Examination patients with diseases in maxilla-facial region

The purpose of the clinical examination of the child is the desire to correctly identify the diagnosis of the disease, which is the key to successful treatment and prevention of disease bol¬nogo. Oral examination - one of the links ob¬sledovaniya child.

Used in dental research methods can be divided into subjective - and objective inquiry of the patient - examination (palpation, zondi¬rovanie, percussion teeth), thermodiagnostics, instrumental (elektrometric, X-ray), laboratory tests (biochemical, bacteriological, immunobiological, blood analysis, histology, cytology, samples: Blistering, histamine, sample Kavetsky-bazaar, allergy tests).

It is considered that the inquiry of the patient and the physical techniques of objective research, based on the perception of our bodies without the use of tools and equipment difficulty are basic. Methods are based on the achievements of modern physics, chemistry, histology, etc. (Rentgenologiches¬koe, electrometric, cytology, etc.) Is considered optional on the grounds that sometimes can be diagnosed without their use.

5.1. Determination of the general condition of the child

Anamnesis.

Toxicosis first half of pregnancy, maternal illness during this period influence the growth and formation of tooth primordia milk occlusion.

Body temperature reflects the general state of the patient. Increase temperatu¬ry (temporary and long-term) often occur in children, making it difficult differential diagnosis. Body temperature rises to vyso¬kih numbers marked in acute stomatitis, acute odontogenic osteomyelitis, lymphadenitis, with growth of malignant tumors (sarcomas Jung and some forms of reticular sarcomas in children).

Objective study of the child, as a rule, begins with an assessment of the state of the skin of the face and body. At the same time pay attention to color, texture and skin turgor, and the presence of skin rashes. Thus, in children with acute herpetic stomatitis, skin rash on the face and paronychia may precede or accompany the underlying disease. Under certain systemic diseases, facial skin and other parts of the body is typical for this disease iz¬meneniya. So, in neurofibromatosis (Recklinghausen disease) area of ​​skin in the pathological focus has brown pigmentation, increased the number of wrinkles, it dramatically reduced turgor. When ectodermal dysplasia violation of the structure of skin tissue clinically expressed in paleness, thinning and su¬hosti, increasing the number of wrinkles due to a sharp decline in turgor. Spetsifich¬nye (dry, keratosis, cracks), changes in the skin on the palmar surface and sto¬pah observed in the syndrome Papillons-Lefebvre. When hemangiomas facial skin within the pathological focus has different colors - from bright pink to purplish-red with a bluish tint.

Inspection of the temporo-mandibular joint start with the definition of the range of motion of the lower jaw. Limited mobility may be due to muscle or vospali¬telnoy scar contractures, ankylosis of temporomandibular joint, the result of a fracture of the zygomatic arch or tumor branches and coronary otro¬stka finally fracture of the mandible. In children, the possibility of excessive podvizh¬nost mandible with hyperextension of the joint and ligament apparatus pri¬vychnom dislocation. The displacement at the time of opening of the mouth of the lower jaw to one side the physician should look on the side opposite to the direction smesche¬niya, pathological lesion in the articular processes or medial pterygoid muscle (inflammatory process, fracture of the articular process, habitual vy¬vih one joint, the articular bone tumor head).

An important when examining a child is to assess the state of periferiches¬kih lymph nodes. It should be noted the number, size, konsis¬tentsiyu (dense, soft, partially softened), mobility, related to neighboring nodes (palpated in isolation, soldered into packages) related to surrounding tissues, skin and subcutaneous tissue (welded or not) chuvstvi¬telnost (painful, painless). Note the sostoya¬nie skin over them: redness, tripe, fistula, etc.

The increase in submandibular lymph nodes observed during exacerbation of chronic pulpitis, periodontitis, ie in the presence of odontogenic hotbed in¬fektsii in the mouth. Submandibular lymphadenitis simultaneously with catarrhal gingivitis is one of the first symptoms of acute gerpetichesko¬go stomatitis in children.

