3. PATIENT MODEL

6.3.1. Criteria and signs defining the patient model

6.3.2. The procedure for including a patient in the Protocol

A patient's condition that meets the diagnostic criteria and signs of a given patient model.

6.3.3. Requirements for outpatient diagnostics

6.3.4. Characteristics of algorithms and features of performing diagnostic measures

Diagnostics is aimed at establishing a diagnosis that corresponds to the patient’s model, excluding complications, and determining the possibility of starting treatment without additional diagnostic and treatment-and-prophylactic measures.

For this purpose, all patients are required to take an anamnesis, examine the oral cavity and teeth, as well as other necessary studies, the results of which are entered into the dental patient’s medical record (form 043/y).

History taking

When collecting anamnesis, they find out the presence of complaints about the nature of pain from irritants, an allergic history, and the presence of somatic diseases. They purposefully identify complaints about pain and discomfort in the area of ​​a specific tooth, complaints about food getting stuck, how long ago they appeared, when the patient paid attention to them. They find out the patient’s profession, whether the patient takes proper hygienic care of the oral cavity, and the time of his last visit to the dentist.

Visual examination, examination of the oral cavity using additional instruments

When examining the oral cavity, the condition of the dentition is assessed, paying attention to the presence of fillings, the degree of their adherence, the presence of defects in the hard tissues of the teeth, and the number of teeth removed. The intensity of caries is determined (KPU index - caries, filling, removed), hygiene index. Pay attention to the condition of the oral mucosa, its color, moisture, and the presence of pathological changes. All teeth are subject to examination; the examination begins with the upper right molars and ends with the lower right molars. They examine all surfaces of each tooth, pay attention to the color, enamel relief, the presence of plaque, the presence of stains, the presence of stains and their condition after drying the surface of the teeth, defects.

The probe is used to determine the density of hard tissues, evaluate the texture and degree of surface uniformity, as well as pain sensitivity.

Pay attention to the fact that probing is carried out without strong pressure. The presence of stains on the visible surfaces of teeth, the area, shape of the edges, surface texture, density, symmetry and multiplicity of lesions are detected in order to establish the severity of the disease and the rate of development of the process, the dynamics of the disease, as well as differential diagnosis with non-carious lesions. When probing an identified carious cavity, attention is paid to its shape, location, size, depth, the presence of softened tissues, changes in their color, pain or, conversely, the absence of pain sensitivity. The approximal surfaces of the tooth are especially carefully examined.

Thermal diagnostics are carried out.

Percussion is used to exclude complications of caries.

To confirm the diagnosis, radiography is performed.

6.3.5. Requirements for outpatient treatment

6.3.6. Characteristics of algorithms and features of non-drug care

Non-drug assistance is aimed at preventing the development of the carious process and includes two main components: ensuring proper oral hygiene and filling the carious defect. Treatment of cement caries with filling allows for compensation of function and stabilization (level of evidence A).

Algorithm for teaching oral hygiene

First visit

The doctor or dental hygienist determines the hygiene index, then demonstrates to the patient the technique of brushing teeth with a toothbrush and dental floss, using dental models, or other demonstration tools.

Teeth brushing begins with an area in the area of ​​the upper right chewing teeth, sequentially moving from segment to segment. The teeth on the lower jaw are cleaned in the same order.

Pay attention to the fact that the working part of the toothbrush should be positioned at an angle of 45° to the tooth, making cleaning movements from gum to tooth, while simultaneously removing plaque from the teeth and gums. Clean the chewing surfaces of the teeth with horizontal (reciprocating) movements so that the fibers of the brush penetrate deep into the fissures and interdental spaces. Clean the vestibular surface of the front teeth of the upper and lower jaws with the same movements as molars and premolars. When cleaning the oral surface, place the brush handle perpendicular to the occlusal plane of the teeth, while the fibers should be at an acute angle to the teeth and capture not only the teeth, but also the gums.

Finish cleaning with circular movements of the toothbrush with the jaws closed, massaging the gums from right to left. Cleaning duration is 3 minutes.

For high-quality cleaning of the contact surfaces of teeth, it is necessary to use dental floss.

Individual selection of oral hygiene products is carried out taking into account the dental status of the patient (the condition of the hard tissues of the teeth and periodontal tissues, the presence of dental anomalies, removable and non-removable orthodontic and orthopedic structures) (see).

Second visit

In order to consolidate the acquired skills, supervised teeth cleaning is carried out.

Controlled teeth brushing algorithm

First visit

Treating the patient's teeth with a staining agent, determining the hygiene index, showing the patient the areas of greatest accumulation of plaque using a mirror.
- The patient brushes his teeth in his usual manner.
- Repeated determination of the hygiene index, assessment of the effectiveness of teeth brushing (comparing the hygiene index indicators before and after brushing), showing the patient, using a mirror, the stained areas where teeth were not successfully brushed.
- Demonstration of the correct technique for brushing teeth on models, recommendations to the patient on correcting deficiencies in hygienic oral care, the use of dental floss and additional hygiene products (special toothbrushes, dental brushes, mono-beam brushes, irrigators - according to indications).

Next visits

Determination of the hygiene index; if the level of oral hygiene is unsatisfactory, repeat the procedure.

The patient is instructed to attend a preventive examination with a doctor at least once every six months.

Algorithm for professional oral and dental hygiene

Stages of professional hygiene:

Teaching the patient individual oral hygiene;
- removal of supra- and subgingival dental plaque;
- polishing of tooth surfaces, including root surfaces;
- elimination of factors contributing to the accumulation of dental plaque;
- applications of remineralizing and fluoride-containing agents (except for areas with high fluoride content in drinking water);
- patient motivation for the prevention and treatment of dental diseases.

The procedure is carried out in one visit.

When removing supra- and subgingival dental plaque (tartar, hard and soft dental plaque), a number of conditions must be observed:

Tartar removal is carried out with application anesthesia;
- carry out antiseptic treatment of the oral cavity with an antiseptic solution (0.06% chlorhexidine solution, 0.05% potassium permanganate solution);
- isolate the teeth being treated from saliva;
- pay attention that the hand holding the instrument must be fixed on the patient’s chin or adjacent teeth, the terminal rod of the instrument is located parallel to the axis of the tooth, the main movements - lever-like and scraping - must be smooth and not traumatic.

In the field of metal-ceramic, ceramic, composite restorations, implants (when processing the latter, plastic tools are used), a manual method of removing dental plaque is used.

Ultrasound devices should not be used in patients with respiratory or infectious diseases, or in patients with a pacemaker.

To remove plaque and polish smooth surfaces of teeth, it is recommended to use rubber caps, chewing surfaces - rotating brushes, contact surfaces - floss and abrasive strips. Polishing infusion should be used, starting with coarse and ending with fine. Fluoride-containing polishing pastes are not recommended for use before certain procedures (fissure sealing, teeth whitening). When processing implant surfaces, fine polishing pastes and rubber caps should be used.

It is necessary to eliminate factors that contribute to the accumulation of plaque: remove overhanging edges of fillings, re-polish fillings.

The frequency of professional hygiene of the oral cavity and teeth depends on the dental status of the patient (hygienic state of the oral cavity, intensity of dental caries, condition of periodontal tissues, presence of fixed orthodontic equipment and dental implants). The minimum frequency of professional hygiene is 2 times a year.

Algorithm and features of filling

For cement caries (usually class V cavities), filling is carried out in one or several visits. After diagnostic studies and a decision on treatment, treatment begins at the same appointment.

Before starting the preparation, be sure to determine the depth of the process under the gum; if necessary, the patient is referred for correction (excision) of the mucous membrane of the gingival margin to open the surgical field and remove the area of ​​hypertrophied gum. In this case, treatment is carried out in 2 or more visits, because after the intervention the cavity is closed with a temporary filling; cement or oil dentin is used as a material for the temporary filling until the tissues of the gingival margin heal. Then filling is carried out.

Before preparation, anesthesia is administered (application, infiltration, conduction). Before anesthesia is administered, the injection site is treated with an application of anesthetics.

General requirements for cavity preparation:

Anesthesia;
- maximum removal of pathologically altered tooth tissues;
- complete preservation of intact tooth tissues is possible;
- cavity formation.

The shape of the cavity should be round. If the cavity is very small, gentle preparation with ball burs without creating retention zones is acceptable (level of evidence B).

To fill defects, amalgams, glass ionomer cements and compomers are used.

In patients who neglect oral hygiene, it is recommended to use glass ionomer (polyalkenate) cements, which provide long-term fluoridation of dental tissues after filling and have acceptable aesthetic characteristics.

In elderly and elderly patients, especially with symptoms of xerostomia (reduced salivation), amalgam or glass ionomers should be used. It is also possible to use compomers that have the advantages of glass ionomers and high aesthetics. Composite materials are indicated for filling defects in cases where the aesthetics of the smile is very important (see).

Patients are scheduled to see a doctor at least once every six months for preventive examinations.

Requirements for outpatient drug care

Characteristics of algorithms and features of the use of medications

Local anesthetics

Before preparation, anesthesia is administered (application, infiltration, conduction) according to indications. Before anesthesia, the injection site is treated local anesthetics(lidocaine, articaine, mepivacaine, etc.).

6.3.9. Requirements for the regime of work, rest, treatment and rehabilitation

Patients should visit a specialist once every six months for preventive examinations and always to polish composite fillings.

6.3.10. Requirements for patient care and ancillary procedures

No special requirements

6.3.11. Dietary requirements and restrictions

There are no special requirements.

6.3.12. Form of voluntary informed consent of the patient when implementing the Protocol

6.3.13. Additional information for the patient and his family members

6.3.14. Rules for changing requirements when implementing the Protocol and terminating the requirements of the Protocol

If signs are identified during the diagnostic process that require preparatory measures for treatment, the patient is transferred to a patient management protocol corresponding to the identified diseases and complications.

If signs of another disease requiring diagnostic and therapeutic measures are identified, along with signs of enamel caries, medical care is provided to the patient in accordance with the requirements:

A) the section of this patient management protocol corresponding to the management of enamel caries;
b) protocol for the management of patients with an identified disease or syndrome.

6.3.15. Possible outcomes and their characteristics

6.3.16. Cost characteristics of the Protocol

Cost characteristics are determined in accordance with the requirements of regulatory documents.

6.4. PATIENT MODEL

6.4.1. Criteria and signs defining the patient model

6.4.2. The procedure for including a patient in the Protocol

A patient's condition that meets the diagnostic criteria and signs of a given patient model.

6.4.3. Requirements for outpatient diagnostics

6.4.4. Characteristics of algorithms and features of performing diagnostic measures

The examination is aimed at establishing a diagnosis that corresponds to the patient’s model, excluding complications, and determining the possibility of starting treatment without additional diagnostic and therapeutic measures.

For this purpose, all patients are required to take an anamnesis, examine the oral cavity and teeth, as well as other necessary studies, the results of which are entered into the dental patient’s medical record (form 043/y).

The main differential diagnostic feature is the color of the spot: pigmented and not stained with methylene blue, in contrast to the “white (chalky) spot”, which is stained.

History taking

When collecting anamnesis, they find out the presence of complaints of pain from chemical and temperature irritants, an allergic history, and the presence of somatic diseases. Complaints of pain and discomfort in the area of ​​a specific tooth, complaints of food getting stuck, patient satisfaction with the appearance of the tooth, the timing of the onset of complaints, when the patient noticed the appearance of discomfort are purposefully identified. They find out whether the patient provides proper hygienic care for the oral cavity, the patient’s profession, the regions of his birth and residence (endemic areas of fluorosis).

Visual examination, external examination of the maxillofacial area, examination of the oral cavity using additional instruments

When examining the oral cavity, the condition of the dentition is assessed, paying attention to the intensity of caries (the presence of fillings, the degree of their adherence, the presence of defects in the hard tissues of the teeth, the number of teeth removed). The condition of the oral mucosa, its color, moisture content, and the presence of pathological changes are determined.

All teeth are subject to examination; the examination begins with the upper right molars and ends with the lower right molars. All surfaces of each tooth are examined in detail, paying attention to the color, enamel relief, the presence of plaque, the presence of stains and their condition after drying the surface of the teeth, defects.

Pay attention to the presence of a matte and/or pigmented spot on the visible surfaces of the tooth, the area, shape of the edges, surface texture, density, symmetry and multiplicity of lesions in order to establish the severity of the disease and the speed of development of the process, the dynamics of the disease, as well as differential diagnosis with non-carious defeats. Fluorescent stomatoscopy can be used to confirm the diagnosis.

Thermodiagnostics is used to identify pain reactions and clarify the diagnosis.

Percussion is used to exclude complications of caries.

Oral hygiene indices are determined before treatment and after oral hygiene training for control purposes.

6.4.5. Requirements for outpatient treatment

6.4.6. Characteristics of algorithms and features of non-drug care

Treatment of suspended caries, regardless of the location of the carious cavity, includes:

If the extent of the spot is less than 4 mm2 on the occlusal surface or one third of the contact surface, application of fluoride-containing drugs and dynamic observation;
- if it is impossible to dynamically monitor the development of the process or if the extent of the lesion is more than 4 mm - creation of a cavity and filling.

Non-drug assistance is aimed at preventing the development of the carious process and includes two main components: ensuring proper oral hygiene and, if necessary, filling the carious defect.

Remineralization therapy and, if necessary, filling treatment provide stabilization (level of evidence B).

Algorithm for teaching oral hygiene

First visit

The doctor or dental hygienist determines the hygiene index, then demonstrates to the patient the technique of brushing teeth with a toothbrush and dental floss, using models of dental rads, and other demonstration tools.

Teeth brushing begins with an area in the area of ​​the upper right chewing teeth, sequentially moving from segment to segment. The teeth on the lower jaw are cleaned in the same order.

Pay attention to the fact that the working part of the toothbrush should be positioned at an angle of 45° to the tooth, making cleaning movements from gum to tooth, while simultaneously removing plaque from the teeth and gums. Clean the chewing surfaces of the teeth with horizontal (reciprocating) movements so that the fibers of the brush penetrate deep into the fissures and interdental spaces. Clean the vestibular surface of the front teeth of the upper and lower jaws with the same movements as molars and premolars. When cleaning the oral surface, place the brush handle perpendicular to the occlusal plane of the teeth, while the fibers should be at an acute angle to the teeth and capture not only the teeth, but also the gums.

Finish cleaning with circular movements of the toothbrush with the jaws closed, massaging the gums from right to left.

Cleaning duration is 3 minutes.

For high-quality cleaning of the contact surfaces of teeth, it is necessary to use dental floss.

Individual selection of oral hygiene products is carried out taking into account the dental status of the patient (the condition of the hard tissues of the teeth and periodontal tissues, the presence of dental anomalies, removable and non-removable orthodontic and orthopedic structures) (see).

Second visit

In order to consolidate the acquired skills, supervised teeth cleaning is carried out.

Controlled teeth brushing algorithm

First visit

Treating the patient's teeth with a staining agent, determining the hygiene index, showing the patient the areas of greatest accumulation of plaque using a mirror.
- The patient brushes his teeth in his usual manner.
- Repeated determination of the hygiene index, assessment of the effectiveness of tooth brushing (comparing the hygiene index indicators before and after brushing), showing the patient, using a mirror, stained areas where plaque was not removed during brushing.
- Demonstration of the correct technique for brushing teeth on models, recommendations to the patient on correcting deficiencies in hygienic oral care, the use of dental floss and additional hygiene products (special toothbrushes, dental brushes, mono-beam brushes, irrigators - according to indications).

