Oro-Dental Diagnosis PDF

Elaboration of the oro-dental diagnosis Definition: represents the identification of some diseases based on clinical laboratory data Types of diagnosis Final diagnosis: - is the diagnosis with a high degree of certainty that is formulated when the signs and symptoms are certain...

Elaboration of the oro-dental diagnosis Definition: represents the identification of some diseases based on clinical laboratory data Types of diagnosis Final diagnosis: - is the diagnosis with a high degree of certainty that is formulated when the signs and symptoms are certain - determines the appropriate treatment for the respective condition Differential diagnosis: - is made when the symptoms of a disease are present in other diseases as well - it is established in order to eliminate other close diagnoses by comparing the symptoms of the disease presented by the patient with symptoms of other diseases  Presumptive diagnosis: - is the probable diagnosis and is established by eliminating other conditions in the absence of sufficient information - it is also called working diagnosis because it allows the initiation of preliminary treatment - it will be completed with complementary tests and examinations to establish the final diagnosis It is not always necessary to estabilish a presumptive diagnosis, in many cases there is enough information to make the differential diagnosis and the final diagnosis. Clinical diagnosis: is the diagnosis established based on the signs and symptoms of the disease without the help of laboratory tests and examinations  Laboratory diagnosis: - it is a complete dental diagnosis based only on laboratory examinations - it is comprehensive and includes all diagnoses for the patient's oro-dental diseases such as: dental lesions (dental diagnosis), edentations (edentulous diagnosis), periodontal lesions (periodontal diagnosis), surgical diagnosis, occlusal dysfunctions, temporomandibular joint dysfunctions Emergency diagnosis: - it is necessary for the rapid resolution of oro-dental emergencies such as: pain, infection, bleeding.. It is made after a more detailed clinical evaluation, consisting in identifying the source and the main cause that produced the emergency in order to eliminate its - after resolving the emergency, the doctor will continue the clinical examination to establish the final diagnosis  Periodic control: - is the procedure used to assess the patient's oral health at certain time intervals such as 6 months, 1 year or less (periodic prophylactic control) - in other situations, it follows the evolution of the patient's state of health after the therapy has began; its goal is to evaluate the effectiveness over time of the applied therapy and to evaluate the possible progression of the disease - the time intervals at which the periodic control is made are established by the doctor depending on the oro-dental condition, the local and general status of the patient  The diagnosis is made after going through several stages: The oro-dental diagnosis, like any other diagnosis, involves several factors such as symptoms and signs. Symptoms: - they represent certain changes in the patient's health that he perceives; they are subjective signs that the doctor collects from the patient with the help of the anamnesis - they may represent only a certain condition, be different from other symptoms, but may also be similar common symptoms for several diseases (for example acute pulpit pain has common symptoms with pain from other diseases such as neuralgia, sinusitis of dental etiology) - the symptoms usually appear before the objective signs and are of two types: General symptoms: - fever, chills, headache, asthenia; are symptoms specific to many diseases but which, corroborated with objective clinical signs, have diagnostic value Local symptoms: - are well-defined clinical manifestations in the oro-dental region Clinical similarities: define perceptible, objective manifestations of the disease that are observed at the consultation by trained staff, doctors and sometimes even by the patients Open questions (open-ended questions) are suited for the communicative patient, aware of his problems they have the advantage of allowing the patient to use his words and summarize his point of view they allow the patient to tell the symptomatology, giving him self-confidence and thus generating a good relationship with the doctor. Closed questions (closed-ended questions) are representative for the non-communicative patient, unfamiliar with his health problems. their advantages are: the questions quickly request specific information, useful for an input of additional information, prevent the deviation from the subject of undecided patients, limiting the patient's response strictly to the subject they have the disadvantage that they restrict the patient's ability to speak Control questions may clarify unclear issues (if the patient gives uncertain information)  The medical questionnaire is a list of questions related to general health, which the patient is invited to complete at the first meeting. the advantage is it provides documentation of the patient's medical history in a short time, thus saving time In general, the questionnaires are long, in order to be comprehensive there is also the possibility that some questions are misunderstood or misinterpreted by the patient so the questionnaire will be used only after the doctor has made sure that the patient understands the meaning of the questions, wants to answer them correctly and mark the answers correctly the questionnaire has the disadvantage that it deprives both the doctor and the patient to build a doctor-patient relationship  The combined method (interrogation plus questionnaire) after the questionnaire is completed by the patient, the doctor reads it, and the answers given can be discussed with the patient, thus clarifying the misunderstandings and / or the wrong answers the combined method has the advantage of providing large volume of information collected, that is correct and well summarized The anamnesis includes data such as: Patient identity: name, surname, age, full address, telephone number, e-mail address, occupation (profession), current or previous job, living conditions, family status (married, unmarried, divorced, if he has children) At this stage, information is collected on the patient's level of education, socio-economic status, as well as exposure to certain toxins such as prolonged exposure to physical agents, sun, wind, moisture, industrial pollutants, physical and chemical, stress, usual habits (tobacco, alcohol, drugs) the name and telephone number of the family doctor will be recorded, and the telephone number of the