Терапевтическая стоматология. Консервативная стоматология = Therapeutic dentistry. Conservative dentistry

L. А. Kazekо  
Е. L. Коlb 
O. A. Tarasenko

Терапевтическая стоматология
КОНСЕРВАТИВНАЯ СТОМАТОЛОГИЯ

Л. А. Казеко  Е. Л. Колб  О. А. Тарасенко

Therapeutic dentistry

CONSERVATIVE DENTISTRY

Утверждено Министерством образования Республики Беларусь
в качестве учебника для иностранных студентов учреждений высшего 
образования по специальности «Стоматология» 

Approved by the Ministry of Education of the Republic of Belarus
as a manual for foreign students of higher education institutions
in the speciality "Dentistry"

Все права на данное издание защищены. Воспроизведение всей книги или любой ее части не может 
быть осуществлено без разрешения издательства.

ISBN 978-985-06-3507-5 
© Казеко Л. А., Колб Е. Л., Тарасенко О.А., 2023
 
© Оформление. УП «Издательство “Вышэйшая
 
 
школа”», 2023

УДК 616.314-08(075.8)-054.6
ББК 56.6я73
 
К14

Р е ц е н з е н т ы: кафедра терапевтической стоматологии с курсом ФПК и ПК УО «Витебский 
государственный ордена Дружбы народов медицинский университет» (заведующий кафедрой кандидат медицинских наук, доцент Ю.П. Чернявский); заведующий кафедрой общей стоматологии  
ГУО «Белорусская медицинская академия последипломного образования» доктор медицинских наук, 
профессор Н.А. Юдина; доцент кафедры современных технологий перевода УО «Минский государственный лингвистический университет» кандидат филологических наук, доцент Т.И. Голикова

Казеко, Л. А. 
Терапевтическая стоматология. Консервативная стоматология = 
Therapeutic dentistry. Conservative dentistry : учебник / Л. А. Казеко, 
Е. Л. Колб, O. A. Тарасенко. — Минск : Вышэйшая школа, 2023. – 369 с. : 
[8] л. цв. вкл. : ил. 
ISBN 978-985-06-3507-5.

Освещаются вопросы гигиены полости рта, диагностики воспалительных процессов, 
способов лечения кариеса, возможных осложнений и рекомендаций по их предупреждению. Важное место отводится описанию стоматологического инструментария, используемых лекарственных средств и пломбировочного материала. Рассматриваются технологии, 
используемые в клинической стоматологии, как в отечественной, так и в зарубежной медицине на основе широко используемых современных подходов к лечению и предупреждению стоматологических проблем.
Для иностранных студентов учреждений высшего образования, обучающихся на английском языке, магистрантов, клинических ординаторов, аспирантов, врачей-стоматологов.

УДК 616.314-08(075.8)-054.6
ББК 56.6я73

К14

INTRODUCTION

The textbook “Therapeutic Dentistry. Conservative Dentistry” is intended to 
serve the educational needs of both dental students and dental practitioners seeking 
updates on diagnostics and restoration of caries and non-caries lesions. The primary 
aim has been to provide an understanding of biological processes involved in caries 
pathology in an easily accessible form and to show how this knowledge affects clinical management. This book outlines the main issues of restorative dentistry.
The textbook gives a description of diagnostic principles of the caries, non-carious lesions and periodontal pathology, presents contemporary views on the aetiology, pathogenesis and classification of these diseases, their course and clinical manifestations, possible mistakes and complications when diagnosing caries lesions.
It also provides a description of restorative materials and instruments as well as 
modern treatment methods of caries. Students will get acquainted with indications 
and contraindications to applying different methods of restorative treatment, basic 
principles of tooth preparation, restorative techniques in different clinical situations. 
It provides the reader with the knowledge of understanding of dental materials’ composition, chemistry, biological aspects of their application improving the management of a different kind of clinical situations.
The textbook gives a description of the classification, advantages and disadvantages, indications for use and methods of working with modern bases and liners in 
therapeutic dentistry, with traditional and modern amalgams in therapeutic dentistry.
One of the chapters presents peculiarities of adhesive systems of the latest generations applied in modern clinical dentistry, their compound, properties, application 
methodology and their disadvantages. The current state of a problem of theoretical 
justification for a differentiated approach to one or another adhesive in accordance 
with clinical setting, determination of dependence between the used adhesive system 
and the quality of restoration is discussed. The chapter is also devoted to the various 
composite materials, available today for direct restorative techniques and the stages 
of the restoration of the posterior and anterior teeth. Polymerisation technique of 
composites is described, the methods of a contact point restoration and information 
on finishing and quality control of the restoration are presented as well as possible 
mistakes and complications when treating caries lesions.
Therefore, we have supplemented the core text with numerous figures and photographs A number of illustrations are taken from manuals published by the authors 
at BSMU, as well as from open internet sources. Providing basic information for 
undergraduate students, the book might be useful for postgraduates and dental practitioners as well. This is the first edition of the book which includes five chapters.
The authors hope that the subject of textbook “Therapeutic Dentistry. Conservative Dentistry” will be useful for foreign students studying dentistry in English.