In the overall condition of the patient is important to establish ha¬raktera breath, finding the depth, rhythm, the number of breaths per minute. Shortness of breath occurs when the total of severe intoxication associated with voyapaleni rd or neoplastic process. Slow breathing can be observed in cherep¬no brain injury, concussion, increased intracranial pressure.

A healthy child the number of breaths per minute is not the same in different periods vozra¬stnye: 40-60 in the newborn, a child 1-2 years 30-35, 5-6 years, 25-30, 20-18 over 7 years. At any age in a healthy child on one breath-Com ditsya 3-4 pulse beats.

Pulse in healthy children average filling, regular, age-incidence of neonatal 140-120, a child 4-6 years 105-95, 90-80 over 6 years of heartbeats per minute. In febrile diseases fever on GS is increased heart rate by 15-20 beats.

Increased heart rate observed in acute inflammatory processes, increased with low filling - in acute blood loss; slowdown indicates traumatic brain injury.

Determination of blood pressure produced machine Riva-Rocci with spe¬tsialnoy child cuff. Normally, the blood pressure in young children is not the same: the newborn maximum pressure of 80 16, mini¬malnoe 46 ± 16 mm Hg. Art., in children 1 year - respectively 96 030 and 66 ± 25 mm Hg. Art. By V.I.Molchanovu maximum blood pressure in childhood is equal to 80 mm Hg. v. twice the number of years, minimum, as an adult, so¬stavlyaet about 2 / 3-1 / 2 maximum.

A clinical study of peripheral blood is carried hirurgiches¬kim all patients, as well as children, contact your dentist with different zabole¬vaniyami oral mucosa and periodontal. Picture of peripheral blood of children is age differences.

Important diagnostic and prognostic role in disease sostoya¬niyah plays correctly read CBC.

Increase in the number of white blood cells (leukocytosis) is most common in in-infectious diseases, as in these cases the protective reaction of the organism. Usually increase leukocytosis runs parallel to an active infection. Odna¬ko should not forget that the very serious infectious processes may be bone marrow and develop leukopenia (decrease koliche¬stva leukocytes).

Leukopenia in children is less common than in adults. When leukopenia naru¬shaetsya red blood cells, in this sense, it is always adverse a nice feature. At pronounced leukopenia need to pay particular attention, since it can easily go to agranulocytosis. In general, the prognosis leukopenia favorable.

Determination of the total white blood cell count becomes differential diagnostic value only when comparing it with the data count ley¬kotsitarnoy formula peripheral blood.

One of the major clinical symptoms of formula leykotsitar¬noy study is the so-called formula left shift, i.e. increase in peripheral blood neutrophil immature cells and increased stab cells and young cells appear - myelocytes. This pereme¬schenie blood picture to the left is one of the most important signs of infection in the body, a sign of greater than izme¬nenie white blood cell count. When shifting to the left first increases soderzha¬nie stab cells, then young cells, and finally, there mie¬lotsity. In extreme shift to the left in the peripheral blood may appear promyelocytes, even myeloblasts.

Amendment of the white blood cells in infectious diseases proceeds as follows: 1) in the acute stage of the disease, an increase of polymorphonuclear cells and shift to the left; 2) when the acute effects subside, kolichest¬vo neutrophils decreases and monocytes increases; 3) increased number peri¬od recovery of lymphocytes and eosinophils.

In acute infectious diseases manifested mainly per¬vaya phase, but because in these cases there is mainly neutrophils and shift to the left; the other two phases are in a short time. In chronic diseases in¬fektsionnyh manifested lymphocytosis.

For an infectious disease characterized by the appearance of plasma cells.

Erythrocyte sedimentation rate (ESR) is not specific to any disease, but increase it always indicates the presence of patologiche¬skogo process. In acute inflammation ESR increases after 24 hours and remains increased even for some time after ischezno¬veniya clinical symptoms. Along with the increase in the number of leukocytes and their le¬vym shift ESR is the most reliable laboratory signs of the presence of an inflammatory or infectious process. Increased erythrocyte sedimentation rate at vospali¬telnyh disease usually occurs in accordance with the severity of pato¬logicheskogo process, so in addition to the diagnostic it is also important prognostic value.