specialist doctor if applicable Reason for presenting to the doctor: the patient is encouraged to describe the reason for coming to the doctor (it is recommended not to interrupt the patient, write the symptoms described, the date of the patinet’s last consultation session or if the patient is at the first session in the office dental) the reason for coming in a dental is usually an emergency and can be: pain, bleeding, infection or a physiognomic problem it can be a functional disorder, the appearance of formations or lesions in the oral cavity,or to request some medical treatments or a prophylactic control The history of the present condition includes: description of the symptoms and signs of the disease from the moment it started (the onset of the disease) until the present moment, chronologically (in order of occurrence) the moment of onset is recorded and also the way in which the disease started, the first subjective signs of the manifestation of the disease and the evolution of the disease the circumstances of the symptoms and the moment of their appearance will be noted, such as: day, night, during the diet, triggered by physical agents (cold, hot), chemical (acids, sour, sweet, concentrated), mechanical agents (mastication), after eating, in physical exertion, in a certain position of the head and body the association of symptoms is also often recorded, as there is not a single isolated symptom local signs will corroborate (associate) with general manifestations if they exist the factors that produce the amelioration or aggravation of the related symptoms are noted  The case history refers to the events, the facts prior to the patient's current condition, and whose research can help establish the diagnosis heredocolateral antecedents concern the health status of the patient's family (diseases from which they suffered): parents, brothers, sisters, children there are pathologies with hereditary predisposition (inherited) and pathologies determined strictly genetically - hereditary diseases (general conditions such as diabetes, hypertension, hepatitis, tuberculosis, and diseases of the dentomaxillary apparatus such as odonto-periodontal lesions, extensive edentations, dentomaxillary abnormalities, occlusion disorders) personal antecedents allow us to assess the general condition of the patient, essential for establishing therapeutic behavior, possibly to correlate certain local pathological manifestations with general causes, and which in turn include: - personal physiological history (chronology of temporary tooth eruption, chronology of permanent tooth eruption) - general and local pathological personal history General personal pathological case history:: the diseases that the patient suffered from in childhood and until now, acute and chronic, immunizations, previous hospitalizations, and adverse drug reactions are recorded. smoking (period, number of cigarettes per day) alcohol consumption if it is under drug treatment, the drugs, doses and time of administration will be recorded  Local personal pathological case history: dental extractions tooth eruption accidents dental, prosthetic, periodontal and orthodontic treatments followed and treatment-related difficulties recent radiographs vicious habits such as finger sucking, interposing objects (pencil) between teeth, posture disorders during sleep, oral breathing, infant swallowing, daytime and nighttime bruxism; these are useful data to outline the etiopathogenic circumstances of some diseases (causes of the disease) it is recorded if the dental treatments were made regularly, at the appointment, or was a symptomatic emergency care or were episodic, sporadic care (less comprehensive treatments).  Examination techniques: The visual inspection or examination includes: passive visualization - passive visual inspection in which the general evaluation of the patient is made active visualization - in which the external aspect is examined: shape, color, symmetry, proportion, contour, size, texture good inspection and good visibility are required for inspection the lighting is very important, generated by the light source of the unit and the dental mirror. During the examination of the oral cavity it lights the dark areas and helps to remove the soft parts the areas that are inspected must be clean and not covered with cosmetics, saliva, bacterial plaque mobile prostheses, glasses must be removed at the time of examination  Palpation is a method of sense (tactile sense and stereometry) deep layers can be examined by palpation, information is obtained about size, consistency, temperature, humidity, compressibility, sensitivity palpation is performed with the fingertips, bidigital, bimanual, or with the dorsal surface of the fingers bimanual palpation is done by gripping the formations between the fingers of one hand and the other (for example buccal floor, submandibular gland) bilateral palpation is used for simultaneous palpation of symmetrical formations (muscles, parotid glands) the temperature change is evaluated with the dorsal face of the fingers, because this area is very well innervated (for example inflamed tissues are warmer)  Mouth probing is palpation with the help of a dental probe or a periodontal probe probing is used to detect cavities using dental probes or to measure periodontal pockets using periodontal probes Percussion is a technique of striking with your fingers or an instrument extraoral percussion is used to detect painful sensitivity in the frontal and maxillary sinuses: place a finger above the sinus and tap lightly with the index finger of the other hand intraoral is used to examine teeth: o for this, the handle of a consultation tool is used, which is used to strike easily in the axis of the tooth o - normally the percussion is painless, the pain appears when a pulpal or periodontal complication occurs (in this case the percussion does not start with the affected tooth) Auscultation is the diagnostic procedure by which sounds are perceived from different structures auscultation can be done with the ear or by intensifying the sound with the stethoscope in the case of ATM, abnormal sounds such as cracking or rubbing may be perceived while the patient closes or opens his  Drug preparation of the patient Dental treatment can cause some patients, emotions, fear and stress reactions therapeutic measures can be more performed more easily in the case of quiet and relaxed cooperating patients your doctor may use additional methods for anxious patients such as inhalation sedation and tranquilizers Tranquilizers they have the role of calming emotional states, anxiety and fear they produce indifference and drowsiness, without influencing sensory