Stomatology

STOMATOLOGY (from Greek stoma-mouth and logos-science), the science of diseases of the organs of the oral cavity, jaws, and adjacent areas, and of the connection of these organs with each other and with the entire organism. In this understanding, S. is the youngest branch of medicine; S. has been developed only during the last two decades and as a scientific and clinical discipline it is most fully developed in the USSR. In S. are united odontology (see), maxillofacial surgery, and dental prosthetics, which constitute the three main departments of the specialty: 1) therapeutic or preventive S, 2) surgical S, and 3) prosthetic S. Therapeutic S. has as its subject the study of physiology, pathology, operative (within the alveolar processes of the jaws) and non-operative therapy and prevention of diseases of the teeth, periodontium, and mucous membrane of the oral cavity. That part of therapeutic S. which is devoted to the treatment of teeth is called odontology or dentistry. A distinction is made between therapeutic dentistry (so-called conservative dentistry) and surgical dentistry. Therapeutic dentistry, to preserve the diseased tooth, uses modified techniques of operative technique in combination with one-time or repeated medicinal application (dressing) in the carious cavity or pulp chamber until the tooth is restored with a filling. Methods of therapeutic dentistry are used in cases where the pathological process has not gone beyond the limits of the tooth; when the periodontium is involved in the disease, it is often necessary to resort to the methods of surgical dentistry, i.e., to methods of typical surgical intervention. The boundaries of surgical dentistry are the alveolar processes of the jaws. From therapeutic S. in the last 10-15 years, pediatric dentistry has separated (as an independent subsection).- The subject of surgical S., maxillofacial surgery (see Jaws), is the study of the diagnosis, pathology and therapy (operative, non-operative and prosthetic) of all types of acute and chronic inflammatory diseases, neoplastic processes, congenital and acquired deformities and traumatic injuries of the maxillofacial skeleton, the surrounding soft tissues, lymphatic and salivary glands. Prosthetic S. is devoted to the study of methods of prosthetic correction and restoration of congenital and acquired deformities and defects of the dental apparatus and parts of the face, as well as disorders of the speech and respiratory apparatus. Prosthetic S. is usually divided into two areas-simple and complex prosthetics. The first implies the clinical and laboratory technique of manufacturing various designs of dental prostheses, not extending beyond the alveolar processes. The second is understood as the manufacture of obturators of the palate, prosthetic devices of therapeutic value (splints, immediate prostheses after resections of the jaws, special orthopedic dressings and appliances, etc.) and prostheses replacing defects of the jaws, as well as cosmetic facial prostheses (prostheses of the cheeks, nose, ears, eyelids, etc.). With the development of surgical S., the field of application of obturators and cosmetic prostheses is constantly narrowing, and the work of therapeutic prosthetics is expanding and becoming more complex. Orthodontics (see) is included in prosthetic S. as its subsection. The significance of S. for medicine is determined by many factors. First, the widespread prevalence of dental diseases, especially caries and marginal periodontitis, creates maximum demand for dental care institutions for specialized help. Second, a large number of diseases, such as acute infections, diseases of the digestive tract, cardiovascular, hematopoietic, autonomic-nervous and endocrine systems, as well as metabolic disorders and avitaminoses, have their initial symptoms in the oral cavity, sometimes long before the clinical detection of one or another pathological condition and even before the appearance of the first subjective complaints typical for a particular disease. It should be emphasized that the stomatogenic manifestations of some diseases of internal organs and their systems are not only early, but in many cases pathognomonic. Such are Koplik-Filatov spots in measles; the raspberry tongue in scarlet fever; Hunter-Müller glossitis as a precursor of pernicious anemia; some forms of marginal periodontitis, not amenable to symptomatic therapy, appearing long before other clinical manifestations of leukemia, aleukia; typical stomatogenic precursors of gastritis, duodenitis, achylia and scurvy; paresthesias of the tongue and gums, as well as 'idiopathic' pains in the latter in autonomic neuroses and gouty diatheses, etc. The