National medical university of LVIV department of therapeutic dentistry

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Practical lesson|occupation| No 1
Theme: Therapeutic Dentistry as the most important dental specialty, main parts of therapeutic dentistry. Contribution of Ukrainian scientists into the development of dentistry. The aim and tasks of preclinical course of therapeutic dentistry.

Short description of a theme
Therapeutic dentistry is the discipline that deals with the etiology, pathogenesis, clinical manifestations and prophylaxis of teeth, periodontal diseases and diseases of organs and structures of the oral cavity which are subjected to conservative and combinational treatment.

The main parts of therapeutic dentistry:

  • preclinical course;

  • odontology;

  • endodontics;

  • periodontology;

  • diseases of the oral mucosa.

Dental diseases influence the human health and create danger for the spreading of infections inside the body. Some special and somatic diseases manifest in the oral cavity. Dentistry thus is connected with therapeutics, endocrinology, haematology, oncology, dermatology, infectious diseases. In their work dentists use different modern techniques and technologies. All dentists should be good psychologists and also they should be familiar with sociology and economics.

Since 1830, dentistry, as the integral part of the medical education was included at the universities of the Austrian and Hungarian Empire (universities of Vienna, Prague, Krakiv, Lviv). At the beginning of the 19-th century the post of the Professor on dental treatment was introduced in the university. This post was held by Karl Prokip Kaliha – the author of the first Halytsky textbook “Diseases of teeth and methods of their treatment”, published in 1838, in Vienna. His successor, the Professor of Dentistry, Vincent Stransky, who was simultaneously acting as the Director of the Medical Education at the University (1834-1862).

Starting from 1894, the university readership course on Odontology and Dentistry was innovated in the curriculum at the medical department of Lviv University. Andriy Hon’ka and Theodore Bohosevych were at the head of that course by turns. In 1905, the clinical base- odontological ambulatory of the university with the school of dental technicians was founded to the purpose of that course. The Odontological Scientific Society began its activity in 1911.

The first department of dentistry in Lviv was founded in 1913 by A. Cieszynski on the basis of the dental ambulatory that had been functioning since 1905.

A.Cieszynski received a higher medical education in Munich and Berlin. In 1913 having been awarded a title  by the Austrian Ministry of Education he became the professor of the Department of Dentistry and the Head of University Dental Clinic of Lviv Medical Faculty.

Professor A.Cieszynski is well-known as the author of the first world atlas and textbook in radiology, which ran into several editions, the author of local novocaine anaesthesia, radical gingiveclomy by Cieszynski – Vidman – Nejman.

Well-deserved scientific successors were prepared by prof. Cieszynski. One of his desciples was  prof. Lyubomyra Lutsyk, who became the chief of the newly organized Department of Therapeutic Dentistry (Dentistry) in the Lviv Medical Institute in 1958.

Since 1970, professor Yu. S. Chuchmay was at the head of the department. The main direction of scientific research has become the working-out and approbation of treatment methods of inflammatory diseases of periodontium by medical means of the prolonged influence. Prof. G.Chuchmay directed the scientific staff of the department towards  the solution of regional tasks and the problems of preventing  and treating  the main dental diseases, providing the dental care of mother and child, elaborating and approbating the methods of treatment including the prolonged effect remedies and the investigation of the periodontal antioxidizing system.

Since 1994 the Department was headed by prof. S.Kukhta. Under his supervision  the investigations of the antioxidizing system condition in inflammatory periodontal diseases and its pharmacological correction were continued.

Since 2000 the Department of Therapeutic Dentistry is headed by D.M.D. V.Zubachyk. Numerous research works of the Department of Therapeutic Dentistry made a valuable contribution to dentistry. Specifically, the role of microcirculational alterations in the pathogenesis of inflammatory periodontal diseases has been revealed, medicational correction of vitamins A,E,C levels and catalase activity have been suggested.

Students start the education at the department|pulpit| of therapeutic dentistry from the III-rd semester.|proceeds|

The work which is carried out in the preclinical rooms is similar to the treatment of patients in the dental consulting rooms. Starting from their first days in the laboratory the students get used to|by| the place of work|job|, the position|rule| near dental unit|armchair|, they learn how to use drills, cuttings instruments|tool|, to work upright, in a sitting position, in four hands|arm|.