Determination of hemoglobin (Hb) is a common laboratory is-route. The reduced concentration of hemoglobin in the blood called oligohronemi rd. What makes it more pronounced the harder the patient's condition.

Along with the definition of hemoglobin count of red blood cells (erythrocytes) - the most important laboratory test. Reducing the number of red blood cells (Oligocene-temiya - eritropeniya) characteristic of anemia.

Color index of red blood cells. Thanks to him, you can get pred¬stavlenie of hemoglobin in red blood cells. This test assesses sostoya¬nie red blood.

Biochemical studies of blood for diagnostic purposes are held by in-dividual indications in systemic diseases, diseases of the oral mucosa and periodontal.

Modern Allergology has a large number of specific diagnostic tests to conduct and interpretation of results which ne¬obhodimy specialists - allergists and related conditions.

In the development of dental diseases allergic nature preimu¬schestvennoe importance of delayed-type reaction, although in practice there are stomatologiches¬koy and immediate allergic reactions. By the nature of emerging diseases, methods and types of immune sensitization fakto¬rov allergic reactions delayed and immediate types have printsi¬pialnye differences. However, these reactions can proceed in parallel, nezavi¬simo from each other; delayed-type hypersensitivity can be a ran¬ney stage allergic response, flowing through the immediate type.

Depending on the prevalence of dental disease in the pathogenesis of some type of allergy, as well as the stage of development of the pathological process the same methodology for the identification of hypersensitivity may have different diagnostic value. In connection with this step and for each type allergiches¬kih manifestations of allergy in modern techniques diagnosti¬cheskih defined complexes.

To establish immediate type allergic reactions used: skin tests with bacterial allergens; leiko- and thrombocytopenic tes¬ty; Shelley basophilic test based on determination of the damaging dey¬stviya allergic to basophilic granulocytes; hemagglutination reaction to Boyd, is to identify the agglutination of red blood cells under the influence of syvo¬rotki homologous to the antigen adsorbed on their surface.

Characterized by delayed type reactions, usually lack any cellular or humoral antibodies.

For this type hypersensitivity diagnosis currently used shiro¬ko allergic skin sample reaction leykotsitoliza test blast transformation of lymphocytes and other small.

Dermatology and allergy tests. In the study of the child's pediatrician or allergo¬loga may be held skin-allergy tests. As allergens is¬polzuyut hemolytic streptococcus, staphylococcus, E. coli and Proteus.

Allergens injected intradermally on the inner surface of the forearm in koli¬chestve 0.1 ml at a distance of 5 cm from each other. The reaction at 24 hours. Di¬agnosticheskoe have positive value and rezkopolozhitelnye reaction.

In order to establish the indications for specific desensitization ispolzu¬yut as laboratory methods: leykotsitoliza reaction, the test-blasttransforma of small lymphocytes, passive hemagglutination reaction and others.

The methodology of the skin-reaction with allergic aktinolizate. On internal surface of the forearm, near the elbow joint, the right and left internal 

rikozhno administered diagnostic aktinolizat in a volume of 0.3 ml. To control ot¬stupya 8-10 cm from the first injections are administered the same dose of the sterile meat-peptone broth (pH 7.0). The result of the reaction is evaluated after 24 hours.

Reaction leykotsitoliza. Carried out according to the procedure and P.P.Saharova E.I.Gudko¬voy. Blood taken from patients in finger volume of 1 ml in a sterile tube, 0.3 ml soder¬zhaschuyu rasvora 5% sodium citrate.

0.15 citrated blood is dispensed into 5 ml vials (number of subjects al¬lergenov 1 vial - control). In 4 tubes allergens added 1 drop (or 0.05 ml) dose of 10 cutaneous doses: hemolytic streptococcus, staphylococcus ge¬molitichesky, E. coli, Proteus, the control probir¬ku - 0.05 ml of buffer solution (pH 8 , 0). The tubes are thoroughly but gently mixed and placed in a thermostat for 1 hour. (37 ° C).