combination of these two factors determines the place occupied by stomatology in the general system of clinical, preventive and social medicine; on the other hand, numerous foci of infection in the oral cavity are often the starting point for many diseases of distant organs (in particular joints, heart, kidneys), subfebrile conditions (see Oral Sepsis), and even more often a factor complicating the clinical course of diseases in general, especially tuberculosis and acute infections. Hence-the significance of S. for the clinic of internal diseases. During the short period of its existence, clinical S. has enriched surgery with a number of new techniques and methods of operative technique. The radical operations of uranoplasty and staphylorrhaphy (Ernst, Limberg and others), surgical treatment of micro- and macrogenia, the field of plastic surgery of the face and oral mucosa (Limberg and others), operations on the jaw joint (Aschausen, Rauer and others) have been newly developed. It should also be noted the importance that the dental development of the section of jaw traumatology and orthopedics (Bruck, Schroder, Tigerstedt and others) had for field surgery. The anatomotopographic relationships of the teeth with the nasal passages, paranasal sinuses and the position of the mouth as a peripheral part of the respiratory system and as a speech organ determine the mutual interest of S. and otorhinolaryngology. Disorders of the eruption cycles of deciduous teeth and their replacement by permanent teeth (see Dentition), anomalies of articulation of dental arches, stomatogenic manifestations of latent rickets, childhood myxedema, mongoloid disease connect S. with pediatrics. The close connection of the organs of the oral cavity with the endocrine system, metabolic disorders, neurotrophic processes, and physiopathology of the female genital sphere characterizes the significance of S. for the corresponding medical disciplines. The manifestations of many skin diseases on the mucous membrane of the oral cavity (pemphigus, lichen ruber planus, etc.), as well as syphilitic and tuberculous lesions of the oral cavity bring S. closer to dermatology and syphilology. Dental research often plays a decisive role in forensic medicine in identifying disfigured or decomposed corpses. Finally, it should also be noted that a number of works on the histogenesis of tooth tissues, on the biochemistry of saliva and electrochemical processes in teeth as biological semipermeable membranes, on the study of the influence of neurotrophic factors on the pathology of oral cavity organs, published in the last 10-12 years in the USSR, along with great practical significance for the discipline, also have general clinical and theoretical interest. History of S. The most complete and ancient monument of S. is the work of the Indian physician of the 8th century BC-Susruta. If the monuments of ancient medicine of Egypt, Assyria, Babylon, Judea and China concern only dentistry in the narrow sense of the word, then ancient Indian medicine, according to Susruta, already distinguishes 65 diseases of the oral cavity, of which 23 different diseases are already attributed to the teeth. Susruta, in describing the extraction of teeth (only on the lower jaw), outlines surgical dentistry and for the first time describes the technique of rhinoplasty. The third department of S.-prosthetics--is not reflected in Susruta, but materials from the same period (9-8th century BC) indicate that among the Etruscans prosthetics was already at a fairly high level of development. In the works of Hippocrates (5th century BC), one can also trace the beginnings of S. Hippocrates also does not limit himself to the description of diseases of the teeth, but speaks of diseases of the gums, mucous membrane of the oral cavity, tongue and jaws, and for the first time points out that diseases of the teeth and gums are observed in diseases of the liver, spleen, stomach, female genital organs. The first very primitive knowledge of the anatomy of the teeth (Aristotle) dates back to the 4th century BC. A new milestone in the development of S. was set in the 1st-2nd centuries AD: the beginning of the division of medicine into specialties during the Alexandrian era, which led even Celsus to isolate diseases of the teeth and oral cavity into a separate chapter of pathology, laid the beginning of the separation of S. from medicine. On the other hand, the widespread prevalence of oral diseases, especially of the teeth, since ancient times, caused a massive need for dental care, and the impossibility of satisfying this need by a relatively small contingent of physicians left dentistry to the care of persons without any medical education.