Basic tasks of preclinical dental course:

  1. To become familiar with|study| the equipment of denal room|study|.

  2. To learn|study| dental instruments (types of instruments, their functions, the way of work, sterilization, etc.).

  3. To learn|study| anatomico-phisiological| peculiarities of the structure|building| of teeth, morphological structure and physiological properties|virtue| of dental tissues.

  4. To master the technique of preparation of carious cavities.

  5. To become familiar with kinds|appearance| and properties|virtue| of dental filling materials|fabric|.

  6. To master techniques of filling the carious cavities of different|diverse| localization of all groups of teeth.

  7. To learn|study| modern instruments|tool|, methods and techniques of the manipulation in the cavities of all groups of teeth.

Control questions to|by| practical lesson|occupation|

  1. The development of dentistry from ancient times.

  2. When the official status of dental specialist (dental doctor) has been acknowledged|physician|?

  3. What instruments|tool| and filling materials|fabric| were for the first time developed in dentistry?

  4. Who was engaged in dental| practice in the time of Kyivska Rus?

  5. Since when the dental schools started to develop intensively in Ukraine?

  6. Enumerate the leading modern higher medical educational institutions of Ukraine responsible for the training of dental specialists?

  7. Prominent|remarkable| scientists of Ukraine, their contribution to the development of dentistry.

  8. What is known about the history of development of the department|pulpit| of Therapeutic dentistry of Danylo Halytskyj Lviv National Medical University?

  9. What scientists played a leading role in the organization of dental faculty and specialized departments |profile||pulpit| in Lviv?

  10. Comment on the tasks of therapeutic dentistry, as a basic|main| dental discipline.

  11. Enumerate the main branches of therapeutic dentistry.

  12. What are the main|main| tasks|task| of therapeutic dentistry?

  13. What can be said about the|relationship| relationship of Therapeutic Dentistry with other medical and biological sciences?

  14. How does the therapeutic dentistry interact with other dental disciplines?

  15. In what way do the diseases of teeth and oral mucosa influence upon the general condition of human health.

  16. What is known about preclinical course, basic|main| tasks|task|.

  17. Comment on the role of knowledges and skills obtained in the preclinical course of study for subsequent|consequent| work in a clinic.

Reference literature

  1. Nikolyshyn a.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook is for the students of dental faculties of higher medical educational establishments of IV level of accreditation in two volumes, T.I.– Poltava: Divosvit, 2005.– 392 p.

  2. Borovskiy E.V. Therapeutic dentistry: a textbook is for the students of dental faculties of higher medical educational establishments.– M.: Med. Inform. agency, 2006.– 840 p.

  3. Nikolyshyn a.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook is for the students of dentistry faculties of higher medical educational establishments of IV level of accreditation in two volumes, T.IІ.–Poltava: Divosvit, 2007.– 280 p.

  4. Preclinical course of therapeutic dentistry: course of lectures|fabric| /L.O. Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv, 2002.–159 p.

  5. The methodological manual for|by| practical of therapeutic dentistry /L.O.Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv, 2003.– 98 p.

Practical lesson|occupation| No 2
Theme: Structure of the tooth. Topography of tissues. Histology of the enamel.

Short description of a theme

Human dental system belongs to|by| dyfiodontal type|, which means two changes|changing| of teeth: deciduons bite which consists of 20 teeth, permanent|constant| bite – 32 teeth. Eruption of deciduons teeth begins on the sixth-seventh month|moon| of the life of a child and is completed|end| in two-three years. At the age of 5-6 years the permanent|constant| teeth started to erupt, the process is completed by the age of 13 with full replacement of deciduons teeth by permanent ones|constant|. Anatomic formula of teeth of deciduous dentition – 2.1.2, that means that on each side|flank| of the upper and lower jaws there are two incisors, one canine|fang|, two molars|. Anatomic formula of teeth of permanent|constant| bite is, that means that on each side|flank| of the upper and lower jaws there are two incisors, one canine|fang|, two premolars, two molars|. In the teeth of deciduous and permanent|constant| dentition there is a crown (corona| dentis|), root (radix| dentis|), and neck (collum| dentis|). Inside of each tooth the pulp chamber is located – cavity (cavum| dentis|) is divided into a crown| part|portion| and root canals. Root canals end in the apical area with a narrow apical| openings (foramen| apicis| dentis|) through which|what| the nerves and vessels enter the|login| tooth cavity.