Then, from each tube was prepared by 3 strokes that paint method Kryu¬kova or Romanovsky-Giemsa and examined under an immersion system with increasing 10x90. Leukocyte count (100 cells) is carried out in sections where the leukocytes were isolated from the erythrocytes.

Allergen, which has a specific action, destroying at least 14% of leukocytes. In the control destroyed leukocytes should be no more than 10.

Test blast transformation of small lymphocytes. Carried out to determine the number of transformed cells in influenced by blasts antigens. Counting is performed at 1000 cells of lymphocytes and the result expressed in pro¬tsentah. For this test, blood is taken from a vein in an amount of 5 ml.

Clinical experience suggests that the development of recurrent stomatologi¬cheskih diseases in children may play a role food allergens that pro¬yavlyayutsya alone or combined with bacterial-toxic allergies.

The most affordable way to identify this etiological factor yav¬lyaetsya filling special medical history, which allows to determine the disposition of the body al¬lergicheskuyu child, and keeping a food diary, which is an exemplary diagram and instructions developed by the Laboratory of Allergy AMS USSR and can be obtained at the allergist (tab. 6 ).

Table B chart conducting a food diary

Date and Time Diet Products Symptoms to treat itching for power to Ms. Where? rash, blisters. Where? swelled up a little cavity-to-Ms. Where? feeling the heat. Where? what? how much? what? how much?

Headache. Where? General symptoms sostoya¬nie Le car-tion-changing, of

hoarse voice-cavity zatrud¬nenie respiratory-of-tion made difficult swallowing and vomiting. What time? stomach ache

Where? Burch-Chair of the stomach. What time? in the nose

As additional methods of diagnosing food allergies based on a food diary can recommend leykopenichesky index Vidal-in-Ghana and thrombotic thrombocytopenic test. Skin tests in this case are less di¬agnosticheskoe value.

Leykopenichesky index Vidal-Vaughan performed with provocative zavtra¬kom. Fasting determine the number of leucocytes in 1 ml of blood through the re-hour count the number of leukocytes, while the difference does not exceed 300 cells per 1 ml. Then the patient eats 50-100 g allergenic foods. After 30-40 min. again count of leukocytes in peripheral blood. The sample is considered positive if the number of leukocytes after pri¬ema food allergens to decrease by 1,000 cells or more. In healthy people, naobo¬rot, after a meal usually white blood cell count increases (so-called Vai digestive leukocytosis).

Thrombocytopenic test. First, count the number of platelets in peripheral blood ne-fasting, and then again after 50, 60 and 90 min. pro¬vokatsionnogo after breakfast. The test is considered positive if the number of trombo¬tsitov reduced by 15-25% after administration of allergenic breakfast.

Biopsy

Biopsy - vivo excision tkayey for later gistologi¬cheskogo study in order to establish the diagnosis. The following types of bi¬opsy: open, puncture and aspiration.

The most common method of open biopsy, comprising isseche¬nii with a scalpel or a portion of the entire pathological tissue under anestezi¬ey. Coagulate the wound surface, it is possible to impose a 1-2 catgut suture. Is¬sekaemy block material should contain not only the pathological tissue ocha¬ga, but peripheral areas surrounding together with a part apparently neizme¬nennyh tissues.

Biopsiruemy piece of tissue should not be subjected to unnecessary injury or rastya¬zheniyu compression and size, with few exceptions, should not be me¬nee 1 cm3.

Fixation material is carried out in a clean glass container with a ground prob¬koy.

Fixing the amount of fluid to exceed the amount fixed by mate-rial at least 10-20 times.

In an accompanying form indicate the name of the institution's name, child's name, age, gender, medical history number, a brief clinical data and diagnosis. Form must be dated and signed by the doctor.

With biopsy trocar different diameter column removed tissue a few millimeters thick, which is embedded in paraffin and celloidin.

