(a) the first test station

Community periodontal index of treatment needs's treatment demand inspection items were added.

The examination time was reduced from 23 minutes to 19 minutes.

The total score ranges from 30 to 24.

(2) the second checkpoint

The assessment items of each candidate are increased from 1 to 3.

The examination time was increased from 17 minutes to 37 minutes.

The total score increased from 40 to 45.

(3) the third test station

The examination items of medical history collection were added, and the examination contents of dentition and X-ray reading were added in case analysis.

The inspection time was increased from 20 minutes to 24 minutes.

The total score increased from 30 to 3 1.

Verb (abbreviation for verb) specific consultation

The first test (***24 points):

1. aseptic operation (4 points, all required)

① Wash hands and wear gloves (required)

Wear hands, wash clothes and trim nails. Wash your hands with soap first, and then brush your hands and arms with a sterile brush dipped in boiling soapy water. At 10 cm, brush your arms alternately from your fingers to your elbows, paying special attention to nail grooves and webbed fingers. Brush three times repeatedly, * * * about 10 minutes. Dry your arm from hand to elbow with a sterile towel, and don't wipe your hands with a towel that has wiped your elbow. Then soak the hands and forearms in 70% alcohol for 5 minutes, and the soaking range is 6㎝ on the elbow. If 70% alcohol is replaced by 1: 1000 bromogeramine solution, the time for brushing hands can be reduced to 5 minutes. Clean the lower arm with disinfectant such as complex iodine and 1/3 twice.

When wearing gloves, remember: after washing your hands and disinfecting them inside and outside, keep your hand posture, your arms should not droop, and you should not touch unsterilized hands, otherwise you should wash your hands again.

② Oral mucosa disinfection (compulsory)

Remove it first and then dip it dry.

Biopsy attention

2. General inspection (3 items, 13)

Any inspection requires adjustment of the seat position (mandatory). Adjustment of the position of the patient's chair: to make the patient comfortable and convenient for the doctor to operate.

① Adjust the backrest of the chair so that the upper edge of the backrest is flush with the upper edge of the patient's scapula to support the waist and ensure the safety and comfort of the patient.

② The patient's head should lean on the treatment chair to prevent the patient's head from moving and being accidentally injured by the instrument.

③ When examining the maxillary teeth, adjust the chair position of the back and head, and lean back slightly, so that the maxillary dentition forms a 45-degree angle with the examination ground plane when the patient opens his mouth.

④ When examining mandibular teeth, the long axis of the patient's head and neck should be in a straight line with the trunk, and the mandibular dentition should be parallel to the ground when the patient opens his mouth.

⑤ Avoid the patient's mouth opening too big, and prevent the facial muscles from being too tense to hinder the examination of the oral vestibule.

Inspection includes

Maxillofacial examination, temporomandibular joint examination, salivary gland examination, oral examination, neck examination, whether the maxillofacial region is symmetrical, whether there are abnormalities, swelling, lumps, etc. Among them, oral examination is the most common, including oral vestibular area, proper oral cavity, occlusal relationship examination, gums, teeth, tongue and palate. Whether the color, arrangement, quantity and shape of teeth, dental caries, residual crowns and roots, and the color, shape and texture of gums have changed.

From the method, it can be divided into visual diagnosis; Inquiry; Percussion; Inquiry; Bite diagnosis; Odor diagnosis, etc.

Visit: Order:

First outside, then inside.

Upper right → upper left → lower left → lower right corner.

Check the main complaint part first, and then check the other parts comprehensively.

① Comprehensive examination: (asking, looking, probing, knocking, touching and loosening teeth) is necessary in clinic, and the difficulty lies in the adjustment of chair position, the purpose and operation method of examination.

What strengthens memory is the content of percussion (never use the end of tweezers, preferably the handle end of metal oral mirror or percussion metal bar), unless the examiner agrees, the end of tweezers can be used for percussion.

② Community demand index for periodontal treatment (CPI)-added in 2009)

It is an oral preparation, which is usually used less by clinicians. It is recommended to remember the form.