Teeth are formed by both hard and soft|mild| tissues. Hard tissues consist of the enamel, dentine and cement. The bulk of tooth is made up by a dentine which is covered by the enamel in the crown area, and|but| by the cement |what| in the roots of teeth. Soft|mild| tissues are formed by the pulp which|what| fills the internal|inlying| cavity of a tooth (pulp| chamber)|cell|. Teeth roots are fixed in the alveolar sockets by|by means of| the pericementum (or periodontal ligament), which|what| is located in a narrow slit between the cement of the tooth root and the alveolar wall|pantry|. In the area of the neck the teeth are densely|tight| embedded the gums.

The crowns of teeth have several|a little| surfaces. In the group of front teeth the four surfaces can be distinguished: vestibular (facies| vestibularis|), lingual (facies| lingualis|), two contact, one of which|what| medial (facies| medialis|), and|but| second – lateral (facies| lateralis|). The line of convergence of lip|labial| and tongue surfaces forms a cutting edge|place| (margo| incisialis|). In the group of premolars| and molars| the vestibular, lingual, occlusal, and two contact surfaces are distinguished.

Enamel  is the most mineralized tissue of the human body. It consists of 95% of inorganic part, 1,2%  organic part and 3,8%  water. The mineral components of the enamel are calcium phosphate, calcium carbonate, fluorine calcium, magnesium phosphate. Mineral structure is organized in the form of crystals (hydroxy-, carbonate-, chlorine-, fluorineapatites). The crystals of apatites are organized in the form of enamel prisms. The enamel prism  is a structural unit of the enamel. Prisms begin from enamel-dentine junction and diverge in radial direction to the surface of the enamel, forming S-shaped curve.

The organic component of the enamel consists of 58% of albumins, 42%  (lipids|, with the small amount of lactates|, sugars| and citrates|.

Organic substance| of the enamel is distributed evenly as a thin network, but in some|certain| places|seat| it forms original structures (enamel plates, tufts and spindles). These are regions of less mineralized enamel.

As the result of cyclic changes during the development of the enamel prisms (decrease of the mineralization|) lines of Retzius are formed. These lines are seen on longitudinal cuts of the enamel as the yellowish brown bands .

The surface of the enamel before eruption| is covered by a cuticle (reduced epithelium) which|what| after the eruption is quickly worn away and replaced|changes| by a pelicule|, that is|appear| a derivation of protein  carbohydrate complexes of the saliva.

Metabolic processes are carried out due to the presence of hydrate| layer of the connected|couple| ions (OH), which|what| appears on the surface of division between the crystal and liquid in each crystal of the enamel. Apart from connected|couple|, there is free water in the enamel which is located in microspaces| and serves as a carrier|transfer| of molecules and ions in the structure of the enamel.

Control questions to|by| practical lesson |fabric|

  1. What is meant under the term the enamel? Comment on its chemical composition|storage|.

  2. What is the structure of mineral component of the enamel?

  3. What|call| tissues form the structure of a tooth? Give a description of their topography.

  4. What is the enamel prism?

  5. How is the organic component of the enamel represented and in what structures of the enamel there is the greatest amount of organic substance?

  6. What are|stripe| Gunter-Shreger’s lines?

  7. How are the lines of Rettsius formed?

  8. What are the enamel plates, tufts and spindles?

  9. What types of correlation of cement and enamel in the area of the dental neck do you know?

  10. What covers the surface of the enamel after the tooth eruption?

  11. What is|appear| the optimal ratio of ions of calcium and phosphorus in the apatites of the enamel and what happens when the balance is disturbed?