perceptions and conditioned reflexes they will be administered one hour before the start of the therapeutic work  Inhalation sedation is a mild form of sedation that uses a mixture of oxygen and hilarious gas, nitrous oxide, administered in the respiratory tract using a mask, which is similar to that for aerosols. It does not create a state of drowsiness, the gas being eliminated quickly through the lungs, and when the treatment ends the patient can resume his daily activities. In case of inhalation the patient is conscious, responds to all stimuli and indications of the doctor Dental treatments in patients with cardiovascular diseases cardiological consultation and the approval of the specialist doctor is mandatory in case of arrhythmias, valvulopathies, heart failure and in patients with anticoagulant medication in patients treated with oral anticoagulants (thrombostop, symptom, marcumar) it is necessary to apply a special protocol to prevent massive bleeding, the medication will be stopped 2-3 days before surgery carefully monitoring the INR test, for values of less than 2.1 (normal 0.8 –1.2); the suture of the wound must be performed and the anticoagulant treatment is resumed the next day. in patients with cardiovascular diseases, in case of bleeding operations (tooth extraction, apical resections) the need for antibioprophylaxis will be taken in consideration the indication for antibioprophylaxis is established according to the risk classes: major, medium or low No local adrenaline anesthetic solutions will be used in digitized patients  Dental treatments in patients with compensated diabetes because the risk of complications in minimal surgery (extractions, apical resections, incisions) is high for patients with diabetes, their preoperative preparation is mandatory: to avoid bacteremia, antibiotic prophylaxis is recommended 2-4 hours before the therapeutic procedure. for the suppression of neuro-vegetative reactions, a minor tranquilizer is administered one hour before the operation. the glycemic value is checked; the blood glucose level above 180mg / dl indicates the postponement of the therapeutic maneuvers until its stabilization. Local anesthetic solutions with elevated vasoconstrictor concentrations will not be used as blood glucose levels increase scheduling is made according to the patient's meal and injection schedule  Dental treatments in patients with liver disease these patients should be treated only with the advice of a specialist: avoiding the use of sedatives in those with liver failure; applying measures to prevent the transmission of infections through blood contamination; interventions on several quadrants will be done in separate sessions, in order to reduce the risk of intoxication with local anesthetics  Hierarchy of treatment sessions according to the general condition of the patient and the type of oral condition the hierarchy of the treatment sessions, and of the approached maneuvers is in full agreement with the general condition of the patient and the type of oral condition the general condition of the patient is a decisive parameter when making the treatment plan In case of the existence of some general ailments (compensated and especially decompensated) the collaboration with the specialist doctor is absolutely necessary and obligatory  Among the diseases that could delay or contraindicate the start of a dental treatment we mention: - cardiovascular diseases (recent myocardial infarction, angina pectoris, heart rhythm disorder, valve prosthesis valvamitral prolapse, pacemaker, uncontrolled hypertension); - blood diseases (leukemia, anemia, coagulation disorder, hemophilia); - diseases of the nervous system (paralysis, depression, psychiatric disorders, strokes); - diseases of the renal system (renal failure, glomerulonephritis); - diseases of the respiratory system (dyspnea, pulmonary emphysema, chronic bronchitis); - liver diseases (cirrhosis, hepatitis); - decompensated diabetes mellitus; - endocrine diseases (thyroid disorders); - HIV, contagious diseases - tumors in the oral cavity, chemotherapy / radiotherapy treatment; - autoimmune diseases (systemic lupus erythematosus, rheumatoid arthritis); - pregnancy (first and last months). Recommendations for the ergonomic approach of patients with different clinical situations: ❖ Patient in good general condition or with conditions in compensated stages and with numerous: - simple and complicated dental / periodontal lesions, root debris - fixed prosthetic restorations to be performed ❖ Patient with general condition affected (by acute or chronic decompensated diseases) and with numerous: - simple and complicated dental / periodontal lesions; - root debris Patient in good general condition and with many simple and complicated dental lesions simple carious lesions located at the level of the 4 quadrants all simple carious lesions located at the level of one quadrant will be completely treated in one session, and in the following sessions the carious lesions located at the level of the other quadrants will be treated simple and complicated carious lesions in case of multiple carious lesions (simple and complicated) the approach of a simultaneous therapy is indicated in the same session we will treat both types of lesions, first the complicated ones (which we treat only temporarily), and then the simple ones (located at the level of a quadrant) we will continue in the other sessions with the treatment of the other simple carious lesions, at the same time carrying out the therapy for the complicated lesions Patient in good general condition and with numerous root debris in special situations, when there are multiple root residues dispersed in the 4 quadrants, it is recommended to perform the dental extractions on the same side in a single session (maxillary and mandibular) the order of performing these extractions: we start with the mandibular arch with the tooth located most distally, continuing with the root situated in the antagonistic quadrant of the maxillary arch with this algorithm we avoid: - multiple treatment sessions; - performing repeated anesthesia; - prolongation of treatment; - affecting the patient's psyche. Patient in good general condition and with numerous fixed prosthetic restorations in the case of fixed prosthetic restorations, the rigorous organization of the treatment session is mandatory, the objectives being: time saving (for doctor, patient and technician), material saving, increased efficiency and comfort for the patient. in the same session will be approached all the hemiarcades that require the application of fixed restorations, the preparation always starting with the distal face of the tooth all the