In the era of imperial Rome, this became the domain of many medical specialties, but the primitiveness of the then-current dental techniques and the exclusively technical skill required for prosthetics were the cause of a somewhat different development from other specialties and a unique course for the further development of Stomatology, which for a long period remained in the hands not only of persons alien to science but often ignorant as well. After Celsus and Galen, the most significant work is that of the famous 9th-century surgeon Abul Kazim (Abul Kasim), in which diseases of the teeth, oral cavity, and jaws and their treatment and prosthetics occupy a prominent place. Besides a number of separate valuable clinical observations and descriptions of previously known (tooth extraction, parulis, epulis) and new (tooth replantation) operations, Abul Kazim presents a rather rich arsenal of special instruments and, among other things, the first set of instruments for removing dental deposits ('dental calculus'). Physicians of the Middle Ages contributed little new to Stomatology. Only in the 16th century did a significant contribution come from the famous surgeon Ambroise Pare, who described a number of methods for the surgical treatment of teeth and jaws (trismus) and the restoration of palate defects with prosthetics; Pare's obturator began the so-called complex prosthetics. In the 16th century, thanks to the works of Vesalius, Eustachius, and Fallopius, Stomatology was enriched with scientific foundations on the development and anatomy of teeth; the 17th century provided a description of the maxillary sinus, already discovered by Leonardo da Vinci, the discovery of dentinal canals by Leeuwenhoek, the first indications by Fabricius (Fabricius Hildanus) of the etiological significance of dental diseases in diseases of other organs, as well as the construction by him of the first wire splint for fixing jaw fragments and the invention by Scultetus of the mouth mirror. A new period in the history of Stomatology opens with the 18th century. The establishment in the early 18th century of a special degree of surgeon-dentist in France and the establishment of corresponding degrees (something between a surgeon and a barber-dentist) over time in other countries became the canonization of almost a complete separation of Stomatology from medicine and outlined the further path of development in the direction of one-sided, predominantly technical, improvement of methods only for dental treatment and prosthetics. For almost 2 centuries, odontology with prosthetics developed in parallel but separately from maxillofacial surgery and the scientific foundations of physiology and pathology of organs of the oral cavity and jaws. Works in the first direction were carried out and very successfully by dentists, in the second by surgeons and theorists. The ideologist of this reform was the French surgeon Fauchard (Pierre Fauchard), who is considered the 'father' of odontology and an advocate for a separate system of training in dental treatment. His monumental two-volume work 'Le Chirurgien Dentiste au traite de dents', published in three editions (1728, 1746 and 1786) and translated into German (1733), created an era in the development of Stomatology. This work not only combined odontology with prosthetics but also gave the first, rather complete classification of diseases of the teeth and surrounding parts, encompassing 103 nosological forms. In this work, the first fundamental, methodological, and technical principles of tooth filling are also given. The second monumental work of this period belongs to the English surgeon Hunter (John Hunter); it contains the first indications on the pathology of the pulp and its therapy. At the same time, the German dentist Pfaff (P. Pfaff) wrote the first guide to therapeutic dentistry--'Treatise on Human Teeth and Their Diseases' (1756). In the 19th century, Stomatology was enriched by a number of new data on the microscopic structure of dental tissues and the comparative anatomy and histology of teeth and jaws, developed primarily by English and German physicians. The appearance of guides by Carabelli (G. Carabelli)--'Anatomie des Mundes' and the famous 'Atlas zur Pathologie der Zahne' by Heider and Wedl (M. Heider, C. Wedl), which have retained their value to the present day, the introduction of arsenic acid anhydride for devitalizing the pulp in 1836 by Spooner and antiseptics by Lister, first applied in odontology by Witzel (A. Witzel), laid the foundation for modern methods of treating pulpitis and their immediate complications. The second half of the 19th century gave a number of valuable works on the pathology and therapy of teeth, which brought odontology out of the chaos of crude empiricism. Parallel to the development of odontology, prosthetics made enormous successes during this period. In the last decade of the 19th century and the first years of the 20th century, the most significant facts in the development of Stomatology were, firstly, the involvement of bacteriology to explain the etiology of diseases of the oral cavity and in particular of caries, and secondly, the use of data from mathematics and mechanics for the scientific