Pain is one of the most common and most difficult on subjective perception of dental symptoms. These domestic and foreign literature stating a fact that more than 80% of patients after endodontic treatment there is a feeling «fullness» in the tooth, pain when biting on the tooth, radiating to neighboring teeth or along the branches of the trigeminal nerve. From the pathogenesis point of view, the above manifestations are acute toxic-traumatic neuropathy of the trigeminal nerve. This often leads to an unreasonable removal of a qualitatively and competently cured tooth. A comparison was made of the analgesic activity of ketanov in the relief of pain that occurs after root canal filling, with the analgesic activity of nimesulide in 57 patients aged 20 to 55 years. In acute pain, an analgesic effect with the administration of ketanov appeared within 15 to 20 minutes, with the administration of nimesil, the effect occurred within 30-40 minutes. After a course of treatment, patients in both groups significantly decreased irritability, sleep normalized. Patients believed in the success of treatment, because a decrease or a significant decrease in the pain syndrome reflexively leads to an improvement in the psycho-emotional sphere of patients, which in turn favors long-term remission.
The most common clinical symptom in dentistry is pain. Doctors-dentists of practical health care have to face symptoms that doctors-forensic experts regard as a defect or neurological complication after dental treatment. Quite often there is acute toxic-traumatic neuropathy of the lower alveolar and chin nerve, which occurs when a filling material enters the mandibular canal during treatment of pulpitis or periodontitis of the premolars of the lower jaw [1-3]. During the filling of the canals, the patient has a very intense acute pain in the area of the lower jaw with numbness of the lower lip and chin. In connection with the wide spread and availability of implantological dental care to the population, neuropathies of traumatic genesis occur, the causes of which are mistakes in the setting of implants. One of the earliest manifestations of the above complications is a painful symptom leading to sleep disruption, the inability to fully fulfill their professional duties, fully eat and communicate, that is, to reduce the quality of life of patients. Using the short form (SF-36) as a questionnaire, 86 patients of dental clinics, who according to the medical documentation, had complications after performing dental interventions with different degrees of pain, found that the quality of life in general, with an increase in pain up to 100%, decreases to an average of 60%.
Аннотация: Увеличение числа судебных исков к врачам стоматологам, занимающимся имплантацией, имеет тенденцию к увеличению. Изучено и проанализировано 27 амбулаторных карт стоматологического больного, медицинская документации, заключения судебно-медицинских экспертиз, проведенных на кафедре судебной медицины Военно-медицинской академии им. С.М Кирова. Было выявлено, что во время операции перфорация верхнечелюстных синусов наблюдалась в 37,03%, ниж-нечелюстного канала в 25,93%, поломка инструмента или отлом кортикальной пластинки в 11,11%, осложнения при анесте-зии в 40,74% случаев. Для предотвращения этих досадных инцидентов надо не только следовать качественным нормам ока-зания медицинских услуг, учитывать психологическое состояние пациента, его сопутствующую патологию, но и соблюдать правила врачебной этики и деонтологии. Ключевые слова: имплантаты, неблагоприятные исходы, судебно-медицинская экспертная оценка.В настоящее время отмечается рост числа судебных разбирательств по искам пациентов к врачам не только государственных, но и частных клиник [1,7]. Доля су-дебных исков в области стоматологии достаточно ве-лика и составляет в настоящее время 20 -27 % с тен-денцией к увеличению [3, 4,5]. Увеличение количества жалоб и претензий со стороны пациентов и тенденция к их росту, по нашему мнению, могут быть обуслов-лены внедрением рыночных отношений в здравоохра-нение и медицинскую практику и осознанием пациен-том своих прав как субъектов правового государства, в котором право граждан на здоровье защищено законо-дательно [2, 6, 8, 9].Несмотря на совершенствование стоматологиче-ской имплантологической помощи, до сих пор имеют место дефекты и неблагоприятные последствия в бли-жайшие и отдаленные сроки.Цель. Провести анализ причин, способствующие возникновению ошибок и осложнений в процессе ле-чения в имплантологии на примере частных клиник г.Санкт-Петербурга Материал и методы. Для получения полной и до-стоверной информации об исследуемой проблеме, нами были изучены и проанализированы медицинская документация, заключения судебно-медицинских экс-пертиз, проведенных на кафедре судебной медицины Военно-медицинской академии им. С.М. Кирова. Ана-лиз документации включал в себя 27 амбулаторных карт стоматологического больного, заключения су-дебно-медицинских экспертиз, а также ряд основных документов, определяющих гражданско-правовое ре-гулирование деятельности медицинских работников и учреждений. Все пациенты обращались за медицин-ской помощью в частные стоматологические клиники г. Санкт-Петербурга.Результаты и их обсуждение. Проведя анализ 27 комиссионных экспертиз по искам к частным стомато-логическим клиникам, мы выявили следующее.Осложнения, возникающие в процессе непосред-ственной стоматологической имплантации, были условно разделены нами на три группы: -во время операции (перфорация верхнече-люстных синусов (10 чел.-37,03%), нижнечелюстного канала (7 чел.-25,93%), поломка инструмента или от-лом кортикальной пластинки (3 чел. -11,11%), повре-ждение соседних зубов (2 чел. -7,4%), осложнения при анестезии (11 чел.-(40,74...