Check gingival bleeding, tartar and periodontal pocket depth.

Inspection tool: CPI probe

The key is to clearly understand the index tooth:

It is divided into six sections: exploration and appreciation.

First, the oral cavity is divided into six parts.

17- 14 13-23 24-27

47-44 43-33 34-37

Check10 index teeth over 20 years old:

17 16 1 1 26 27

47 46 3 1 36 37

Check 6 index teeth under the age of 20:

16 1 1 26

46 3 1 36

③ Fill in the checklist: pay attention to details.

3. Special examination (4 points, 0 items in 65438+5, no required items. The examination of infratemporal joint and submandibular gland needs to be relaxed a little, and the examiner generally pays more attention to the examination of pulp, periodontal and occlusion. ):

(1) pulp vitality test:

Reaction of temperature and current

Look: Lesions? Stage? Vigor?

Normal 20-50 degrees, no response.

Temperature test < 10, > 60, healthy teeth first, then sick teeth, first down, then up, then forward.

Compared with adjacent teeth and contralateral teeth with the same name

The results of electrical measurement were compared with those of adjacent teeth and contralateral teeth with the same name.

Pay attention to the changes of aging and physiological state.

Temperature test is divided into cold diagnosis method and hot diagnosis method.

I cold diagnosis uses cold water, popsicles, carbon dioxide or ethyl chloride as cold stimuli.

The stimulus source of thermal diagnosis can be hot water, hot gutta percha or hot metal instruments, and the teeth of metal crown can also be polished with rubber wheel to generate heat for pulp test.

Clinical significance of temperature measurement;

Ⅰ Normal: The response of the tested teeth is the same as that of the control teeth;

Ⅱ sensitivity: the reaction is stronger than that of the control teeth, and the pain lasts for a period of time after the stimulation is removed;

Ⅲ. Delayed pain: That is, it takes some time for the affected teeth to have a painful reaction after the stimulation is relieved, and it lasts for a period of time.

Ⅳ Blunt: The same cold and hot stimulation can cause much less reaction than the control teeth.

ⅴ No response: The tested teeth did not respond to stimulation.

Acute pulpitis is rapid and severe pain;

Clinical significance of vitality test: in the exam, candidates mainly express to the examiner and strengthen their memory.

(2) periodontal probing examination:

Six loci:

The buccal (labial) and lingual surfaces of teeth were recorded in the distal, central and proximal directions respectively.

Four quadrants:

Full-mouth dental examination is generally completed from the right upper posterior teeth in turn.

Check the attachment depth of periodontal pocket and the number and distribution of subgingival calculus.

Requirements: the fulcrum is stable, close to the tooth surface, parallel to the long axis of the tooth, 20-25g, pulling and inserting.

(3) check the occlusal relationship:

normality

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abnormal

This part of the course is very clear, just remember it, without skill.

(4) Examination of temporomandibular joint:

symmetrical

Opening and closing, extension, lateral movement, function, pain, click noise, opening deviation.

Need to pay attention to palpation skills:

Put your little fingers into the external auditory canal and touch forward. Put your thumbs on the outside of the anterior joint of the tragus on both sides, and ask the patient to open and close his mouth to understand the movement of condyle.

(5) Submandibular gland examination (increased in 2009):

Pay attention to the method of joint diagnosis with both hands

Requirements: Two-sided contrast inspection

Inspection requirements: shape, size, texture, saliva secretion.

Focus on inspection sites: catheter mouth, catheter and stones.

4. Professional quality: the teacher gives 3 points as appropriate. It's similar to the clinical major, which is reflected in your operation, clothes, language and attitude.

Second stop exam (***45 points)

No.2 kaodian

1. Basic operation skills:

Exercise 12 test 3,

Assistant 8 points, 3 points, ***33 points (20+ 10+3 bass brushes are required (3 points), and the other 20 points together, 10 points together);

2. Basic first aid techniques:

Practitioners and assistants are both 4 exams and 2 exams.

Obviously, basic first aid operation is the key to keep score (*** 12, blood pressure measurement +X).