ABBREVIATIONS 
AND CONVENTIONS

FDA – U.S. Food and Drug Administration
FDI – The Federation Dentaire Internationale
HBV – hepatitis B virus
HCV – hepatitis C virus
HIV – human immunodeficiency virus
TRS – WHO Technical Report Series
UV – ultraviolet 
WHO – World Health Organisation

CHAPTER 

ORGANISATION 
OF DENTAL CARE DELIVERY

DEONTOLOGY IN THERAPEUTIC 
DENTISTRY. DENTAL OFFICE. 
STERILISATION OF DENTAL 
INSTRUMENTS

1.1 DEONTOLOGY IN THERAPEUTIC DENTISTRY

Deontology is an ethical theory that uses rules to distinguish right from wrong. 
Deontology is often associated with the philosopher Immanuel Kant. Kant believed 
that ethical actions follow universal moral laws, such as “Don’t lie. Don’t steal. Don’t 
cheat”.
Deontology is simple to apply. It just requires that people should follow the rules 
and do their duty. This approach tends to fit well with our natural intuition about 
what is ethical or not.
Ethics is defined as a branch of philosophy that deals with thinking about morality, moral problems and moral judgments. Ethics, also called m o r a l  p h i l o s o p h y, is the discipline concerned with what is morally good and bad and morally 
right and wrong. The term is also applied to any system or theory of moral values and 
principles.
Medical ethics is an applied branch of ethics which analyses the practice of clinical medicine and the related scientific research. Medical ethics is based on a set of 
values that professionals can refer to in the case of any confusion or conflict. These 
v a l u e s include:
1. Autonomy: Patients basically have the right to determine their own healthcare.
2. Justice: Distributing the benefits and burdens of care across society.
3. Beneficence: Doing good for the patient.
4. Non-maleficence: Making sure a dentist is not harming a patient.
However, ethical values are not limited to just these four principles. There are 
other important values to consider, such as truth-telling, transparency, showing 
respect for patients and families, and showing respect for patients’ own values. In 
addition, medical ethics is not just a thought process. It also involves people’s 
skills, such as gathering the facts necessary to make a decision and presenting 
your decision in a way that wins over the confidence of all parties. But such tenets 
may allow doctors, care providers, and families to create a treatment plan and 
work towards the same common goal. It is important to note that these four 

1

CHAPTER 

values are not ranked in order of importance or relevance and that they all encompass values pertaining to medical ethics. However, a conflict may arise leading to the need for hierarchy in an ethical system, so as some moral elements 
overrule others with the purpose of applying the best moral judgement to a difficult medical situation.
Medical ethics differs from morality. Ethics is based on values and reasoning 
using persuasion to get its message across, whereas morality involves adhering to a 
specific belief system or code of conduct.
Morality relies on an authority such as the Bible to justify its message. Morality 
does not just involve religion. It can be political or personal, grounded in faith or 
tradition rather than facts or arguments.
In contrast, medical ethics has a flexible set of solutions. It is based on facts and 
logic, and not a religious doctrine. A dentist can still have political opinions and religious faith, but he/she will need to set them aside when forming and offering an 
ethical opinion to those who do not follow their personal morality.
There are several c o d e s of conduct. The Hippocratic Oath discusses basic 
principles for medical professionals. This document dates back to the 5th century 
BC. Both The Nuremberg Code (1947) and The Declaration of Helsinki (1964) 
are two well-known and well respected documents contributing to medical ethics. 
Other important markings in the history of Medical Ethics include Roe v. Wade 
in 1973 and the development of Hemodialysis in the 1960s. More recently, new 
techniques for gene editing aiming at treating, preventing and curing diseases 
utilising gene editing, are raising important moral questions about their applications in medicine and treatments as well as societal impacts on future generations.
Doctors are expected to uphold the well-being of patients in general, not just 
their own patients. This means they have a duty to report a doctor who is abusing 
drugs or molesting patients, for example.
Special ADA (American Dental Association) Code is available for 
dentists. The ADA Code has three main components: The Principles of 
Ethics, the Code of Professional Conduct and the Advisory Opinions.
The Principles of Ethics are the aspirational goals of the profession. 
They provide guidance and offer justification for the Code of Professional Conduct and the Advisory Opinions.
The Code of Professional Conduct is an expression of specific types of conduct 
either required or prohibited. The Code of Professional Conduct is a product of the 
ADA’s legislative system. All elements of the Code of Professional Conduct result 
from the resolutions adopted by the ADA’s House of Delegates. The Code of Professional Conduct is binding on members of the ADA, and violations may result in a 
disciplinary action.
The Advisory Opinions are interpretations applying the Code of Professional 
Conduct to specific fact situations. They are adopted by the ADA’s Council on Ethics, Bylaws and Judicial Affairs to provide guidance to the membership on how the 

