ANATOMY AND HISTOLOGY - edumedicus.de · Anatomy and histology of the: Central nervous system 12...

MEDICAL UNIVERSITY OF SOFIA

FACULTY OF MEDICINE

DEPARTMENT OF ANATOMY, HISTOLOGY DND EMBRYOLOGY

PROGRAM

ANATOMY AND HISTOLOGY

for students in DENTAL MEDICINE

Subject:

Sort of the subject:

For students in:

Hours in total:

Duration:

Forms of teaching:

Student’s knowledge evaluation Semester

in which the final exam is held:

Anatomy and

Histology Mandatory

Dental Medicine, first and second year

240

3 semesters (first to third including)

Lectures and practical seminars

Mid-exams and a final exam (practical and theoretical)

Third

SEMESTERS LECTURES SEMINARS

Weekly/total Weekly/total

First (15 weeks) - 1 15 Second (15 weeks) 3 45 4 60 Third (15 weeks) 2 30 6 90

DISTRIBUTION OF HOURS

Hours in total: 75

165

LECTURE PROGRAM

FIRST SEMESTER 0 hours

SECOND SEMESTER 45 hours

Anatomy and histology of the: Digestive system 16 hours

Respiratory system 6 hours

Urinary system 3 hours

Reproductive system 6 hours

Endocrine system 4 hours

Circulatory (cardiovascular) system 8 hours

Lymphatic system and hematopoietic organs 2 hours

THIRD SEMESTER 30 hours

Anatomy and histology of the: Central nervous system 12 hours

Peripheral nervous system 4 hours

Vegetative nervous system 2 hours

Sense organs 5 hours

Topographic anatomy of the: Head 5 hours

Neck 2 hours

SEMINAR PROGRAM

FIRST SEMESTER (ANATOMY) 15 hours

Ostelogy (bones of the skull) 10 hours

Mid-exam on the bones of the skeleton 2 hours

Arthrology (Joints) 3 hours

SECOND SEMESTER (ANATOMY) 60 hours Dissection of trunk, overview of muscles, vessels and nerves of limbs 58 hours Mid-exam on trunk 2 hours

THIRD SEMESTER (ANATOMY AND SPECIAL HISTOLOGY) 90 hours

ANATOMY 60 hours

Dissection of head 42 hours

Dissection of brain and sense organs 16 hours

Mid-exam (head, brain, sense organs) 2 hours

LECTURE PROGRAM

RECOMMENDED TEXTBOOKS

1. Gray’s Anatomy for medical students

2. Clinical anatomy (edited by Keith Moore)

RECOMMENDED ANATOMICAL ATLASES

1. Atlas “Human Anatomy” (Атлас „Aнатомия на човека”), edited by

Sinelnikov (Синелников)

2. Atlas of human anatomy (of Frank Netter)

3. Atlas of human anatomy (of Sobbota)

SPECIAL HISTOLOGY 30 hours Digestive system 6 hours

Respiratory system 2 hours

Urinary system 2 hours

Male reproductive system 2 hours

Female reproductive system 2 hours

Endocrine system 2 hours

Circulatory (cardiovascular) system 2 hours

Mid-exam 2 hours

Lymphatic system and hematopoietic organs 2 hours

Skin (integument) and derivatives 2 hours

Nervous system and sense organs 4 hours

Overview 2 hours

30 30 Hours in total:

MEDICAL UNIVERSITY OF SOFIA FACULTY OF MEDICINE

DEPARTMENT OF ANATOMY, HISTOLOGY AND EMBRYOLOGY

PROGRAM

CYTOLOGY. GENERAL HISTOLOGY AND GENERAL EMBRYOLOGY

for students in DENTAL MEDICINE

Subject:

Sort of the subject:

For students in:

Hours in total:

Duration:

Forms of teaching:

Student’s knowledge evaluation Semester

in which the final exam is held:

Cytology, General Histology and General Embryology

Mandatory

Dental Medicine, first year 60

One (the first) semester

Lectures and practical seminars

A mid- and a final exam (practical and theoretical)

First

DISTRIBUTION OF HOURS

SEMESTERS LECTURES SEMINARS Weekly/total Weekly/total

First (15 weeks) 2 30 2 30

LECTURE PROGRAM

- 4 hours

- 2 hours

- 2 hours

- 2 hours

- 2 hours

- 2 hours

- 4 hours

- 2 hours

- 2 hours

- 3 hours

- 5 hours - 2 hours

- 2 hours - 2 hours

- 2 hours

- 2 hours

- 4 hours

- 4 hours

- 2 hours

- 2 hours

- 2 hours

- 2 hours

- 4 hours

CYTOLOGY

Outer and inner morphology of cells Membrane-limited cell organelles

Cell nucleus

Non-membrane-limited organelles

BASIC PROCESSES IN CELLS

GENERAL HISTOLOGY Epithelial tissue Connective tissue Blood

Muscle tissue Nerve tissue

GENERAL EMBRYOLOGY

SEMINAR PROGRAM

Work with the light microscope. Preparation of permanent histological specimen slide:

CYTOLOGY

Plasma membrane and its derivatives

Nucleus, nucleolus, cytocenter, cytoskeleton Mitochondria, endoplasmic reticulum, Golgi apparatus, secretory vesicles, lysosomes and peroxisomes

CYTOCHEMISTRY

GENERAL HISTOLOGY:

Epithelial tissue Connective tissue Blood

Muscle tissue Nerve tissue

Mid-exam: Cytology and General Histology GENERAL EMBRYOLOGY.

REPRODUCTIVE CELLS

RECOMMENDED BASIC TEXTBOOKS

1. L. Carlos Junqueira, Jose Cameiro, Robert O. Kelley. Basic Histology. Middle East Edition.

Sevent edition. Librairie du Liban. Appelton & Lange. 1992.

2. T. W. Sadler. Langman's Medical Embryology. Sixth edition. Williams & Wilkins: Baltimore - Hongkong - London - Sydney, 1990

RECOMMENDED ADDITIONAL TEXTBOOKS

B. Alberts, D. Bray, J. Lewis, M. Raff, K. Roberts, J. D. Watson. Molecular Biology of the Cell. Third

edition. Garland Publishing, Inc. New York & London. 1994.

MEDICAL UNIVERSITY – SOFIA

FACULTY OF DENTAL MEDECINE

CURRICULUM

Subject: Biology and genetics for dental medical students

For students of: Dental Medicine

Subject is taught in year: 1st

Subject is taught in semester: 1st and 2nd

Examination after semester: 2nd

The course length is: 105 academic hours

DISTRIBUTION OF THE TEACHING HOURS

FORM OF TEACHING HOURS 1st semester total per week

2nd semester total per week

Lectures 30 2 15 1

Practicals 30 2 30 2

ALL:

60 acad. hours 45 acad. hours

PROGRAMME OF THE HUMAN BIOLOGY (MEDICAL

BIOLOGY) COURSE

A. LECTURES

Unit 1. Basic principles in the organization of living systems 4 h

1.1. Subject, place and significance of biology. Basic methods in biology. 1 h 1.2. 1.3. Molecular organization of the living matter 1 h

Proteins - structure and function. Nucleic acids - types and functions. Self-assembly of the macromolecular subunits. Biological importance of macromolecules for the organism.

1.4. Cellular basis of life. 1 h Prokaryotic and eukaryotic cells - comparative structural and functional

characterization. Origin and evolution of cells. The cell as an open biological system. Cell communications. Cell juctions. Cell receptors. Individual development of cells. Cell senescence

1.5. Cell reproduction. Cell growth and division 1 h Cell (mitotic) cycle - interphase, mitosis. Phases and mechanism of mitosis. MPF

description. Control of cell division in multicellular organisms.

Unit 2. Molecular and cellular mechanisms of inheritance and variation 16 h

2.1. Molecular mechanisms of the basic genetic processes 8 h Replication of DNA (DNA biosynthesis). Basic modes of replication. Transcription. RNA processing. Genetic code. Translation. Protein sorting into cellular organelles. Posttranslational modification of proteins. Senescence and degradation of proteins. Mutagenic factors and the mechanism of their action. DNA repair. Genome organization in prokaryotic and eukaryotic cells. Regulation of gene expression. Sumbicroscopic structure of the chromosomes. Microscopic structure of the chromosomes. Karyotype.

2.2. Laws of heredity 6 h Heredity. Inheritance. Genotype and phenotype. Methods of genetic analysis -

cytogenetic methods, molecular genetic methods. Allelic form of the genes. Interaction between genes. Basic types of inheritance. Inheritance of linked genes. Crossingover.

Groups of linked genes in the human. Heredity and environment. Reaction norm. Phenocopies. Morphoses. Genocopies. Cytoplasmic heredity. Extrachromosomal heredity. Modificational and genetic variation. Hybrid and recombinational variation. Molecular mechanisms of crossingover. Mutational variation. Types of mutations. Gene mutations and disease. Chromosomal mutations. Genome mutations. Cytoplasmic mutations.

2.3. Genetic and gene engineerin 2 h Genetic engineering at the level of population. Genetic engineering at the level of

organism. Genetic engineering at cellular level. Genetic engineering at subcellular level. Recombinant DNA technologies and gene engineering. Specific DNA cleavage. Most important enzymes in recombinant DNA techniques. DNA sequencing. DNA libraries. Nucleic acid hybridization. DNA cloning. Polymerase chain reaction. Gene engineering and gene therapy.

Unit 3. Immunobiology. The organism as a unified system. Immunological homeostasis 11 h

3.1.Immune system l h

Central and peripheral organs of the immune system. Cells of the immune response. Complement system.

3.2. Antigens as inducers of the immune response 2 h

Human alloantigens: ABO (H) system, Lewis system, biosynthesis of the A, B, H and Lewis antigens. Rhesus system. Origin and biological significance of the alloantigens.

3.3. Antibodies. 2 h

Immimoglobulins. Immunoglobulin classes. Genetic control of the antibody

synthesis. Isotypic, allotypic and idiotypic determinants. V- and C-genes.

3.4. Immune response 2 h Cellular interactions during the immune response. Phases in differentiation of

immunocompetent cells. Types of immune responses. Major histocompatibility complex. Genetic control of the immune response intensity.

3.5 Immunobiological aspects of transplantation and anti-tumor immunity.

Immune tolerance. 2 h Laws for transplantation of tissues between inbred animal strains. Transplantation

antigens in mouse and human. Host versus graft reaction. Immune tolerance. Graft versus host reaction. Anti-tumor immunity. Tumor antigens. Immune mechanisms directed against malignant tumors.

3.6. Regulation and control of the immune processes. Immunity theories.

Evolution of immunity 2 h

Unit 4. Reproduction and individual development 4 h 4.1. Reproductive biology 2 h 4.2.