Basic first aid techniques include:

1. Measure blood pressure.

2. Take oxygen.

3. artificial respiration.

4. Chest compressions. The content of the exam, like that of a clinician, is the key to maintaining the score.

Detailed basic operation skills:

1. Items that may score 20 points:

Preparation of compound cavities of isolated molars

Pulping operation

Tooth extraction and anesthesia-simulated head model;

Supgingival scaling

Dental preparation for casting full crown of posterior teeth

2. Items that may account for 10.

Dentition impression making

Pit and fissure sealant

Brushing bass is a must (3 points)

Bass brush method-model;

Also known as horizontal vibration method and gingival sulcus method. An effective method to remove plaque near gingival margin and in gingival sulcus.

Key points of operation: parallel first, then form a 45-degree angle, gently press, put the hair tail in the gingival sulcus for a short distance of 2-3 mm, and vibrate horizontally, not leaving the gingival sulcus, at least 10 times, 2-3 pieces each time, and the lingual side and palatal side of the anterior teeth can be placed vertically.

Precautions:

1. Brush the gingival margin of the neck properly, and don't use too much force to avoid gum damage.

2. The distance of the short-distance horizontal vibration toothbrush should not be too long, and it should be controlled at about 2-3 mm. Too long will damage the hard tissue of the tooth neck.

3. Brush your teeth in a certain order to ensure that every part and every tooth surface are brushed without omission.

1. Preparation of composite cavities of molars in vitro

note:

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Second, pulpotomy.

(a) Qualification criteria for intramedullary methods

1. The shape of the inlet hole of the cavity is correct:

The standard entrance hole of maxillary molar is blunt triangle, not in the center of occlusal surface, but in the mesiobuccal tip.

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2. All medullary apexes are exposed.

3. All root canals can be exposed to the direct-view hole.

4. The root canal file can directly enter the top of the root canal.

5. Only the tip of the instrument entering the root canal contacts the root canal wall, and the hole edge and pulp chamber side wall will not hinder or block the instrument.

6. Preserve the tooth tissue to the greatest extent, without operational defects.

(b) Frequently asked questions

In the operation, the operation method may not be standardized, and it is more likely that various defects will occur due to improper preparation.

Frequently asked questions include:

1. The operation method is not standardized.

Improper selection or holding of instruments, no fulcrum; Continuous pressure drilling and grinding, the turbine drill will not cool; The operation sequence is chaotic and the steps are omitted.

2. The shape of the entrance hole is poor, the position is wrong, the shape is not standardized, and the hole is too big and too small.

3. It is impossible to establish a smooth passage into the root canal.

(1) The pulp cavity was not opened, and only 3 ~ 4 pulp holes were drilled at the root canal orifice corresponding to the bottom of the deep dentin cavity, which was mistaken for the root canal orifice.

(2) The top of the pulp chamber is not fully exposed, and the pulp cavity is not fully exposed. When the probe is used to probe the four walls of the small curved end, there is still a place where the probe tip can be hooked.

(3) The dentin collar on the pulp chamber side wall was not removed, which blocked the root canal orifice and even leaked the root canal.

4. Excessive destruction of tooth tissue

(1) The pulp chamber wall is worn too much, forming a depression, and the pulp chamber is beer barrel-shaped, or has steps and perforations.

(2) If the pulp chamber floor is penetrated, the natural shape will be destroyed or even perforated.

Third, supragingival scaling

1. The doctor-patient posture is not good, and the patient's posture is often too high, which is higher than the doctor's elbow, resulting in the doctor's posture being bad and unable to maintain the correct posture.

2. Improper instrument selection in buccal or lingual scaling of posterior teeth leads to incorrect instrument angle in scaling operation.

3. There is no fulcrum when zooming, or the fulcrum is unstable and there is no fulcrum or only the ring finger is used as the fulcrum. This is a very common problem. Therefore, tartar can not be effectively removed, and it will also cause the instrument to slide and form damage.

4. During the operation, the tip of the dental scaler leaves the tooth surface to stab the gums, which should be avoided.