Next visits

Determination of the hygiene index; if the level of oral hygiene is unsatisfactory, repeat the procedure.

The patient is instructed to attend a preventive examination with a doctor at least once every six months.

Algorithm for professional oral and dental hygiene

Stages of professional hygiene:

Teaching the patient individual oral hygiene;
- removal of supra- and subgingival dental plaque;
- polishing of tooth surfaces, including root surfaces;
- elimination of factors contributing to the accumulation of plaque;
- applications of remineralizing and fluoride-containing agents (except for areas with high fluoride content in drinking water);
- patient motivation for the prevention and treatment of dental diseases.

The procedure is carried out in one visit.

When removing supra- and subgingival dental deposits (tartar, hard and soft plaque), a number of conditions must be observed:

Tartar removal is carried out with application anesthesia;
- carry out antiseptic treatment of the oral cavity with an antiseptic solution (0.06% chlorhexidine solution, 0.05% potassium permanganate solution);
- isolate the teeth being treated from saliva;
- pay attention that the hand holding the instrument must be fixed on the patient’s chin or adjacent teeth, the terminal rod of the instrument is located parallel to the axis of the tooth, the main movements - lever-like and scraping - must be smooth and not traumatic. In the field of metal-ceramic, ceramic, composite restorations, implants (when processing the latter, plastic tools are used), a manual method of removing dental plaque is used.

Ultrasound devices should not be used in patients with respiratory, infectious diseases and those on medication to control electrolyte balance, as well as in patients with a pacemaker.

To remove plaque and polish smooth surfaces of teeth, it is recommended to use rubber caps, chewing surfaces - rotating brushes, contact surfaces - floss and abrasive strips. The polishing paste should be used from coarse to fine. Fluoride-containing polishing infusions are not recommended for use before certain procedures (fissure sealing, teeth whitening). When processing implant surfaces, fine polishing pastes and rubber caps should be used.

Pay attention to the need to eliminate factors that contribute to the accumulation of dental plaque: remove the overhanging edges of the fillings, and re-polish the fillings.

The frequency of professional hygiene depends on the dental status of the patient (hygienic state of the oral cavity, intensity of dental caries, condition of periodontal tissues, presence of fixed orthodontic equipment and dental implants). The minimum frequency of professional hygiene is 2 times a year.

Sealing the tooth fissure with sealant

To prevent the development of caries, the fissures of the teeth are sealed with a sealant in the presence of deep, narrow (pronounced) fissures.

Algorithm and features of filling

First visit

Treatment is carried out in one visit.

A cavity is created by removing pigmented demineralized tissue. Pay attention to the fact that the cavity is formed within the enamel. If preventive expansion of the cavity is necessary to fix the filling, the transition of the enamel-dentin border is allowed. When treating chewing teeth, cavity formation is carried out in the contours of natural fissures. The edges of the cavity are finished, washed and dried before filling. Then filling is carried out. Pay attention to the mandatory restoration of the anatomical shape of the tooth, and check the occlusal and proximal contacts (see).

6.4.7. Requirements for outpatient drug care

6.4.8. Characteristics of algorithms and features of the use of medications

The main method of treating suspended caries in the presence of a pigmented spot is fluoridation of hard tooth tissues.

Fluoridation of hard dental tissues

Applications of 1-2% sodium fluoride solution are carried out every 3rd visit. after application of the remineralizing solution on a cleaned and dried tooth surface for 2-3 minutes.

Coating of teeth with fluoride varnish, as an analogue of 1-2% sodium fluoride solution, is carried out every 3rd visit after application of a remineralizing solution on the dried surface of the tooth. After application, the patient is not recommended to eat for 2 hours and brush his teeth for 12 hours. The criterion for the effectiveness of fluoridation is the stable state of the spot size.

6.4.9. Requirements for the regime of work, rest, treatment and rehabilitation

Patients with enamel caries should visit a specialist once every six months for observation.

6.4.10. Requirements for patient care and ancillary procedures

6.4.11. Dietary requirements and restrictions

After completing each treatment procedure, it is recommended not to take a mouthful or rinse your mouth for 2 hours.

Limit the consumption of foods and drinks with low pH values ​​(juices, tonic drinks, yoghurts) and thoroughly rinse your mouth after eating them. Limiting the presence of carbohydrates in the oral cavity (sucking, chewing candies).

6.4.12. Form of informed voluntary consent of the patient when implementing the Protocol

6.4.13. Additional information for the patient and his family members

6.4.14. Rules for changing requirements when implementing the Protocol and terminating the requirements of the Protocol

If signs are identified during the diagnostic process that require preparatory measures for treatment, the patient is transferred to a patient management protocol corresponding to the identified diseases and complications.

If signs of another disease requiring diagnostic and therapeutic measures are identified, along with signs of enamel caries, medical care is provided to the patient in accordance with the requirements:

A) the section of this patient management protocol corresponding to the management of enamel caries;
b) protocol for the management of patients with an identified disease or syndrome.

6.4.15. Possible outcomes and their characteristics

6.4.16. Cost characteristics of the Protocol

Cost characteristics are determined in accordance with the requirements of regulatory documents.

VII. GRAPHICAL, SCHEMATIC AND TABULAR REPRESENTATION OF THE PROTOCOL

Not required.

VIII. MONITORING

CRITERIA AND METHODOLOGY FOR MONITORING AND EVALUATING THE EFFECTIVENESS OF PROTOCOL IMPLEMENTATION

Monitoring is carried out throughout the Russian Federation.

Scroll medical institutions, in which monitoring of this document is carried out, is determined annually by the institution responsible for monitoring. Medical organization informed about inclusion in the list of monitoring protocols in writing. Monitoring includes:

Collection of information: on the management of patients with dental caries in medical institutions of all levels;
- analysis of the received data;
- drawing up a report on the results of the analysis;
- submission of a report to the Protocol developer group in the Department of Standardization in Health Care of the Institute of Public Health and Health Management of the Moscow Medical Academy named after. I. M. Sechenov.

The initial data for monitoring are:

Medical documentation - medical record of a dental patient (form 043/у);
- tariffs for medical services;
- tariffs for dental materials and medicines.

If necessary, other documents may be used when monitoring the Protocol.

In medical and preventive institutions defined by the monitoring list, once every six months, based on medical documentation, a patient record () is compiled on the treatment of patients with dental caries corresponding to the patient models in this protocol.

The indicators analyzed during the monitoring process include: criteria for inclusion and exclusion from the Protocol, lists medical services mandatory and additional range, lists of medicines of mandatory and additional range, disease outcomes, cost of medical care under the Protocol, etc.

PRINCIPLES OF RANDOMIZATION

In this Protocol, randomization ( medical institutions, patients, etc.) is not provided.

PROCEDURE FOR EVALUATING AND DOCUMENTING SIDE EFFECTS AND DEVELOPMENT OF COMPLICATIONS

Information about side effects and complications that arose during the diagnosis and treatment of patients is recorded in the patient’s record (see).

PROCEDURE FOR EXCLUDING A PATIENT FROM MONITORING

A patient is considered included in monitoring when a Patient Card is filled out for him. Exclusion from monitoring is carried out if it is impossible to continue filling out the Card (for example, failure to show up for a medical appointment) (see). In this case, the Card is sent to the institution responsible for monitoring, with a note indicating the reason for excluding the patient from the Protocol.

INTERIM EVALUATION AND PROTOCOL CHANGES

Evaluation of the implementation of the Protocol is carried out once a year based on the results of analysis of information obtained during monitoring.

Amendments to the Protocol are made if information is received:

A) about the presence in the Protocol of requirements that are detrimental to the health of patients,
b) upon receipt of convincing data on the need for changes to the mandatory level requirements of the Protocol.

The decision on changes is made by the development team. The introduction of changes to the requirements of the Protocol is carried out by the Ministry of Health and Social Development of the Russian Federation in the prescribed manner.

PARAMETERS FOR ASSESSING QUALITY OF LIFE WHEN IMPLEMENTING THE PROTOCOL

To assess the quality of life of a patient with dental caries, corresponding to the Protocol models, an analogue scale (S) is used.

ASSESSMENT OF THE COST OF PROTOCOL IMPLEMENTATION AND PRICE OF QUALITY

Clinical and economic analysis is carried out in accordance with the requirements of regulatory documents.

COMPARISON OF RESULTS

When monitoring the Protocol, the results of fulfilling its requirements, statistical data, and performance indicators of medical institutions are annually compared.

PROCEDURE FOR FORMING A REPORT

The annual monitoring results report includes quantitative results obtained during the development of medical records, and them qualitative analysis, conclusions, proposals for updating the Protocol.

The report is submitted to the Ministry of Health and Social Development of the Russian Federation by the institution responsible for monitoring this Protocol. The results of the report may be published publicly.

Annex 1

LIST OF DENTAL MATERIALS AND INSTRUMENTS REQUIRED FOR THE WORK OF A DOCTOR MANDATORY RANGE

ADDITIONAL ASSORTMENT

Appendix 2

GENERAL RECOMMENDATIONS FOR THE SELECTION OF HYGIENE PRODUCTS DEPENDING ON THE PATIENT'S DENTAL STATUS

Appendix 3

FORM OF VOLUNTARY INFORMED CONSENT OF THE PATIENT WHEN IMPLEMENTING THE PROTOCOL APPENDIX TO THE MEDICAL CARD No._____

Patient ____________________________________________________

FULL NAME _________________________________

receiving clarification regarding the diagnosis of caries, I received the following information:

about the features of the course of the disease ____________________________________________________________

probable duration of treatment_________________________________________________________________

about the probable prognosis______________________________________________________________________________

The patient is offered an examination and treatment plan, including _____________________________________________

The patient was asked________________________________________________________________________________

from materials _________________________________________________________________________________

The approximate cost of treatment is approximately __________________________________________________________

The patient knows the price list accepted at the clinic.

Thus, the patient received clarification about the purpose of treatment and information about the planned methods

diagnosis and treatment.

The patient is informed of the need to prepare for treatment:

_____________________________________________________________________________________________

The patient is informed of the need during treatment

_____________________________________________________________________________________________

_____________________________________________________________________________________________

The patient received information about the typical complications associated with this disease, with the necessary diagnostic procedures and with treatment.

The patient is informed about the probable course of the disease and its complications if treatment is refused. The patient had the opportunity to ask any questions he was interested in regarding his state of health, disease and treatment and received satisfactory answers to them.

The patient received information about alternative methods treatments, as well as their approximate cost.

The interview was conducted by a doctor________________________ (doctor’s signature).

"___"________________200___g.

The patient agreed with the proposed treatment plan, in which

signed with his own hand_______________________________________________________________________________

(patient signature)

signed by his legal representative_______________________________________________________________

What do those present during the conversation certify?

(doctor's signature)

_______________________________________________________

(witness signature)

The patient did not agree with the treatment plan

(refused the proposed type of prosthesis), for which he signed with his own hand.

(patient signature)

or signed by his legal representative__________________________________________________________

(signature of legal representative)

What do those present during the conversation certify?

(doctor's signature)

_______________________________________________________

(witness signature)

The patient expressed a desire:

In addition to the proposed treatment, undergo an examination

Receive additional medical services

Instead of the proposed filling material, get

The patient received information about the specified method of examination/treatment.

Because the this method examination/treatment is also indicated for the patient and is included in the treatment plan.

(patient signature)

_________________________________

(doctor's signature)

Since this method of examination/treatment is not indicated for the patient, it is not included in the treatment plan.

"___" ___________________20____ _________________________________

(patient signature)

_________________________________

(doctor's signature)

Appendix 4

ADDITIONAL INFORMATION FOR THE PATIENT

1. Filled teeth should be brushed with a toothbrush and toothpaste in the same way as natural teeth - twice a day. After eating, you should rinse your mouth to remove any remaining food.

2. To clean the interdental spaces, you can use dental floss (floss) after training in their use and on the recommendation of a dentist.

3. If bleeding occurs when brushing your teeth, you cannot stop hygiene procedures. If bleeding does not go away within 3-4 days, you should consult a doctor.

4. If, after filling and the end of anesthesia, the filling interferes with the closure of the teeth, then it is necessary to contact your doctor as soon as possible.

5. If you have fillings made of composite materials, you should not eat food containing natural and artificial dyes (for example: blueberries, tea, coffee, etc.) during the first two days after filling the tooth.

6. There may be a temporary appearance of pain (increased sensitivity) in a sealed tooth while eating and chewing cabbage soup. If these symptoms do not go away within 1-2 weeks, you should contact your dentist.

7. If sharp pain occurs in a tooth, you must contact your dentist as soon as possible.

8. To avoid chipping the filling and the hard tooth tissue adjacent to the filling, it is not recommended to eat and chew very hard food (for example: nuts, crackers), or bite off large pieces (for example: a whole apple).

9. Once every six months you should visit a dentist for preventive examinations and necessary manipulations (for fillings made of composite materials - to polish the filling, which will increase its service life).

Appendix 5

PATIENT CARD

Case history No. ____________________________

Name of institution

Date: start of observation_________________ end of observation___________________________

FULL NAME. ____________________________________________________age.