  12. In what way the exchange processes in the enamel takes place?

Situation tasks and test control
1. What is the content of mineral elements in the enamel?

A. 90%

B. 95%

C. 87%

D. 83%
2. What is the optimal correlation of calcium and phosphorus in the crystals of hydroxyapatites|?

A. 1,67

B. 2,43

C. 1,17

D. 2,71
3. In what part|portion| of the tooth enamel the layer is the thinnest?

A. In the area of fissures

B. In the neck area

C. In an aproximal| area

D. On the slopes of cusps
4. Lines which are|appear| the optical phenomenon and are visible in the result of different|diverse| orientation of prisms in the relation to the plane|flatness| of the enamel section:

A. Lines of Rettsius

B. Lines of Owen

C. Lines of Guntera-Shreger

D. Lines of Pikerilya
5. Lines which are|appear| the result of cyclic changes during the formation of the enamel prisms:

A. Lines of Rettsius

B. Lines of Guntera-Shregera

C. Lines of Owen

D. Lines of Pikerilya
6. The thin leaf-like structures in the enamel with reduced mineralization|, which|what| pass from the surface of the enamel to|by| enamel-dentine connection|compound|:

A. Enamel spindles

B. Enamel tufts

C. Enamel plates

D. Enamel prisms
7. Longitudinal formations in the enamel which diverge from enamel-dentine connection |compound| and penetrate into the enamel up to one third of its thickness:

A. Enamel prisms

B. Enamel spindles

C. Enamel tufts

D. Enamel plates
8. Thin „blind” canals| in the enamel which diverge from enamel-dentine junction|compound| and contain|maintain| remnants of odontoblastic sprouts |:

A. Enamel spindles

B. Enamel tufts

C. Enamel prisms

D. Enamel plates
9. What correlation of the cement and enamel is more frequent in tooth neck| area is found more frequently?

A. Cement covers the enamel

B. The edges|place| of enamel and cement are in close contact with each other

C. The enamel covers the cement

D. The enamel and the cement are at some distance from each other
10. What enamel structure proved to be the most resistant to caries|?

A. Carbonic calcium

B. Fluoride of calcium

C. Carbonate apatite

D. Hydroxyfluor apatite
11. The thin acquired organic film on the surface of the enamel, invisible with a naked eye:

A. Dental calculus|rock|

B. Pellicle

C. Soft|mild| dental plaque

D. Primary cuticle
12. What is the odonoglyphics|?

A. Knowledge about the relief of the surface of teeth

B. Knowledge about the structure|building| of the cavity in the tooth

C. Knowledge about tissues which encircle the tooth

D. There is no right answer
13. The chemical analysis of the substance showed that the investigated tissue consists of 95% inorganic material component matter, 1,2% organic material and contains|maintain| 3,8% of water. What type of tissue of a human being it can be|storage|?

A. The cement

B. The dentine

C. The enamel of the tooth

D. Cancellous bone of the alveolar process

E. The bone

14. The roentgenogram made for the patient after the trauma of maxillofacial area reveals the fracture of the tooth hidden by the alveolar bone. Name the part|portion| of a tooth, located in the alveolar and covered by a cement?

A. Dental post|pillar| (columna| dentis|)

B. Root of a tooth (radix| dentis|)

C. Zygapophysis (processus| articularis| dentis|)

D. Leg of a tooth (pedunculus pedicle|)

E. Alveolar process (processus| alveolaris| dentis|)

Reference literature

  1. Nikolyshyn a.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook for the students of dental faculties of higher medical educational establishments of IV level of accreditation in two volumes, T.I.– Poltava: Divosvit, 2005.– 392 p.

  2. Borovskiy E.V. Therapeutic dentistry: a textbook is for the students of dental faculties of higher medical educational establishments.– M.: Med. Inform. agency, 2006.– 840 p.

  3. Nikolyshyn a.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook is for the students of dentistry faculties of higher medical educational establishments of IV level of accreditation in two volumes, T.II.– Poltava: Divosvit, 2007.– 280 p.