Aspiration biopsy produce a thick needle. The resulting material is punctate, which can be subjected only sitological study.

Byopsiynoe study in some cases can be performed ex-friction within 20-40 min. Express biopsy is usually done at the beginning of ope¬ratsii providing for removal of the tumor. On diagnostic and postoperative biopsy Zion response can be obtained in 2-3 days. And the study of hard tissues of the tooth or bone - only 5-7 th day.

5.4. Cytological examination

Cytological method consists in studying cellular elements, structural features and combinations. Material for the study can be polu¬chat via print, scraping, puncture and rinsing the mouth for oral liquid sludge.

Smear mark was prepared as follows: student's gum nare¬zayut narrow columns with a working part of 5x5 cm and sterilized by boiling. Is Followed-site in the mouth with gauze and dried him with gum-imposes. Thereafter, the resultant material was printed onto a dry glass obezzhi-Renn, causing 4-8 prints. This way you can get only in surfactant, it separates the cells.

Scraping from different parts of the surface under study done with the help of me-metallic spatula or spoon kyuretazhnoy.

Punctate obtained by introducing into the study area the needle, put on dry ste-sterile syringe. Gaining material and placed on a glass slide, distribution, Breaking up with a thin layer with another slide.

Oral liquid precipitate obtained by successive rinsing in saline oral cavity. In special tsentrifugiru¬yut tubes, the supernatant was decanted and the pellet drop placed on a microscope slide. The method for producing a material can be YASYNIVSKY uses van leukocytes for determining active and for rapid diagnosis VJ retroviral diseases by immunofluorescence.

Detection of specific cellular elements during tsitologiche¬skogo study may have diagnostic value. So, akantolitiche-cal cells is small in size and have large, "monstrous" core surrounded by a bright perinuclear and dark blue zona¬mi peripheral cytoplasm.

Giant cells are formed by ballooning degeneration and acantholysis dystrophy cellular elements, manifested their merger, partial dis-fusion of cell membranes. They differ polymorphism large size. Contain from 2 to several hundred nuclei collected in the center, okra, are suspended in a blue or purple color.

Characterized by tumor cells and cell nuclear polymorphism forms ati pichnye fission frequently found in mitosis them. In tumor tissue, usually found "naked nuclei" due to the instability of the cytoplasm glue-current.

If nonspecific inflammation in formulations exhibit lymphocytes, neutrophils, plasma, epithelial cells are destroyed or imeyu¬schie conventional structure, microorganisms and other elements. Identification of these elements, in fact, has no direct diagnostic value, nevertheless conclude lab "picture nonspecific inflammation" yavlyaet¬sya insufficient. Detailed description of the cytological picture indicating the predominance of certain elements, events completed or perverted phagocytosis, the number of different cells at each stage in the dynamics of investigation-tion allows the dental specialist an idea of ​​the trends in the development process and the effectiveness of its treatment.

Determination of pH of mixed saliva. To determine the concentration of hydrogen ions (pH) using kits saliva litmus. The strips have known a certain scale, respectively, indicated under urov¬nyu pH indicator and standard. A strip of paper is introduced into the child's mouth, where it is evenly moistened with saliva for 3-5 seconds. After removing it, vayut compare with the control. The pH of the mixed saliva of healthy children and co-alkalescent fluctuates from 7.0 to 7.4.

Determination of the temperature of the oral mucosa. To measure the temperature, the oral mucosa used medical elektroter¬mometr TCM-2. Scale thermometer allows registering the temperature in the range from 16 ° to 40 ° C, scale 0,2 ° C. To study the surface Glue dyval-point sensor, and then register indicated by the arrow on the scale of temperature. The temperature of the oral mucosa corresponds tempera-round of a healthy child.

Bacterioscopic and bacteriological tests carried out for the refinement of the causes of the disease, the oral mucosa caused by spe- cific-infection. In the laboratory, which receives material from the mouth of a sick child, you can determine the cause of diseases such proyavlyayuschih¬sya in the mouth, such as syphilis, tuberculosis, gonorrhea, actinomycosis, fungal by-disease.