Main diagnosis ________________________________________________________________________________

Accompanying illnesses: ____________________________________________________________

Patient Model: ______________________________________________________________________________

Volume of non-drug medical care provided:__________________________________________

Medication (specify the drug used):

Drug complications (specify manifestations): Name of the drug that caused them: Outcome (according to the outcome classifier):

Information about the patient has been transferred to the institution monitoring the Protocol:

(Name of institution) (Date)

Signature of the person responsible for monitoring the protocol

in a medical institution: ______________________________________________________________

OM - oral mucosa NOS - other specified disease TMJ - temporomandibular joint LP - lichen planus V/Ch - upper jaw L/H - lower jaw

Block (K00-K14)

K00 - developmental and teething disorders

K00.0 - edentulous

K00.00 - partial edentia (hypodentia) (oligodentia) K00.01 - complete edentia

K00.09 - edentulous, unspecified

K00.1 - supernumerary teeth

K00.10 - incisor and canine areas mesiodentium (median tooth) K00.11 - premolar areas K00.12 - molar areas distomolar tooth, fourth molar, paramolar tooth

K00.19 - supernumerary teeth, unspecified

K00.2 - anomalies in the size and shape of teeth

K00.20 - macrodentia K00.21 - microdentia K00.22 - fusion K00.23 - fusion (synodontia) and bifurcation (schizodentia) K00.24 - protrusion of teeth (additional occlusal cusps) K00.25 - invaginated tooth (tooth in tooth) (dilated odontoma) K00.26 - premolarization K00.27 - abnormal tubercles and enamel pearls (adamantoma) K00.28 - bovine tooth (taurodontism)

K00.29 - other and unspecified anomalies in the size and shape of teeth

K00.3 - mottled teeth

K00.30 - endemic (fluorotic) enamel mottling (dental fluorosis) K00.31 - non-endemic enamel mottling (non-fluorotic darkening of the enamel)

K00.39 - mottled teeth, unspecified

K00.4 - disorder of tooth formation

K00.40 - enamel hypoplasia K00.41 - perinatal enamel hypoplasia K00.42 - neonatal enamel hypoplasia K00.43 - aplasia and hypoplasia of cement K00.44 - dilacerasia (enamel cracks) K00.45 - odontodysplasia (regional odontodysplasia) K00.46 - Turner tooth K00.48 - other specified disorders of tooth formation

K00.49 - disorders of tooth formation, unspecified

K00.5 - hereditary disorders of tooth structure, not classified elsewhere

K00.50 - incomplete amelogenesis K00.51 - incomplete dentinogenesis K00.52 - incomplete odontogenesis K00.58 - others hereditary disorders tooth structures (dentin dysplasia, cancerous teeth)

K00.59 - hereditary disorders of tooth structure, unspecified

K00.6 - teething disorders

K00.60 - natal teeth (erupted at the time of birth) K00.61 - neonatal (in a newborn, prematurely erupted) teeth K00.62 - premature eruption (early eruption) K00.63 - delayed (persistent) change of primary (temporary) teeth K00 .64 - late eruption K00.65 - premature loss of primary (temporary) teeth K00.68 - other specified teething disorders

K00.69 - teething disorder, unspecified

K00.8 - other dental developmental disorders

K00.80 - change in the color of teeth during formation due to incompatibility of blood groups K00.81 - change in color of teeth during formation due to a congenital defect of the biliary system K00.82 - change in color of teeth during formation due to porphyria K00.83 - change in color of teeth during the process formation due to the use of tetracycline

K00.88 - other specified disorders of dental development

K00.9 - disorder of dental development, unspecified

K01 - impacted and impacted teeth

K01.0 - impacted teeth (changed their position during eruption without obstruction from an adjacent tooth)

K01.1 - impact teeth (changed their position during eruption due to an obstacle from an adjacent tooth)

K01.10 - maxillary incisor K01.11 - mandibular incisor K01.12 - maxillary canine K01.13 - mandibular canine K01.14 - maxillary premolar K01.15 - mandibular premolar K01.16 - maxillary molar K01 .17 - lower jaw molar K01.18 - supernumerary tooth

K01.19 - impact tooth, unspecified

K02 - dental caries

K02.0 - enamel caries stage of white (chalk) spot (initial caries) K02.1 - dentin caries K02.2 - cement caries K02.3 - suspended dental caries K02.4 - odontoclasia, childhood melanodentia, melanodontoclasia K02.8 - other specified dental caries

K02.9 - dental caries, unspecified

K03 - other diseases of dental hard tissues

F45.8 - bruxism

K03.0 - increased tooth abrasion

K03.09 - abrasion of teeth, unspecified

K03.1 - grinding (abrasive wear) of teeth

K03.10 - caused by tooth powder (wedge-shaped defect NOS) K03.11 - habitual K03.12 - professional K03.13 - traditional (ritual) K03.18 - other specified grinding of teeth

K03.19 - grinding of teeth, unspecified

K03.2 - dental erosion

K03.20 - professional K03.21 - caused by persistent regurgitation or vomiting K03.22 - caused by diet K03.23 - caused medicines and medications K03.24 - idiopathic K03.28 - other specified dental erosion

K03.29 - dental erosion, unspecified

K03.3 - pathological tooth resorption

K03.30 - external (external) K03.31 - internal (internal granuloma) (pink spot)

K03.39 - pathological tooth resorption, unspecified

K03.4 - hypercementosis

K03.5 - ankylosis of teeth

K03.6 - deposits (growths) on teeth

K03.60 - pigmented plaque (black, green, orange) K03.61 - due to the habit of using tobacco K03.62 - due to the habit of chewing betel nut K03.63 - other extensive soft deposits (white deposits) K03.64 - supragingival tartar K03. 65 - subgingival calculus K03.66 - dental plaque K03.68 - other specified deposits on teeth

K03.69 - deposits on teeth, unspecified

K03.7 - changes in the color of hard tissues of teeth after eruption

K03.70 - caused by the presence of metals and metal compounds K03.71 - caused by bleeding of the pulp K03.72 - caused by the habit of chewing betel nut K03.78 - other specified color changes

K03.79 - color changes, unspecified

K03.8 - other specified diseases of dental hard tissues

K03.80 - sensitive dentin K03.81 - changes in enamel caused by irradiation

K03.88 - other specified diseases of dental hard tissues

K03.9 - disease of dental hard tissues, unspecified

K04 - diseases of the pulp and periapical tissues

K04.0 - pulpitis

K04.00 - initial (hyperemia) K04.01 - acute K04.02 - purulent (pulp abscess) K04.03 - chronic K04.04 - chronic ulcerative K04.05 - chronic hyperplastic (pulp polyp) K04.08 - other specified pulpitis

K04.09 - pulpitis, unspecified

K04.1 - pulp necrosis (pulp gangrene)

K04.2 - denticular pulp degeneration, pulp calcifications, pulp stones

K04.3 - improper formation of hard tissue in the pulp

K04.4 - acute apical periodontitis of pulpal origin

K04.5 - chronic apical periodontitis (apical granuloma)

K04.6 - periapical abscess with fistula (dental abscess, dentoalveolar abscess, periodontal abscess of pulpal origin)

K04.60 - having a connection (fistula) with the maxillary sinus K04.61 - having a connection (fistula) with the nasal cavity K04.62 - having a connection (fistula) with the oral cavity K04.63 - having a connection (fistula) with the skin

K04.69 - periapical abscess with fistula, unspecified

K04.7 - periapical abscess without fistula (dental abscess, dentoalveolar abscess, periodontal abscess of pulpal origin)

K04.8 - root cyst (apical (periodontal), periapical)

K04.80 - apical and lateral K04.81 - residual K04.82 - inflammatory paradental

K04.89 - root cyst, unspecified

K04.9 - other unspecified diseases of pulp and periapical tissues

K05 - gingivitis and periodontal diseases

K05.0 - acute gingivitis

A69.10 - acute nectrotic ulcerative gingivitis (fusospirochetous gingivitis, Vincent gingivitis) K05.00 - acute streptococcal gingivostomatitis K05.08 - other specified acute gingivitis

K05.09 - acute gingivitis, unspecified

K05.1 - chronic gingivitis

K05.10 - simple marginal K05.11 - hyperplastic K05.12 - ulcerative K05.13 - desquamative K05.18 - other specified chronic gingivitis

K05.19 - chronic gingivitis, unspecified

K05.2 - acute periodontitis

K05.20 - periodontal abscess (periodontal abscess) of gingival origin without fistula K05.21 - periodontal abscess (periodontal abscess) of gingival origin with fistula K05.22 - acute pericoronitis K05.28 - other specified acute periodontitis

K05.29 - acute periodontitis, unspecified

K05.3 - chronic periodontitis

K05.30 - localized K05.31 - generalized K05.32 - chronic pericoronitis K05.33 - thickened follicle (papillary hypertrophy) K05.38 - other specified chronic periodontitis

K05.39 - chronic periodontitis, unspecified

K05.4 - periodontal disease

K05.5 - other periodontal diseases

K06 - other changes in the gingiva and edentulous alveolar margin

K06.0 - gum recession (includes post-infectious, post-operative)

K06.00 - local K06.01 - generalized

K06.09 - gingival recession, unspecified

K06.1 - gingival hypertrophy

K06.10 - gingival fibromatosis K06.18 - other specified gingival hypertrophy

K06.19 - gingival hypertrophy, unspecified

K06.2 - lesions of the gums and edentulous alveolar margin caused by trauma

K06.20 - caused by traumatic occlusion K06.21 - caused by brushing teeth K06.22 - frictional (functional) keratosis K06.23 - hyperplasia due to irritation (hyperplasia associated with wearing removable denture) K06.28 - other specified lesions of the gums and edentulous alveolar margin caused by trauma

K06.29 - unspecified lesions of the gingiva and edentulous alveolar margin caused by trauma

K06.8 - other specified changes in the gingiva and edentulous alveolar margin

K06.80 - adult gingival cyst K06.81 - giant cell peripheral granuloma (giant cell epulis) K06.82 - fibrous epulis K06.83 - pyogenic granuloma K06.84 - partial ridge atrophy

K06.88 - other changes

K06.9 - changes in the gingiva and edentulous alveolar margin, unspecified

K07 - maxillofacial anomalies (including malocclusions)

K07.0 - major anomalies in jaw size

E22.0 - acromegaly K07.00 - macrognathia of the upper jaw K07.01 - macrognathia of the lower jaw K07.02 - macrognathia of both jaws K07.03 - micrognathia of the upper jaw (hypoplasia of the upper jaw) K07.04 - micrognathia of the lower jaw (hypoplasia of the lower jaw ) K07.08 - other specified anomalies in jaw size

K07.09 - anomalies in jaw size, unspecified

K07.1 - anomalies of maxillo-cranial relationships

K07.10 - asymmetry K07.11 - prognathia n/h K07.12 - prognathia h/h K07.13 - retrognathia n/h K07.14 - retrognathia h/h K07.18 - other specified anomalies of maxillo-cranial relationships

K07.19 - anomalies of maxillo-cranial relationships, unspecified

K07.2 - anomalies of the relationship of the dental arches

K07.20 - distal bite K07.21 - mesial bite K07.22 - excessively deep horizontal bite (horizontal overlap) K07.23 - excessively deep vertical bite (vertical overlap) K07.24 - open bite K07.25 - cross bite (anterior , posterior) K07.26 - displacement of the dental arches from the midline K07.27 - posterior lingual bite of the lower teeth K07.28 - other specified anomalies of the relationships of the dental arches

K07.29 - anomalies of dental arch relationships, unspecified

K07.3 - anomalies of tooth position

K07.30 - crowding (imbrile overlap) K07.31 - displacement K07.32 - rotation K07.33 - violation of interdental spaces (diastema) K07.34 - transposition K07.35 - impacted or impacted teeth with incorrect position of their or neighboring teeth K07 .38 - other specified anomalies of teeth position

K07.39 - anomalies of tooth position, unspecified

K07.4 - malocclusion, unspecified

K07.5 - maxillofacial anomalies of functional origin

K07.50 - improper closing of the jaws K07.51 - malocclusion due to swallowing disorders K07.54 - malocclusion due to mouth breathing K07.55 - malocclusion due to sucking of the tongue, lips or finger K07.58 - other specified maxillofacial anomalies of functional origin

K07.59 - maxillofacial anomaly of functional origin, unspecified

K07.6 - HFNS diseases

K07.60 - syndrome of painful dysfunction of the TMJ (Costen's syndrome) K07.61 - "clicking" jaw K07.62 - recurrent dislocation and subluxation of the TMJ K07.63 - pain in the TMJ not qualified in other categories K07.64 - stiffness of the TMJ not qualified in other headings K07.65 - TMJ osteophyte K07.68 - other specified diseases

K07.69 - TMJ disease, unspecified

K08 - other changes in teeth and their supporting apparatus

K08.1 - loss of teeth due to accident, extraction or localized periodontitis

K08.2 - atrophy of the edentulous alveolar margin

K08.3 - remaining tooth root

K08.8 - other specified changes in teeth and their supporting apparatus

K08.80 - toothache NOS K08.81 - irregular shape of the alveolar process K08.82 - hypertrophy of the alveolar edge NOS

K08.88 - other changes

K08.9 - changes in teeth and their supporting apparatus, unspecified

K09 - cysts of the oral region, not elsewhere classified

K09.00 - cyst during teething K09.01 - gingival cyst K09.02 - horny (primary) cyst K09.03 - follicular (odontogenic) cyst K09.04 - lateral periodontal cyst formed during the formation of teeth K09.08 - other specified odontogenic cysts formed during the formation of teeth

K09.09 - odontogenic cyst formed during the formation of teeth, unspecified

K09.1 - growth (non-odontogenic) cysts of the mouth area

K09.10 - globulomaxillary ( maxillary sinus) cyst K09.11 - midpalatal cyst K09.12 - nasopalatine (incisive canal) cyst K09.13 - palatine papillary cyst K09.18 - other specified growth cysts of the oral area

K09.19 - growth cyst of the mouth area, unspecified

K09.2 - other jaw cysts

K09.20 - aneurysmal bone cyst K09.21 - single bone (traumatic, hemorrhagic) cyst K09.22 - epithelial cysts of the jaw, not identified as odontogenic or non-odontogenic K09.28 - other specified cysts of the jaw

K09.29 - jaw cyst, unspecified

K10 - other diseases of the jaws

K10.0 - developmental disorders of the jaws

K10.00 - torus of the lower jaw K10.01 - torus of the hard palate K10.02 - hidden bone cyst K10.08 - other specified disorders of jaw development

K10.09 - developmental disorders of the jaws, unspecified

K10.1 - giant cell granuloma central

K10.2 - inflammatory diseases of the jaws

K10.20 - osteitis of the jaw K10.21 - osteomyelitis of the jaw K10.22 - periostitis of the jaw K10.23 - chronic periostitis of the jaw K10.24 - neonatal osteomyelitis of the upper jaw K10.25 - sequestration K10.26 - radiation osteonecrosis K10.28 - other specified inflammatory diseases of the jaws

K10.29 - inflammatory disease jaws, unspecified

K10.3 - alveolitis of the jaws, alveolar osteitis, dry socket

K10.8 - other specified diseases of the jaws

K10.80 - cherubism K10.81 - unilateral hyperplasia of the condylar process of the n/h K10.82 - unilateral hypoplasia of the condylar process of n/h K10.83 - fibrous dysplasia of the jaw

K10.88 - other specified diseases of the jaws, exostosis of the jaw

K11 - diseases of the salivary glands

K11.0 - salivary gland atrophy

K11.1 - salivary gland hypertrophy

K11.2 - sialoadite

K11.3 - salivary gland abscess

K11.4 - salivary gland fistula

K11.5 - sialolithiasis, stones in the salivary duct

K11.6 - mucocele of the salivary gland, ranula

K11.60 - mucous retention cyst K11.61 - mucous cyst with exudate

K11.69 - salivary gland mycocele, unspecified

K11.7 - disorder of the secretion of the salivary glands

K11.70 - hyposecretion K11.71 - xerostomia K11.72 - hypersecretion (ptyalism) M35.0 - Sjogren's syndrome K11.78 - other specified disorders of the secretion of the salivary glands

K11.79 - disorder of secretion of salivary glands, unspecified

K11.8 - other diseases of the salivary glands

K11.80 - benign lymphoepithelial lesion of the salivary gland K11.81 - Mikulicz disease K11.82 - stenosis (narrowing) salivary duct K11.83 - sialectasia K11.84 - sialosis

K11.85 - necrotizing sialometaplasia

K12 - stomatitis and related lesions

A69.0 - acute gangrenous L23.0 - allergic B37.0 - candidal B34.1 - caused by the Coxsackie virus T36-T50 - medicinal B37.0 - mycotic B08.4 - vesicular with exanthema

K05.00 - streptococcal gingivostomatitis

K12.0 - recurrent oral aphthae

K12.00 - recurrent (small) aphthae, aphthous stomatitis, ulcerative lesions, Mikulicz aphthae, minor aphthae, recurrent aphthous ulcers. K12.01 - recurrent muco-necrotizing periadenitis, cicatricial aphthous stomatitis, large aphthae, Sutton's aphthae K12.02 - herpetiform stomatitis (herpetiform rash) K12.03 - Bernard's aphthae K12.04 - traumatic ulceration associated with wearing a denture K12.08 - other specified recurrent oral aphthae