distal faces of the teeth will be approached with the same cutter, the dental cutter will be changed with another one and the same face will be prepared at the level of all the teeth. after the preparation, in the same session, the imprinting of the organic substructures is performed and the application of their protection the duration of these fixed restorations must not be longer than two weeks therefore, a new and efficient method is the CAD / CAM systems, which eliminates several technological stages by shortening the time to complete a work. in the case of the classical method, patients have to make at least three visits to the doctor's office, but with the help of modern computer technology, a single visit is sufficient. Patient with a general condition affected (by acute or chronic decompensated diseases) and with numerous complicated dental / periodontal lesions in these situations we will first approach the dental emergency in a non-invasive way until the general condition is rebalanced. for example: a patient with an affected general condition comes in the office for an acute serous pulpitis; immediately apply a soothing dressing, the following maneuvers taking place after balancing the general condition, maintaining collaboration with the specialist doctor  Hearing aid protection it is recognized that noise is detrimental to health it not only affects hearing, but can have negative consequences for the whole body the noise produced at the level of the auditory analyzer are: hearing fatigue (temporary increase in the threshold of auditory perception following exposure to intense noise, 10- 15 db); it is reversible after a few minutes, hours or days after exposure hearing loss of the right ear (left ear of the left ear) may occur after exposure to short-term but high-intensity noise or vice versa occupational deafness is a permanent and irreversible loss of hearing function due to prolonged exposure to noise  Hearing loss and occupational deafness are among the most common occupational diseases reported nationwide The extra auditory effects of noise are recorded: At the level of the nervous system: dizziness, headache, migraines, decreased attention, fatigue sleep disturbances (deep sleep period decreases, daytime sleepiness occurs) the appearance of mental disorders (psychosis, neurosis, depression) decreased cognitive and intellectual performance At the level of the respiratory system: accelerating respiratory rate short-term breathing movements At the level of the cardiovascular system: accelerating heart rate increase in blood pressure EKG path changes increased risk of myocardial infarction At the level of the digestive tract, the noise determines: the appearance of gastritis, ulcers Also: ❖ interpersonal relationships degrade ❖ it can favor the occurrence of incidents or work accidents ❖ the quality of work is affected  In dental offices, the noises are of origin: external: street traffic, neighbors, children, waiting room, entrance hall, telephones internal : noises related to the daily activity in the office (dental turbine, straight / contra-angle parts, ultrasonic descaling device, compressor, suction, static instruments) In order not to disturb the quality of work activity, a series of organizational measures have been introduced to prevent and limit noise levels. Organizational measures related to hearing protection organizational measures refer to individual hearing protection there are three types of hearing protection each with advantages and disadvantages: 1. Earplugs, 2. internal earphones, 3. headphones (external earphones) Internal earphones a) they are made of foam, rubber or plastic b) they have universal or different sizes: small, medium, large c) some are disposable, others are reusable d) are inserted into the external auditory canal e) very rarely infections or irritations occur in the external auditory canal f) there are also custom-made earphones that provide increased comfort  Headphones (external earphones) a) covers the entire ear and is preferred by some people; b) inside it has a lining with the role of changing or filtering certain noises c) they have a longer lifespan than internal earphones d) the disadvantage of the headphones is that they do not seal well in the case of people who wear glasses e) there are also attached headphones (some earphones are attached to helmets or goggles / visors) on the packaging of the headphones or earphones there is crz (noise reduction class) which is measured in decibels. the higher the number, the better the protection offered. Earplugs a) it resembles very well the internal earphones but they do not enter the external auditory canal but only block it; b) it does not protect as well as internal or external earphones Evaluation of the auditory analyzer these measures include regular medical check-ups and audiometric tests; hearing tests assess a person's ability to hear by measuring their ability to hear sounds centrally audiometric tests can detect the early stages of hearing loss, determine the presence of hearing loss, its type, severity and cause of installation audiometric examination is performed in a noise-free environment (soundproof rooms or cabins) with the help of the audiometer the audiometric examination consists of: liminal tonal audiometry; supraliminary tonal audiometry; vocal audiometry; impedance.  Visual analyzer protection the eye has a very important role in human life and just like the other organs it is subject to fatigue visual analyzer protection aims to: 1) avoid direct contact with aerosols, powders, saliva from the patient 2) reduction of visual fatigue eyes will be protected with special glasses, facial shields, visors The role of eye protection is to physically isolate the skin and eye membranes during operations where there is a risk of splashing / splashing with biological fluids from the patient, limiting biological contamination.  