  4. Preclinical course of therapeutic dentistry: course of lectures|fabric| /L.O. Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv, 2002.– 159 p.

  5. The methodological manual for|by| practical of therapeutic dentistry /L.O.Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv, 2003.– 98 p.

  6. Borysenko A.V. Dental caries|.– K.: Book plus, 2000.– 342 p.

  7. Dmitrieva AA. Therapeutic dentistry|.– M.: Medpress-inform, 2003.– 896 p.

  8. Pediatric dentistry (Editor prof|. L.O. Khomenko).– K.: Book plus, 1999.– 524 p.

  9. Tsarynskiy M.M. Therapeutic dentistry |.– Rostov: Feniks, 2008.– 508 p.

  10. Therapeutic dentistry (Editor Yu.M. Maksimovskyj).– M.: Medicine, 2002.– 640 p.

  11. Preclinical course of therapeutic dentistry | /E.A. Skorikova, V.A. Volkov, N.P. Bazhenova, N.V. Lapina, I.V. Erechev.– Rostov.: Feniks, 2002.– 640 p.

Practical lesson|occupation| No 3
Theme: Structure of the tooth. Topography and histology of the cement and dentine.

Short description of a theme
A dentine (dentinum)  is a hard tissue, located between the pulp and tissues which are on the external surface of a tooth. A dentine, as well as the enamel, has no cells, blood vessels and nervous fibres. Cells which form a dentine (odontoblasts) are located in the peripheral layer of a pulp.

A dentine is composed of 70-72% of inorganic components, 20% – of organic components and 10% of water. Basic|main| inorganic bondings|compound| are|appear| hydroxy-| and fluorapatites|, carbonic| calcium, magnesium and other. Organic part|portion| of a dentine consists of collagen| type I and noncollagens| (glycoproteins and glycozaminoglycans|).

Basic mineralized |main| substance of a dentine, which|what| consists of bands of collagen| fibres and crystals of inorganic material, is crossed by thin canals (canaliculi| dentales|) in radial direction. Part|portion| of a dentine, located very close to a pulp possesses a low content of mineralsand is called predentin|call|.

In canals of a dentine sprouts of odontoblasts are located| the so-called|so called| Tomse fibres which are submerged in a dental liquid|.

Depending on the direction of collagen | two layers can be distinguished in dentine: external and internal|inlying| (near the pulp|). Radial direction of fibres (fibres of Korf) prevails in an external layer, while in parapulpal layer| tangential (fibres of Ebner) prevail.

Depending on the degree of the mineralization of dentinal matrix there can be distinguished highly mineralized | basic|main| substance (peritubular dentine) which|what| forms the wall of dentinal canals|; medium mineralized substance (intertubular dentine) which is between dentinal canals|, and low mineralized| substance (around odontoblasts sprouts) which is in dentinal canals.

Depending on time and mechanism of origin a few|a little| types of dentine can be distinguished. A dentine which|what| appears during dentinogenesis, before the tooth eruption is called|call| primary. Dentine which|what| appears after the eruption| of teeth is of two types: second|secondary| regular, which|what| is producted in reply to functional stimulis on an intact tooth, and second|secondary| irregular (tertiary) (appears in reply to pathological processes in tissues of a tooth and has no regular structure.

Dentinogenesis sometimes | takes place directly|immediately| in the pulp tissues that leads to the formation of denticles ( dense|tight| compact structures of different|diverse| form|shape| and size|dimension|.

Cement (cementum)  is a hard tissue of a tooth which fully covers the external surface of the root of a tooth. It consists of 50-60% of inorganic components, 23-26%  organic matter and 12% of water. The basic inorganic components of cement are apatites, calcium, phosphorus and other substances. Collagen is the basic organic constituent of a cement.

Depending on the presence or absence of cells|mew| in calcified cement| cellular and acellular cements are distinguished|. Acellular cement covers the neck| equal to one third or half of tooth root, cellular cement is located near the apex|top| of the root, and|but| in multirooted teeth  in the area of bifurcations|.

The basic|main| substance of the cement is pierced by collagen| fibres which diverge in different|diverse| directions.

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