To collect the material using special sterile tubes. Before taking smears rinse your mouth with warm water without using any pharmaceuticals-governmental rinsing the surface element rashes dry gauze there- Ponomarev. Material taken from the depths of the studied lesions close pro¬birku, up direction, indicating a presumptive diagnosis and otprav¬lyayut to the appropriate laboratory.

The content of lysozyme in the saliva mixed determined by enzymatic li¬zisu thereto sensitive bacteria M.lysodeicticus agar diffusion method (K.A.Kagramanova 1964). As the substrate used in the slurry M.lysodeicticus 1% agar.

M.lysodeicticus agar slurry in an amount of 15 ml is made in a Petri dish. After solidification of the agar cut holes which make 0.1 ml of mixed saliva. The medium was incubated at 37 ° C for 20-24 hours. Due to the diffusion of lysozyme is formed transparent zones. Activity is determined by comparing lizo¬tsima diameters in lysis of bacteria standart¬nymi agar solutions of lysozyme and saliva samples tested.

The average content of lysozyme in saliva of healthy children between the ages of 1 month. up to 6 years 59 ± 41,06 mg / ml.

Determination of interferon in the saliva based on the study of its activity by the cytopathic effect of delaying the test virus. To conduct this issledo¬vaniya 2-3 ml of saliva was collected with a sterile rubber balloon and poured into a sterile test tube. Then, to eliminate microflora added 6% hydrochloric acid to pH 2.0 (as interferon and not inactivated at low pH).

The test material is sent to the competent laboratories, usually with virological offices.

In the saliva of healthy children interferon missing.

Determination of quantitative and qualitative composition of the microflora of the oral cavity (G.A.Shalnova, 1962). Filter paper using stationery dy¬rokola prepared wheels (5 mm diameter), which was sterilized with dry heat for ne¬skolko pieces in paper bags. Disc captured and calcined ostuzhen¬nym forceps is applied to a particular portion of the mucous membrane of the mouth po¬losti. Due to the high hygroscopicity of filter paper impregnated with a secret quickly. Thereafter, once the disk is placed in a test tube with 5 ml of sterile isotonic solution. Then, the tube contents were poured into a mortar and triturated with a sterile pestle until disk milling. This emulsification liquid obes¬pechivaet all microbes residing on disk. On solid nutrient media (cups with IPA, blood agar, etc.) produce seeding OD ml of this suspension. After the necessary incubation in an incubator count the number of colonies and produce them ob¬scheprinyatoy identification method. Knowing the area of ​​the disc (19.6 mm2) and defining therein a mass vpitav¬shegosya secretion by checkweighing ve¬sah on torsion disc before and after the print from the mucosa can compute the number mikro¬bov a certain area of ​​the mucosa and a certain amount of her secret.

Determination of the sensitivity of microorganisms to antibiotic mouth is to establish the minimum concentration of drug podavlyayu¬schey microbial growth. Currently, there are two main methods of determining sensitivity of microorganisms: method of diffusion in agar primeneni¬em method of successive disks and serial dilutions in a liquid or solid medium. To collect the material using a sterile swab after koto¬ry swab in a sterile test tube is sent to the bacteriological laboratory.

5.6. Elektroodoreactional study of dental pulp

In order to determine electroexcitability pulp used by electron-troodontodiagnostiki. Carrying out this method by using ap¬paratov OD-1, OD-2.

The study conducted by a doctor with an assistant, who may be a doctor or a nurse.

After applying the active electrode on the investigated tooth at the corresponding points assistant operator turns the knob potentiometer, increasing the current until the threshold of irritation, and visually observes digital dan¬nye. In the study it is necessary to use a plastic spatula. Thus it is necessary to closely monitor the fact that the active electrode from slipping off the sensitive point. As a rule, the study carried out by direct current. In cases when there is no study tooth sensitivity intact even at very high digital data must change polarity, but sometimes the current view. In case of severe polarization when a change polyar¬nosti can not achieve the goal, move on to the study of excitability with po¬moschyu AC.