Simple glasses: simple glasses provide partial protection (they prevent only 75% of the particles from reaching the conjunctiva of the eye) because they are open around the nose and on the sides goggles may present as an additional protective element frames with increased width up to close to the pretragian area, eliminating the risk of lateral sources the glasses are made of transparent plastic, they have different shapes depending on the manufacturer, and the facial coverage is limited only to the upper floor of the face. Protective goggles against concentrated light beams: : when using the laser in case of light curing of composite materials Face shields, visors facial coverage is more extensive than in the case of glasses the lateral covering is made up to the pretragian area Protective screens the support of the screen on the spectacle frames is made with the help of clamps  Visual fatigue is reversible (at rest) and can be prevented by an ergonomic organization of work and work environment (appropriate light and color).. The ergonomic organization of the activity refers to: observing a correct working distance the operating field and the instrumentation will be placed in a frame at the level of the operator's elbow, so that the operator's view is perpendicular to the operating field, and the lighting parallel to the direction of view the organization of the workplace will be done in such a way as to avoid the frequent accommodation of the visual analyzer, by placing the instrument in the visual field, at an angle of 40-45 degrees around the doctor or nurse, at a distance of 20-40 cm and in -an angle of 30-60 degrees in relation to the symmetrical plane of the practitioner; teamwork (4-6 hands) to identify the instrumentation in addition to sufficient lighting we will use color codes (easy differentiation of instruments is ensured) Ergonomic organization of the activity in the dental office Staging the activity: the ergonomics of the activity in the dental office presupposes first of all a perfect organization of the activity for each patient. in order for the activity in the office to have a good result, it must be carried out according to a well-established algorithm  1. Patient scheduling: The appointment of the first session lasts 15-30 minutes, the time being necessary for the discussion with the patient / anamnesis and the clinical examination. at the beginning of the first session the patient dominates the dialogue through the information provided The objective of the stage is to establish the causes of the patient's presentation to the doctor the second part of the discussion is controlled by the doctor through questions that converge towards obtaining a presumptive diagnosis The doctor's questions must be clear and simple, keeping boundaries and taking care of the patient's privacy the third stage of the dialogue is also directed by the doctor and its main objective is to inform the patient on the diagnosis, prognosis and treatment modalities. in support of his diagnosis and edification of the patient, the doctor also uses modern methods of exploration; In this dialogue it is important to know the patient's opinion, expectations and hopes  Another important aspect of the dialogue is the investigation of the patient's financial resources, having the obligation to present to the patient all the therapeutic options, with the advantages and disadvantages of each also, the risk associated with each therapeutic operation will be presented, an aspect that is often omitted by the doctor. after establishing the treatment plan, the therapeutic act is organizated The hierarchy is dependent on the type and severity of the condition, and on the number of odonto-periodontal units affected.  Patient scheduling is performed by the physician or by any member of the office team scheduling is done in a diary or on the computer (istoma) it is very important that it is respected by both parties respecting the appointment, the doctor gives the first proof of professionalism, strengthening the doctor-patient relationship patient scheduling depends on: a) pacient; b) doctor; c) dental technician. Patient scheduling is based on: type of dental condition (acute / chronic): if the patient comes for an acute condition (acute purulent pulpitis / serous, acute apical periodontitis, horizontal or periodontal abscess the first meeting represents the first treatment session, and later the other dental / periodontal / prosthetic problems will be solved. the patient's environment (urban, rural when we will perform several therapeutic operations in a single session); patient age (elderly patients will be scheduled in the summer at the beginning / end of the program) professional activity general condition of the patient: Patients with cardiovascular diseases will be brought to the beginning of the program Diabetes patients will be scheduled according to meal times and injection therapy Patients with hvb, hvc, hiv - will be resolved at the end of the program The doctor's appointment depends on: number of scheduled patients (maximum 10-15 patients per day); the work done The technician's schedule depends on technological times for prosthetic restorations the necessary evidence degree of congestion of working time Conclusion ❖ ifunforeseen changes to the schedule occur on any of the days, patients must be notified ❖ Emergencies, pregnant women and children have priority over scheduling.  Definition: damage to muscles, tendons, joints, intervertebral discs, peripheral nerves or vascular system that does not result from an acute or instantaneous event and is installed gradually or chronically the osteo-musculoskeletal manifestations in dentists are numerous and diverse, all being dominated by the pain element, deposting, muscle-tendon tension, compression of the nerve elements pain, stiffness, fatigue, cramps, paresthesias, burning sensation, deviations, deformities, decreased muscle strength, decreased range of motion are the main semiological elements the most common locations are recorded in the cervical spine, The main sufferings encountered in the activity of the dentist are: Spinal cord injury Disc herniation the vertebral disc is made up of two elements: the ring and the nucleus pulposus. Immediately after the growth stops, the structural protein of both components deteriorates, which is followed by the appearance of radial cracks on the surface of the ring. under normal or overloading mechanical conditions, the nucleus pulposus that presses in the anteflexion movement the posterior wall of the ring can initiate its rupture with the expulsion of a disc fragment in the interdisco-ligament space where the root of the spinal nerve is irritated or even compresses it. This pathological condition is called disc herniation disc herniation is manifested by pain in the lumbar and radicular to the heel in the herniation of the l5-s1 disc and to the toe in the l4-l5 hernia. Sometimes there are phenomena of decreased muscle strength with the impossibility of walking on the heel and on the toes. fragmentation and migration of the nucleus pulposus is a "disc herniation", a state of disc damage that is irreversible, sometimes requiring even neuro-surgical treatment  Spine deviations normal vertebral statics records a series of curves in the sagittal plane resulting from the adaptation to the vertical position in conditions of congenital origin, disc herniation, vicious positions kept for a long time, the spine covers