Sex determination and differentiation. Reproduction of organisms. Sexual reproduction. Haploid-diploid cycle. Benefits of sexual reproduction. Cytological basis of sexual reproduction. Meiosis. Origin of germ cells. Gametogenesis. Oogenesis. Molecular mechanisms of oocyte maturation. Characteristic features of mature ova. Spermatogenesis. Characteristic features of male gametes. Fertilization. Stages of external fertilization. Mechanisms for blocking polyspermy. Completion of fertilization. Internal fertilization in mammals. In vitro fertilization and other reproductive techniques. Atypical forms of reproduction.

4.3. Developmental biology (individual development) 2 h Embryonic period. Cellular and molecular mechanisms of gastrulation. Embryonic

development of mammals and human. Differentiation. Differences between cells and cell memory in development. Postembryonic period. Ageing and death.

Unit 5. Biological evolution 2 h 5.1. Population genetics and biology 2 h

Population. Phenotype, genotype and gene frequences. Types of mating. Hardy-Weinberg law. Factors influencing gene frequences. Mutations. Natural selection, balanced polymorphism, genetic homeostasis. Migration. Isolation. Quantitative traits. Molecular evolution.

Unit 6. Ecology and interactions between humans and environment 1 h

Populations, communities and ecosystems. Interactions between organisms in communities. Humans and the biosphere. Biology of behaviour.

Unit 7. Invertebrate evolution with elements of medical parasitology 3 h

Parasitism as a biological phenomenon. Parasites and hosts. Origin of parasitism. Parasite adaptation to the host. Host - parasite interactions. Ecology of parasitism.

Unit 8. Comparative anatomy and human evolution 4 h

Systematics of chordates. Origin of vertebrates. Origin and evolution of skull and digestive system.

PRACTICAL COURSE

1. Techniques for light microscopy. Phylum Sarcomastigophora. Subphylum Mastigophora (Flagellata). Trichomonas hominis. Trichomonas vaginalis. Lamblia intestinalis (Giardia lamblia). 2 h

2. Phylum Sarcomastigophora. Subphylum Mastigophora (Flagellata). Trypanosoma rhodesiense and Trypanosoma gambiense (Trypanosoma brucei). Trypanosoma equiperdum. Leishmania donovani. Leishmania tropica. Subphylum Sarcodina. Entamoeba histolytica. Entamoeba gingivalis 2 h

3. Phylum Sporozoa (Apicomplexa). Plasmodium vivax. Plasmodium malariae. Plasmodium falciparum. 2 h

4. Phylum Sporozoa (Apicomplexa). Toxoplasma gondii. Phylum Ciliophora. Class Ciliata. Balantidium coli. Paramecium caudatum. Transition to Metazoa. Phylum Coelenterata. Genus Hydra. 2 h

5. Phylum Platyhelminthes (Plathelminthes). Class Trematoda. Fasciola hepatica. Dicrocoelium lanceatum (Dicrocoelium dendriticum). Genus Schistosoma. 2 h

6. Phylum Platyhelminthes. Class Cestoda. Taenia solium. Taeniarhynchus saginatus (Taenia saginata). Diphyllobothrium latum. Echinococcus granulosus. 2 h

7. Phylum Nematoda. Ascaris lumbricoides. Enterobius vermicularis. Trichocephalus trichiurus. Trichinella spiralis. 2 h

8. Phylum Arthropoda Class Arachnoidea (Arachnida, arachnids). Order Scorpiones (scorpions). Order Aranei (spiders). Order Acari (ticks and mites) - Sarcoptes scabiei, genus Dermatophagoides. Ticks - vectors of transmissive diseases: Ixodes ricinus, Dermacentor marginatus, Hyalomma plumbeum, Rhipicephalus sanguineus. 2 h

9. Phylum Arthropoda. Class Insecta. Pediculus hominis. Phthirius pubis. Cimex lectularius. Pulex irritans. The role of insects as vectors of transmissive diseases. 2 h

10. Phylum Arthropoda. Class Insecta. Genus Culex and genus Anopheles. Phlebotomus papatasii. The role of insects as mechanical carriers of pathogens and parasites. 2 h

11. Colloquium of parasitology 2 h

12. Comparative anatomy of skull (Neurocranium) 2 h 13. Comparative anatomy of skull (Cranium viscerale) 2 h

14. Comparative anatomy of the digestive system 2 h 15. Venomous animals and poisonous plants and fungi 2 h

16. Methods for protein purification: salting out and chromatographic separation according to the molecular mass. 2 h

17. DNA and chromatin. Giant chromosomes in Chironomus larvae. Barr body in oral mucosa cells. 2 h

18. Cell cycle and cell division. Mitosis, atypical forms of mitosis. 2 h

19. Karyotype. Normal human and animal karyotype. Evolution of karyotype. 2 h 20. Cellular basis of sexual processes. Meiosis. Gametogenesis. 2 h 21. Fertilization in mammals. In vitro fertilization - a mouse model. 2 h 22. Individual development. Embryonic period: cleavage, gastrulation, organogenesis. Slides of

echinoderm, fish and frog. Postembryonic period: direct development, metamorphosis. 2 h 23. Central and peripheral organs of the immune system. Demonstration and removal of thymus,

lymph nodes, spleen, bone marrow. Methods for preparation and evaluation of lymphocyte suspensions. Phagocytosis. 2 h

24. Immunogenetics. ABO (H) system. Blood group determination. Blood group inheritance.2 h

25. Immunological methods: agglutination - titration of serum; agglutination inhibition; Secretor’s status 2 h

26. Immunological methods: precipitation (ring test); Ouchterlony double gel immunodifusion; ELISA, PCR, FISH

27. Colloquium of developmental biology and immunology. 2 h 28. Methods in population genetics: qualitative traits. Hardy - Weinberg law. 2 h 29. Methods in population genetics: quantitative traits. 2 h 30. Mutation frequency. Natural selection. Migration. Isolation. Genetic drift. Kinship and

inbreeding coefficients. Solving genetic problems. 2 h

REQUIRED MINIMUM OF PRACTICAL SKILLS

1

Microscopic observation. 2

Preparation of temporary microscope slides. 3

Knowledge of methods for statistical analysis of the population. 4

Blood group determination. 5

Dissection of vertebrates. 6

Preparation of cell suspensions and quantitative analysis of immunocompetent cells. 7

Knowledge of methods for detection of antigens and antibodies. Titration of immune serum 8

Observation and recognition of parasites. 9

Knowledge of a mammalian in vitro fertilization model. 10. Recognition of normal human karyotype. 11. Solving problems in medical genetics.

LECTURES IN BIOLOGY AND GENETICS FOR ENGLISH

SPEAKING DENTAL MEDICAL STUDENTS

I SEMESTER

1. Levels of organization of living organisms - from Prokaryotes to Eukaryotes.

Parasitism as a biological phenomenon. Parasites and hosts. Origin of parasitism.

Parasite adaptation to the host. Host - parasite interactions. Ecology of parasitism.

2. Protozoology. Phylum Sarcomastigophora. Phylum Sporozoa (Apicomplexa)

3. Comparative anatomy. Systematic of chordates. Origin of vertebrates. Origin and

evolution of skull

4. Comparative anatomy. Origin and evolution of digestive system.

5. Cellular basis of life. Origin and evolution of cells. The cell as an open biological

system. Cell communications. Cell receptors. Individual development of cells. Cell

senescence. Cell (mitotic) cycle. Phases and mechanism of mitosis. MPF description.

Control of cell division in multicellular organisms.

6. Basic trends in human genetics. Regularities of heredity. Allelic form of the genes.

Interaction between alleles. Interaction between non-allelic genes. Penetrance and

expressivity. Autosomal and sex-linked inheritance. Inheritance of independently

combining genes. Inheritance of linked genes. Crossing over.

7. Molecular bases of inheritance. DNA replication in prokaryotes and eukaryotes

Basic modes of replication. DNA repair.

8. Molecular bases of inheritance. Transcription. RNA processing.

9. Modern concept of the gene. Organization of the genome. Control of gene

expression. Translation. Genetic code.

10. Biological evolution. Biology and genetic of populations. Population. Phenotype,

genotype and gene frequencies. The Hardy-Weinberg law. Application of the Hardy-

Weinberg law

11. Biological evolution Biology and genetic of populations. Factors influencing gene

frequencies.

12. Biological evolution Biology and genetics of populations. Quantitative traits.

Molecular evolution

13. Organization of the genetic material in cells. Chromosomal basis of inheritance.

Structure of the chromosomes. Human karyotype. Evolution of the karyotype

14. Reproductive biology. Meiosis. Gametogenesis. Fertilization. External fertilization.

Mechanisms for blocking polyspermy. Internal fertilization in mammals. Atypical

forms of reproduction

15. Genetic and gene engineering. Perspectives of the gene engineering (social and

ethical aspects).

16. The concept for homeostasis. Genetical homeostasis. Immunological homeostasis.

Immune system. Immune response cells.

17. Inductors of the immune response. Natural antigens. Human alloantigens. ABO (H)

and Lewis systems. Rhesus system. System of the complement

18. Immune response. Cellular interaction during the immune response. Phases in

differentiation of immunocompetent cells. Types of immune responses. Major

histocompatibility complex. Phases in the immune response.

19. Immune response. Humoral immune response. Cellular immune response. Primary

and secondary immune response.

20. Genetics of the immune response. The generation of diversity of Immunoglobulin -

and T cell- recepors

21. Regulation and control of the immune processes. Cytokines. Immunity theories.

Evolution of the immunity

22. Immunobiological aspects of transplantation and anti-tumor immunity.

Transplantation antigens. Host versus graft reaction. Immune tolerance. Graft versus

host reaction. Anti-tumor immunity. Tumor antigens. Immune mechanisms directed

against malignant tumors.