5. The included angle between the scaler surface and the tooth surface is incorrect in operation, and should be kept between 45 and 90, with 80 being the best.

6. Incorrect force is applied during operation, and layers of tartar are scraped on the surface, resulting in a thin layer of tartar remaining on the tooth surface. Pay attention to the elbow and wrist force and remove the tartar in one piece.

7. In the operation of gingival injury during scaling, the tip of the scaler is far away from the tooth surface, especially when it is turned to the adjacent surface, the tip of the instrument is more inclined upward, and the angle between the surface of the scaler and the tooth surface during operation is >; 90. Instability of the fulcrum will lead to slippage of the instrument, which will cause gum damage. Should be carefully avoided.

8. Forgetting to wash or scrub the treatment area with 3% hydrogen peroxide solution after scaling is also a common problem and should be avoided.

Four. Tooth extraction and anesthesia (model)

Pay attention to the concept of sterility and the steps of tooth extraction.

Precautions for tooth extraction:

1. Always pay attention to the concept of sterility in all links and avoid contact with tissues in non-surgical areas, such as lips, cheeks, tongue and other teeth.

2. Complete the operation completely, and don't miss details, such as gingival separation before tooth extraction, avoiding clamping gingival tissue when placing dental forceps, and squeezing the extraction socket after tooth extraction.

3. Pay attention to the protection of soft and hard tissues in the oral cavity, especially the protection of jaw teeth and the protection of soft tissues around the affected teeth when teeth are dislocated.

4. According to the anatomical form of each root, the dislocation of the affected tooth can be completed, which can not only improve the work efficiency, but also prevent accidental root breakage.

5. Preparation of dentition impression

Before proceeding to the next step, be sure to try the tray to find a suitable one:

Precautions:

1. Adjust the head position of the seat position to ensure that the patient is in the most relaxed and comfortable position.

2. Eliminate the patient's nervous mood and move gently.

3. Correct posture, mouth opening impression, dental arch file://c:/docume ~1/admini ~1/locales ~1/temp/msohtml11/clip _ Avoid too much impression material flowing to the pharynx, which will stimulate the pharynx and make the patient feel sick.

Put the back first, then put the front. Muscle functional plastic surgery.

5. Avoid tray compression and tissue damage, and ensure patient comfort and impression quality.

6. Check the quality of the impression, is it complete and clear? Take it all? Moderate edge extension? Bubbles?

Six, the tooth preparation of posterior teeth casting full crown (generally require candidates to bring their own teeth in vitro)

Precautions:

1. Organization protection

During the preparation of teeth, care must be taken to protect the affected teeth and surrounding tissues. If water jet cooling is used, the high-speed turbine grinding is interrupted to avoid irritating the pulp of the affected teeth. When preparing, the visual field should be clear, protect the oral mirror, form a stable fulcrum on the adjacent teeth of the affected teeth, avoid excessive grinding or even pulp exposure, and pay attention to avoid damaging the adjacent teeth, gums and buccal and lingual tissues.

2. Control the amount of tooth preparation. Tooth preparation should not only create enough repair space for the prosthesis, but also ensure that the prosthesis has enough strength, restore the correct axial shape, abutment relationship and occlusal contact relationship, and make the edge tight. However, excessive preparation and stimulation should be avoided to expose the pulp.

Seven, pit and fissure closure

Precautions:

1. Be careful not to wipe the tooth surface after acid etching, because it will destroy the tooth glaze after acid etching and reduce the bonding force. When placing corrosive agent, we should pay attention to the proper amount of acid to avoid spilling out of oral soft tissue.

2. Keeping the tooth surface dry and not contaminated by saliva before sealing is the key to successful sealing. Therefore, it is necessary to ensure that the tooth surface after acid etching is not polluted by saliva during the operation. When the saliva pollutes and etches the enamel, it should be thoroughly cleaned and dried, and the sealant should be applied after repeated acid etching for 60 seconds.

Basic first aid techniques:

First, blood pressure measurement-required test (2 points), test each other between candidates;

Second, take oxygen.

Third, artificial respiration.