pathological aspects which are: Scoliosis - is defined as the deviation of the spine in the frontal plane accompanied or not by the rotation of the vertebral bodies; may be present on the dorsal and lumbar spine. The deformity resonates with the statics and dynamics of the entire spine but also with the function of the thoraco- abdominal organs. Kyphosis - is the most common deviation of the spine and is manifested by accentuating the sagittal curvature; dorsal kyphosis is often found due to some pathological conditions Hyperlordosis - the physiological lordosis of the spine can be increased, which is a pathological aspect. The accentuation of lordosis is found both on the cervical and lumbar level  Peripheral osteo-muscular-articular damage The usual activity but especially the prolonged overload causes a series of changes on the musculoskeletal system with inflammatory or degenerative results. These are: arthrosis arthritis tendinitis and tenosynovitis periarthritis carpal tunnel syndrome muscular cramps  PREVENTION OF BACK PAIN as in all fields of medicine, prevention is more favorable than therapy the activity of the dentist is not only related to the handicap of inappropriate positions, but also to the fact that they are often maintained for a long time. for this reason it is important that the musculoskeletal system is well prepared to face these forces, in order to not reach an unrecoverable situation.  we need proper muscle tone to help us maintain a working posture in conditions of reduced fatigue and greater endurance To prevent Excessive fatigue of the musculoskeletal system back pain: should be avoided sudden and violent movements that can cause muscle-ligament tension should be avoided  In the current conditions, the most common working position is the sitting one In this situation it is essential to keep the lumbar region in an upright position a neutral sitting position, with a minimum of changes, requires: a) a hard and rigid chair with a firm back b) an appropriate height of the chair to allow the knees to be flexed freely, with the feet well supported on the floor c) a firm support for the back, located 10-15cm from the seat d) a straight back with a flat lumbar curvature  A fundamental way to prevent spinal pathology is to perform musculoskeletal exercises. Three types of exercises are recommended: Pelvic exercise - aims to reduce lumbar lordosis and tighten the abdominal and gluteal muscles - from the initial position lying on a hard surface, with the back well glued and with the knees bent, the pelvis is raised keeping the lumbar region supported Pelvic-abdominal strengthening exercise - from the supine position, a partial flexion is performed that is maintained for a while, after which it returns to the initial position. Leg stretching exercise - from the supine position one knee is bent to the chest keeping the other stretched, then both knees are raised holding them close to the chest for 5 seconds, during which time the head is raised and lowered at the end, the legs cross over each other  Conclusion the therapy of improving wrong working habits in order to prevent the back pain is made to correct those elements that cause the pain, among which the defective positions, the wrong movements performing exercises to strengthen the muscles involved in maintaining the correct position is a fundamental means of prevention systematic training should be done to avoid fatigue and muscle disaster  THE BACK PAIN OF THE DENTIST there is no person who at some point does not complain of back pain lumbosacral pain is one of the most common and constant diseases, being a pathology that affects society the dentist belongs to the category of those who currently accuse such suffering In most cases, back pain is not due to organic problems, but to posture incorrect posture, continuous and stressful overwork, favors back pain this causes absenteeism at work, leading to a persistent pathology if appropriate measures are not taken to avoid it. Predisposing factors for back pain can be divided into: A) Work factors, represented by: repeated vibrations - present in our activity repeated movements - there is an obvious correlation between repeated bending and low back pain, as well as between the inclination on one side and the pain on the opposite side B) individual factors represented by: age - the first symptoms appear between 30-50 years different typologies - Eurasian people have a lower pathology than Caucasians constitution - overweight people are more prone to pain C) organizational and psychological risk factors: strict work requirements and low autonomy lack of breaks or opportunities to change work position work at a fast pace as a result of new technologies extended working hours or in shifts reduced job satisfaction In general, all the factors that lead to stress, fatigue, anxiety or other reactions, in turn, increase the risk of osteo-musculoskeletal pathology Back pain caused by movement can occur in three different situations: by abnormal tension on a normal back: this tension can be produced by an extraordinary effort or weight, by force or average weight applied eccentrically or in an unfavorable position, as well as by light force or weight maintained but for a longer period of time by normal tension on an abnormal back: in this situation the force or normal weight acts on a defective structure, with a much diminished dynamics by normal tension on a normal or unprepared back: any physical activity must be prepared to perform a movement with appropriate muscular intensity; this situation is common in our profession  the proper posture is one that does not cause fatigue, does not require effort, is painless over a reasonable period of time and has an acceptable aesthetic appearance various factors, structural anomalies, habitual positions and training intervene in the adult's posture; the posture is inherited from the parents and during childhood it can be modified by training and by socio-cultural and educational situations  from a practical point of view we are interested in the working position; it is influenced by the usual correct or incorrect posture; whatever the back position, it must be straight and in balance with the polygon of the center of gravity in this way the lumbosacral angle will be reduced and the lumbar lordosis will be reduced, loading the joints less, leading to a reduced ligament distension, to a reduced muscular tone and to a reduced fatigue. after any period of prolonged inactivity, a low-impact exercise regimen is recommended walking, swimming, even for 30 minutes can increase muscle strength and flexibility do not bend over while sitting on a chair or standing The lower