23. In vitro fertilization and new reproductive techniques.

Syllabus of Biology and Genetics for students of dental medicine

(1st year)

A. HUMAN BIOLOGY 1. Subject, place and significance of biology. Basic methods in biology. 2. Nucleic acids DNA - helix types and functions, RNA - types and functions 3. Comparative structural and functional characterization of prokaryotic and eukaryotic cells Prokaryotic and eukaryotic cells. Origin and evolution of cell. 4. The cell as an open biological system. Cell signaling. Cell junctions. Cell receptors. 5. Individual development of cells. Cell senescence. Apoptosis. 6. Cell reproduction Phases and mechanism of mitotic division. Mitosis 7. Cell reproduction Consecutive events in mitosis (M-phase) and cytokinesis. Cell cycle control, MPF description. 8. Molecular mechanisms of the basic genetic processes DNA replication. Basic modes of replication. DNA repair 9. Molecular mechanisms of the basic genetic processes Transcription. RNA processing 10. Molecular mechanisms of the basic genetic processes Genetic code. Translation. 11. Molecular mechanisms of the basic genetic processes Protein sorting into cellular organelles. Posttranslational modification of proteins. Senescence and degradation of proteins 12. Organization of the prokaryotic genome. Regulation of gene expression in prokaryotic cells 13. Organization of the eukaryotic genome. Levels of regulation of gene expression in eukaryotic cells Molecular biology of the gene. Types of DNA sequences. DNA-binding proteins 14. Submicroscopic structure of chromosomes. Cytoplasmic heredity 15. Microscopic structure of chromosomes. Karyotype. Evolution of karyotype. 16. Human karyotype. Methods of karyotyping and chromosomal analysis. 17. Laws of heredity Allelic form of the genes 18. Laws of heredity Basic types of inheritance. Inheritance of independently combining genes 19. Laws of heredity Inheritance of linked genes. Crossing over. Molecular mechanisms of crossing over. Groups of linked genes in the human 20. Heredity and environment. Reaction norm, Phenocopies and genocopies Genotype variation. Recombinational variation 21. Mutational variation - gene, chromosomal and genome mutations Mutations and disease. Causes for mutations (mutagenic factors) 22. Genetic engineering Genetic engineering at the level of population, organism and cell 23. Genetic engineering Genetic engineering at subcellular level, cloning by transplantation of somatic cell nuclei into oocytes 24. Recombinant DNA techniques and gene engineering

Specific DNA cleavage, most important enzymes in recombinant DNA techniques. DNA sequencing 25. Recombinant DNA techniques and gene engineering DNA cloning. Polymerase chain reaction. Gene engineering and gene therapy 26. The organism as a unified system. Immunological homeostasis. Organs of the immune system 27. Antigens as inducers of the immune response. Haptens 28. Human alloantigens ABO(H) system. Lewis system. Biosynthesis of the A,B, H and Lewis antigens 29. Human alloantigens Rhesus system. Immunological conflict between mother and fetus. Origin and biological importance of alloantigens. 30. Cells involved in immune response T lymphocytes, B lymphocytes, phagocytic and antigen-presenting cells 31. Antibodies. Complement system Structure and function of antibodies, antigenic determinants of antibodies. Antigen - antibody reaction 32. Genetic control of the antibody synthesis 33. Cellular interactions during the immune response Activation of antigen-presenting cells. Activation of T lymphocytes. Cell-mediated immune response. 34. Cellular interactions during the immune response Activation of B lymphocytes. Humoral immune response. 35. Phases in differentiation of immunocompetent cells. Primary and secondary immune response. 36. Major histocompatibility complex (MHC). Transplantation immunity. Host versus graft reaction Types of transplantation. Primary and secondary rejection 37. Graft versus host reaction. Anti-tumor immunity Runt disease, homologous wasting disease. Tumor antigens and anti-tumor defense 38. Regulation and control of the immune processes. Immune tolerance 39. Immunity theories. Evolution of immunity 40. Reproductive biology Sex determination and differentiation 41. Reproductive biology Haploid-diploid cycle. Cytological basis of sexual reproduction. Meiosis 42. Reproductive biology Gametogenesis. Spermatogenesis. Characteristic features of male gametes. Origin of germ cells 43. Reproductive biology Oogenesis. Molecular mechanisms of oocyte maturation. Characteristic features of mature ova 44. Reproductive biology Fertilization. External fertilization and mechanisms for blocking polyspermy. Completion of fertilization 45. Reproductive biology Fertilization. Internal fertilization in mammals. Differences between external and internal fertilization 46. Reproductive biology In vitro fertilization. ICSI method. Atypical forms of reproduction 47. Developmental biology Embryonic period in vertebrates. Formation of the blastula.

48. Developmental biology Embryonic period in vertebrates. Gastrulation. Cellular and molecular mechanisms of gastrulation 49. Developmental biology Embryonic development of mammals and human. Differentiation, differences between cells, cell memory 50. Developmental biology Postembryonic period. Life span, ageing and death 51. Population genetics and biology Population. Qualitative traits - phenotype, genotype and gene frequences. Types of mating. 52. Population genetics and biology Hardy - Weinberg law and its application 53. Population genetics and biology Factors influencing gene frequences. Mutations. Migration 54. Population genetics and biology Natural selection. Balanced polymorphism. Genetic homeostasis. Isolation 55. Population genetics and biology Quantitative traits 56. Theory of evolution Species. Speciation. Speciation mechanisms 57. Theory of evolution Evolution of higher ranks (macroevolution). Origin of high-rank systematic groups. Direction of evolution 58. Molecular evolution 59. Human evolution Anthropogenesis 60. Human races. Origin of the human races. Factors of racial diversification. Racism 61. Ecology. Interaction between humans and environment Populations, communities, ecosystems. The overpopulation problem 62. Behaviour - genetic basis and adaptive value Components of behaviour. Social organization and sociobiology. Strategy of natural selection 63. Ecology of parasitism Parasitism as a biological phenomenon. Parasites and hosts 64. Ecology of parasitism Origin of parasitism, parasite adaptation to the host. Host - parasite interactions

B. PARASITOLOGY 65. Characteristics of Protozoa. Phylum Sarcomastigophora. Subphylum Mastigophora (Flagellata). Leishmania donovani. Leishmania tropica. 66. Phylum Sarcomastigophora. Lamblia intestinalis (Giardia lamblia). 67. Phylum Sarcomastigophora. Trichomonas tenax. Trichomonas vaginalis. 68. Phylum Sarcomastigophora. Trypanosoma rhodesiense and Trypanosoma gambiense (Trypanosoma brucei). Trypanosoma equiperdum. 69. Subphylum Sarcodina. Entamoeba histolytica. 70. Phylum Sporozoa (Apicomplexa). Plasmodium vivax. Plasmodium malariae. Plasmodium falciparum. 71. Phylum Sporozoa (Apicomplexa). Toxoplasma gondii. Phylum Ciliophora. Class Ciliata. Balantidium coli. 72. Transition to Metazoa. Phylum Coelenterata (Cnidaria). Genus Hydra. 73. Phylum Plathelminthes (Platyhelminthes). Class Trematoda. Fasciola

hepatica. 74. Class Trematoda. Dicrocoelium lanceatum (Dicrocoelium dendriticum). Genus Schistosoma and its species. 75. Class Cestoda. Taenia solium. 76. Class Cestoda. Taeniarhynchus saginatus (Taenia saginata). Diphyllobothrium latum. 77. Class Cestoda. Echinococcus granulosus. 78. Phylum Nematoda. Ascaris lumbricoides. 79. Phylum Nematoda. Enterobius vermicularis. Trichocephalus trichiurus (Trichuris trichiura). 80. Phylum Nematoda. Trichinella spiralis. 81. Phylum Annelida. Lumbricus terrestris. Hirudo medicinalis. 82. Phylum Arthropoda - general characterization. Class Arachnoidea (Arachnida, arachnids). Order Scorpiones (scorpions) and order Aranei (spiders). 83. Order Acari (ticks and mites). The role of ticks as vectors of transmissive diseases 84. Class Insecta (insects). The role of insects as vectors of transmissive diseases 85. Class Insecta (insects). Pediculus hominis (Pediculus humanus). Phthirius pubis. 86. Class Insecta. Cimex lectularius. Pulex irritans. 87. Genus Culex and genus Anopheles - morphological differences. Phlebotomus papatasii.

C. COMPARATIVE ANATOMY OF VERTEBRATES 88. Origin and evolution of skull Cartilaginous cerebral skull. Bony cerebral skull 89. Origin and evolution of skull Cartilaginous visceral skull. Bony visceral skull 90. Comparative anatomy of skull 91. Comparative anatomy of oral cavity, teeth, tongue and oral glands.

REFERENCES Markell E.K., M. Voge, D.T. John. Medical Parasitology. 6th Edition. W.B.

Saunders Company, Philadelphia, 1986. Vilee C.A., E.P. Solomon, P.W. Davis. Biology. CBS College Publishing,

Philadelphia, 1985. Strickland G.T. Hunter’s Tropical Medicine. 7th Edition. W.B. Saunders

Company, Philadelphia, 1988. Brown H.W., F.A. Neva. Basic Clinical Parasitology. 5th Edition. Prentice/Hall

International Inc., USA, 1983. Hickman C.P., L.S. Roberts, F.M. Hickman. Biology of Animals. 4th Edition.

Times Mirror/Mosby College Publishing, St. Louis, 1986. Warren K.S., A.A.F. Mahmoud. Tropical and Geographical Medicine. 2nd

Edition. McGraw-Hill Inc., USA, 1990. De Beer G. Textbooks of Animal Biology. Vertebrate Zoology. Sidguick &

Jackson Ltd. Torrey T.W. Morphogenesis of the Vertebrates. 2nd Edition. John Wiley and

Sons, Inc., New York. Alberts B., A. Johnson, J. Lewis, M. Raff, K. Roberts, P. Walter, Molecular

biology of the cell, 4th Ed. Garland Publ. Inc., 2002. Benjamini E., S. Leskowitz, IMMUNOLOGY: A Short Course. Wiley-Liss

Inc., New York, 1991. Connor J.M., M.A. Ferguson-Smith, ESSENTIAL MEDICAL GENETICS, 3rd

Edn., Blackwell Scientific Publ., 1995.

Curtis H„ Barnes N.S., BIOLOGY, New York, 1998. Eaton, T. H„ COMPARATIVE ANATOMY OF VERTEBRATES, Second

Edition, Harper & Brothers, New York, 1998. Gottfried S.S., BIOLOGY TODAY. Mosby-Year Book Inc., St. Louis,

Missouri, 1993. Hirsch-Kaufmann M., M. Schweiger, BIOLOGIE FUR MEDIZINER UND

NATURWISSENTSCHAFTLER Stuttgart, G. Thieme Verlag, 1996. Keeton W. T„ J.L. Gould, BIOLOGY SCIENCE, 4th Edn W.W. Norton Co.,

New York and London, 1986. Lodish H., D. Baltimor, A. Berg, S.L Zipursky, P. Matsudaira and J. Darnell,

MOLECULAR CELL BIOLOGY, Freeman and company, New York, hird Eddition, 1995.

Purves W.K., G.H. Orians, LIFE. THE SCIENCE OF BIOLOGY, 2nd Edn. Sinauer Associates Inc., Sunderland, Massachusetts, 1987.

Raven P.H., G.B. Johnson, BIOLOGY, 3rd Edn. Mosby-Year Book Inc., St. Louis, Missouri, 1992.

Roitt I., J. Brostoff, D. Male, IMMUNOLOGY, Mosby-Year Book Europe Ltd., London, 1993.

Thompson M.W., R.R. Mclnnes, H.F. Willard, Thompson & Thompson GENETICS IN MEDICINE, 5th Edn. W.B. Saunders Co, Philadelphia, 1991.