Subject. In the practice of a dentist there are patients with complications after dental interventions in the form of post-filling pains and overestimation of fillings, accompanied by intense and constant pain, discomfort and violation of occlusion. Patients turn to the dentist again with complaints of pain in a recently filled tooth, patients note a violation of mastication, loose closing of the jaws, pain in the temporomandibular joint. The subject of this article was the research of the influence of the most common iatrogenic complications in the treatment of caries on the quality of life of patients. Goal — improving the effectiveness of therapeutic treatment of tooth decay, taking into account the dynamics of indicators of quality of life for patients. Methodology. A survey was conducted of 25 patients aged 20 to 40 years who came to the dental clinic complaining of post-filling pains, pain in the temporomandibular joint and incomplete closure of the jaw using the SF-36 questionnaire and the Russian-adapted OHRQoL questionnaire. Clinical examination methods included questioning, examination, palpation and percussion of teeth. Results. After analyzing the results of the adapted OHRQoL questionnaire, it was found that the state of oral health “greatly affects” the quality of life of patients. The average results in a survey of 25 patients amounted to 11.12 points; according to the results of this questionnaire, oral health did not play an insignificant role for any patient. According to the results of the SF-36 questionnaire, quality of life declined on most scales. The largest negative dynamics was noted on a scale of role functioning (RP) of 46 ± 0.03 points out of 100 and vital activity indicators (VT) - 27 ± 0.06 points out of 50. A decrease in the quality of life is caused by a feeling of constant discomfort and pain in the jaw facial area, anxious state of the patient and psychological maladaptation. Findings. Dental health plays a significant role in maintaining the high quality of life of any person. Dentists need to timely diagnose pathologists, choose the right treatment tactics, avoiding mistakes, and prevent complications.
COVID-19 is an extremely severe acute respiratory infection caused by the SARS-CoV-2 coronavirus. This virus infects various organs both through direct infection and through the body's immune response. The presence of a patient in a state of immunosuppression contributes to the development of diseases that can be caused by opportunistic viruses, bacteria or fungi, which under normal conditions do not cause pathology in healthy people without damage to the immune system. The results of examination of the oral cavity in dental patients who have undergone COVID-19 demonstrate a variety of manifestations of dental diseases in the oral cavity. At the moment, there is no direct evidence of what exactly the underlying factor in the development and exacerbation of chronic diseases in the oral cavity after is suffering a coronavirus infection. This may be the virus itself, as well as drugs that patients took during treatment. Due to the widespread spread of COVID-19, the number of dental patients with various diseases of the oral cavity that developed against the background of a new coronavirus infection is steadily growing, among which there are various lesions of the dental pulp, including chronic gangrenous pulpitis. Actual is the problem of effective diagnosis and rational drug therapy in the treatment of this form of pulpitis. One of the reasons causing complications in the treatment of chronic gangrenous pulpitis is the lack of therapeutic complexes that can completely eliminate the inflammatory process. Treatment of pulpitis according to the standard method and only with antimicrobial drugs does not provide sufficient efficiency, therefore, in medical complex, along with etiotropic, it is necessary to use medicinal substances of pathogenetic influence. In the work, based on research, the diagnosis and treatment of chronic gangrenous pulpitis was carried out in 58 patients who had previously undergone COVID-19. Pulposcopic examination revealed elements of Candida yeast-like fungi. The data obtained substantiate the necessity and expediency of introducing an antifungal drug in the treatment of chronic gangrenous pulpitis, as one of the components at the stage of temporary root canal filling during endodontic treatment of a tooth.
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