ADA code

1 

Council might interpret the Code of Professional Conduct in a disciplinary proceeding.
The ADA Code is an evolving document and by its very nature cannot be a complete articulation of all ethical obligations. The ADA Code is the result of an ongoing 
dialogue between the dental profession and society, and as such, is subject to a continuous review.
Although ethics and the law are closely related, they are not the 
same. Ethical obligations may – and often do – exceed legal duties. In 
resolving any ethical problem not explicitly covered by the ADA Code, 
dentists should consider the ethical principles, the patient’s needs and 
interests, and any applicable laws.

1.2 DENTAL OFFICE

The sanitation and hygiene standards in healthcare providing institutions are 
regulated by the Decree of the Ministry of Health of the Republic of Belarus No. 73 
of 05.07.2017.
The document deals with sanitary requirements on a therapeutic dentistry department in Belarus. The floor area in the office should be at least 12 m2 per one 
dentist. In the office with the floor area exceeding 12 m2 per one dentist, up to two 
additional dental operation chairs may be installed. In this case, each chair requires 
7 m2 of free floor area, and each chair with universal dental unit requires 10 m2. 
Dental operation chairs should be separated with medical privacy screens. If the 
office room has one-sided ambient lighting (i.e. windows are placed in only one wall) 
then office’s depth should not exceed 6 m. The height of the office room should be 
higher than 3,3 m. 
For clean up optimisation purposes, walls, floor, and ceiling should be glib, 
seamless, covered with a moisture disinfectant-proof material. The surface of joints 
in walls, floor and ceiling should be rounded. Joints in the sheets of floor covering 
materials and exit sites of trunks should be filled with putty and coated with nitrocellulose paint.
Walls and floor covering should be painted in bright colours (bright green, sienna, bright grey, light-blue) with reflecting the coefficient of 40 and higher.
In the dental office, the wall with windows should face a northward direction 
(north, northwest, northeast). The regulatory requirement on in-door natural 
illumination are as follows: A window-to-floor area ratio should be at least 1:4–
1:5, and the coefficient of natural illumination (daylight ratio) should be at least 
1.5%. A dental office should be equipped with luminescent and electric filament 
lamps as the main source of lighting. In the dental office, illumination provided 
by luminescent lamps should amount to 500 lx. Illumination provided by spot 
lightning (a reflector at a dental operation chair) should range within 2,000–
5,000 lx.

Code of  
Ethics (EU)

A dental office should be equipped with a positive-pressure ventilation system 
with the following target parameters: 3 air changes per hour for air draft and 2 air 
changes per hour for air intake. Except for normal windows, there should be transom 
windows or windows with small hinged panes for ventilation.
A dental office should be equipped with germicidal lamps.
Each health care staff member (including nurses and junior nurses) should 
have a personal work place in the dental office. The dentist’s workplace is tooled 
up with a dental unit, an adjustable-height stool, a dental chair, a table (for drugs 
and materials). A nurse’s workplace consists of a sorting table for utilised dental 
equipment, a dry air cabinet, the steriliser for syringes, an aseptic table for the 
dental equipment, an adjustable-height stool. A junior nurse’s workplace consists 
of a sorting table and a wash-bowl for the utilised dental equipment. A dental office should be equipped with a writing table. In the dental office, storing the dental materials, instruments, toxic agents, and dangerous drugs are permitted just in 
a special room.

1.3 STERILISATION OF DENTAL INSTRUMENTS

General concept of health-care associated 
infection in dentistry

Health-care associated (HAI) in a patient is a clinically significant infectious 
disease that developed either due to healthcare delivery regardless of the place (hospital/outpatient settings) or due to the outpatient visit without undergoing any medical procedures. To HAI also refers an infectious disease developed in a healthcare 
staff member as a result of carrying out professional activities regardless of the time 
of the disease manifestation.
The main risk factors are divided into t w o groups – patient’s risk factors and 
exogenous risk factors.
Patient’s risk factors are:
1) age (children under 1 year and people over the age of 60);
2) chronic health conditions (hormonal disorders, hemopathies, a chronic kidney disease and a chronic liver disease);
3) congenital or secondary immunodeficiency;
4) malignancies;
5) homelessness, substance abuse.
Exogenous risk factors are:
1) medical equipment;
2) medical clothing and hand of healthcare staff members;
3) reusable devices;
4) dressing and suture material.