K12.09 - recurrent oral aphthae, unspecified

K12.1 - other forms of stomatitis

K12.10 - artificial stomatitis K12.11 - geographic stomatitis K12.12 - stomatitis associated with wearing a denture B37.03 - candidal stomatitis associated with wearing a denture K12.13 - papillary hyperplasia of the palate K12.14 - contact stomatitis, stomatitis “cotton roll” K12.18 - other specified forms of stomatitis

K12.19 - unspecified stomatitis

K12.2 - phlegmon and abscess of the mouth area

J36 - peritonsillar abscess

K13 - other diseases of the lips and oral mucosa

K13.0 - lip diseases

L56.8Х - actinic cheilitis E53.0 - ariboflavinosis K13.00 - angular cheilitis, fissure of the lip commissure (jamming) B37.0 - jamming due to candidiasis E53.0 - jamming due to riboflavin deficiency K13.01 - granular apostematous cheilitis K13.02 - exfoliative cheilitis K13.03 - cheilitis NOS K13.04 - cheilodynia K13.08 - other specified diseases of the lips

K13.09 - disease of the lips, unspecified

K13.1 - biting cheeks and lips

K13.2 - leukoplakia and other changes in the epithelium of the oral cavity, including the tongue

B37.02 - candidal leukoplakia B07.X2 - focal epithelial hyperplasia K13.20 - idiopathic leukoplakia K12.21 - leukoplakia associated with tobacco use K13.22 - erythroplakia K13.23 - leukodema K13.24 - nicotinic leukokeratosis of the palate (smoker's palate, nicotine stomatitis) K13.28 - other epithelial changes

K13.29 - unspecified epithelial changes

K13.3 - hairy leukoplakia

K13.4 - granuloma and granuloma-like lesions of the oral mucosa

K13.40 - pyogenic granuloma K13.41 - eosinophilic granuloma of the oral mucosa D76.00 - eosinophilic granuloma of bone

K13.42 - verrucous xanthoma

K13.5 - submucosal fibrosis of the oral cavity

K13.6 - hyperplasia of the oral mucosa due to irritation

K06.23 - hyperplasia associated with wearing a removable denture

K13.7 - other and unspecified lesions of the oral mucosa

K13.70 - excessive melanin pigmentation, melanoplakia, smoker's melanosis K13.71 - oral fistula T81.8 - oroantral fistula K13.72 - voluntary tattoo K13.73 - focal mucinosis of the oral cavity K13.78 - other specified lesions of the oral mucosa, white line

K13.79 - lesions of the oral mucosa, unspecified

K14 - tongue diseases

K14.0 - glossitis

K14.00 - abscess of the tongue K14.01 - traumatic ulceration of the tongue K14.08 - other specified glossitis

K14.09 - glossitis, unspecified

K14.1 - geographic tongue, exfoliative glossitis

K14.2 - median rhomboid glossitis

K14.3 - hypertrophy of the tongue papillae

K14.30 - coated tongue K14.31 - “hairy” tongue K14.38 - hairy tongue due to antibiotics K14.32 - hypertrophy of the foliate papillae K14.38 - other specified hypertrophy of the tongue papillae

K14.39 - papillary hypertrophy, unspecified

K14.4 - atrophy of the tongue papillae

K14.40 - caused by tongue cleaning habits K14.41 - caused by systemic disorders K14.42 - atrophic glossitis K14.48 - other specified atrophy of the tongue papillae

K14.49 - atrophy of the papillae of the tongue, unspecified

K14.5 - folded, wrinkled, grooved, split tongue

K14.6 - glossodynia

K14.60 - glossopyrosis (burning in the tongue) K14.61 - glossodynia (pain in the tongue) R43 - impaired taste sensitivity K14.68 - other specified glossodynia

K14.69 - glossodynia unspecified

K14.8 - other tongue diseases

K14.80 - serrated tongue (tongue with teeth imprints) K14.81 - hypertrophy of the tongue K14.82 - atrophy of the tongue

K14.88 - other specified diseases of the tongue

K14.9 - disease of the tongue, unspecified

K50 - Crohn's disease (regional enteritis) manifestations in the oral cavity L02 - skin abscess, boil and carbuncle L03 - phlegmon K12.2Х - phlegmon of the mouth L03.2 - phlegmon of the face L04 - acute lymphadenitis I88.1 - chronic lymphadenitis L08 - other local infections skin and subcutaneous tissue L08.0 - pyoderma L10 - pemphigus L10.0Х - pemphigus vulgaris, manifestations in the oral cavity L10.1 - pemphigus vegetans L10.2 - pemphigus foliaceus L10.5 - pemphigus caused by drugs L12 - pemphigoid L13 - other bullous changes L23 - allergic contact dermatitis L40 - psoriasis L40.0 - psoriasis vulgaris L42 - pityriasis rosea L43 - lichen planus L43.1 - lichen planus bullous L43.8 - other lichen planus L43.80 - papular manifestations of LP in the oral cavity L43.81 - manifestations of LP reticular in the oral cavity L43.82 - manifestations of LP atrophic and erosive in the oral cavity L43.83 - manifestations of LP (typical plaques) in the oral cavity L43.88 - manifestations of LP specified in the oral cavity L43.89 - manifestations of LP unspecified in the cavity mouth L51 - erythema multiforme L51.0 - non-bullous erythema multiforme L51.1 - bullous erythema multiforme L51.9 - erythema multiforme, unspecified L71 - rosacea L80 - vitiligo L81 - other pigmentation disorders L82 - seborrheic keratosis L83 - acanthosis negroid L90 - atrophic skin lesions L91.0 - keloid scar L92.2 - granuloma of the face (eosinophilic granuloma of the skin) L92.3 - granuloma of the skin and subcutaneous tissue caused by a foreign body L93 - lupus erythematosus L93.0 - discoid lupus erythematosus L94.0 - localized scleroderma

L98.0 - pyogenic granuloma

Infectious arthropathy

M00 - pyogenic arthritis M02 - reactive arthropathy

M00.3X - Reiter's disease of TMJ

Inflammatory polyarthropathy

M05 - seropositive rheumatoid arthritis M08 - juvenile (juvenile) arthritis M12.5Х - traumatic arthropathy of the TMJ M13 - other arthritis

M13.9 - arthritis, unspecified

Arthrosis

M15 - polyarthrosis M19.0Х - primary arthrosis of the TMJ M35.0Х - sicca syndrome (Sjogren's syndrome) manifestation in the oral cavity M79.1 - myalgia M79.2Х - neuralgia and neuritis, unspecified head and neck M79.5 - residual foreign body in soft tissues M80.VХ - osteoporosis with pathological fracture of the jaws M84.0Х - poor healing of a head and neck fracture M84.1Х - non-union of a fracture (pseudoarthrosis) of the head and neck M84.2Х - delayed healing of a head and neck fracture M88 - Paget's disease O26.8 - others specified conditions associated with pregnancy O26.80 - gingivitis associated with pregnancy O26.81 - granuloma associated with pregnancy O26.88 - other specified manifestations in the oral cavity

O26.89 - manifestations in the oral cavity, unspecified

Congenital anomalies

Q85.0 - neurofibromatosis Q35-Q37 - cleft lip and palate Q75 - congenital anomalies of the zygomatic and facial bones Q18.4 - macrostomia Q18.5 - microstomia Q18.6 - macrocheilia Q18.7 - microcheilia Q21.3Х - tetralogy of Fallot manifestations in the cavity mouth Q38.31 - bifurcation of the tongue Q38.32 - congenital commissure of the tongue Q38.33 - congenital fissure of the tongue Q38.34 - congenital hypertrophy of the tongue Q38.35 - microglossia Q38.36 - hypoplasia of the tongue Q38.40 - absence of the salivary gland or duct Q38. 42 - congenital fistula of the salivary gland Q38.51 - high palate Q90 - Down syndrome R06.5 - breathing through the mouth (snoring) R19.6 - bad breath (bad breath) R20.0 - skin anesthesia R20.1 - skin hypoesthesia R20.2 - parasthesia of the skin R20.3 - hyperesthesia R23.0Х - cyanosis manifestations in the oral cavity R23.2 - hyperemia (excessive redness) R23.3 - spontaneous ecchymosis (perichia) R43 - disturbances of smell and taste sensitivity R43.2 - parageusia

R47.0 - dysphasia and aphasia

Injury

S00 - superficial head injury S00.0 - superficial injury to the scalp S00.1 - bruise of the eyelid and infraorbital region (bruise in the eye area) S00.2 - other superficial injuries of the eyelid and periorbital region S00.3 - superficial injury of the nose S00.4 - superficial injury to the ear S00.50 - superficial injury to the inner surface of the cheek S00.51 - superficial injury to other areas of the mouth (including the tongue) S00.52 - superficial injury to the lip S00.59 - unspecified superficial injury to the lip and oral cavity S00.7 - multiple superficial head injuries S01 - open wound of the head S01.0 - open wound of the scalp S01.1 - open wound of the eyelid and periorbital region S01.2 - open wound of the nose S01.3 - open wound of the ear S01.4 - open wound of the cheek and temporal area mandibular region S01.5 - open wound of teeth and oral cavity S02.0 - fracture of the calvarium S02.1 - fracture of the base of the skull S02.2 - fracture of the nasal bones S02.3 - fracture of the floor of the orbit S02.40 - fracture of the alveolar process of the upper jaw S02 .41 - fracture of the zygomatic bone (arch) S02.42 - fracture of the upper jaw S02.47 - multiple fractures of the zygomatic bone and upper jaw S02.5 - fracture of the tooth S02.50 - fracture of the tooth enamel only (enamel chipping) S02.51 - fracture crown of a tooth without damage to the pulp S02.52 - fracture of the crown of a tooth without damage to the pulp S02.53 - fracture of the root of a tooth S02.54 - fracture of the crown and root of a tooth S02.57 - multiple fractures of teeth S02.59 - unspecified tooth fracture S02.6 - fracture mandible S02.60 - fracture of the alveolar process S02.61 - fracture of the body of the mandible S02.62 - fracture of the condylar process S02.63 - fracture of the coronoid process S02.64 - fracture of the ramus S02.65 - fracture of the symphysis S02.66 - fracture of the angle S02 .67 - multiple fractures of the lower jaw S02.69 - fracture of the lower jaw of unspecified localization S02.7 - multiple fractures of the skull and facial bones S02.9 - fracture of an unspecified part of the skull and facial bones S03 - dislocation, sprain and strain of joints from the ligaments of the head S03.0 - dislocation of the jaw S03.1 - dislocation of the cartilaginous septum of the nose S03.2 - dislocation of the tooth S03.20 - luxation of the tooth S03.21 - intrusion or extrusion of the tooth S03.22 - dislocation of the tooth (exarticulation) S03.4 - sprain and strain joint (ligaments) of the jaw S04 - injury to the cranial nerves S04.3 - injury to the trigeminal nerve S04.5 - injury facial nerve S04.8 - injury to other cranial nerves S04.9 - injury to an unspecified cranial nerve S07.0 - crushing of the face S09.1 - injury to the muscles and tendons of the head S10 - superficial injury to the neck S11 - open injury to the neck T18.0 - foreign body in the mouth T20 - thermal and chemical burns of the head and neck T28.0 - thermal burn mouth and pharynx T28.5 - chemical burn of the mouth and pharynx T33 - superficial frostbite T41 - poisoning with anesthetics T49.7 - poisoning with dental preparations used locally T51 - toxic effect of alcohol T57.0 - toxic effect of arsenic and its compounds T78.3 - angioedema (giant urticaria, angioedema) T78.4 - unspecified allergy T88 - shock caused by anesthesia T81.0 - bleeding and hematoma complicating an unqualified procedure T81.2 - accidental puncture or rupture during the procedure (accidental perforation) T81.3 - dehiscence of the edges of the surgical wound, T81.4 - infection associated with the procedure, not classified elsewhere T81.8 - procedure emphysema (subcutaneous) due to the procedure T84.7 - infection and inflammatory reaction due to internal orthopedic prosthetic devices, implants, grafts Y60 - accidental cut, puncture, perforation or bleeding during surgical and medical procedures Y60.0 - during surgery Y61 - accidental abandonment foreign body in the body when performing surgical and therapeutic procedures Y61.0 - when performing a surgical operation

Neoplasms

D10.0 - lips (frenulum) (inner surface) (mucous membrane) (red border). Excludes: lip skin (D22.0, D23.0); D10.1 - tongue (lingual tonsil); D10.2 - floor of the mouth;

D10.3 - other and unspecified parts of the mouth (minor salivary gland NOS). (except for benign odontogenic neoplasms D16.4-D16.5, mucous membrane of the lip D10.0, nasopharyngeal surface of the soft palate D10.6);

D11 - benign neoplasm of the major salivary glands

(except for benign neoplasms of the specified minor salivary glands, which are classified according to their anatomical location, benign neoplasms of the minor salivary glands NOS D10.3)

D11.7 - other large salivary glands

D11.9 - major salivary gland, unspecified

C00 - malignant neoplasm of the lip (except for the skin of the lip C43.0, C44.0)

C00.0 - outer surface of the upper lip

C00.1 - outer surface of the lower lip; C00.2 - outer surface of the lip, unspecified; C00.3 - inner surface of the upper lip;

C00.4 - inner surface of the lower lip;

C01 - malignant neoplasms of the base of the tongue

C02 - malignant neoplasm of other and unspecified parts of the tongue

C02.0 - dorsum of the tongue (except for the upper surface of the base of the tongue C01) C02.1 - lateral surface of the tongue, tip of the tongue C02.2 - lower surface of the tongue; C02.3 - anterior 2/3 of the tongue, unspecified part C02.4 - lingual tonsil Excludes: tonsils NOS (C09.9) C02.8 - lesion of the tongue extending beyond one or more of the above localizations ( malignancy language, which, based on its place of origin, cannot be classified in any of the categories C01-C02.4)

C02.9 - language of unspecified part

C03 - Malignant neoplasm of the gums (except for malignant odontogenic neoplasms C41.0-C41.1)

C03.0 - gums of the upper jaw; C03.1 - gums of the lower jaw;

C03.9 - gums, unspecified;

C04 - Malignant neoplasm of the floor of the mouth

C04.0 - anterior part of the floor of the mouth (anterior part to the canine-premolar contact point); C04.1 - lateral part of the floor of the mouth; C04.8 - damage to the floor of the mouth, extending beyond one or more of the above localizations;

C04.9 - floor of the mouth, unspecified;

C05 - Malignant neoplasm of the palate

C05.0 - hard palate; C05.1 - soft palate (except for the nasopharyngeal surface of the soft palate C11.3); C05.2 - tongue; C05.8 - lesions of the palate that extend beyond one or more of the above localizations;

C05.9 - unspecified palate;

C06 - Malignant neoplasm of other and unspecified parts of the mouth

C06.0 - buccal mucosa; C06.1 - vestibule of the mouth; C06.2 - retromolar region; C06.8 - damage to the mouth that extends beyond one or more of the above localizations;

C06.9 - unspecified mouth;

C07 - Malignant neoplasm of the parotid salivary gland

C08 - Malignant neoplasm of other and unspecified major salivary glands

(except for malignant neoplasms of specified minor salivary glands, which are classified according to their anatomical location, malignant neoplasms of minor salivary glands NOS C06.9, parotid salivary gland C07)

C08.0 - submandibular or submaxillary gland; C08.1 - sublingual gland;

C08.8 - damage to the major salivary glands, extending beyond one or more of the above localizations;

C08.9 - large salivary gland, unspecified;

For intact (healthy) teeth, the code is set:

Z01.2 - dental examination

When there is bleeding from a socket after tooth extraction, the following diagnoses are made:

R58 - Bleeding, not elsewhere classified K08.1 - Loss of teeth due to accident, extraction or localized periodontitis

When a baby tooth is removed due to physiological root resorption, the following diagnosis is made:

K00.7 - teething syndrome

If there is no eruption of a permanent tooth, then:

K08.88 - other changes

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Classification of dental diseases ICD-10

B00.10 - herpes simplex of the face

B00.11 - herpes simplex of the lips

B00.2Х - herpetic gingivostomatitis

B02.20 - postherpetic neuralgia of the trigeminal nerve

B02.21 - postherpetic neuralgia of other cranial nerves

B02.8Х - manifestation of herpes zoster in the oral cavity

B07 - viral warts

B07.X0 - simple wart of the oral cavity

B07.X1 - genital condyloma of the oral cavity

B08.3X - infectious erythema (fifth disease) manifestations in the oral cavity

B08.4X - enteroviral vesicular stomatitis

V08.5 - herpangina

B20.0X - a disease caused by HIV with manifestations of mycobacterial infection, manifestations in the oral cavity

B20.1X – a disease caused by HIV with manifestations of other bacterial infections, manifestations in the oral cavity

B20.2X - a disease caused by HIV with manifestations of cytomegovirus disease, manifestations in the oral cavity

B20.3X - a disease caused by HIV with manifestations of other viral infections, manifestations in the oral cavity.