Immunology, Instant Notes, Peter Lydyard et all, 2007 second edition, Taylor and Francis Informa, US, UK

Molecular Biology, Instant Notes, Phil Turner et all, third edition, 2006, Taylor and Francis Informa, US, UK

Genetic, Instant Notes, Hugh Fletcher et all, 2008 Taylor and Francis Informa, US, UK


FACULTY OF DENTAL MEDICINE

CURRICULUM

Name of the discipline: BIOPHYSICS

Educational degree: Master

Type of the discipline: Obligatory

Course duration: One semester

Course degree: M degree (Master’s)

Evaluation methods: During the practical exercises the students are subjected to continuous assessment; at the end of the semester an exam on the practical exercises is carried out in form of a test; the final exam on the whole course (covering the learning material from the lectures and practicum) contains written answers and discussion on them.

Training methods used during the course: Lectures – 15 hours, Practical (laboratory) exercises – 15 hours; before coming to the laboratory exercises the students have to prepare themselves on a given topic (list of several keywords) from recommended reference sources (textbook, laboratory guide, new written texts); during the practicum the basic training form is the discussion; after finishing the laboratory practice the students have to write an individual standardized protocol concerning the experimental work, the obtained results and their discussion – working out this protocol is important part of the training.

Final exam at the end of semester: YES

Leading instructor: Associated professor Trayko Traykov

Home department: Department of medical physics and biophysics

ANNOTATION OF COURSE

Subject of biophysics are the physical principles, on which all processes in the living systems are

based. It is a precise quantitative interdisciplinary science between physics and biology. It is

experimental and theoretical discipline closely related to mathematics, biochemistry and

physiology. Biophysics is also connected with many areas of physics, chemistry and physical

chemistry. Learning biophysics formats a problem based scientific thinking of the students in

medicine, due to the needs of using knowledge of variety of scientific disciplines for clarifying

the working mechanisms in biological matter at all levels of organization.

The teaching in BIOPHYSICS is worked out mainly on the parts “Molecular Biophysics” and

“Cellular Biophysics” and includes specific knowledge important for the medical education. The

theoretical part of the course involves the principles of the biothermodynamics and the

quantitative description of transport of substances and energy, as well as energetically and

functionally coupling of processes in the biological systems. In the chapter “Biological and

artificial membranes” the physical laws concerning the self-organization of biomolecular

structures are explained. The interrelationship between biochemical properties of molecules,

physical characteristics and biological functions is elucidated. Questions directly related to

medical practice and therapy are discussed in the chapters “Transport through biological

membranes” and “Passive electrical properties of cells and tissues”. In the chapter “Free radical

damage of membranes and cells” some specific molecular mechanisms of free radical reactions

caused by ionizing radiation are presented. Some formal theories for optimization of radiation

therapy are offered. The importance of free radicals in the pathogenesis of several diseases is

also discussed. The students learn also about some cellular biotechnological application based on

modern biophysical methods – tests for vitality, biophysical basis of electroacupuncture,

dielectrophoresis, electroporation, electrofusion of cells, some separation technologies and

electromanipulation of cells.

Formation of the overall mark for the course:

- Final examination – the mark for written answers on two theoretical questions from the lecture course material and discussion on them; eventually additional questions – 75 %

- Final mark for the practicum (25%) – formed on the basis of: o Average grade from the continuous assessment o The mark from the final test on the practicum

Aspects of the student’s evaluation:

During the practical exercises:

- Assessment of the students ability to obtain knowledge working individually with the reference sources

- Evaluation of the students participation in the discussion on the keywords given - Assessment of the students experimental work in the laboratory - Evaluation of the students skills to process statistically the obtained results (by using

computer programs and to represent them in tables, graph and to discuss them in the context of the aim of the study

During the final examination:

- Assessment of the ability of the students to give written answers on the given questions - Evaluation of the students skill to react on additional questions concerning his written

answers and on the eventually formulated additional questions - Assessment of the students competence to interrelate the theoretical knowledge with the

practical problems investigated during the laboratory practice RESOURCES USED DURING THE COURSE:

Lectures: - computer based multimedia presentation

Laboratory practice: experimental set-ups, chemicals, computers

Course objectives:

The students should gain knowledge and skills for introduction of biophysical methods (theoretical, experimental, and instrumental) in the organization of dental medicine care in accordance with the modern European standards in Health service.

Course goals:

1. Students have to gain the basic knowledge from the Lecture course (see the THEMATIC CALENDAR SCHEDULE of the LECTURES)

2. Students should learn the experimental methods introduced in the laboratory exercises (see THEMATIC CALENDAR SCHEDULE of the LABORATORY EXERCISES)

3. Students have to learn to process statistically (calculate mean values and standard deviations, do linear and non-linear regressions using statistical programs – e.g. Excel, Prism) the obtained experimental results and to represent them in tables, graph and to discuss them in the context of the aim of the study

4. After finishing the laboratory practice the students have to be able to write an individual standardized protocol concerning the experimental work, the obtained results and their discussion

Requirements:

Successful finished courses in: chemistry, physics, biology and high school mathematics

Learning outcomes:

From the lecture course the students have to obtain the basic biophysical knowledge

In the practice the students learn:

- to formulate concrete aims and problems for experimental study; - based on the knowledge offered in these materials, the students must be able to propose and

discuss ideas about how the aims of the experiments have to be realized; - to process statistically the obtained experimental data and represent them in tables and graphs; - to comment the importance and application of the obtained information about the particular

object investigated in biophysical, general biological and medical context; - to document precisely the discussion, the experimental work and results in an individual protocol,

which is close in form and structure to a scientific paper. The practical skills offered to the students aim to familiarize them with basic knowledge about methods used in research and clinical laboratories. They learn:

- to format a monomolecular layer of amphiphylic substance and determine its molecular dimensions;

- to perform drug ionophoresis through the human skin and estimate the amount of the substance brought into it;

- to acquire a method for investigation of the viscoelastic properties of human skin; - to estimate the acidic resistance and age distribution of erythrocytes from different blood samples; - to master the method of cellular electrophoresis and the estimation of the surface electric charge

density of cells; - to use an approach for measuring electric potential differences in model systems; - to measure the volume fraction of erythrocyte (hematocrit value) and mean cellular volume of

those cells; - to determine the coefficient of permeability for given substance of an artificial membrane used

fore hemodialysis.

Literature for preparation: 1. Lecture notes – offered on the web too; 2. Materials for every experimental practice – given as a text 3. Glaser, R., Biophysics, 2001, 361 pp. 162 figs 4. Weiss, T. F., Cellular Biophysics - Two Volume Set, 1996, 1318 pp., 758 illus.

Topics for individual preparation: see the list of the laboratory exercises and the corresponding keywords

Literature for preparation:

1. Lecture notes – offered on the web too; 2. Materials for every experimental practice – given as a printed text 3. Glaser, R., Biophysics, 2001, 361 pp. 162 figs 4. Weiss, T. F., Cellular Biophysics - Two Volume Set, 1996, 1318 pp., 758 illus.

THEMATIC CALENDAR SCHEDULE of the LECTURES in BIOPHYSICS

for dental medicine students

during the third (winter) semester of the second academic year

Lectures - 15 hours, Course Duration: one semester, the third semester (Even weeks - 2 hours, odd

weeks - no lectures)

Week No.

Subject Hours number

2-nd

The subject of biophysics. Divisions and methods of biophysics. Biophysics and Medical Sciences.

I. Biomechanics and biothermodynamics

1. Subject and importance of biomechanics. Rheology of the solid biomaterials. Viscoelastic properties of bones and muscles. Biomechanics of the chewing apparatus.

2. Passive mechanical properties of blood vessels – Lame’s equation, volume-pressure dependencies. Pulse wave. Mechanics of breathing. The role of Laplace pressure and the surfactant.

3. Biothermodynamics: basic concepts. First law of thermodynamics, internal energy. Second law of thermodynamics, entropy.

2 hours

4-th

4. Energy sources, types of work and heath in the living systems. Electrochemical potential, free energy and direction of processes. Steady state and thermodynamic equilibrium.

II. Biological and artificial membranes

5. Subject and importance of the biological membranology, types of membranes. Functions and basic chemical composition of the biomembranes. Membrane phospholipids, glycolipids and cholesterol.

6. Membrane proteins and glycoproteins - functions, localization and binding. Membrane models and methods for investigation of biomembranes.

7. Lipid associates and model artificial membranes - types, preparation methods, properties and significance. Liposomes as drug carriers.

8. Mobility of the membrane components - lateral and transversal diffusion. Liquid-crystalline state of the lipid bilayer. Molecular mechanism of the phase transitions..

2 hours

9. Free radicals - generation in biological systems. Types of free radicals, basic reactions and properties. Reactive oxygen species (ROS). Basic

2 hours

6-th

methods for registration and investigation of ROS.

10. Oxidation of the membrane components - consequences. Biophysical mechanisms of the oxidative stress caused by different factors. Antioxidant defense systems of an organism..

III. Transport of substances through membranes

11. Subject and importance of the membrane transport. Types of transport (classification). Free diffusion of non-charged particles - first and second Fick’s laws. The Stokes-Einstein equation.

12. Free diffusion of ions – the Nernst-Plank equation, dimensionless potential. Non- free diffusion through a pored membrane.

8-th

13. Osmosis and filtration. Dialysis and hemodialysis. Water exchange through membranes and between blood and tissues

14. Facilitated diffusion. Ionophores i) - mobile carriers (Valinomycin) and ii) - channel-forming carriers (Gramicidin A). Principles of action, molecular structure and selectivity.

15. Active transport. Sodium-potassium pump and calcium pump – importance, role of ATP, molecular structure and model of action.

2 hours

10-th

IV. Electrical properties of cells and tissues

16. Diffusion, equilibrium (Nernst) and Donnan potentials - conditions and mechanisms of generation, dependencies on concentration and time.

17. Origin of the resting potential - theories. Goldmann equation. The effect of electrogenic pump. Resting potential components.

2 hours

12-th

18. Action potential - origin, generation, propagation. The Hodgkin-Huxley’s equations. Structure of the ionic channels. The effect of different toxins and drugs on their behavior.

19. Importance and origin of the surface electric charge of the cells – double electric layer and potential distribution. The Poisson-Boltzmann equation. Potential decay across the membrane and near its both sides.

2 hours

14-th

20. Electrophoretic mobility – dependence on pH and ionic strength (salt concentration) of the medium. Stability of the biosuspensions. Types of electrophoresis.

21. Electroconductivity of cells and tissues for DC (direct current). Types of polarization of dielectrics and heterogeneous systems.

22. Electroconductivity of cells and tissues for alternating current (AC). Impedance and dispersion of the dielectric permittivity. Physiological and pathological changes in the electrical conductivity of tissues. Biophysical basics of elecroacupuncture diagnostics and therapy.