In studies carried out carious tooth cavity from the bottom, previously washed posled¬nyuyu well dried (the active elek¬trod should be dry). In teeth with large fillings, when mounds are destroyed, or teeth with large, approximo located carious polostya¬mi study is best done with a seal groove, and in the front teeth - with the lingual side of the tubercle.

Electroexcitability permanent and deciduous teeth varies: in the period pro¬rezyvaniya she lowered (or even absent), with the growth and formation of roots excitability increases, reaching normal values ​​at the time of formation of the root okoncha¬telnogo. Electroexcitability teeth, standing outside the arc, does not differ from that of the teeth facing in the dentition, and corresponds to the period raz¬vitiya tooth.

Electroexcitability teeth affected by caries in primary and secondary, vy¬she than intact teeth. Electroexcitability carious fissures significantly higher than intact.

When deep caries depends not electroexcitability cavity depth, and the state of the pulp.

Electroexcitability pulp with pulpitis reduced and corresponds to 18-20 mA at an initial pulp with a total of 40-50 mA and fibrous pulpi¬te and 80-90 mA at the death of the root pulp.

To obtain data on electroexcitability modified pulp razviva¬yuschihsya teeth, it is recommended as the initial use of indicators in-stroke teeth in the same group on the opposite side.

Increase electroexcitability pulp observed in children with malocclusion (open, deep, and others.). "

Electroexcitability milk teeth poorly understood, due to difficulties in obtaining objective information from children under the age of 3-5 years. Electroexcitability intact pulp of deciduous teeth and teeth with various forms of uncomplicated caries is individual for each child. It does not depend on the state of the pulp (normal, inflammation, etc.) and is determined ste¬penyu resorption roots type baby's nervous system, etc. Elektrovoz¬budimost pulp of deciduous teeth with surface caries is 3-9 mA, 5-10 mA, with an average, and with deep caries 7-12 mA.

X-ray study allows to obtain about 80% of all diagno¬sticheskih indicators on the status of various elements of the teeth-chelyu¬stnoy of facial and cranial.

Many of these indicators can not be properly represented without is¬polzovaniya X-ray method.

However, the risk of exposure to ionizing radiation to the growing body of a child makes use it with caution and with a special vni¬maniem relate to methods and techniques of X-ray examination de¬tey and adolescents.

Radiographs of the teeth-jaw system in children should be made on films of good quality, allowing to reduce the maximum recording time. Extraoral shooting must be done by a stationary X-ray appara¬tov with long focal length (at least 1 m), using usili¬vayuschih screens with high resolution, which also allows rez¬ko reduce the radiation dose. Care must be taken to ensure that the field in which the incident X-rays, was severely limited by a diaphragm and do not exceed the recordable area. Iris field on dental¬nyh devices made filters, nested at the base of the tube-lock-analyzer. It should use a different set of filter openings with different thicknesses depending on the Teeth removable group. Stationary rent¬genovskih devices for optical iris is used tsent¬ratory with sliding doors diaphragms.

On dental devices to be used long tubes, localizers, which allow take X-ray tube to 25-35 cm from the skin, reduce the amount of soft scattered rays, providing both when sialography.

Among other special techniques of X-ray studies in pediatric dentistry rarely have to resort to tomography, contrast excretory ducts of the salivary glands, or blood vessels. Scheme issledova¬niya in these cases depends on the character of pathological changes, but printsi¬pialno study design and methods of protecting children from ionizing izluche¬niya not differ from those of adults.

In recent years, the diagnosis of various strains of the teeth-chelyu-stnoy system and the skull all bo¬lee widely used as nazy¬vaemaya teleroentgenography at ko¬toroy on radiographs proizvo¬ditsya series of anthropometric iz¬mereny to determine the size and ratios of the various divisions of the facial and cranial.

Fig. 18. The scheme of the side-we telerentgenogram facial skull.