B20.4X - a disease caused by HIV with manifestations of candidiasis, manifestations in the oral cavity

B37.00 - acute pseudomembranous candidal stomatitis

B37.01 - acute erythematous (atrophic) candidal stomatitis

B37.02 - chronic hyperplastic candidal stomatitis (candidal leukoplakia, multiple type of chronic hyperplastic candidal stomatitis)

B37.03 - chronic erythematous (atrophic) candidal stomatitis (stomatitis under removable dentures caused by candidal infection)

B37.04 - mucocutaneous candidiasis

B37.05 - candidal granuloma of the oral cavity

B37.06 - angular cheilitis

B37.08 - other specified manifestations in the oral cavity

B37.09 - unspecified manifestations in the oral cavity (candidal stomatitis NOS thrush NOS)

B75.VХ - trichinosis manifestations in the oral cavity

Neoplasms

C00 - malignant neoplasm of the lip

C43.0 - malignant neoplasm of the skin of the lip melanoma

C44.0 - malignant neoplasm of the skin of the lip

C00.0X - malignant neoplasm of the outer surface of the red border of the upper lip

C00.1X - malignant neoplasm of the outer surface of the red border of the lower lip

C01 - malignant neoplasm of the base of the tongue (the upper surface of the base of the tongue, the posterior third of the tongue)

C02 - malignant neoplasm of other and unspecified parts of the tongue

C03 - malignant neoplasm of the gums (mucous membrane of the alveolar process of the gums)

C04 - malignant neoplasm of the floor of the mouth

C05 - malignant neoplasm of the palate

C06.0 - malignant neoplasm of the buccal mucosa

C06.1 - malignant neoplasm of the oral vestibule

C06.2 - malignant neoplasm of the retromolar region

C07 - malignant neoplasm of the parotid salivary gland

C08 - malignant neoplasm of other and unspecified major salivary glands

C31 - malignant neoplasm of the paranasal sinuses

C41.1 - malignant neoplasm of the lower jaw

C41.10 - sarcoma

C41.11 - malignant odontogenic tumor

Neoplasms in situ

D00 - carcinoma in situ of the oral cavity

D00.00 - mucous membrane and red border of the lip

D00.01 - buccal mucosa

D00.02 - gums and alveolar ridge with edentulous

D00.03 - sky

D00.04 - floor of the mouth

Benign neoplasms

D10.0 - benign formation of the lip

D10.1 - benign tongue formation

D10.2 - floor of the mouth

D10.30 - buccal mucosa

D10.31 - buccal mucosa along the closure line

D10.32 - buccal groove

D10.33 - gums and alveolar ridge with edentulous congenital epulis

K06.82 - fibrous epulis

K06.81 - giant cell peripheral granuloma

O26.8 – granuloma associated with pregnancy

D10.34 - hard palate junction (border) of the hard and soft palate

D10.35 - soft palate

D10.37 - retromolar region

D10.38 - maxillary tubercle

Benign formation of the major salivary glands

D11.0 - parotid salivary gland

D11.70 - submandibular gland

D11.71 - sublingual gland

D11.9 - major salivary gland, unspecified

K10. 88 - exostosis of the jaw

K10.80 - Cherubism

K10.1 - giant cell granuloma

K10.00 - tori of the jaw

D16.4 - bones and skulls

D16.5 - lower jaw bone part

D17.0 - benign neoplasm adipose tissue of the skin and subcutaneous tissue of the head, face and neck

D18.0X - hemangioma of any location in the oral cavity

D18.1X - lymphangioma manifestations in the oral cavity

D22. - melanoform nevus

E14.XX - diabetes manifestations in the oral cavity

Nervous system diseases

G40.VX - epilepsy manifestations of the oral cavity

G50 - damage to the trigeminal nerve

G50.0 - trigeminal neuralgia (painful tic)

G50.1 - atypical facial pain

G50.8 - other lesions of the trigeminal nerve

G50.9 - lesions of the trigeminal nerve, unspecified

G51 - facial nerve damage

G52.1X - glossopharyngeal neuralgia

G52 - lesions of the hypoglossal nerve

Diseases of the circulatory system

I78.0 - hereditary hemorrhagic telangiectasia

I86.0 - varicose veins sublingual veins

I88 - nonspecific lymphadenitis

Respiratory diseases

J01 - acute sinusitis

J01.0 - acute maxillary sinusitis

J01.1 - acute frontal sinusitis

J03 - acute tonsillitis

J10 - flu

J32 - chronic sinusitis

J32.0 - chronic maxillary sinusitis

J35.0 - chronic tonsillitis

J36 - peritonsillar abscess.

Digestive diseases

K00 - developmental and teething disorders

K00.0 - adentia

K00.00 - partial adentia (hypodentia) (oligodentia)

K00.01 - complete edentia

K00.09 - edentia, unspecified

K00.1 - supernumerary teeth

K00.10 - areas of the incisor and canine mesiodentium (middle tooth)

K00.11 - premolar areas

K00.12. - molar areas distomolar tooth, fourth molar, paramolar tooth

K00.19 - supernumerary teeth, unspecified

K00.2 - anomalies in the size and shape of teeth

K00.20 - macrodentia

K00.21 - microdentia

K00.22. - fusion

K00.23 - fusion (synodontia) and bifurcation (schizodentia)

K00.24 - protrusion of teeth (additional occlusal cusps)

K00.25 - invaginated tooth (tooth in tooth) (dilated odontoma)

K00.26 - premolarization

K00.27 - abnormal tubercles and enamel pearls (adamantoma)

K00.28 - bovine tooth (taurodontism)

K00.29 - other and unspecified anomalies in the size and shape of teeth

K00.3 - speckled teeth

K00.30 - endemic (fluorosis) mottling of enamel (dental fluorosis)

K00.31 - non-endemic mottling of enamel (non-fluorous darkening of the enamel)

K00.39 - mottled teeth, unspecified

K00.4 - violation of tooth formation

K00.40 - enamel hypoplasia

K00. 41 - perinatal enamel hypoplasia

K00.42 - neonatal enamel hypoplasia

K00.43 - aplasia and hypoplasia of cement

K00.44. - dilacerasia (enamel cracks)

K00.45 - odontodysplasia (regional odontodysplasia)

K00.46 - Turner tooth

K00.48 - other specified disorders of tooth formation

K00.49 - disorders of tooth formation, unspecified

K00.5 - hereditary disorders of the tooth structure, not classified elsewhere

K00.50 - incomplete amelogenesis

K00.51 - incomplete dentinogenesis

K00.52 - incomplete odontogenesis

K00.58 - other hereditary disorders of the tooth structure (dentine dysplasia, cancerous teeth)

K00 59 - hereditary disorders of tooth structure, unspecified

K00.6 - teething disorders

K00.60 - natal teeth (erupted at the time of birth)

K00.61 - neonatal (in a newborn, prematurely erupted) teeth

K00.62 - premature eruption (early eruption)

K00.63 - delay (persistent) change of primary (temporary) teeth

K00.64 - late eruption

K00.65 - premature loss of primary (temporary) teeth

K00.68 - other specified disorders of teething

K00.69 - disturbance of teething, unspecified

K00.7 - teething syndrome

K00.8 - other dental development disorders

K00.80 - change in tooth color during formation due to incompatibility of blood groups

K00.81 - change in tooth color during formation due to a congenital defect of the biliary system

K00.82 - change in tooth color during formation due to porphyria

K00.83 - change in tooth color during formation due to the use of tetracycline

K00.88 - other specified disorders of dental development

K00.9 - disorder of dental development, unspecified

K01 - impacted and impacted teeth

K07.3 - impacted and impacted teeth with incorrect position of their or neighboring teeth

K01.0 - impacted teeth (changed their position during eruption without obstruction from an adjacent tooth)

K01.1 - impact teeth (changed their position during eruption due to an obstacle from an adjacent tooth)

K01.10 - maxillary incisor

K01.11 - lower jaw incisor

K01.12 - maxillary canine

K01.13 - lower jaw canine

K01.14 - maxillary premolar

K01 15. - maxillary molar

K01.17 - lower jaw molar

K01.18 - supernumerary tooth

K01.19 - impact tooth, unspecified

K02 - dental caries

K02.0 - enamel caries stage of white (chalky) spots (initial caries)

K02.1 - dentin caries

K02.2 - cement caries

K02.3 - suspended dental caries

K02.4 - odontoclasia, childhood melanodentia, melanodontoclasia

K02.8 - other specified dental caries

K02.9 - dental caries, unspecified

K03 - other diseases of dental hard tissues

F45.8 - bruxism

K03.0 - increased tooth abrasion

K03.00 - occlusal

K03.08 - other specified tooth abrasion

K03.09 - unspecified tooth abrasion

K03.1 - grinding (abrasive wear) of teeth

K03.10 - caused by tooth powder (wedge-shaped defect NOS)

K03.11 - usual

K03.12 - professional

K03.13 - traditional (ritual)

K03.18 – other refined grinding of teeth

K03.19 – grinding of teeth, unspecified

K03.2 - tooth erosion

K03.20 - professional

K03.21 - caused by persistent regurgitation or vomiting

K03.22 - due to diet

K03.23 - caused by drugs and medications

K03.24 - idiopathic

K03.28 - other specified dental erosion

K03.29 - dental erosion, unspecified

K03.3 - pathological tooth resorption

K03.30 - external (external)

K03.31 - internal (internal granuloma) (pink spot)

K03.39 - pathological tooth resorption, unspecified

K03.4 - hypercementosis

K03.5 - ankylosis of teeth

K03.6 - deposits (growths) on teeth

K03.60 - pigmented coating (black, green, orange)

K03.61 - due to the habit of using tobacco

K03.61 - caused by the habit of chewing betel nut

K03.63 - other extensive soft deposits (white deposits)

K03.64 - supragingival tartar

K03.65 - subgingival tartar

K03.66 - dental plaque

K03.68 - other specified deposits on teeth

K03.69 - unspecified deposits on teeth

K03.7 - changes in the color of hard tissues of teeth after eruption

K03.70 - due to the presence of metals and metal compounds

K03.71 - caused by pulp bleeding

K03.72 - due to the habit of chewing betel nut

K03.78 - other specified color changes

K03.79 - unspecified color changes

K03.8 - other specified diseases of dental hard tissues

K03.80 - sensitive dentin

K03.81 - changes in enamel caused by irradiation

K03.88 - other specified diseases of hard dental tissues

K03.9 - disease of dental hard tissues, unspecified

K04 - diseases of the pulp and periapical tissues

K04.0 - pulpitis

K04.00 - initial (hyperemia)

K04.01 - spicy

K04.02 - purulent (pulp abscess)

K04.03 - chronic

K04.04 - chronic ulcerative

K04.05 - chronic hyperplastic (pulp polyp)

K04.08 - other specified pulpitis

K04.09 - pulpitis, unspecified

K04.1 - pulp necrosis (pulp gangrene)

K04.2 - degeneration of dental pulp, pulp calcifications, pulp stones

K04.3 - improper formation of hard tissue in the pulp

K04.4 acute apical periodontitis of pulpal origin K04.5 chronic apical periodontitis (apical granuloma)

K04.6 periapical abscess with fistula (dental abscess, dentoalveolar abscess, periodontal abscess of pulpal origin)

K04.60 - having communication (fistula) with the maxillary sinus

K04.61 - having a connection (fistula) with the nasal cavity K04.62 - having a connection (fistula) with the oral cavity

K04.63 - having a connection (fistula) with the skin

K04.69 - periapical abscess with fistula, unspecified

K04.7 - periapical abscess without fistula (dental abscess, dentoalveolar abscess, periodontal abscess of pulpal origin)

K04.8 - root cyst (apical (periodontal), periapical)

K04.80 - apical and lateral

K04.81 - residual

K04.82 - inflammatory paradental

K09.04 - lateral periodontal cyst formed during the formation of teeth

K04.89 - root cyst, unspecified

K04.9 - other unspecified diseases of the pulp and periapical tissues

K05 - gingivitis and periodontal diseases

K05.0 - acute gingivitis

K05.22 - acute pericoronitis

A69.10 - acute nectrotic ulcerative gingivitis (fusospirochetous gingivitis, Vincent gingivitis)

K05.00 - acute streptococcal gingivostomatitis

K05.08 - other specified acute gingivitis

K05.09 - acute gingivitis, unspecified

K05.1 - chronic gingivitis

K05.10 - simple marginal

K05.11 - hyperplastic

K05.12 - ulcerative

K05.13 - desquamative

K05.18 - other specified chronic gingivitis

K05.19 - chronic gingivitis, unspecified

K05.2 - acute periodontitis

K05.20 - periodontal abscess (periodontal abscess) of gingival origin without fistula

K05.21 - periodontal abscess (periodontal abscess) of gingival origin with fistula

K05.28 - other specified acute periodontitis

K05.29 - acute periodontitis, unspecified

K05.3 - chronic periodontitis

K05.30 - localized

K05.31 - generalized

K05.32 - chronic pericoronitis

K05.33 - thickened follicle (papillary hypertrophy)

K05.38 - other specified chronic periodontitis

K05.39 - chronic periodontitis, unspecified

K05.4 - periodontal disease

K05.5 - other periodontal diseases

K06 - other changes in the gingiva and edentulous alveolar margin

K06.0 - gum recession (includes post-infectious, post-operative)

K06.00 - local

K06.01 - generalized

K06.09 - gum recession, unspecified

K06.1 - gingival hypertrophy

K06.10 - fibromatosis of the gums

K06.18 - other specified gingival hypertrophy

K06.19 - gingival hypertrophy, unspecified

K06.2 - lesions of the gums and edentulous alveolar margin caused by trauma

K06.20 - caused by traumatic occlusion

K06.21 - caused by brushing teeth

K06.22 - frictional (functional) keratosis

K06.23 - hyperplasia due to irritation (hyperplasia associated with wearing a removable denture)

