Three-tier system of dental care
The public dental service is divided into three functional levels, each addressing its own specific tasks.
First level Represented by dental departments in multidisciplinary polyclinics, central district hospitals, medical-sanitary units, as well as offices in enterprises, schools, kindergartens, and antenatal clinics. The main tasks are individual prevention, treatment of common diseases, oral sanitation, and basic prosthetics.
Second level These are state and municipal polyclinics of administrative districts. They provide highly qualified care in core specialties (conservative dentistry with endodontics, surgery, prosthetics), implement municipal programs, and serve as organizational and methodological centers for the district.
Third level Includes polyclinics of constituent entities of the Federation, medical institutes, and specialized centers. Patients are admitted here strictly on referral from first- and second-level specialists. Care in narrow subspecialties is provided here: periodontology, complex prosthetics, implantation, dental oncology, and maxillofacial surgery. Third-tier institutions also manage the entire dental service of the region.
Structure of dental departments
To provide comprehensive care, dental institutions are divided into specialized departments:
- Therapeutic (Conservative Dentistry): treatment of caries, non-carious lesions, diseases of the oral mucosa (OM), and periodontal diseases.
- Orthopedic: all types of dental prosthetics and treatment of temporomandibular joint (TMJ) disorders.
- Surgical: surgical treatment of maxillofacial diseases.
- Pediatric: provision of comprehensive care for children.
- Orthodontic: correction of malocclusion and tooth position (often part of the pediatric department).
- Prevention and Hygiene: carrying out preventive procedures and teaching proper oral hygiene.
In addition to departments, there are separate specialized offices (screening, anesthetic, periodontal) and mobile teams that serve residents of remote settlements, enterprises, schools, and immobile patients.
Role of the dental polyclinic
The dental polyclinic is the central hub of the municipal dental service. Its activities are regulated by the baseline Regulations (USSR Ministry of Health Order No. 1166 of 1976).
The polyclinic operates on the territorial-production principle: its service boundaries are determined by the healthcare authority. It serves not only the attached population of the district, but also enterprise workers, construction organization employees, students, and schoolchildren.
Key tasks of the polyclinic:
- Mass prevention of maxillofacial diseases.
- Organization of examinations for the early detection of pathologies.
- Provision of qualified outpatient care.
Briefly: answers to topical questions
What specialized offices (in addition to the main departments) operate in a dental polyclinic?
In a dental polyclinic, alongside basic departments, additional highly specialized and auxiliary offices may operate. These include:
- Periodontal office — for the treatment of periodontal diseases.
- Office for patients with oral mucosal pathologies — for the treatment of the oral mucosa.
- Anesthesiology, orthodontics, prevention, and screening offices — for corresponding specialized tasks.
- Alternative and functional medicine offices — include acupuncture, hirudotherapy, and functional diagnostics offices.
- Auxiliary offices — physiotherapy, radiology (radiodiagnostics), and clinical laboratory.
What equipment is included in the standard outfitting of a conservative dentistry office?
The standard outfitting of a conservative dentistry office includes primary and auxiliary equipment, as well as furniture and sterilization supplies.
- Primary equipment — dental unit (with handpieces and burs), patient chair, doctor and assistant stools, doctor's dental cart/table.
- Auxiliary equipment — electrodontometry devices, apex locators, curing lights, amalgamator, and electrosurgical unit (diatermocoagulator).
- Sterilization equipment — dry-heat sterilizer, glass-bead sterilizer, quartz lamp, fume hood, and sterile instrument table.
- Additional outfitting — sinks, containers with detergent solutions, multi-tier cabinets, a desk with a computer for the nurse, and an emergency medical kit.
What types of dental services are provided free of charge under the CHI (compulsory health insurance) policy?
The basic compulsory health insurance (CHI) program guarantees free medical care. Specific types of services are not listed in the sources, but it is indicated that dental care is provided in full to certain privileged categories of citizens. These include:
- Persons under 18 years of age;
- Pupils and students;
- Veterans of the Great Patriotic War;
- Pregnant women;
- Women with children under 3 years of age.
What accounting and reporting documents does a doctor fill out during an outpatient dental appointment?
During an outpatient dental appointment, the doctor fills out a medical record and documents confirming temporary disability. The main documents include:
- Dental patient's medical record (Accounting Form No. 043/U) — a crucial legal and scientific document (case history). The doctor fills out sections with the final diagnosis, development of the present illness, treatment plan, and notes on procedures performed.
- Certificate of temporary disability (sick leave certificate) — issued based on the results of temporary disability expertise.
All actions of the doctor in the medical record must be dated.
Class and exam questions
Where is the bulk of dental care provided in Russia?
Despite the growth of private medicine, the bulk of care continues to be provided by state and municipal medical institutions, primarily dental clinics.
What is the difference between primary and tertiary level facilities?
The first level provides basic treatment, sanitation, and prevention (offices in schools, departments in central district hospitals). The third level (regional polyclinics, institutes) provides complex, highly specialized care (implantology, dental oncology) strictly by referral.
Who do mobile dental teams serve?
They are equipped with mobile equipment and travel to small settlements, enterprises, schools, as well as to the homes of severely ill patients.
What else to study on this topic
- Organization of private dental clinics
- Functions and outfitting of specialized offices (periodontal, anesthesiological)
- Patient routing for complex oral mucosa and TMJ pathologies
- Implementation of municipal dental programs at the second level
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Other topics in "Chapter 2. Organization of Dental Practice"
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