3 hours

COURSE OUTLINE: The course duration is 30 academic hours divided as follows:

Lectures: 15 hours

THEMATIC CALENDAR SCHEDULE of the LABORATORY EXERCISES for dental medicine students

during the third (winter) semester of the second academic year

LABORATORY PRATICE - 15 hours,

Course Duration: one semester, the third semester (Even weeks - 2 hours, odd weeks - no practices)

Topic

1 Investigation on the mechanical properties of human skin in vivo – 2 hours

Keywords for preparation: passive mechanical properties of biological tissue – mechanical stress, strain, velocity gradient; types of mechanical properties – elastic, Hook’s law; viscous – Newton’s law or viscoelastic – equation for viscolelastic materials; mechanical models in the rheology – kinetic properties; methods for investigation of the mechanical properties of biological membranes

Aim of the study: to determine the type of the mechanical properties of

human skin – elastic, viscous or viscoelastic; to estimate the elastic modulus E (Young’s modulus) of human skin

2

The acid hemolysis of red blood cells (RBC) – a dynamic method for investigation of alterations in RBC resistance - 2 hours Keywords for preparation: hemolysis – types, acidic resistance of RBC – time for 50% hemolysis (t

50%), differential erythrogram – RBC resistance distribution, differential

erythrogram – and RBC age distribution, diagnostic importance

Aim of the study: to compare the acidic resistance and age distribution of RBC from two different blood samples

3

The influence of the osmotic pressure on the volume of erythrocytes - 2 hours Keywords for preparation: osmotic pressure of solutions – equations for ideal and real solutions; osmosis and filtration; osmotic equilibrium at a biological membrane; dependence of red blood cell volume on the osmotic pressure of the suspending medium; apparent osmotically inert volume (Vn).

Aim of the study: to determine the dependence between erythrocyte volume and osmotic pressure of the suspending medium; from the obtained relation to estimate the apparent osmotically inert volume (Vn).

4

Determination of the size of amphipathic molecules by monolayer - 2 hours Keywords for preparation: chemical composition of the biological membranes; molecular structure and physicochemical properties of the membrane phospholipids; Lipid associates and model artificial membranes – micelles, monolayers, bilayers, liposomes

Aim of the study: To determine the length, average area per molecule and the diameter

of the oleic acid molecule using monolayer. 5

Assessment of the ionophoretic permeability of human skin - 2 hours Keywords for preparation: electrophoresis types, drug electrophoresis; coefficient of permeability of human skin – importance, comparison of drug electrophoresis with other methods of drug application (for example – oral and venous); modern methods for drug delivery in the organism – liposomes as a drug carrier.

Aim of the study: to determine the coefficient of permeability of human skin for Novocain ions

6

Transport of substances through artificial membrane - 2 hours Keywords for preparation: passive transport through membranes – free diffusion and diffusion through a membrane; concentration change with time – the halftime (t0,5); dialysis and hemodialysis.

Aim of the study: to determine the coefficient of permeability for given substance of an artificial membrane

7 Estimation of the electrokinetic potential of cells. Dependence on pH and ionic strength - 2 hours

Keywords for preparation: surface electric charge of cells – contributions of the different membrane components; sialic acids; double electric layer – definition, schematic representation, thickness of the electric double layer; quantitative estimation of the surface electric charge density with cell electrophoresis; electrophoretic mobility and electrokinetic potential of cells – relation to surface electric charge; effects of the pH and ionic strength of the suspending medium.

Aim of the study: to study the effect of ionic strength of the medium on the electrophoretic mobility and electrokinetic potential of erythrocytes

8 Equilibrium and diffusion potential in model systems - 2 hours Keywords for preparation: mechanisms of formation of a potential difference on a membrane – diffusion potential and Nernst equilibrium potential; dependence on the concentration gradient and time; determination of the ratio of ion mobilities in the model system.

Aim of the study: to determine the dependence of the diffusion potential in a model system on the concentration gradient. From the obtained relationship to estimate the ratio of the ion mobilities in the model system; to follow up the time dependence of the diffusion potential in the model system

Exam on the laboratory exercises – final test

(60 min, the rest time – checking the results of the test and semester attestation)

- the last week in the semester

Practical (laboratory) exercises: 15 hours – every practice lasts 2 hours and contains seminar part ant experimental work

SYNOPSYS FOR THE FINAL EXAMINATION

1. Subject and importance of biomechanics. Rheology of the solid biomaterials. Viscoelastic

properties of bones and muscles. Biomechanics of the chewing apparatus.

2. Passive mechanical properties of blood vessels – Lame’s equation, volume-pressure

dependencies. Pulse wave. Mechanics of breathing. The role of Laplace pressure and the

surfactant.

3. Biothermodynamics: basic concepts. First law of thermodynamics, internal energy.

Second law of thermodynamics, entropy.

4. Energy sources, types of work and heath in the living systems. Electrochemical potential,

free energy and direction of processes. Steady state and thermodynamic equilibrium.

5. Subject and importance of the biological membranology, types of membranes. Functions

and basic chemical composition of the biomembranes. Membrane phospholipids, glycolipids and

cholesterol.

6. Membrane proteins and glycoproteins - functions, localization and binding. Membrane

models and methods for investigation of biomembranes.

7. Lipid associates and model artificial membranes - types, preparation methods, properties

and significance. Liposomes as drug carriers.

8. Mobility of the membrane components - lateral and transversal diffusion. Liquid-

crystalline state of the lipid bilayer. Molecular mechanism of the phase transitions.

9. Free radicals - generation in biological systems. Types of free radicals, basic reactions

and properties. Reactive oxygen species (ROS). Basic methods for registration and investigation

of ROS.

10. Oxidation of the membrane components - consequences. Biophysical mechanisms of the

oxidative stress caused by different factors. Antioxidant defense systems of an organism.

11. Subject and importance of the membrane transport. Types of transport (classification).

Free diffusion of non-charged particles - first and second Fick’s laws. The Stokes-Einstein

equation.

12. Free diffusion of ions – the Nernst-Plank equation, dimensionless potential. Non- free

diffusion through a pored membrane.

13. Osmosis and filtration. Dialysis and hemodialysis. Water exchange through membranes

and between blood and tissues

14. Facilitated diffusion. Ionophores i) - mobile carriers (Valinomycin) and ii) - channel-

forming carriers (Gramicidin A). Principles of action, molecular structure and selectivity.

15. Active transport. Sodium-potassium pump and calcium pump – importance, role of ATP,

molecular structure and model of action.

16. Diffusion, equilibrium (Nernst) and Donnan potentials - conditions and mechanisms of

generation, dependencies on concentration and time.

17. Origin of the resting potential - theories. Goldmann equation. The effect of electrogenic

pump. Resting potential components.

18. Action potential - origin, generation, propagation. The Hodgkin-Huxley’s equations.

Structure of the ionic channels. The effect of different toxins and drugs on their behavior.

19. Importance and origin of the surface electric charge of the cells – double electric layer

and potential distribution. The Poisson-Boltzmann equation. Potential decay across the

membrane and near its both sides.

20. Electrophoretic mobility – dependence on pH and ionic strength (salt concentration) of

the medium. Stability of the biosuspensions. Types of electrophoresis.

21. Electroconductivity of cells and tissues for DC (direct current). Types of polarization of

dielectrics and heterogeneous systems.

22. Electroconductivity of cells and tissues for alternating current (AC). Impedance and

dispersion of the dielectric permittivity. Physiological and pathological changes in the electrical

conductivity of tissues. Biophysical basics of elecroacupuncture diagnostics and therapy.

Head of Department

Medical Physics and Biophysics:

Assoc.Prof. D. Mihov

SYLLABUS OF THE BULGARIAN LANGAUGE

1ST COURSE

The syllabus includes basic grammar rules and vocabulary:

1ST WEEK Nouns – gender, plurals, article use.

2ND WEEK Adjectives – gender, plurals, article use and degrees of comparison

3RD WEEK Verbs – conjugation

4TH WEEK Types of verbs

5th WEEK Compound predicates. Reflexive verbs

6th WEEK Imperative mood. Types

7th WEEK Demonstrative, interrogative, relative and negative pronouns

8th WEEK Numerals. Types

9th WEEK Present and Future tense of the Verb

10th WEEK Past Perfect and Past Imperfect form of the Verb

11th WEEK Passive voice. Synonyms

12th WEEK Past Indefinite tense of the verb

13th WEEK Future tense in the past. Conditional mood

14th WEEK System of the verb tenses in the Bulgarian language

15th WEEK Transformation from direct to indirect speech

II COURSE

The syllabus includes education in science terminology, basic medical terms and basic knowledge of specialized Bulgarian language

1st WEEK Nouns in the scientific text. Word-formation

2nd WEEK Adjectives in scientific text. Semantics – form, size, colour. Word-formation

3rd WEEK Verbs in the scientific text

4th WEEK Word groups in the scientific text

5th WEEK Terminological definition (qualification) of objects, processes and phenomena

6th WEEK Working with a scientific text – grammar, semantics, key words

7th WEEK Organs and systems in the human body – basic terminology

8th WEEK Medical examination of basic illnesses and complaints per systems – the

locomotive system and respiratory system

9th WEEK Illnesses and complaints per systems – cardiovascular system and digestive

system

10th WEEK Illnesses and complaints per systems – excretory system

11th WEEK Mechanical properties of the elements

12th WEEK Infection and the infection process

13th WEEK Immunity

14th WEEK Taking down a case history

15th WEEK Aspects of doctor-patient communication when taking down a case history


FACULTY OF DENTISTRY

CURRICULLUM

Discipline name: Conservative dentistry Educational degree: Master Educational mode: Obligatory Course duration: Seven semesters (IV, V, VI, VII, VIII, IX and X semester) Course level: M level (master degree) Assessment forms: Current assessment, participation in seminars, tests, practical and theoretical exams Educational forms and methods: Lectures, seminars, tests, discussions Terminal exam: Yes Lecturers: Assoc.prof. d-r R.Vassileva, Assoc.prof. d-r Sn.Topalova-Pirinska, Assoc.prof. d-r E. Boteva Department: Conservative dentistry

Course annotation: Conservative dentistry course gives the opportunity to acquire knowledge and competences in operative dentistry and endodontics which are necessary for organizing and carrying out a successful dental help. Course description: The educational course consists of 600 academic hours, including: Propaedeutics of Conservative dentistry: Lectures – 60 hours Exercises – 135 hours including:

Demonstrations – 30 hours Seminars – 8 hours

Clinics of Conservative dentistry: Lectures – 60 hours Exercises – 315 hours including:

Demonstrations – 30 hours Seminars – 14 hours

Knowledge assessment – a complex one, including:

1. Evaluation of students’ activity during the training course 2. Test examination marks at the end of each term 3. Practical exam marks 4. Theoretical exam marks (test, written and oral questions)

Aspects of knowledge assessment:

1. Specific knowledge and activity during discussions and seminars in Propaedeutics and Clinics

2. Certain quantity and quality of finished diagnostic and medical procedures 3. Results from practical examination 4. Results from theoretical examination (test, written and oral questions)

Teaching subsidiary instruments:

Slides, multimedia presentations, diagrams, models, tests, work on a clinical problem

Curricullum objective: Operative dentistry gives theoretical knowledge and practical skills about diagnostics, treatment and prophylaxis of carious and noncarious lesions of hard dental tissues of elderly population. Endodontics gives theoretical knowledge and practical skills about diagnostics, treatment and prophylaxis of dental pulp and periodontal diseases. The acquired competencies enable the organization of dental help in accordance with European standards for medical service.