K06.28 - other specified lesions of the gums and edentulous alveolar margin caused by trauma

K06.29 - unspecified lesions of the gums and edentulous alveolar margin caused by trauma

K06.8 - other specified changes in the gingiva and edentulous alveolar margin

K06.80 - adult gingival cyst

K06.81 - giant cell peripheral granuloma (giant cell epulis)

K06 82 - fibrous epulis

K06.83 - pyogenic granuloma

K06.84 - partial ridge atrophy

K06.88 - other changes

K06.9 - changes in the gums and edentulous alveolar margin, unspecified

K07 - maxillofacial anomalies (including malocclusions)

K07.0 - main anomalies in jaw size

E22.0 - acromegaly

K10.81 - unilateral condylar hyperplasia

K10.82 - unilateral condylar hypoplasia

K07.00 - macrognathia of the upper jaw

K07.01 - macrognathia of the lower jaw

K07.02 - macrognathia of both jaws

K07.03 - micrognathia of the upper jaw (hypoplasia of the upper jaw)

K07.04 - micrognathia of the lower jaw (hypoplasia n/h)

K07 08 - other specified anomalies in jaw size

K07.09 - anomalies in jaw size, unspecified

K07.1 - anomalies of maxillo-cranial relationships

K07.10 - asymmetry

K07.11 - prognathia n/h

K07.12 - prognathia in the h/h

K07.13 - retrognathia n/h

K07.14 - retrognathia v/h

K07.18 - other specified anomalies of maxillo-cranial relationships

K07.19 - anomalies of maxillo-cranial relationships, unspecified

K07.2 - anomalies in the relationship of the dental arches

K07.20 - distal bite

K07.21 - mesial bite

K07.22 - excessively deep horizontal bite (horizontal overlap)

K07.23 - excessively deep vertical bite (vertical overlap)

K07.24 - open bite

K07.25 - crossbite(front, rear)

K07.26 - displacement of dental arches from the midline

K07.27 - posterior lingual bite of the lower teeth

K07.28 - other specified anomalies of the relationships of the dental arches

K07.29 - anomalies in the relationships of the dental arches, unspecified

K07.3 - anomalies in tooth position

K07.30 - crowding (tile-shaped floor)

K07.31 - offset

K07.32 - turn

K07.33 - violation of interdental spaces (diastema)

K07.34 - transposition

K07.35 - impacted or impacted teeth with incorrect position of their or adjacent teeth

K07.38 - other specified anomalies of tooth position

K07.39 - anomalies of tooth position, unspecified

K07.4 - unspecified malocclusion

K07.5 - maxillofacial anomalies of functional origin

K07 50 - improper closing of the jaws

K07.51 - malocclusion due to impaired swallowing

K07.54 - malocclusion due to mouth breathing

K07.55 - malocclusion due to sucking of the tongue, lips or finger

K07.58 - other specified maxillofacial anomalies of functional origin

K07.59 - maxillofacial anomaly of functional origin, unspecified

K07.6 - HFNS diseases

K07.60 - TMJ pain dysfunction syndrome (Costen syndrome)

K07.61 - “clicking” jaw

K07.62 - recurrent dislocation and subluxation of the TMJ

K07.63 - pain in the TMJ not qualified in other categories

K07.64 - TMJ stiffness not qualified in other categories

K07.65 - TMJ osteophyte

K07.68 - other specified diseases

K07.69 - TMJ disease, unspecified

K08 - other changes in teeth and their supporting apparatus

K08.1 - loss of teeth due to accident, extraction or localized periodontitis

S03.2 - tooth dislocation

K08.2 - atrophy of the edentulous alveolar edge

K08.3 - remaining tooth root

K08.8 - other specified changes in teeth and their supporting apparatus

K08.80 - toothache NOS

K08.81 - irregular shape of the alveolar process

K08.82 - hypertrophy of the alveolar margin NOS

K08.88 - other changes

K08.9 - changes in teeth and their supporting apparatus, unspecified

K09 - cysts of the oral area, not classified elsewhere

K04.8 - root cyst

K11.6 - mucocele of the salivary gland

K09.00 - cyst during teething

K09.01 - gum cyst

K09.02 - horny (primary) cyst

K09.03 - follicular (odontogenic) cyst

K09.04 - lateral periodontal cyst

K09.08 - other specified odontogenic cysts formed during the formation of teeth

K09.09 - odontogenic cyst formed during the formation of teeth, unspecified

K09.1 - growth (non-odontogenic) cysts of the mouth area

K09.10 - globulomaxillary (maxillary sinus) cyst

K09.11 - midpalatal cyst

K09.12 - nasopalatine (incisive canal) cyst

K09.13 - palatine papillary cyst

K09.18 - other specified growth cysts of the mouth area

K09.19 - growth cyst of the mouth area, unspecified

K09.2 - other jaw cysts

K09.20 - aneurysmal bone cyst

K09.21 - single bone (traumatic, hemorrhagic) cyst

K09.22 - epithelial cysts of the jaw, not identified as odontogenic or non-odontogenic K09.28 - other specified cysts of the jaw

K09.29 - jaw cyst, unspecified

K10 - other diseases of the jaws

K10.0 - disorders of jaw development

K10.00 - torus of the lower jaw

K10.01 - torus of the hard palate

K10.02 - hidden bone cyst

K10.08 - other specified disorders of jaw development

K10.09 - developmental disorders of the jaws, unspecified

K10.1 - central giant cell granuloma

K10.2 - inflammatory diseases of the jaws

K10.20 - osteitis of the jaw

K10.3 - alveolitis of the jaws, alveolar osteitis, dry socket

K10.21 - osteomyelitis of the jaw

K10.22 - periostitis of the jaw

K10.23 - chronic periostitis of the jaw

K10.24 - neonatal osteomyelitis of the upper jaw

K10.25 - sequestration

K10.26 - radiation osteonecrosis

K10.28 - other specified inflammatory diseases of the jaws

K10.29 - inflammatory disease of the jaws, unspecified

K10.8 - other specified diseases of the jaws

K10.80 - Cherubism

K10.81 - unilateral hyperplasia of the condylar process of the n/h

K10.82 - unilateral hypoplasia of the condylar process of the n/h

K10.83 - fibrous dysplasia of the jaw

K10.88 - other specified diseases of the jaws, exostosis of the jaw

K11 - diseases of the salivary glands

K11.0 - atrophy of the salivary gland

K11.1 - hypertrophy of the salivary gland

K11.2 - sialoadite

K11.4 - salivary gland fistula

K11.5 - sialolithiasis, stones in the salivary duct

K11.6 - mucocele of the salivary gland, ranula

K11.60 - mucous retention cyst

K11.61 - mucous cyst with exudate

K11.69 - mccocele of the salivary gland, unspecified

K11.7 - violation of the secretion of the salivary glands

K11.70 - hyposecretion

M35.0 - Sjögren's syndrome

K11.71 - xerostomia

K11.72 - hypersecretion (ptialism)

K11.78 - other specified disorders of the secretion of the salivary glands

K11.79 - disorder of the secretion of the salivary glands, unspecified

K11.8 - other diseases of the salivary glands

K11.80 - benign lymphoepithelial lesion of the salivary gland

K11.81 - Mikulicz disease

K11.82 - stenosis (narrowing) of the salivary duct K11 83 - sialectasia

K11.84 - sialosis K11.85 - necrotizing sialometaplasia

K12 - stomatitis and related lesions

A69.0 - acute gangrenous

L23.0 - allergic

B37.0 - candida

K12.14 - contact B34.1 - caused by the Coxsackie virus

T36-T50 - medicinal

B37.0 - mycotic

K13.24 - nicotine

B08.4 - vesicular with exanthema

K05.00 - streptococcal gingivostomatitis

K12.0 - recurrent oral aphthae

K12.00 - recurrent (small) aphthae, aphthous stomatitis, ulcerative lesions, Mikulicz aphthae, small aphthae, recurrent aphthous ulcers.

K12.01 - recurrent muco-necrotic periadenitis, cicatricial aphthous stomatitis, large aphthae, Sutton's aphthae

K12.02 - herpetiform stomatitis (herpetiform rash)

K12.03 - Bernard's aphthae

K12.04 - traumatic ulceration

K12.08 - other specified recurrent oral aphthae

K12.09 - recurrent oral aphthae, unspecified

K12.1 - other forms of stomatitis

K12.10 - artificial stomatitis

K12.11 - geographic stomatitis

K14.1 - geographical language

K12.12 - stomatitis associated with wearing dentures

B37.03 - candidal stomatitis associated with wearing a denture K12.04 - traumatic ulceration associated with wearing a denture

K12.13 - papillary hyperplasia of the palate

K12.14 - contact stomatitis, “cotton roller” stomatitis

K12.18 - other specified forms of stomatitis

K12.19 - unspecified stomatitis

K12.2 - phlegmon and abscess of the mouth area

K04.6-K04.7 - periapical abscess

K05.21 - periodontal abscess

J36 - peritonsillar abscess

K11.3 - abscess of the salivary gland

K14.00 - tongue abscess

K13 - other diseases of the lips and oral mucosa

K13.0 - lip diseases

L56.8Х - actinic cheilitis

E53.0 - ariboflavinosis

K13.00 - angular cheilitis, fissure of the commissure of the lips (jamming)

B37.0 - seizure due to candidiasis

E53.0 - seizure due to riboflavin deficiency

K13.01 - granular apostematous cheilitis

K13.02 - exfoliative cheilitis

K13 03 - cheilitis NOS

K13.04 - cheilodynia

K13.08 - other specified diseases of the lips

K13.09 - unspecified lip disease

K13.1 - biting cheeks and lips

K13.2 - leukoplakia and other changes in the epithelium of the oral cavity, including the tongue

B37.02 - candidal leukoplakia

B07.X2 - focal epithelial hyperplasia

K06.22 - frictional keratosis

K13.3 - hairy leukoplakia

K13.20 - idiopathic leukoplakia

K12.21 – leukoplakia associated with tobacco use

K13.24 - nicotinic leukokeratosis of the palate

K13.24 - smoker's sky

K13.22 - erythroplakia

K13.23 - leukodema

K13.28 - other epithelial changes

K13.29 - unspecified changes in the epithelium

K13.4 - granuloma and granuloma-like lesions of the joint

K13.40 - pyogenic granuloma

K13.41 - eosinophilic granuloma of the oral mucosa

D76.00 - eosinophilic bone granuloma

K13.42 - verrucous xanthoma

K13.5 - submucosal fibrosis of the oral cavity

K13.6 - hyperplasia of the oral mucosa due to irritation

K06.23 - hyperplasia associated with wearing a removable denture

K13.7 - other and unspecified lesions of the oral mucosa

K13.70 - excessive melanin pigmentation, melanoplakia, smoker's melanosis

K13.71 - fistula of the oral cavity

T81.8 - oroantral fistula

K13.72 - voluntary tattoo

K13.73 - focal mucinosis of the oral cavity

K13.78 - other specified lesions of the oral mucosa, white line

K13.79 - lesions of the oral mucosa, unspecified

K14 - tongue diseases

K14.0 - glossitis

K14.42 - atrophic glossitis

K14.00 - tongue abscess

K14.01 - traumatic ulceration of the tongue

K14.08 - other specified glossitis

K14.09 - glossitis, unspecified

K14.1 - geographic tongue, exfoliative glossitis

K14.2 - median rhomboid glossitis

K14.3 - hypertrophy of the tongue papillae

K14.30 - coated tongue

K14.31 - “hairy” tongue

K14.38 - hairy tongue due to taking antibiotics

K14.32 - hypertrophy of foliate papillae

K14.38 - other specified hypertrophy of the lingual papillae

K14.39 - unspecified papillary hypertrophy

K14.4 - atrophy of the papillae of the tongue

K14.40 - caused by habits of cleaning the tongue

K14.41 - caused by systemic disorders

K14.48 - other specified atrophy of the papillae of the tongue

K14.49 - atrophy of the papillae of the tongue, unspecified

K14.5 - folded, wrinkled, grooved, split tongue

K14.6 - glossodynia

K14.60 - glossopyrosis (burning in the tongue)

K14.61 - glossodynia (pain in the tongue)

R43 - impaired taste sensitivity

K14.68 - other specified glossodynia

K14.8 - glossodynia, unspecified

K14.8 - other tongue diseases

K14.80 - serrated tongue (tongue with teeth imprints)

K14.81 - tongue hypertrophy

K14.82 - tongue atrophy

K14.88 - other specified diseases of the tongue

K14.9 - disease of the tongue, unspecified

K50 - Crohn's disease (regional enteritis) manifestations in the oral cavity

L02 - skin abscess, boil and carbuncle

L03 - phlegmon

K12.2X - phlegmon of the mouth

L03.2 - facial phlegmon

L04 - acute lymphadenitis

I88.1 - chronic lymphadenitis

L08 - other local infections of the skin and subcutaneous tissue

L08.0 - pyoderma

L10 - pemphigus

L10.0Х - pemphigus vulgaris, manifestations in the oral cavity

L10.1 - pemphigus vegetans

L10.2 - pemphigus foliaceus

L10.5 - drug-induced pemphigus

L12 - pemphigoid

L13 - other bullous changes

L23 - allergic contact dermatitis

L40 - psoriasis

L40.0 - psoriasis vulgaris

L42 - pityriasis pink

L43 - lichen planus

L43.1 - lichen planus bullous

L43.8 - other lichen planus

L43.80 - papular manifestations of LP in the oral cavity

L43.81 - reticular manifestations of LP in the oral cavity

L43.82 - atrophic and erosive manifestations of LP in the oral cavity

L43.83 - manifestations of LP (typical plaques) in the oral cavity

L43.88 - manifestations of LP specified in the oral cavity

L43.89 - manifestations of LP, unspecified in the oral cavity

L51 - erythema multiforme

L51.0 - nonbullous erythema multiforme

L51.1 - bullous erythema multiforme

L51.9 - erythema multiforme, unspecified

L71 - rosacea

L80 - vitiligo

L81 - other pigmentation disorders

L82 - seborrheic keratosis

L83 - acanthosis negroid

L90 - atrophic skin lesions

L91.0 - keloid scar

L92.2 - granuloma of the face (eosinophilic granuloma of the skin)