Fourth, chest compression

Blood pressure measurement-required (2 points)

Therefore, the correct measurement of blood pressure needs to do the following:

(1) Choose a suitable sphygmomanometer: Mercury sphygmomanometer is commonly used, barometer sphygmomanometer and electronic sphygmomanometer are also commonly used. The cuff is too narrow, the measured blood pressure value is high, and the cuff is too long, so the measured blood pressure value is low.

(2) Choose a suitable pressure measuring environment: Patients should rest for 5- 10 minutes in a quiet environment with suitable temperature, and there should be no excessive restraint between sleeves and arms to avoid pressure measurement after smoking, catching a cold and drinking coffee.

(3) Select the correct pressure measurement step: The patient takes the sitting position with his right arm flush with the sitting right atrium, the upper arm is exposed, the palm is horizontally extended, the elbow is flush with the heart, the upper arm is at a 45-degree angle with the body, the distance from the lower edge of the cuff to the anterior elbow space is 2-3 cm, and then 4.0 kPa (30 mm Hg) is added after the radial artery pulsation disappears, which is the maximum inflation level. If the pressurization is too high, the systolic blood pressure will be too high. If the inflation reaches the level of 40.0 kPa (300 mm Hg), it will lead to "airbag inflation hypertension". Then gradually deflate at a speed of 0.27 kPa (2 mm Hg)/sec,

The first auscultation sound is systolic pressure, and when the pulsation sound disappears, it is diastolic pressure (the old unit blood pressure reading should be accurate to 2 mm Hg). Inflatable compression time should not be too long, otherwise it will easily lead to the illusion of hypertension.

The third test ***3 1 min,

With many contents and many examination items, it is the most competitive stop and the one that is most closely combined with the written test.

1. Medical history collection: oral test, 5 points; I have a medical history of 12 and passed the examination of 1. The assistant recited 7 and got 1. There are many contents and scattered knowledge points, which basically cover common oral symptoms. As long as you recite carefully, the exam is comprehensive, and the goal is 4 out of 5. This test item is simpler than case analysis. And * * * scores a lot, it is not easy to get 5 points, but no matter how many * * * scores, it is not a big problem not to get 3 points, which is nothing more than the current medical history and related medical history.

Definition of medical history collection: through doctor's consultation, understand the reasons and requirements of patients seeking medical treatment, and obtain the information of patients' systematic medical history and oral medical history. This is a medical history collection.

Therefore, no matter what symptoms we encounter in the exam, the current medical history and related medical history are what we need to focus on.

Outpatient medical records include: comprehensive requirements

Name, sex, age, marriage, occupation, place of birth, location of complaint, time, nature and degree, current medical history, relevant medical history, allergic history and physical examination.

X-ray, cold and hot diagnosis and other laboratory tests, preliminary diagnosis and treatment advice, signed by the doctor.

Especially in relation to the mouth and teeth:

Current medical history and related medical history:

The number of teeth (whether the patient can locate), the nature of pain, the inducement, what situation is relieved, the difference between day and night, local or radiation pain, whether it has been treated, whether there is systemic disease, and whether there is a history of injury;

2. Case study: oral English.

In case analysis, we should pay more attention to:

For a case, there must be a primary diagnosis and a secondary diagnosis.

For example, the patient has caused pulpitis after deep caries, and it will be diagnosed as pulpitis according to the case, but it is not enough to say that there is deep caries.

Countermeasures:

1. Conduct a thorough study and investigation of the case. The scope of the investigation has been delimited very small and confidential.

2. Look at the medical records carefully, and don't make a diagnosis first.

Current medical history, medical history, allergic history, physical examination, X-ray, cold and hot diagnosis and other laboratory tests.

Match the information given to you with the knowledge you have learned.

As long as the diagnosis is correct, the next step is a smooth case study. By the way, I took the diagnosis points together. Why? You don't need to use your brain to diagnose the evidence at all, just read out the part of the case you gave the teacher. This is the basis of diagnosis. The later stage of syndrome differentiation and treatment is to compare the memory of candidates, which is equivalent to an essay question. There is no skill in this part, the key lies in memory.