Curricullum goals:

1. To acquire knowledge about dental materials, medicines, appliances, instruments in the field of Operative dentistry and Endodontics.

2. To acquire basic knowledge about biological basis of diseases of hard dental tissues and endodontium.

3. To have knowledge about current methods for diagnostics of diseases of hard dental tissues and endodontium and their complications.

4. To have theoretical and practical knowledge about treatment methods of diseases of hard dental tissues and endodontium and their complications.

5. To be acquainted with the means and methods for keeping staff and patients out of infectious diseases.

6. To have necessary competences of looking for and accomplishing consultations. Preliminary requirements: To start Conservative dentistry course students must have basic knowledge in anatomy, physiology, genetics, pathological anatomy and physiology, physics, biophysics, biochemistry, pathobiochemistry, microbiology, pharmacology. Expected results: At the end of their course of education students must be able to:

Diagnose diseases of hard dental tissues and endodontium and their complications

Use diagnostic and treatment appliances Work out treatment plan for patients with diseases of hard dental tissues

and endodontium Analyze and synthesize the data for patient’s condition (status) Realize the treatment plan and accomplish different treatment procedures,

like anesthesia, isolation of working field, preparation and restoration of cavities with different restorative materials, preparation and filling of root canals, restoration of teeth with considerable crown destructions, differentiation between diseases with dental and another origin

Recommended literature:

1. Lectures in Propaedeutics of Conservative dentistry 2. Textbook in Propaedeutics of Conservative dentistry 3. Practical manual of Propaedeutics of Conservative dentistry 4. Lectures in Clinics of Conservative dentistry 5. Textbook in Clinics of Conservative dentistry 6. Practical manual of Clinics of Conservative dentistry

CONSERVATIVE DENTISTRY PRECLINICAL SYNOPSIS

ORAL EXAM 1. Anatomy of the cavity form - basic elements. 2. Requirements to the cavity form. 3. General principles of cavity preparation (First principle of caries treatment) – basic factors affecting outline cavity form. 4. General principles of cavity preparation – additional factors affecting outline cavity form. 5. Factors affecting outline cavity form - practical significance for cavity borders determination on each tooth surface. 6. General principles (guidelines) of cavity preparation – creating resistance forms. 7. General principles (guidelines) of cavity preparation – creating retention forms. 8. General principles of cavity preparation - practical significance for initial outline form and carious dentin removal. 9. General principles of cavity preparation - practical significance for enamel margins finishing (beveling). 10. Class I cavity preparation for amalgam restorations – occlusal cavities first type. 11. Class I cavity preparation for amalgam restorations – occlusal cavities second type. 12. Class I cavity preparation for amalgam restorations – foramen coecum (buccal or lingual pit) cavities. 13. Class I cavity preparation for amalgam restorations – occlusobuccal cavities first type. 14. Class I cavity preparation for amalgam restorations – occlusobuccal cavities second type. 15. Class II cavity preparation for amalgam restorations – general characteristics and basic parts of the common form. 16. Class II cavity preparation for amalgam restorations – characteristics and elements of the proximal outline form. 17. Class II cavity preparation for amalgam restorations – characteristics and elements of the occlusal outline form. 18. Class II cavity preparation for amalgam restorations – box-only form. 19. Class II cavity preparation for amalgam restorations – conventional form. 20. Class II cavity preparation for amalgam restorations – conservative form (“slot” preparation). 21. Class II cavity preparation for amalgam restorations – approximo-occluso-buccal (approximo-occluso-lingual) form. 22. Class V cavity preparation for amalgam restorations. 23. Microretentiones – characteristics, preparation technique, retention significance and SEM characteristics. 24. Adhesive systems – classification, chemical compounds (composition) and characteristics. 25. Class III cavity preparation for composite resin (tooth-colored) restorations – proximal form. 26. Class III cavity preparation for composite resin (tooth-colored) restorations – linguoproximal form. 27. Class III cavity preparation for composite resin (tooth-colored) restorations – buccoproximal form. 28. Class III cavity preparation for composite resin (tooth-colored) restorations – linguobuccoproximal form. 29. Class IV cavity preparation for composite resin (tooth-colored) restorations – incisoproximal form. 30. Class IV cavity preparation for composite resin (tooth-colored) restorations – incisoproximolingual form. 31. Class IV cavity preparation for composite resin (tooth-colored) restorations – incisoproximobuccolingual form.

32. Class IV cavity preparation for crown fractures of the incisal ridge. Providing retention in clinical conditions. 33. Class I and II cavity preparation for direct composite resin (tooth-colored) restorations – basic rules. 34. Class V preparation for amalgam and composite resin restorations. 35. Parapulpal pins – indications, types of pins and biomechanical problems associated with their insertion. 36. Parapulpal pins – anatomical consideration about application site. 37. Parapulpal pins – instruments and insertion technique. 38. Medicatio cavi dentis (Second principle of cavity treatment) – basic concepts, reasons for medication and goals. 39. Medicatio cavi dentis (Second principle of caries treatment) – medicaments, pharmaco-dynamics, application errors. 40. Temporary fillings – function, materials, requirements, critical analysis, indications for application. 41. Obturatio cavi dentis (third general principle of caries treatment) – basic concepts. Restorative materials – biological, mechanical and esthetic requirements. 42. Obturatio cavi dentis (third principle of caries treatment) – indications, contraindications and relative contraindications for application of restorative materials. Factors affecting the choice of appropriate material. 43. Obturatio cavi dentis (third principle of caries treatment) – dentine liners. Biomechanical requirements to the materials and critical analysis. 44. Obturatio cavi dentis (third general principle of caries treatment) – insulation bases. Application techniques and basic configurations depending on different kind of base materials. 45. Restoration contours – basic characteristics depending on the tooth crown form. Errors, complications and repair options. 46. Interproximal contacts - basic characteristics depending on the tooth crown form. Errors, complication as a result of uncorrect proximal contacts and contours restoration. Repair options. 47. Amalgam restorations – instruments and application technique. 48. Esthetic restorative materials - instruments and application technique. 49. Cast metal restorations – indications, contraindications and relative contraindications for their application. Specific rules for cavity preparation. 50. Cast metal inlay restorations. Direct (clinical, chairside) method – indications, instruments and technique. 51. Cast metal inlay restorations. Indirect (laboratory) method – indications, instruments and technique. 52. Cast metal restorations – adjustment, cementation and removal of the inlay. 53. Endodontium – definition. Endodontic internal anatomy. 54. General principles of endodontic treatment. Principles of endodontic access. 55. Endodontic access to pulp chamber - cavity preparation and location of orifices. 56. Removal of different kinds endodontic space content (vital or necrotic pulp tissues) – instruments, techniques, errors and complications. 57. Working length determination of the root canal. 58. Chemo-mechanical preparation of the root canals (cleaning and shaping) – endodontic instruments and their ISO standardization. 59. Chemo-mechanical preparation of the root canals – basic guidelines and hand instrument techniques. 60. Chemo-mechanical preparation of the root canals – standard and step-back techniques. 61. Irrigation protocol – intracanal irrigants, guidelines and techniques for application. 62. Obturation of the root canals – requirements to the root canal sealers, instruments and techniques.

63. Lateral condensation – basic concepts, indications, instruments, advantages and disadvantages. 64. Methods and criteria for root canal filling assessment. 65. Root canal sealers – pharmacologic characteristics of their basic ingredients (compounds). 66. Aseptics and antiseptics (sterilization). Protection against acute infectious diseases. 67. Preparation of the operation field and patient for caries treatment and endodontic treatment. 68. Methods for pain control during caries and endodontic treatment – anesthetics and devices for their application. 69. Etiology and pathogenesis of the tooth caries. 70. Examination methods for the hard tooth tissues in cariology. 71. Inflammatory disorders/diseases of the dental pulp – etiology, pathogenesis and classification. 72. Inflammatory diseases of the dental pulp – main clinical signs and symptoms, paramedical investigations. 73. Examination methods and treatment approaches in endodontics – general characteristics. 74. Periodontium – anatomy, histology and physiology. Etiology and pathogenesis of the periodontal diseases. 75. Examination methods in periodontology. Classification of the periodontal diseases. 76. Inflammatory periodontal diseases - main clinical signs and symptoms, paramedical investigations.

WRITTEN EXAMINATION 1. Dental caries – definition and classification. 2. Dental caries – treatment aspects, indications, contraindications. 3. General principles for the treatment of dental caries by obturation. 4. Cavity configurations. Factors affecting cavity preparation. 5. Initial cavity preparation stage – instruments, general considerations depending of filling material. 6. Gingival wall - requirements for Class II - MO, DO and MOD cavities. 7. Dovetail retention form – indications, internal configuration. 8. Dentin retentions – different types, indications, position, techniques of preparation depending of cavity configuration and filling material. 9. Occlusal outline retention form in molars - indications, internal configuration. 10. Filling materials for treatment of dental caries. 11. Dental amalgam – classification, composition, mechanism of hardening. 12. Dental amalgam – clinical characteristic. 13. General configurations and characteristics of the Class I cavity preparation for amalgam restorations. 14. General configurations of the Class II cavity preparation for amalgam restorations. 15. Composition and types of composite materials. 16. Clinical characteristic of composite materials. 17. General configurations and characteristics of the cavities of Class III and V for composite filling materials. 18. General configurations and characteristics of the cavities of Class IV for composite filling materials. 19. Glassionomer cements – types and mechanism of setting. 20. Glassionomer cements – clinical characteristics and indications. 21. Root canal anatomy of upper molars. 22. Root canal anatomy of lower molars.

23. Characteristics of apical zone – physiological constriction, physiological foramen, apical foramen, anatomical apex, radiographic apex. 24. Endodontic barbed broaches - characteristics and techniques of use. 25. Basic hand endodontic instruments. 26. Hand endodontic instruments - standardization. 27. Root canal preparation – Step-back technique. 28. Lateral condensation – technique of application. 29. Pharmacodynamic effect of Eugenol and ZnO in composition of root canal pastes. 30. Dental caries – radiographic characteristics. 31. Histology of pulp tissue. 32. Physiology of pulp tissue. 33. Pulpal diseases – classification. Basic principals and critical analysis. 34. Pulpitis acuta serosa – clinical characteristic. 35. Pulpitis acuta purulenta – clinical characteristic. 36. Pulpitis chronica – clinical characteristic. 37. Periodontal diseases – basic principals of classification. 38. Chronic periodontitis – radiographic characteristics.