L92.3 - granuloma of the skin and subcutaneous tissue caused by a foreign body

L93 - lupus erythematosus

L93.0 - discoid lupus erythematosus

L94.0 - localized scleroderma

L98.0 - pyogenic granuloma

Infectious arthropathy

M00 - pyogenic arthritis

M02 - reactive arthropathy

M00.3X - Reiter's disease of TMJ

Inflammatory polyarthropathy

M05 - seropositive rheumatoid arthritis

M08 - juvenile (juvenile) arthritis

M12.5X - traumatic arthropathy of the TMJ

M13 - other arthritis

M13.9 - arthritis, unspecified

Arthrosis

M15 - polyarthrosis

M19.0X - primary arthrosis of the TMJ

M35.0X - dryness syndrome (Sjögren's syndrome) manifestation in the oral cavity

M79.1 - myalgia

M79.2 X - neuralgia and neuritis, unspecified head and neck

M79.5 - residual foreign body in soft tissues

M80.VX - osteoporosis with pathological fracture of the jaws

M84.0X - poor healing of head and neck fractures

M84.1X - non-union of fracture (pseudoarthrosis) of the head and neck

M84.2 X - delayed healing of head and neck fractures

M88 - Paget's disease

O26.8 - other specified conditions associated with pregnancy

O26.80 - gingivitis associated with pregnancy

O26.81 - granuloma associated with pregnancy

O26.88 - other specified manifestations in the oral cavity

O26.89 - manifestations in the oral cavity, unspecified

Congenital anomalies

Q85.0 - neurofibromatosis

Q35- Q37- cleft lip and palate

Q75 - congenital anomalies zygomatic and facial bones

Q18.4 - macrostomia

Q18.5 - microstomia

Q18.6 - macrocheilia

Q18.7 - microcheilia

Q21.3Х - tetralogy of Fallot manifestations in the oral cavity

Q38.31 - forked tongue

Q38.32 - congenital tongue adhesion

Q38.33 - congenital tongue fissure

Q38.34 - congenital hypertrophy of the tongue

Q38.35 - microglossia

Q38.36 - tongue hypoplasia

Q38.40 - absence of salivary gland or duct

Q38.42 - congenital fistula of the salivary gland

Q38.51 - high sky

Q90 - Down syndrome

R06.5 - breathing through the mouth (snoring)

R19.6 - bad breath (bad breath)

R20.0 - skin anesthesia

R20.1 - skin hypoesthesia

R20.2 - parasthesia of the skin

R20.3 - hyperesthesia

R23.0Х - cyanosis manifestations in the oral cavity

R23.2 - hyperemia (excessive redness)

R23.3 - spontaneous ecchymosis (perichia)

R43 - disturbances of smell and taste sensitivity

R43.2 - parageusia

R47.0 - dysphasia and aphasia

Injury

S00 - superficial head injury

S00.0 - superficial injury to the scalp

S00.1 - bruise of the eyelid and infraorbital region (bruise in the eye area)

S00.2 - other superficial injuries of the eyelid and periorbital region

S00.3 - superficial trauma to the nose

S00.4 - superficial ear injury

S00.50 - superficial injury to the inner surface of the cheek

S00. 51 - superficial trauma to other areas of the mouth (including tongue)

S00.52 - superficial lip injury

S00.59 - superficial injury of lip and oral cavity, unspecified

S00.7 - multiple superficial head injuries

S01 - open head wound

S01.0 - open wound of the scalp

S01.1 - open wound of the eyelid and periorbital area

S01.2 - open wound of the nose

S01.3 - open ear wound

S01.4 - open wound of the cheek and temporomandibular region

S01.5 - open wound of teeth and oral cavity

S02.0 - calvarial fracture

S02.1 - fracture of the base of the skull

S02.2 - fracture of the nasal bones

S02.3 - fracture of the orbital floor

S02.40 - fracture of the alveolar process of the upper jaw

S02.41 - fracture of the zygomatic bone (arch)

S02.42 - fracture of the upper jaw

S02.47 - multiple fractures of the zygomatic bone and upper jaw

S02.5 - tooth fracture

S02.50 - pearl of tooth enamel only (enamel chipping)

S02.51 - fracture of the tooth crown without damage to the pulp

S02.52 - fracture of the tooth crown without damage to the pulp

S02.53 - tooth root fracture

S02.54 - fracture of the crown and root of the tooth

S02.57 - multiple tooth fractures

S02.59 - tooth fracture, unspecified

S02.6 - fracture of the lower jaw

S02.60 - fracture of the alveolar process

S02.61 - fracture of the body of the lower jaw

S02.62 - fracture of the condylar process

S02 63 - fracture of the coronoid process

S02.64 - fracture of the branch

S02.65 - symphysis fracture

S02.66 - corner fracture

S02.67 - multiple fractures of the lower jaw

S02.69 - fracture of the lower jaw of unspecified localization

S02.7 - multiple fractures of the skull and facial bones

S02.9 - fracture of an unspecified part of the skull and facial bones

S03 - dislocation, sprain and strain of joints from the ligaments of the head

S03.0 - jaw dislocation

S03.1 - dislocation of the cartilaginous nasal septum

S03.2 - tooth dislocation

S03.20 - tooth luxation

S03.21 - intrusion or extrusion of tooth

S03.22 - tooth dislocation (disarticulation)

S03.4 - sprain and strain of the joint (ligaments) of the jaw

S04 - cranial nerve injury

S04.3 - trigeminal nerve injury

S04.5 - facial nerve injury

S04.8 - injury to other cranial nerves

S04.9 - unspecified cranial nerve injury

S07.0 - facial crush

S09.1 - injury to muscles and tendons of the head

S10 - superficial neck injury

S11 - open neck injury

T18.0 - foreign body in the mouth

T20 - thermal and chemical burns of the head and neck

T28.0 - thermal burn of the mouth and pharynx

T28.5 - chemical burn of the mouth and pharynx

T33 - superficial frostbite

T41 - poisoning by anesthetics

T49.7 - poisoning with dental preparations applied topically

T51 - toxic effects of alcohol

T57.0 - toxic effect of arsenic and its compounds

T78.3 - angioedema (giant urticaria, Quincke's edema)

T78.4 - allergy, unspecified

T88 - shock caused by anesthesia

T81.0 - bleeding and hematoma complicating the unqualified procedure

T81.2 - accidental puncture or rupture during the procedure (accidental perforation)

T81.3 - divergence of the edges of the surgical wound,

T81.4 – procedure-associated infection, not elsewhere classified

T81.8 - procedures emphysema (subcutaneous) due to the procedure

T84.7 - infection and inflammatory reaction caused by internal orthopedic prosthetic devices, implants and grafts

Y60 - accidental cut, puncture, perforation or bleeding during surgical and therapeutic procedures

Y60.0 - during surgery

Y61 - accidental leaving of a foreign body in the body during surgical and therapeutic procedures

Y61.0 - during surgery

Classification of dental diseases ICD 10

ICD definition - 10

The need to somehow classify and organize the entire spectrum pathological conditions human body led scientists and practitioners to the idea of ​​creating certain clusters.

The classification of diseases consists of headings, each of which, in accordance with predetermined criteria, includes diseases.

Such criteria may vary depending on the purposes for which the classification is formed.

The first such classification was approved in 1893 and was called the International List of Causes of Death. After that, it was revised, changed and supplemented more than once.

The 10th revision of the classification turned out to be the most successful (came into force in 1993), at which time the modern name and, accordingly, the abbreviation appeared.

The groups of diseases, injuries and pathologies displayed in the ICD-10 allow a more rational and specific approach to the diagnostic process, assessment of the epidemiological condition and quality of medical care.

The changes made to ICD-10 concern the organization of the classification structure (the alphanumeric coding system replaced the digital one), some diseases (for example, immune) were moved to another group, since this approach is more correct, new classes were added (for example, for eye diseases )

ICD definition - C

ICD-C, or international classification Dental diseases are extracted from ICD - 10 and represent classes of diseases of the oral cavity and related systems.

There are several reasons for the appearance of ICD-C:

• The diseases presented in ICD-10 and of interest to practicing dentists are not sufficiently classified;
• Dental diseases presented in ICD-10 are distributed over 2 volumes, which is inconvenient from the point of view of use.

Having identified the need to create such a dental classification, we can determine the main tasks of the ICD-C:

• Allow dentists to most accurately diagnose and select treatment methods for port diseases, relying in their work on a comprehensive classification;
• Provide a simple classification of dental diseases and pathologies in accordance with standards.

This registration method allows you to collect statistical data on the prevalence of oral diseases and the condition of this cavity. The information received is important not only at the state, but at the international level.

A special place in this work is occupied by the section on neoplasms of benign and malignant nature; much attention is paid to the procedure for differentiating neoplasms and inflammatory hyperplasias. Tumors of the salivary glands and odontogenic tumors are of interest.

Coding in ICD - C

Each category in ICD-C is designated by a three-digit code. They repeat the coding adopted in ICD-10. However, some dental classification headings are designated by a five-digit code, which indicates their singularity.

In other words, a code consisting of 5 characters belongs exclusively to ICD-C. In this case, the first 3 characters belong to ICD-10, and the remaining 2 reflect the characteristics of dental diseases.

It happens that ICD-10 in some of its sections is also marked with a five-digit code, which, however, is not suitable for dental classification. In this case, in the latter, the 4th character is replaced with an empty sign - V.

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Bleeding from the tooth socket (due to tooth extraction) (Y60.0) - Haemorrhagia alveolaris

Bleeding from the socket is capillary-parenchymal bleeding, which occurs more often after tooth extraction surgery.

ETIOLOGY AND PATHOGENESIS

The cause of bleeding from the tooth socket is tissue trauma, rupture of blood vessels (dental artery, arterioles and capillaries of the periodontium and gums) during operations in the maxillofacial area, most often tooth extraction or trauma. After a few minutes, blood clotting in the hole occurs and bleeding stops. However, some patients experience disruption of clot formation in the socket, which leads to prolonged bleeding. More often this is due to significant damage to the gums, alveoli, oral mucosa, pathological processes in the maxillofacial area (trauma, bacterial inflammation), less often - the presence of concomitant systemic diseases in the patient ( hemorrhagic diathesis, acute leukemia, infectious hepatitis, arterial hypertension, diabetes mellitus, etc.), taking drugs that affect hemostasis and reduce blood clotting (NSAIDs, antiplatelet agents, anticoagulants, fibrinolytic drugs, oral contraceptives, etc.).

With prolonged bleeding, the patient’s condition worsens, weakness, dizziness, and pallor appear. skin, acrocyanosis, decreased blood pressure and a reflex increase in heart rate.

If the patient was administered a local anesthetic drug with epinephrine, which has a vasoconstrictor effect, when its concentration in the tissues decreases, the vessels dilate and stopped bleeding can resume, i.e. Early secondary bleeding may occur. Late secondary bleeding occurs after several hours or days.

CLASSIFICATION

■ Primary bleeding - bleeding does not stop on its own after surgery.

■ Secondary bleeding - bleeding that has stopped after surgery develops again after some time.

CLINICAL PICTURE

Typically, socket bleeding is short-lived and occurs within 10-20 minutes. stops on its own. However, a number of patients with concomitant somatic pathology may develop long-term hemorrhagic complications immediately after surgery or after some time due to washout or disintegration of the blood clot.

DIFFERENTIAL DIAGNOSTICS

When determining the indications for hospitalization of a patient at the prehospital stage, differential diagnosis of bleeding from a tooth socket with the following diseases is necessary.

■ Bleeding with concomitant systemic diseases(hemorrhagic diathesis, acute leukemia, infectious hepatitis, arterial hypertension, diabetes mellitus and other diseases) or after taking drugs that affect hemostasis and reduce blood clotting (NSAIDs, antiplatelet agents, anticoagulants, fibrinolytic drugs, oral contraceptives and other drugs), which requires urgent hospitalization and assistance in a specialized hospital.

■ Bleeding caused by trauma to the gums, alveoli, oral mucosa, pathological processes in the maxillofacial area (trauma, inflammation), which can be stopped at home or by a doctor at an outpatient surgical dental appointment.

ADVICE FOR THE CALLER

■ Determine blood pressure.

□ If blood pressure is normal, apply a sterile gauze pad to the bleeding area.

□ If blood pressure is high, it is necessary to take antihypertensive drugs.

ACTIONS ON CALL

Diagnostics

REQUIRED QUESTIONS

■ What is the patient's general condition?

■ What causes the bleeding?

■ When did the bleeding occur?

■ Has the patient rinsed his mouth?

■ Did the patient not eat after surgery?

■ What is the patient's blood pressure?

■ How does bleeding usually stop when there is tissue damage (cuts and other injuries) in a patient?

■ Is there fever or chills?

■ How did the patient try to stop the bleeding?

■ What comorbidities does the patient have?

■ What medications does the patient take?

INSPECTION AND PHYSICAL EXAMINATION

■ External examination of the patient.

■ Examination of the oral cavity.

■ Determination of heart rate.

INSTRUMENTAL RESEARCH

Blood pressure measurement.

INDICATIONS FOR HOSPITALIZATION

With persistent heavy bleeding, which cannot be stopped on an outpatient basis, the patient must be hospitalized in a dental surgical hospital. If the patient has a history of blood disease after dental care, hospitalization in the hematology department is necessary.

■ If the bleeding is caused by trauma to the gums, alveoli, oral mucosa, or pathological processes in the maxillofacial area (trauma, inflammation), after stopping the bleeding, it is recommended not to take hot food or drink during the day.

■ To improve blood clotting, you can prescribe ethamsylate, calcium chloride, calcium gluconate, aminocaproic acid, aminomethylbenzoic acid, ascorbic acid, menadione sodium bisulfite, ascorutin*. If blood pressure is elevated, antihypertensive therapy is necessary.

COMMON ERRORS

■ Insufficiently complete history taking.

■ Incorrect differential diagnosis, leading to errors in diagnosis and treatment tactics.

■ Prescribing drugs without taking into account the somatic condition and the drug therapy used by the patient.

METHOD OF APPLICATION AND DOSES OF MEDICINES

The method of administration and dosage of the drug are given below.

■ Etamzilate is prescribed orally at a dose of 250-500 mg/day in 3-4 doses, IM and IV at 125-250 mg/day.

■ Calcium chloride is prescribed orally in 10-15 ml of 5-10% solution, intravenously in a dose of 5-15 ml of 10% solution, diluted in 100-200 ml of 0.9% sodium chloride solution.

■ Calcium gluconate is indicated orally at a dose of 1 g 2-3 times a day, IM and IV 5-10 ml of 10% solution per day.

■ Aminocaproic acid is prescribed orally in a dose of 2-3 g 3-5 times a day; 4-5 g are injected intravenously over 1 hour into 250 ml of 0.9% sodium chloride solution.

■ Aminomethylbenzoic acid is prescribed orally at a dose of 100-200 mg 3-4 times a day, topically in the form of a sponge.

■ Ascorbic acid is indicated orally at a dose of 50-100 mg 1-2 times a day, IM and IV 1-5 ml of 5-10% solution.

■ Ascorbic acid + rutoside (ascorutin*) is prescribed orally, 1 tablet 2-3 times a day.

CLINICAL PHARMACOLOGY OF DRUGS

■ For any bleeding, the cause must be determined. If the bleeding is due to local causes, you should wash the hole with a solution of hydrogen peroxide, dry it with a gauze swab and perform a tight tamponade with gauze soaked in a hemostatic drug (thrombin, etc.) or turunda with iodoform * or iodinol *.

■ In case of late secondary bleeding, the hole is washed with a solution of an antiseptic drug, dried and filled with turunda with a hemostatic drug and an antiseptic. Tamponade can slow down healing, so the tampon should not be left in the socket for a long time. To increase blood clotting, you can prescribe ethamsylate, calcium chloride, calcium gluconate, aminocaproic acid, Ambien*, ascorbic acid, menadione sodium bisulfite, ascorutin. If blood pressure is elevated, antihypertensive therapy is necessary.