substantiation of the problem of articulation and occlusion of dental rows in dental prosthetics. In place of the primitive interpretations of the origin of carious destruction of teeth, Miller put forward the chemical-parasitic theory of caries, which stood at the level of science of that time. Prosthetics was raised from a craft to the level of a scientific discipline and in turn divided into departments (orthodontics, complex prosthetics). The doctrine of infection and immunity is indebted to Stomatology for that new stage when the role and significance of stomatogenic and in particular odontogenic foci in the general problem of focal infection were determined. The doctrine of the so-called 'oral sepsis', the conjectures of which were already built by physicians of the 7th century BC, on which Fabri more specifically indicated in the 17th century, which was confirmed on clinical material by a number of clinicians in the early years of the 19th century (Darwin, Petit, Siebold, Ruch), again put forward in 1908-10 by internists (Passler, Landgraf, Guert, W. Hunter), bacteriologists (school of Rosenow), physiologists (Fr. Billings) and others, was the first decisive moment for the creation of modern clinical Stomatology. The problem of 'oral sepsis' and the significant successes achieved by Stomatology in the field of maxillofacial surgery forced proper attention to be paid to diseases of organs of the oral cavity and jaws and awakened in dentists the desire to seek rational methods of prevention in the fight against diseases of teeth and their consequences and to further improve special methods of therapy. Both of these caused for Stomatology the need to revise the methods of treating teeth, considered scientifically justified since the 1870s, and most importantly forced a rethinking of the interpretations of the pathogenesis of a number of diseases of organs of the oral cavity, which in turn required a more detailed and in-depth study of the biopathology of organs of the oral cavity in their interdependence with each other and with the organism as a whole. Such a revolution in the theory and practice of Stomatology required a significant expansion of the general level of knowledge, mastery of the latest methods for studying biopathological processes, and re-equipping the methodology of scientific analysis and synthesis. Such is the state of Stomatology at the current stage of its development. The most effective expression of this state of the discipline is embodied in Soviet Stomatology. In the last 15-20 years, i.e., during the period of the current stage of the discipline, Stomatology has been enriched by a number of new and valuable data. Soviet scientists played an active role in this, not only including in the sphere of their attention almost without exception all the problems of the specialty but also saying their new and weighty word on each of them. The works of Fischer, Euler (Euler) and others abroad and Yasvoyn and Ryvkind in the USSR expanded and deepened knowledge on the histology and histogenesis of dental tissues. Much new has been introduced into the interpretation of the biology of dentin and enamel and their physiology (Urbantschitsch, Fich, Lukomsky with others), in particular the permeability of enamel has been proven and the question of the exchange of substances in it has been resolved positively (Entin with others). The influence of nervous trophics on the biopathology of organs of the oral cavity has been established (Glushkov, Entin). The predominant role of nutrition in the biopathology of teeth, in particular in the etiology of caries, has been proven (Mac Collum, Mellanby and others). The pathogenesis of caries is given a completely new interpretation in the theories of Lukomsky and Entin. The study of peri-dental tissues as a separate organ--amphodont (Ampho-dont-P. N. Nesmeianov) or paradentium (paradentium-Weski) has been newly posed and its normal and pathological histology has been studied in detail. The pathogenesis of chronic marginal periodontitis (so-called alveolar pyorrhea) is being successfully studied in the light of the pathology of the endocrine and nervous systems and metabolism. The works of Yasvoyn in the field of cytology of the pulp, establishing the formation of odontoblasts from less differentiated cellular elements, the discovery in the pulp of lymphatic spaces (Snitzer and Zolkover) and elements of the reticulo-endothelial system (Blutevogel, E. M. Gofung, Yasvoyn) have explained much in the biology and pathology of the pulp and the treatment of its diseases. The greatest merit in the treatment of pulpitis and apical periodontitis (see Peridontitis) belongs to Muller (O. Muller) in Switzerland and G. L. Feldman in the USSR with their collaborators. Enormous successes have been achieved during this period in the field of prosthetic Stomatology in connection with the problem of physiology and pathology of chewing and oral digestion in the functional evaluation of prosthetics, as well as in the field of orthodontics (see) (Gelman, Katz and others). In the post-war period in Stomatology, a new type of specialized assistance was introduced--stationary, i.e., the opening of dental clinics in a number of countries.