CONSERVATIVE DENTISTRY CLINICAL SYNOPSIS

ORAL EXAM

1. Dental caries – classification. Basic principles for composition and critical analysis of the existing classifications.

2. Pathomorphologic characteristics of the acute and chronic dental caries. 3. Clinical and paraclinical characteristics of the different types of dental caries. 4. Differential diagnosis of the dental caries. 5. Early diagnosis of the dental caries – critical analysis of the basic methods in use. 6. Methods and resources for the treatment of incipient carious defects (spots or

maculas). 7. Physiotherapeutic resources for the treatment of dental caries. 8. Medico-biological bases of the treatment of dentin wound. 9. Secondary caries – definition, etiology, pathogenesis. 10. Secondary caries – clinical characteristics and differential diagnosis. 11. Prevention of the secondary caries. 12. Dental hyperesthesia (hypersensitivity) – types and reasons for beginning. 13. Clinical characteristics, differential diagnosis and treatment of the dental hyperesthesia

(hypersensitivity). 14. Basic indicators for estimation of the clinical condition of teeth with significant

(substantial) destruction of the clinical crown. 15. Analysis of the existing hard dental structures in connection with their preparation for

restoration of considerable destructions of the clinical dental crown. 16. Principle requirements for dental preparation in the presence of significant

destructions, affecting different parts of the dental crown. 17. Indications and contraindications for indirect resin obturations (resin inlays). 18. Characteristics of the cavity for indirect resin obturations (resin inlays). 19. Methods for making indirect resin obturations (resin inlays). 20. Critical analysis of the direct and indirect resin obturations. 21. Atrophy and dystrophy of the dental pulp – basic clinical and paraclinical

characteristics. Differential diagnosis. Prognosis and treatment. 22. Calcium metaplasia of the dental pulp. Clinical and paraclinical characteristics.

Differential diagnosis. Treatment. 23. Blood vessel diseases of the dental pulp. Clinical and paraclinical characteristics.

Differential diagnosis. Reversible and irreversible alterations (changes). Treatment. 24. Acute pulpitis. Clinical and paraclinical characteristics. Reversibility and

irreversibility of the processes. Differential diagnosis. Treatment. 25. Chronic pulpitis. Clinical and paraclinical characteristics. Differential diagnosis.

Treatment. 26. Medico-biological bases of the conservative (biological, pulp capping) methods for

treatment of the dental pulp. 27. Indirect pulp capping. Technique, medicaments, prognosis. 28. Direct pulp capping. Technique, medicaments, prognosis. 29. Essence of the biological treatment methods of the dental pulp (pulp capping

methods). Indications and contraindications. Critical analysis of the pulp capping methods.

30. Vital amputation – indications, contraindications, medicaments, prognosis. 31. Vital extirpation – essence, anatomic preconditions. Indications and contraindications.

Prognosis. 32. Vital extirpation – technique. Possibilities for effective anaesthesia. Choosing an

appropriate root canal sealer.

33. Acute apical periodontitis – clinical and paraclinical characteristics. Differential diagnosis.

34. Acute apical periodontitis – treatment. 35. Chronic apical periodontitis - clinical and paraclinical characteristics. Differential

diagnosis. 36. Chronic apical periodontitis – treatment. 37. Exacerbated chronic apical periodontitis – clinical and paraclinical characteristics.

Differential diagnosis. Treatment specifics. 38. Essence and type of the healing processes after root canal treatment of irreversible

pulpitis and apical periodontitis. 39. Emergency endodontics – definition, essence, characteristics. 40. Basic aims of emergency endodontics and ways to complete them. 41. Most frequent nosological units that are objects of emergency endodontics. Treatment

schemes. 42. Basic components of post and core restoration of teeth after root canal treatment.

Purpose, indications and contraindications for application of root canal posts. 43. Types of root canal posts. Requirements towards posts. Biomechanical problems

connected with the application of the different types of root canal posts. 44. Application technique of the basic types of root canal posts. 45. Basic reasons for difficult or incorrect diagnostics in endodontics. 46. Basic symptoms, diagnostics and prognosis of cracks and fractures of the hard dental

tissues, connected with endodontic practice. 47. Non-odontogenic units (conditions) that might be confused for endodontic diseases –

anatomical structures and pathological changes. 48. Problems, connected with retreatment of endodontically treated teeth. 49. Reasons and methods for retreatment of endodontically treated teeth. 50. Basic techniques of endodontic surgery. Incisions for drainage. 51. Apical surgery – aim, indications, contraindications. Basic manipulations. Retrograde

cavity preparation an obturation. Postoperative medical care. 52. Endodontic surgery – root resection, hemisection, bicuspidation. 53. Physiotherapeutic methods for treatment of dental pulp – conservative treatment and

extirpation methods. 54. Physiotherapeutic methods for treatment of infected root canals. 55. Physiotherapeutic methods for treatment of acute apical periodontitis aiming pain

reduction and healing process stimulation. 56. Physiotherapeutic treatment for chronic apical periodontitis aiming healing process

acceleration after root canal treatment. 57. Endodontic microbiology – characteristics of endodontic microorganisms. Control of

the microorganisms during endodontic diseases. 58. Teeth bleaching – basic techniques and materials.

WRITTEN EXAMINATION 1. Classification of carious diseases of hard tooth tissues. 2. Clinical and paraclinical differentiation of chronic from acute carious process. 3. Caries profunda - differential diagnosis. 4. Opportunities and critical analysis of radiographic diagnosis of initial carious lesions. 5. Cavity preparation – errors, leading to secondary caries /indication without comment/. 6. Obturation with dental amalgam – errors, leading to secondary caries /indication without comment/. 7. Dental hyperesthesia - differential diagnosis.

8. Cast metal restorations for Class II cavity - indications, contraindications. 9. Composite inlay - indications, contraindications. 10. Hyperaemia pulpae - differential diagnosis. 11. Pulpitis acuta purulenta totalis - differential diagnosis. 12. Pulpitis chronica ulcerosa - differential diagnosis. 13. Direct and indirect pulp capping – indications, contraindications. 14. Root canal treatment on teeth with vital pulps - indications, contraindications. 15. Periodontitis acuta purulenta – differential diagnosis. 16. Periodontitis chronica granulomatosa diffusa – differential diagnosis. 17. Periapical abscess – techniques of draining the pus. 18. Radicular posts – biomechanical rules for the applications. 19. Apical endodontic surgery - indications, contraindications. 20. Root resection, hemisection, bicuspidation - indications, contraindications. 21. Endodontic retreatment – root canal filling removal. 22. Intraligamental anesthesia. 23. Intrapulpal and intraossal anesthesia. 24. Critical analysis of materials used for restorations of teeth after endodontic treatment. 25. Endodontic microbiology – species characteristic of the endodontic microflora. Bacteroides. 26. Endodontic microbiology – conditions and ways of penetration of microorganisms in dental pulp and periodontal tissue. 27. Endodontic microbiology – rules for successful microbiological examination in endodontics. 28. Teeth bleaching – complications. 29. Teeth bleaching – causes of discolorations.

SYNOPSIS OF CONSERVATIVE DENTISTRY – STATE FINAL EXAMINATION (SERTIFICATION)

1. Etiology and pathogenesis of tooth caries. 2. Classification and pathomorphology of tooth caries. 3. Clinical and differential diagnosis of tooth caries. 4. Early diagnosis of tooth caries - clinical features and non operative treatment. 5. Dentine wound – types, main characteristics and treatment. 6. Non-aesthetic restorative materials – types, chemical composition, physical properties,

indications and contraindications. 7. Aesthetic restorative materials - types, chemical composition, physical properties,

indications and contraindications. 8. Asepsis and antiseptics in operative dentistry. 9. Factors, determining the borders of cavity preparations. 10. Class I cavity preparations for non aesthetic plastic restorative materials. Main

configurations and characteristics. 11. Class V cavity preparations for non aesthetic plastic restorative materials. Main

configurations and characteristics. 12. Class II cavity preparations for non aesthetic plastic restorative materials. 13. Cavity preparation for indirect restorations. 14. Class III cavity preparations for aesthetic plastic restorative materials. Main

configurations.

15. Class IV cavity preparations for aesthetic plastic restorative materials. Main configurations.

16. Class V cavity preparations for aesthetic plastic restorative materials. Main configurations.

17. Class I and II cavity preparations for aesthetic plastic restorative materials. 18. Clinical procedures preparing the patient for definitive restoration. 19. Biomechanical problems of different cavity preparations. 20. Restorative technique for dental amalgam. 21. Restorative technique for cast metal restorations. 22. Restorative technique for aesthetic restorations. 23. Anaesthesia in cariology and endodontology. 24. Pins. 25. Secondary caries lesions. 26. Tooth hyperaesthesia. 27. Non caries lesions – erosion, fluorosis, 28. Clinical presentation and diagnosis of acute pulpitis. 29. Clinical presentation and diagnosis of chronic pulpitis. 30. Reversible and irreversible pulpal diseases. Clinical presentation and prognosis. 31. Clinical presentation and diagnosis of acute periodontitis. 32. Clinical presentation and diagnosis of chronic and reactivated periodontitis. 33. Difficult differentiation diagnoses in endodontics. 34. Endodontic cavity preparation, pulpal removal, enlargement of orifices. 35. Cleaning and shaping of root canal system. 36. Endodontic mishaps: detection, correction and prevention. 37. Obturation of root canal system. 38. Post systems. Types, biomedical problems. Indications and contraindications.

Placement technique. 39. Vital pulp therapy. 40. Vital methods for pup treatment. 41. Microbiology of endodontics – bacteria, cultured from root canals. Bacteroides sp.

Collection of microbial sample. 42. Microbiology of endodontics – ways of bacterial invasion in pulp and periodontal

tissues. Main characteristics of microorganisms. 43. Tooth bleaching. 44. Criteria and methods for evaluation of endodontic treatment. 45. Retreatment in endodontics. 46. Restoration of the endodontically treted tooth. 47. Emergency endodontics. 48. Endodontic surgery.

DENTAL PHYSIOTHERAPY

1. Electric pulp testing procedures in cariology and endodontics. 2. Physiotherapy in extirpation methods for pulpal desease treatment. 3. Physical methods for treatment of gangrene and periapical lesions. 4. Physical methods for treatment of infected root canals.