back can support a person's weight easily when the curvature is reduced when standing, keep your weight balanced on both feet hold your shoulders back change sitting positions frequently or stretch your muscles slightly to release tension Conclusion there is no ideal working position, all positions will eventually be tiring and painful what to look for is always the working position that is more ergonomic and that causes as little fatigue as possible, being very important to change the position after a longer period of time. thus a correct postural management creates the premises of the ergonomic attitude ANTIMICROBIAL AND ANTIVIRAL PROTECTION MEASURES The dental office presents a series of elements that favor the transmission of pathogens, such as: a) dental units are provided with long tubes with many inaccessible areas; b) instrument tables, dental unit lamps have narrow surfaces, angles where hygiene is difficult to perform; c) the air spray causes a massive dispersion of microbes from the patient's oral cavity into the environment; d) the dynamic instrumentation (turbine, right piece, contra-angle) is difficult to sterilize, it cannot be changed after each patient and its disinfection between patients is difficult; e) computer keyboards are good places for microbes to grow  DECONTAMINATION is the way in which the number of germs on an object or on a surface is reduced. This can be done in several ways: Antisepsis is the method by which the destruction or inhibition of microorganisms in wounds, skin and mucous membranes is achieved with the help of bacteriostatic antiseptic chemicals (non-toxic to the skin): ethyl alcohol 70 °, 5% iodine tincture, cationic detergents. Disinfection is the process by which the destruction of 99.99% of pathogenic microorganisms (except bacterial spores) on surfaces, air or objects in the inert environment is pursued and can be achieved by: a. physical means (incineration, boiling); b. ultraviolet rays (disinfection of smooth surfaces and air in cabinets); c. chemical means Sterilization is the process by which any form of microbial life (viruses, bacteria, spores, fungi) is destroyed. Asepsis – involves the application of measures and methods to prevent contamination of a product, object or organism. It is obtained by sterilization and disinfection. GENERAL RULES OF ASESPSY AND ANTISEPSY The modern organization of the medical activity contributes to the decrease of the degree of infection of the office For this purpose we will try to take into account the following: ❖ the separation of the circuit from children and adults, if it can't be done through different cabinets, it's good to do it by scheduling at different times ❖ reducing the number of patients treated daily ❖ the number of people in the office must be reduced to the maximum, the doctor, the nurse and the patient ❖ separation of bleeding and non-bleeding treatments; It would be ideal to have separate offices for surgical operations, maneuvers with a high degree of septicity ❖ starting and stopping water and liquid soap for hand washing to be done by foot pedals or photoelectric cell devices ❖ use as much as possible disposable items (glasses, napkins, paper fields, suction cannulas for saliva); the sharp ones will be stored in a rigid container that will be filled only three quarters of its volume 1) Decontamination, disinfection of the cabinet at the beginning or at the end of the program, the hygiene in the dental office must be performed cleaning is the method of decontamination that ensures the removal of microorganisms (in proportion of 95-98%) from surfaces, objects, along with the removal of dust and organic substances staff who ensure proper disinfection of furniture (cabinets, tables, chairs), equipment (dental unit, various appliances), and all surfaces in the office (sinks, walls, floors) use various substances based on glutaldehyde, formaldehyde, alcohol whose effect is bactericidal, fungicidal, virulicidal and sporicidal  THE FLOOR OF THE CABINET must be covered with polyvinyl foil and not with tiles, because they can retain various microorganisms in the joints between the boards. It should be washed daily with water and detergent at the end of the program. THE WALLS OF THE CABINET covered with paint or washable lime must be decontaminated monthly, by washing with water and detergent. THE AIR IN THE OFFICE (VENTILATION) must be decontaminated by ventilating the office, which is done after each patient or 2-3 times a day, by opening the windows wide. ultraviolet lamps may be used to complete decontamination in the cabinets before the start of the program; these lamps can be fixed or mobile, indicated to function in the absence of man (direct radiation lamps) or in his presence (indirect radiation lamps, shielded). THE DENTAL UNIT (patient's armchair, armrests, headrest, instrument table, unit lamp, spittoon) must also be decontaminated after each patient. Pentru dezinfectia unitului dentar putem folosi doua tehnici: 1) THE FIRST TECHNIQUE USES DISINFECTANTS IN THE FORM OF SPRAY Way of working: a. protect your hands with thick, durable rubber household gloves; b. spray the disinfectant on a paper towel and firmly wipe the smooth surfaces of the dental unit (table, armchair, lamp). If the surface has been contaminated with blood, spray the disinfectant directly and leave it on for at least 10 minutes; c. on each piece of the unit the disinfectant is sprayed and wiped firmly with a paper towel; d. after all the parts of the unit have been disinfected, they are put in their place and once again sprayed disinfectant on the entire dental unit; e. leave for 10-15 minutes for the substance to exert its antimicrobial effect, then remove the excess liquid by dabbing with a paper towel.  2) THE SECOND TECHNIQUE USES DISINFECTANT AS A SOLUTION the working method is similar to the one specified in the first technique, only difference is that a sponge moistened with disinfectant solution is used both techniques are effective microbiologicaly, the disadvantage being that it generates breaks in the activity of the dentist To avoid these breaks and approximate decontamination, it is recommended to apply paper covers, protective foils, made of plastic, with shapes and sizes appropriate to each part of the dental unit, which will be changed after each patient. complete, rigorous disinfection by one of the above techniques must be performed at the beginning and end of daily activity. after the first disinfection, the surfaces of the unit are covered with protective foils that will then change after each patient.  