N - nazion bone, upper Suturae nasofrontalis; Se - the middle of the entrance to the sella; Go - gonion angle of the mandible; Gn - gnation, the deepest point of the bottom surface of the chin; Pog - pogonion, the most anterior point of the mandibular symphysis; ANS (Sna) spina nasatis anterior - front overhang the bottom of the pear-shaped otver¬stiya; PNS (Snp) spina nasalis posterior - gra¬nitsa hard palate at the intersection with fossa pterygo palatina; A - the deepest point pe¬redney surface of the upper jaw at the vertices of the central incisors; B - the deepest point on the front poverhno¬sti body of the mandible; P - porion, na¬ruzhny ear canal line; N-Se - the length of the base of the anterior cranial fossa: SpP - length of the base of the upper jaw; MT1 (Gn-Go) - the length of the lower body chelyus¬ti; MT2 (Go-P) - the length of the branch. ANB - angle protrusion of the mandible; (5 hectares - angles of the central incisors to the base of the jaw; and - mezhreztsovy angle.

The term "teleroentgenography" refers to a method of shooting at a distance bol¬shom focus film. Te lerentgenogrammoy sni¬mok is produced from a distance of more than 2 m. Therefore, experts are used to tsefalometriches-cal low-power research den¬talnye rentgenoapparaty, pozvo¬lyayuschie remove the film is not more than 1.5 m from the focus X-ray tube (namely this distance is accepted as a standard by the Congress of American orthodontists in 1956), essentially telerentgenogramm not receive.

In practice, most tselesoob¬razno use survey with dvuhme¬trovogo distance. Increased in this case is about 8%.

Another important factor to consider when koto¬ry po¬luchenii telerentgenogramm, yavlyaet¬sya scattering object film. Snima¬emaya side adjacent to the cassette, and the opposite spaced therefrom to

13-16 cm. If the X-ray source is a short film by rasstoya¬nii, diverging beam gives a large increase to the opposite side of a release, which is a source of inaccuracies in the data reduction radiographs.

During the X-ray the patient must be motionless. Po¬etomu necessary to use very short exposure, which is only possible in the presence of powerful X-ray machine. The most suitable sledu¬yuschie shooting conditions telerentgenogramm in children and adolescents: 75-90 kV, 80-110 mA, exposure to 0.3. These parameters provide a minimum and oblu¬chenie during radiography.

Upon receipt telerentgenogramm must use kraniostat, ko¬tory must not only the fixing device providing ne¬podvizhnost skull and allow to label its most important parts. Application kraniostata necessary to obtain a series of identical tele¬rentgenogramm dynamics.

Preparation and analysis of only the side telerentgenogramm that ne¬kotorymi practiced orthodontics - the main source of inaccuracies and false vyvo¬dov at telerentgenologicheskom study.

The only way to overcome these errors is the multi-view teleroentgenography. Should produce images in frontal and lateral projections, and the full study design should include and axial radiographs. In this case, it is necessary to use the rear axial projection, which can be removed with the same focal length as the frontal and lateral radiographs.

Telerentgenogramm shooting in all three projections should be made on the size of 24x30 cm kasse¬tah, fully capturing the entire face and cranium. When installing the head of the test is recommended to use the generally accepted rules of packings (Fig. 18).

On the side telerentgenogrammah addition array skull bone, and should be visible to the soft tissues of the face. With proper selection of shooting modes of the image is clear enough. More reliably coat with soft tka¬ni facial midline any radiopaque mixture easier vse¬go thick suspension of barium sulfate. If necessary, you can contrast the language back and back of the throat Lipiodol. During the shooting should za¬schischat body and gonad area studied using prosvintsovannyh aprons or screens.

Telerentgenogramm calculation can be done in different ways: directly on the x-ray film at contact prints from it or by transferring lines osnov¬nyh skull on tracing paper or graph paper with subsequent izmere¬niyami. Use a ruler and a protractor or a specially designed device made of transparent Plexiglas, combining a ruler and protractor.