The greatest merits in the brilliant development of the surgical department of Stomatology belong to the clinics of Lindemann and Wassmund in Germany and A. A. Limberg and A. K. Rauer in the USSR. In the field of pathology and therapy of acute odontogenic infection, much has also been done in the clinics of Wassmund, Limberg, Lukomsky, and Lvov. This type of work in dental clinics, which predominantly determined, and in the mentioned clinics exclusively determined, the surgical character of activity, however, left aside the problem of chronic stomatogenic infection and intoxication (so-called oral sepsis). Oral focal infection has been introduced and is still being developed almost exclusively by therapists and bacteriologists, sometimes with the participation, and often without the participation, of dentists. For most countries, where dentists are often narrow specialists without complete general medical training, because the system of medical education in Stomatology has been excluded, such a state of affairs is inevitable. In the USSR, there are prerequisites for, by developing the path of maxillofacial surgery, to develop this special section of the clinic of internal diseases together with therapists and bacteriologists in dental clinics. In the USSR, special clinics are beginning to be created, the first of which opened in the Leningrad Dental Institute in 1931 (head: Entin) and the second in the State Institute of Dental and Odontological Medicine in Moscow in 1932 (head: Lukomsky). Stomatology in the USSR. In Russia before the revolution, Stomatology as a clinical discipline did not exist, although its rudiments in the form of dentistry already have a two-century history. Information about the first dentist who came from Germany, Hoffmann (Fr. Hoffmann), who practiced privately in the former Livland province, dates back to 1730. But since the Senate decree on the mandatory examination for the right to practice dates back to 1721, there are reasons to believe that dentistry penetrated Russia even earlier. The first dentists who appeared in Russia in the 60s and 70s of the 18th century were Clairet (I. Clairet), a student of Fauchard, Bobell (P. Bobell), Debruyll (Fr. Debruyll), and others. They served the high aristocracy, although for advertising purposes they announced free treatment for the poor. Training in dentistry in special institutions began only in 1881, when the government gave permission Vazhinsky to open in Petersburg the 'First Russian School for the Study of Dental Art'. In Russia before 1913, there were 12 dental schools - in Petersburg, Moscow, Kharkov, Kiev, Odessa, Warsaw, and Tomsk. During the period from 1913 to the October Revolution, 5-6 more dental schools were opened. Since the training period was 2 1/2 - 3 years, the private owners of such schools pursued mainly commercial goals, and the volume of medical knowledge of those completing this education could not be sufficient. Nevertheless, some of the schools, thanks to good organization and selection of teachers, gave more or less qualified personnel for that time. Among the dentists and dentists of pre-revolutionary Russia, there were individual physicians with general medical education who were engaged in dentistry. Through the efforts of a small group of dentists and physicians and their communication with Western Europe, new ideas, methods, and techniques of Stomatology began to penetrate into Russia from abroad. Among this group should be mentioned the names of Ya. V. Dzhems-Levy, I. I. Khrushchev, Prof. A. K. Limberg, F. I. Vazhinsky, A. P. Sinitsyn, A. V. Fisher, I. N. Margolin, I. M. Kovsky, M. M. Chemodanov. In 1883, the first society of dentists was organized, and in 1885 the first specialized journal 'Dental Herald' was founded (by Sinitsyn), which was published until 1917; from 1898 to 1914, the second journal was published - 'Odontological Review' (organ of the Moscow Odontological Society under the editorship of Kovsky, Urenius, and Chemodanov). In 1896, the first All-Russian Odontological Congress was convened, and in total, 6 congresses were held before the revolution. The first specialized textbook in Russian appeared in 1882 and was compiled by Dzhems-Levy ('Guide to the Science of Dentistry'), in the following years an original textbook by Khrushchev appeared (in 1886) and 3 translated ones - Parreidt in 1890, Miller, Baume in 1896, and Scheff (J. Scheff) in 1898. Before the revolution, other original textbooks [Fisher, Dubrovin, Zverzhekhovsky, Gofung (1st ed.), Izachik] and several translated ones were published. In 1912, classical specialized guides on normal (Altukhov) and pathological (Abricosov) anatomy were published. The most significant phenomena in the field of scientific stomatology of the pre-revolutionary period were the dissertations of A. K. Limberg (the first in Russia before 1891 dissertation in the field of odontology), Nesmeianov, Astakhov, Vilga, Zverzhekhovsky, and the monumental work of Znamensky. The research of these authors has not lost its interest and significance to this day. This state of stomatological science in pre-revolutionary Russia found its vivid reflection in journal articles, almost exclusively of a review and compilative nature, in the life of scientific societies, which were mainly engaged in professional and everyday issues, and in the activity of congresses, which, both in the number of participants and in the nature of the very few reports, differed little from the report meetings of large, metropolitan odontological societies and at best were a tribune for protests against