WASTE MANAGEMENT waste management includes all activities of collection, transport, treatment, recovery and disposal of waste the responsibility for waste management activities lies with their generators Types of waste: 1. household waste (non-hazardous) 2. medical waste (hazardous) depending on the degree of contamination and toxicity, they are divided into: a. clinical waste (increased risk of contamination); b. cytotoxic waste; c. radioactive waste. 1. Household waste (non-hazardous) non-hazardous household waste is collected in black polyethylene bags, labeled "non-hazardous waste”. If you don’t have such bags, transparent and colorless polyethylene bags can be used also. the waste does not present a major risk because it did not come into contact with the patient or with his biological products. does not require destruction by incineration; are taken over by the sanitation services 2. Medical waste (hazardous) Depending on the degree of contamination and toxicity, they are divided into: A. Clinical waste (increased risk of contamination) B. Cytotoxic waste C. Radioactive waste each type benefits from a different storage, packaging and destruction / processing regime for clinical waste the "biological hazard" icon is used and for chemical and pharmaceutical waste the appropriate hazard pictograms are used: "flammable", "corrosive", "toxic" A. Clinical waste is represented by: human blood, compresses / blood rolls pathological residues: tissues, bone, teeth sharp items (cutting, stinging): hypodermic syringes, atraumatic needles, scalpel blades, suture needles; unsharpened items: protective gloves, glasses, saliva suction cannulas, patient protection elements Sharp waste storage: it is made in boxes made of materials resistant to mechanical actions: polypropylene the boxes must be provided at the top with a special lid that allows the introduction of waste and prevents its removal after filling, being equipped for this purpose with a permanent closure system (self-locking lid) the lid of the box has holes for inserting the syringe needles and scalpel blades the boxes are yellow with the "biohazard" indicator the storage of unsharpened waste is done in rigid cardboard boxes provided inside with a yellow polyethylene bag, marked with the indicator "biological danger" destruction is achieved by incineration by specialized units approved by the environmental protection departments B. Liquid cytotoxic wastes B. Liquid cytotoxic wastes Waste destruction is also achieved by incineration at 1100 degrees only by specialized institutions. C. Radioactive waste residual chemicals from radiodiagnostic units must be stored (collected) in red containers the destruction of radioactive waste is done by incineration but only in specialized units the packaging in which the collection is made and which comes in direct contact with the hazardous waste resulting from the medical activity is for single use and is disposed at the same time with the contents the color codes of the packaging in which the waste from the sanitary units is collected are: a) yellow - for hazardous waste (infectious, stinging, chemical and pharmaceutical); b) black - for non-hazardous waste (waste assimilated to household waste) the duration of temporary storage will be as short as possible, and the storage conditions will comply with the hygiene rules in force for hazardous waste, the duration of temporary storage must not exceed 72 hours, of which 48 hours inside the unit and 24 hours for transport and final disposal.  TRAINING OF THE DENTIST AND THE NURSE HAND HYGIENE Sanitizing the hands of dental staff is the most important way to prevent contamination or spread of microbial agents: at the entrance and exit of the dental office before using protective gloves after removing the protective gloves before and after the examination of each patient after removing the used protective masks after various administrative activities (decontamination of various surfaces in the office, after handling waste); after passing the hand through the hair after removing jewelry (rings, bracelets) use soap and water for regular washing (15-60 seconds) In cases of urgency, the use of antiseptics as a washing substitute is permitted wiping, drying is mandatory, it is done with a disposable paper towel  Hygienic hand disinfection after washing and drying hands apply an antiseptic, the contact time being between 30 seconds - 1 minute The goal is to destroy the microorganisms present on the skin and a large percentage of the resident flora. for the usual therapeutic maneuvers (clinical examination or non-invasive procedures) you can use simple hand washing with soap and water followed by the use of an antiseptic Surgical hand disinfection after the surgical procedure of hand washing and drying, the antiseptic substance is applied, the contact time being between 3-5 minutes, the hands being permanently moistened with antiseptic The goal is to destroy the existing flora on the skin and a large percentage of the resident flora, in order to reduce the diffusion in the operative site in case of stinging or rupture of the gloves, thus preventing the risk of infection of the operative wound. PRACTICAL RECOMMENDATIONS no special soaps, antiseptic soaps should be used; the best soap is the one tolerated by everyone's skin there are no special antiseptics that can be recommended; the safest and most effective antiseptics are 70% ethyl alcohol and 0.5% chlorhexidine solution in 70% ethyl alcohol do not traumatize the skin of the hand and forearm; skin integrity is very important in our profession it is forbidden to wear rings, wedding rings, watches while working all parts of the hands should be washed evenly; it has been found that the dominant hand is washed less conscientiously recontamination of the hands with a textile towel, touching the tap should be avoided Definitii, termeni: Cleaning is the first mandatory step in any activity or procedure to remove dirt from surfaces including skin or objects, by mechanical or manual operations, using physical and / or chemical agents that are performed in sanitary units, so that the activity to be carried out in optimal security conditions Disinfection represents the procedure for the destruction of pathogenic or non-pathogenic microorganisms on any surface using physical and / or chemical agents Sterilization is the operation by which microorganisms are eliminated, including those in a vegetative state from inert contaminating objects, the result of this operation being the state of sterility Chemical sterilization represents a higher level of disinfection, which is strictly applied to reusable medical devices, intended for invasive maneuvers, and does not support autoclaving, destroying all microorganisms in vegetative form and a large number of spores