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Bleeding after tooth extraction

Alveolitis is an inflammation of the jaw socket as a result of its infection after traumatic tooth extraction. In this case, damage to the socket itself and crushing of the surrounding gums are often observed. It can also develop as a consequence of a violation of the postoperative regimen, when the blood clot is washed out of the hole by actively rinsing the mouth, microbes penetrate into it, causing inflammation. Food getting into the socket and lack of oral hygiene also contribute to the occurrence of alveolitis.

Alveolitis is an inflammatory disease of the walls of the alveoli. May be a manifestation of both pathological processes of a systemic nature (diseases connective tissue, weakened immunity, etc.), and as a result of exposure to dust, allergens, toxic substances, and infectious agents penetrating into the alveoli during breathing on the walls. Primary symptoms of alveolitis, as a rule, correspond to those observed in acute respiratory diseases However, with a prolonged course of alveolitis, it is accompanied by profound changes in the structure of the lung tissue, followed by its degeneration and an increase in the phenomena of severe respiratory failure.

Normally, healing of the socket after tooth extraction is almost painless and 7–10 days after removal the socket becomes epithelialized.

Causes

Alveolitis can also develop as a consequence of a violation of the postoperative regimen, when the blood clot is washed out of the hole by actively rinsing the mouth, microbes penetrate into it, causing inflammation. Food getting into the socket and lack of oral hygiene also contribute to the occurrence of alveolitis.

Alveolitis can also be caused by:

• pushing dental plaque into the socket during tooth extraction surgery;
• unsatisfactory treatment of the hole after tooth extraction (bone fragments, cyst, granuloma, granulations were not removed);
• violation of the rules of asepsis and antisepsis during tooth extraction;
• reduced patient immunity;
• traumatic (complicated) tooth extraction.

After a tooth is removed, the hole fills with blood. The bleeding stops a few minutes after the tooth is removed. The blood in the socket coagulates and a blood clot is formed, which is a biological barrier that protects the socket from mechanical damage and infection by oral fluid.

If for some reason the blood clot is destroyed, this leads to inflammation of the walls of the socket.

Classification

Symptoms

The disease often begins 2–3 days after surgery (the appearance of severe pain in the area of ​​the socket of the extracted tooth, an increase in body temperature to 37.5–38.5 ° C.) Gradually, the pain intensifies, spreading to neighboring parts of the head, and a foul odor appears from the mouth.

The submandibular areas enlarge and become painful The lymph nodes. The duration of the disease is up to two weeks.

The gum near the hole is inflamed, swollen, and looks reddened. There is no blood clot in the socket, the socket is covered with a gray coating, and purulent discharge is often observed. In the submandibular areas, the lymph nodes enlarge and become painful.

Diagnostics

Treatment

Scraping the hole, treating it with a solution of hydrogen peroxide, proteolytic enzymes and drainage. Often resort to repeated curettage. Analgin, amidopyrine, and physiotherapy are prescribed.

Treatment of alveolitis at home before consulting a doctor, which is necessary when the symptoms described above appear, includes frequent rinsing of the mouth with a warm solution (3%) of hydrogen peroxide, baking soda (1/2 teaspoon per glass of water), and painkillers. Alveolitis can be complicated by osteomyelitis of the socket, which lengthens the time of illness and rehabilitation of the patient.

Forecast

The prognosis is favorable, disability is 2–3 days. Often, socket pain lasts for 2–3 weeks. Prevention: atraumatic tooth extraction.

The caries classification system is designed to categorize the degree of damage. It helps to choose a technique for further treatment.

Caries is one of the most famous and common dental diseases throughout the world. If tissue damage is detected, mandatory dental treatment is required to prevent further destruction of dental elements.

General information

Doctors have repeatedly made attempts to create a single, universal system of classifications of human diseases.

As a result, in the 20th century the “International Classification - ICD” was developed. Since the creation of the unified system (in 1948), it has been constantly revised and supplemented with new information.

The final, 10th revision was carried out in 1989 (hence the name ICD-10). Already in 1994, the International Classification began to be used in countries consisting of World Organization Healthcare.

In the system, all diseases are divided into sections and marked with a special code. Diseases of the oral cavity, salivary glands and jaws K00-K14 belong to the section of diseases digestive system K00-K93. It describes all dental pathologies, not just caries.

K00-K14 includes the following list of pathologies related to dental lesions:

• Item K00. Problems with development and teething. Edentia, the presence of extra teeth, abnormalities in the appearance of teeth, mottling (fluorosis and other darkening of the enamel), disturbances in the formation of teeth, hereditary underdevelopment of teeth, problems with teething.
• Item K01. Impacted (sunk) teeth, i.e. changed position during eruption, in the presence or absence of an obstacle.
• Item K02. All types of caries. Enamel, dentin, cement. Suspended caries. Pulp exposure. Odontoclasia. Other types.
• Item K03. Various lesions of hard dental tissues. Abrasion, enamel grinding, erosion, granuloma, cement hyperplasia.
• Item K04. Damage to the pulp and periapical tissues. Pulpitis, pulp degeneration and gangrene, secondary dentin, periodontitis (acute and chronic apical), periapical abscess with and without cavity, various cysts.
• Item K06. Pathologies of the gums and the edge of the alveolar ridge. Recession and hypertrophy, trauma to the alveolar margin and gums, epulis, atrophic ridge, various granulomas.

Item K07. Changes in bite and various jaw anomalies. Hyperplasia and hypopalsia, macrognathia and micrognathia of the upper and lower jaws, asymmetry, prognathia, retrognathia, all types of malocclusion, torsion, diastema, trema, displacement and rotation of teeth, transposition.

Incorrect jaw closure and acquired malocclusions. Diseases of the temporomandibular joint: looseness, clicking when opening the mouth, painful dysfunction of the TMJ.

• Item K08. Functional problems with the supporting apparatus and changes in the number of teeth due to exposure external factors. Loss of teeth due to injury, extraction or disease. Atrophy of the alveolar ridge due to long-term absence of a tooth. Pathologies of the alveolar ridge.

Let's take a closer look at section K02 Dental caries. If a patient wants to find out what entry the dentist made in the chart after treating a tooth, he needs to find the code among the subsections and study the description.

K02.0 Enamels

Initial caries or chalk stain is the primary form of the disease. At this stage, there is still no damage to hard tissues, but demineralization and high susceptibility of the enamel to irritation are already diagnosed.

In dentistry, 2 forms of initial caries are defined:

• Active(White spot);
• Stable(brown spot).

During treatment, caries in an active form can either become stable or disappear completely.

The brown spot is irreversible; the only way to get rid of the problem is by preparation and filling.

Symptoms:

1. Pain– toothache is not typical for the initial stage. However, due to the fact that demineralization of the enamel occurs (its protective function is reduced), the affected area may experience strong susceptibility to influences.
2. External disturbances– visible when caries is located on one of the teeth in the outer row. It looks like an inconspicuous white or brown spot.

Treatment directly depends on the specific stage of the disease.

When the stain is chalky, remineralizing treatment and fluoridation are prescribed. When the caries is pigmented, preparation and filling are performed. With timely treatment and oral hygiene, a positive prognosis is expected.

K02.1 Dentine

A huge number of bacteria live in the mouth. As a result of their vital activity, organic acids are released. They are the ones responsible for the destruction of the basic mineral components that make up the crystal lattice of the enamel.

Dentin caries is the second stage of the disease. It is accompanied by a violation of the structure of the tooth with the appearance of a cavity.

However, the hole is not always noticeable. It is often possible to notice irregularities only at a dentist’s appointment when a diagnostic probe is inserted. Sometimes it is possible to notice caries on your own.

Symptoms:

• the patient is uncomfortable chewing;
• pain from temperatures (cold or hot food, sweet foods);
• external disturbances, which are especially visible on the front teeth.

Painful sensations can be provoked by one or several foci of the disease, but quickly disappear after the problem is eliminated.

There are only a few types of dentin diagnostics - instrumental, subjective, objective. Sometimes it is difficult to detect a disease solely based on the symptoms described by the patient.

At this stage, you can no longer do without a drill. The doctor drills the diseased teeth and installs a filling. During the treatment process, the specialist not only tries to preserve the tissue, but also the nerve.

K02.2 Cement

Compared to damage to enamel (initial stage) and dentine, cementum (root) caries is diagnosed much less frequently, but is considered aggressive and harmful to the tooth.

The root is characterized by relatively thin walls, which means that the disease does not take much time to completely destroy the tissue. All this can develop into pulpitis or periodontitis, which sometimes leads to tooth extraction.

Clinical symptoms depend on the location of the disease focus. For example, when the cause is located in the periodontal area, when the swollen gum protects the root from other influences, we can talk about a closed form.

With this outcome, no obvious symptoms are observed. Usually, with a closed location of cement caries, there is no pain or it is not expressed.

Photo of an extracted tooth with cement caries

In an open form, in addition to the root, the cervical area can also be destroyed. The patient may be accompanied by:

• External disorders (especially pronounced in the front);
• Inconvenience while eating;
• Painful sensations from irritants (sweets, temperature, when food gets under the gum).

Modern medicine makes it possible to get rid of caries in several, and sometimes even in one, dentist appointment. Everything will depend on the form of the disease. If the gum covers the lesion, bleeds, or greatly interferes with the filling, then gum correction is performed first.

After getting rid of the soft tissue, the affected area (with or without exposure) is temporarily filled with cement and oil dentin. After the tissue has healed, the patient comes back for a second filling.

K02.3 Suspended

Suspended caries is a stable form of the initial stage of the disease. It appears as a dense pigment spot.

Typically, such caries is asymptomatic, patients do not complain about anything. The stain can be detected during a dental examination.

Caries is dark brown, sometimes black. The surface of tissues is studied by probing.

Most often, the focus of suspended caries is located in the cervical part and natural depressions (pits, etc.).

The treatment method depends on various factors:

• Spot size– formations that are too large are prepared and filled;
• From the wishes of the patient– if the stain is on the external teeth, then the damage is eliminated with photopolymer fillings so that the color matches the enamel.

Small dense foci of demineralization usually occur over a period of time with a periodicity of several months.

If the teeth are properly cleaned and the amount of carbohydrates consumed by the patient is reduced, then the future progressive development of the disease may be stopped.

When the spot grows and becomes soft, it is prepared and filled.

K02.4 Odontoclasia

Odontoclasia is a severe form of dental tissue damage. The disease affects the enamel, thinning it and leading to the formation of caries. No one is immune from odontoclasia.

The appearance and development of damage is influenced by a huge number of factors. Such prerequisites even include poor heredity, regular oral hygiene, chronic disease, metabolic rate, bad habits.

The main visible symptom of odontoclasia is toothache. In some cases, due to non-standard clinical form or an increased pain threshold, the patient does not feel this.

Then only the dentist will be able to make the correct diagnosis during the examination. The main visual sign indicating problems with enamel is tooth damage.

This form of the disease, like other forms of caries, is treatable. The doctor first cleans the affected area, then fills the painful area.

Only high-quality oral cavity prevention and regular dental examinations will help to avoid the development of odontoclasia.

K02.5 With pulp exposure

All tooth tissues are destroyed, including the pulp chamber - the partition separating dentin from the pulp (nerve). If the wall of the pulp chamber is rotten, then the infection penetrates into the soft tissues of the tooth and causes inflammation.

The patient feels severe pain if food or water gets into carious cavity. After cleansing it, the pain subsides. In addition, in advanced cases, a specific smell from the mouth appears.

This condition is considered deep caries and requires long, expensive treatment: mandatory removal of the “nerve”, cleaning of the canals, filling with gutta-percha. Several visits to the dentist are required.

Details of the treatment of all types of deep caries are described in the article.

Item added in January 2013.

K02.8 Another view

Another caries is a medium or deep form of the disease that develops in a previously treated tooth (relapse or re-development near the filling).

Medium caries is the destruction of the enamel elements on the teeth, accompanied by attack or permanent painful sensations in the area of ​​the outbreak. They are explained by the fact that the disease has already spread to the upper layers of dentin.

The form requires mandatory dental care, in which the doctor removes the affected areas, followed by their restoration and filling.

Deep caries is a form that is characterized by extensive damage to the internal dental tissues. It affects a large area of ​​dentin.

The disease cannot be ignored at this stage, and refusal of treatment can lead to nerve (pulp) damage. In the future, if you do not get medical help, pulpitis or periodontitis develops.

The affected area is completely removed, followed by restorative filling.

K02.9 Unspecified

Unspecified caries is a disease that develops not on living, but on pulpless teeth (those from which the nerve has been removed). The reasons for the formation of this form do not differ from standard factors. Typically, unspecified caries occurs at the junction of a filling and an infected tooth. Its appearance in other places of the oral cavity is observed much less frequently.

The fact that dead tooth, does not protect it from the development of caries. Teeth depend on the presence of sugar that enters the oral cavity along with food and bacteria. After the bacteria are saturated with glucose, acid begins to form, leading to the formation of plaque.

Caries of a pulpless tooth is treated according to the standard scheme. However, in this case there is no need to use anesthesia. The nerve that is responsible for pain is no longer in the tooth.

Prevention

The condition of dental tissue is greatly influenced by a person’s diet. To prevent caries, you need to follow some recommendations:

• eat less sweets and starchy foods;
• balance the diet;
• monitor vitamins;
• chew food well;
• rinse your mouth after eating;
• brush your teeth regularly and correctly;
• avoid eating cold and hot food at the same time;
• periodically inspect and sanitize the oral cavity.

The video presents Additional Information on the topic of the article.

Timely treatment will help you quickly and painlessly get rid of caries. Preventive measures prevent damage to the enamel. It is always better to prevent illness than to treat it.

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Find out information of interest about any of the types of diseases, their clinical manifestations, methods of diagnosis and therapy, as well as the onset of consequences, today it is possible without resorting to special sources.

The International Classification of Dental Diseases ICD-10 is an improved guide where you can find any information on fertility and mortality rates, analyze this data and compare the indicators of many countries at different times. This system allows you to reliably store information and use its data and values.

Very interesting is the way to achieve consensus in the classification, which determines the presence of clear approaches when adding new sections to the ICD. But this does not indicate the lack of meaning of the ICD context, which will allow obtaining reliable information and making a correct diagnosis.

RSDENT service

The RSDENT service is a source that is structured according to the principles of classification of dental diseases and offers an introduction to 14 different sections.

Each of them contains the maximum amount of information about the suspected dental disease. A special feature of the site is its clear structuring into sections, which will allow you to conveniently and quickly find the disease of interest. Infection is a common pathogen, particularly in the dental field.

Infectious diseases are classified according to different signs, including the type of pathogen and the onset of consequences of the disease. More information about this can be found in the first section of the site.

The next four groups will talk about possible formations in the oral cavity, which formed for various reasons and include different ways treatment.

Destabilization nervous system leads to disruption of the facial, hypoglossal and trigeminal nerves. This section will provide a complete list of possible ailments associated with the nervous system.

Poor blood circulation in the body can affect the oral cavity in the form of the development of varicose veins of the sublingual veins, lymphadenitis or hemorrhagic telangiectasia. This section provides information about these diseases in full.

Processes occurring in the digestive system can cause a number of diseases, the development of which manifests itself in the oral cavity. A huge section on “Diseases of the Digestive Organs” explains in detail and carefully possible diseases associated with this system.

The following sections describe dental diseases associated with pathology circulatory system, respiratory, previous injuries, the development of arthrosis, chronic anomalies, as well as infections that cause arthropathy.