the arbitrariness of the tsar, which hindered the development of dentistry (4th congress in 1905). Thus, in tsarist Russia there was a relatively large educational literature, a small group of researchers who gave solid scientific works, journals were published, scientific societies existed, scientific congresses were convened, there was an almost ten-thousand-strong army of dentists, but there was not only stomatological but also dental science. The reason for this lay in the content and form of special education, half-artisan, half-medical, which excluded the presence of bases for scientific research, in the organizational forms of professional work, devoid of the possibility of collective creativity, and in the absence of elements of social orientation in the work and knowledge of specialists. The imperialist war gave a small shift in this regard. The opening in 1915 in Petrograd, Moscow, and Kiev of jaw lazarets and special departments in some surgical hospitals led many dentists to the path of joint work with surgeons. Involvement in clinical work on jaw traumatology led to intensified activity in finding new ways in the field of jaw orthopedics and complex prosthetics. On the basis of these jaw lazarets, the first dental hospitals in Russia were created: the maxillofacial department of the Leningrad Institute of Traumatology and the Moscow Therapeutic-Prosthetic Institute. The October Revolution widely opened the doors of medical faculties for dentists and created that decisive shift which had been foretold and determined the progress of Stomatology. By the decrees of the NKZdr. and NKProsa of 1/X 1918 'on the re-

The resolutions of the People's Commissariat of Education of 1918 'on the introduction of dental education into medical faculties' and of the People's Commissariat of Health of December 26, 1918 'on the state organization of dental care in the republic' provided the basis for the creation of Soviet stomatology as an independent medical discipline; the organization of departments of stomatology and the regulation of the mandatory nature of this subject in the system of medical education, as well as the opening of scientific research and scientific-practical institutes, laid the foundation for the creation and development of Soviet dental science. The creator of this reform is P. G. Daugé, who in the era of autocratic reaction led the struggle for faculty stomatology. In 1920, the first department in the USSR 'surgery of the oral cavity and jaws with odontology' was organized at the medical faculty of the 1st Moscow State University, and in 1923, 1924, and 1925, dental departments (initially called odontological) were created at the 1st and 2nd Leningrad medical institutes, at the medical faculty of the 2nd Moscow State University, at the Military Medical Academy of the Red Army, etc., at the medical faculty of Kazan University, and in Rostov-on-Don, Irkutsk, Kharkov, and Voronezh medical institutes. In 1922, the first State Scientific Research Institute of Dentistry was created in Moscow, soon renamed after P. G. Daugé as the State Institute of Stomatology and Odontology, and in the following years scientific-practical dental institutes were opened in Leningrad, Odessa, Minsk, and Gorky. In addition to the extensive network of large dental institutions of a polyclinic type for therapeutic, surgical, pediatric odontology, prosthetics, and orthodontics, in the last 10-15 years, a number of dental clinics have been organized at departments and institutes: 4 in Moscow, 3 in Leningrad, and 1 each in Rostov, Kharkov, Kiev, Odessa, Minsk, Perm, and Novosibirsk, with a total of over 300 beds. In these numerous institutions, some of which have no equal in Western Europe and America, extensive clinical work has been carried out, covering the entire pathology of the organs of the oral cavity and jaws. In addition to the large scale of scientific research and clinical work, another typical and significant phenomenon characterizes the features of Soviet stomatology. This is the mass character, accessibility, and planned nature of outpatient dental and prosthetic care. No country in the world has such a highly branched network of dental and prosthetic outpatient clinics with such throughput capacity as in the Soviet Union. The principle of planned sanitation of the oral cavity (see) of Kantorowicz, transferred by Daugé to Soviet conditions, has been used in the USSR not only in relation to schoolchildren, but since 1925, after the experience of the dental clinic of the Military Medical Academy, it has been introduced into the system of dental care in the Red Army and other organized groups of the adult population. After the October Revolution, three all-union odontological congresses were held: in 1923, 1925, and 1928, four regional congresses and a number of conferences, in which the number of participants increased 5-10 times compared to pre-revolutionary congresses. The number of scientific works published by Soviet dentists in the specialized and general medical press, not only in the USSR but also abroad, only for the period 1923-28, i.e. for 6 years of the existence of Soviet stomatology, far exceeds the scientific output of the entire pre-revolutionary period. From a semi-craft, semi-medical profession, in 10 years of its existence Soviet stomatology has taken an honorable place in world dental science, establishing its authority in all countries. In a short period of its existence, Soviet stomatology caught up with, and in the experimental study of the pathogenesis of caries (works of Lukomsky and Entin with their colleagues), biopathology of the pulp and apical paradentitis (works of Ryvkind, Feldman and Yasvoyn with their colleagues), etiology of marginal paradentitis (works of Entin with colleagues) and in the field of maxillofacial surgery (Limb and Rauer with their colleagues) even surpassed the corresponding achievements of world specialized science. Dental (odontological) societies in the form of independent scientific associations or sections of medical associations currently exist in all major cities where there are medical institutes. In full accordance with the state of dental science in the USSR, the nature and intensity of the work of scientific societies have changed. The special monthly journals 'Soviet Stomatology', founded by Daugé in 1919 (as 'Bulletin of Social Dentistry', and then as 'Journal of Odontology and Stomatology'), and 'Odontology', published until 1931 (ed. Gofung) in Kharkov, cannot accommodate the scientific output of Soviet dentists, and therefore in the post-revolutionary period, in addition to individual monographs, a number of collections and bulletins of the works of departments and institutes of Moscow, Leningrad, Odessa, and Kharkov have appeared. Teaching of stomatology in the USSR has gone through a number of phases. Until the 1890s, dental personnel were trained in private offices; after 3 years of work in an office and passing the established examination, a diploma was obtained for the title of dentist, which gave the right to independent work. From 1881, private dental schools appeared. In 1891, a resolution of the State Council 'on the reorganization of the teaching of dental art' was published and two categories of specialists in dentistry were legalized: dentists, whose training remained unchanged, and dental physicians graduating from private schools. In the RSFSR, dentists until 1929 were formed exclusively from graduates of medical institutes who had additionally completed a special internship, in the Ukrainian SSR stomatology, as in the RSFSR, became a mandatory subject in the curriculum of medical institutes, but for the formation of cadres, special odontological institutes (odontological faculties) with a 4-year period of study were created. The reform of higher medical education carried out in 1930 in the direction of specialization and the establishment, along with other specializations, of a dental specialization reconciled the defenders of various views on the reform of dental education. The next step in the development of the resolution of the Central Committee of the All-Union Communist Party (Bolsheviks) 'on medical care for workers and peasants' was the inclusion of dental teaching in the system of medical technical schools. Thus, at present, in the USSR there are two forms of dental education: one in the form of a dental department with a 4-year course of study in the system of medical higher educational institutions (Kharkov and Kiev medical institutes), the other - in the form of a dental department with a 3-year period of study in the system of medical technical schools, in which retraining of middle-level medical personnel into dental physicians is also carried out for 1 year. In the system of institutes for the improvement of physicians, there are also departments and associate professorships used for the advanced training of dental personnel. In Moscow, there is a department of maxillofacial surgery with associate professorships in surgical and therapeutic odontology and dental departments in the Leningrad and Kharkov postgraduate medical institutes. In the Ukrainian SSR, there is also an Institute of Correspondence Retraining of Dental Physicians and Stomatologists. In addition, in scientific-practical institutes, cycles for the improvement of dental physicians are periodically organized. In the post-revolutionary period, Soviet stomatology has been enriched with a large original educational literature. In addition to four textbooks-'Course of Odontology' by Govseev, 'Clinical Odontology' by Gofung, 'Practical Manual of Stomatology' and 'Operative Stomatology' by Lukomsky-in recent years many monographs have appeared. These include monographs by G. I. Kovsky, Verlatsky and Vaysblat on surgical S, Rauer on maxillofacial trauma, Gusinov on plastic surgery of the face, Agapov on dystrophies of the dental system, Evdokimov and Melik-Pashaev on topographic anatomy, Lukomsky on dental oncology and tuberculosis of the oral cavity, Feldman on pathology and therapy of pulpitis and apical paradentitis, Buzikov, Gofung on prosthetics, Roizman on orthodontics, M. O. Kovsky on the history of dentistry and some others. Individual chapters on maxillofacial surgery were written by Limberg, and on maxillofacial trauma by Entin ('Field Surgery', ed. by Prof. S. P. Fedorov). Abroad, dental personnel are trained in special institutes with a 4-year period of study. Only in Austria and Sweden is the completion of a medical faculty and subsequent 2-year study in dental institutes mandatory. In the curricula of medical faculties, the study of stomatology is not mandatory, and only in some universities in America, Italy, and Poland are elective courses offered, although stomatology as an independent discipline actually exists and is de jure recognized in almost all countries of Western Europe and America. National policy, caste exclusivity, bourgeois arrogance, and above all competition-these are the reasons that, before the October Revolution in Russia, and in other countries still hold, kept the door of medical faculties closed to stomatology and thereby slow its progress.