EDUCATIONAL PROGRAM

Discipline: Propaedeutics of Consrvative Dentistry Educational level: Faculty of Dentistry-Sofia Department of Conservative dentistry

LECTURE COURSE II course, IV semester 1. Оbject, aim and tasks of conservative dental medicine phantom course. Dental caries - process main point and classification. Treatment methods. Basic principles of dental caries treatment by means of restoration. First basic principle. Types of cavities. Basic cavitiy elements. Requirements for cavity design. 2. Cavity preparations principles. Practical application of cavity preparation basic principles – stages of cavity preparation. 3. Dental amalgam – types of alloys, composition, chemical reactions. 4. Cavity preparation for dental amalgam – part I. I class cavity preparation – indications, basic design. Characterization of basic cavity configurations. Preparation techniques. 5. Cavity preparation for dental amalgam – part II. II class cavity preparation – indications, basic design. Characterization of basic cavity configurations. Instruments and preparation techniques. 6. Cavity preparation for dental amalgam – part III. Class V cavity preparation – indication, basic design. Characterization of basic cavity configurations. Instruments and preparation techniques. III course, 5 semester 1. Aesthetic restorative materials – groups, composition, physico-chemical properties. 2. Cavity preparation for aesthetic restorative materials – III and IV class cavities - indications, basic design, instruments and preparation techniques. 3. Cavity preparation for aesthetic restorative materials – I, II and V class cavities - indications, basic design, instruments and preparation techniques. 4. Pins – indications, groups, biomechanical and anatomical application aspects. Placement technique. 5. Second basic principle of caries treatment by means of restoration (operative caries treatment) – main point (essence), application reasons, medicines, pharmacodynamics, application technique. Temporary restorations – groups, requirements, critical analysis, application indications. 6. Third basic principle of operative caries treatment – main point. Clinical requirements towards restorative materials. Application indications and contraindications. Dressing (lining) and base materials – groups, biomechanical requirements, placement technique and basic configurations. 7. Restoration contours and interdental contacts. 8. Instruments and placement technique for amalgam restorations. 9. Cast restorations – cavity preparation characteristics. Instruments, preparation and clinical techniques for direct and indirect cast inlays – impressions, fitting and cementation.

10. Instruments and placement techniques for aesthetic material restorations. 11. Pulp chamber and root canal (endodontium) – definition. Three- dimensional anatomy. Endodontic treatment principles. Access cavity preparation with pulp chamber opening and orifice location. 12. Root canal preparation for obturation. Types of canal contents and their removal. Root canal working length estimation. Chemo-mechanical root canal preparation. Instruments, irrigants and medications. Principles of action and usage.

3 course, 6 semester

1. Obturation of root canal system – objectives, requirements, materials, techniques, criteria for root canal obturation’s assessment. Root canal filling materials. Basics of posts and cores in restoration of nonvital endodontically treated teeth.

2. Disinfection and sterilization. Methods for preventing cross-contamination and acute infectious disease. Preparation for caries treatment and teeth with pulp and periapical pathology. Methods and anesthetics for the aims of pain management in conservative dental medicine

3. Dental caries aetiology and patogenesis. Topographic classification. Basic symptoms of caries. Examination methods for carious lesions.

4. Anatomy and physiology of the dental pulp and periodontium. Pulp and periodontium diseases classification. Inflammatory diseases of dental pulp - aetiology and patogenesis

5. Examination methods for diseases of dental pulp and periodontium. Basic symptoms of inflammatory diseases of dental pulp and periodontium. Treatment methods for inflammatory diseases of dental pulp. Critical analysis of nonvital methods.

SEMINARS PROGRAMME II course, IV semester

1. Armamentarium – purpose. Requirements for the elements of a preparation. Elements of retention – methods of preparation, mechanism of action. When does a preparation satisfy the following requirements: easy and accurate adjustment of forming appliances (matrix, wedge, etc.); easy application of obturation materials; precise establishing of tooth form and proximal contacts; satisfying aesthetic results.

2. Class I preparations for dental amalgam. III course, V semester

1. Class II preparations for dental amalgam – basic configurations. 2. Preparations for aesthetic materials in the anterior region – types, basic configurations.

Armamentarium used for class II preparations for aesthetic materials. Requirements for every particular element and slice of the preparation. When does a preparation allow: efficient etching, easy appliance of an adhesive system and obturation material, invisible transition between tooth structures and obturation material, precise construction of tooth form and proximal contacts, preserving the incisal leading, preserving the vitality of the tooth.

3. Preparations for aesthetic materials in distal teeth (molars and premolars) – types, basic configurations. Indications and contraindications. Requirements for every particular element and slice of the preparation. When does a cavity form allow: preserving the occlusal interrelations, good adhesion between the obturating material and tooth structures, lowered polymerization shrinkage of the obturation material, periodontal tissues injury preventing, retention of the obturation material, including placement of parapulpal posts. Technique for placement of parapulpal posts.

4. Dental amalgam obturations - Instruments. Sequence and purpose of the manipulations used. Obturation polishing – terms, mistakes, consequences. Criteria for determining the accuracy of an obturation – defended thesis.

III course, VI semester

1. Composite materials obturations – Instruments. Sequence and purpose of the manipulations used for obturating III, IV and II class preparations. Possible ways for leading and compensating the polymerization shrinkage of composite materials.

2. Endodontic access cavity – Purpose. Factors affecting the position of the endodontic access cavity. Instruments and their purpose, used for preparing an endodontic access cavity and for shaping the pulp chamber. Basic configurations of the endodontic access cavities for incisors, canines, molars and premolars. Age differences in endodontic access cavities. Number and position of the orifices of root canals. Prevention of crown discoloration after endodontic treatment.

3. Step-back technique for cleaning and shaping root canals. Instruments. Essence, purpose and sequence of the manipulations used for removing the contents of a root canal. Determining working length. Root canal cleaning and shaping.

4. Obturation of root canals with cold lateral compaction. Criteria for determining the adequacy of canal preparation before obturation. Master cone and compactor selection. Objective control of the obturating manipulations. Preparation and placement of the root canal sealer – paste-like root canal filling material, actual lateral compaction, accessory cones. Objective control of the quality of root canal filling.

EDUCATIONAL PROGRAM Discipline: Clinics of Consrvative Dentistry Educational level: Faculty of Dentistry-Sofia Department of Conservative dentistry

LECTURE COURSE Course IV, VII semester

1. Dental caries – classification, pathomorphology, clinical symptoms, differential diagnosis. Early diagnosis, noninvasive treatment.

2. Treatment planning in operative dentistry. 3. Dentine caries – types of dentine and clinical differentiation. Dental materials and

medication for treatment of dentinal caries and their pharmacology. Reasons for one visit and two visits treatment.

4. Biomechanical problems after placing restorations from amalgam, resin materials and glass-ionomers.

5. Secondary dental caries – clinical symptoms and diagnosis. Etiology and reasons for secondary caries prevention. Recurrent caries and root caries- clinical symptoms and diagnosis, treatment.

6. Restoration of vital teeth with massive enamel and dentine losses – discussion and analysis of available tooth structures, occlusal forces and their functional efficiency.

7. Revision of lectures 1 to 6. Course IV, VIII semester

1. Restoration of endodontically treated teeth. Root canal posts – types, technology, iatrogenic errors. Post and core restorations.

2. Non carious dental defects, part I – acute and chronic dental trauma, heat and chemical tooth causes, iatrogenic causes. Etiology, pathogenesis, clinical symptoms, diagnosis, treatment and prevention.

3. Non carious dental defects, part II – Fluorosis, abrasion, erosion, dental hypoplasia. Etiology, pathogenesis, clinical symptoms, diagnosis, treatment and prevention.

4. Endodontic treatment planning – links with diagnosis, reasons for multiple visit choices and the role of JDP. Initial treatment, definitive treatment, difficulties during treatment. Professional links between specialists in endodontics and JDP.

5. Regressive changes in the pulp. Non inflammatory pulp pathology: Atrophy, Dystrophy, pulp stones, blood vessels pulp pathology - . Etiology, pathogenesis, clinical symptoms, diagnosis, treatment.

6. Acute and chronical pulp pathology. Inflamation in pulp pathology. Reversible and nonreversible pulp pathology. Clinical symptoms, diagnosis, treatment.

7. Revision of lectures 1 to 6.

Course V, IX semester

1. Biological treatment of the pulp - reversible and nonreversible conditions: pulp

capping. Diagnosis, inclusion and exclusion criteria, treatment methods, medication

and materials. Critical revision.

2. Pulp extirpation under anesthesia – methodology, inclusion and exclusion criteria,

possible complications. One and two visits motivation.

3. Pain control in endodontics: the pain in orofacial pathology, pain as a leading

endodontic syndrome. Clinical behavior and approach to patients with acute dental

pain.

4. Acute periapical pathology. Clinical symptoms, diagnosis, treatment.

5. Periapical lesions. Clinical symptoms, diagnosis, treatment, follow up duration.

6. Pathogenesis of dental pulp and periapex recovery after different treatment methods in

pulp pathology and endodontics.

7. Revision of lectures 1 to 6.

Course V, X semester

1. Indirect resin restorations – cavity preparation, technology, critical review of advantages and disadvantages.

2. Retreatment in endodontics: Legal, professional and economical aspects. Inclusion and exclusion criteria and clinical decision making.

3. Difficult differential diagnostic problems in endodontics. Non endodontic structures as diagnostic mistakes – traumatic cysts, sinusitis, Herpes zoster, neuralgia, cracks and fractures of hard dental tissues.

4. Endodontic surgery: general information, inclusion and exclusion criteria. Main techniques in surgical endodontics: apicoectomy, hemisection, retrograde root canal obturation. Follow up duration and criteria for valuation of treatment outcome.

5. Emergency endodontics – definition and aspects of the problem, diagnosis which requires emergency. Techniques in root canal smear layer removal, root canal preparation and medication and pathways for evacuation of the exudate. Reduction of the occlusal forses. Different schemes of evidence based clinical behavior.

6. Microbiology in endodontics – microbial flora in non-infected and infected root canals in necrotic pulp. Main bacteria and their relation to hard dental structure diseases. Microbiology probation in endodontics – special needs, methods of probation and reasons for antibiotic therapy.

7. Bleaching – vital and nonvital. Reasons, techniques, cavity preparations, risks and prevention of complications during bleaching. Technology of facets from resin materials.

SEMINARS PROGRAMME IV course / VII semester

1. Premedication and anesthesia used for conservative dentistry purpose. Control of the complications – haematoma, traumatic injuries, paresthesia, allergic reactions.

2. Dentine wound – types, medicine treatment. Differential diagnosis of caries profunda. Biomechanical problems of obturations made of dental amalgam, composite materials and glass-ionomer cements.

3. Most common mistakes made when removing the biological content of a root canal and shaping the latest. Cause and ways for correcting the following mistakes: bleeding of a root canal, traumatic and infectious apical periodontitis, perforations, zip perforations, edges, apical plugs, emphysema, separation of root canal instruments, toxic periodontitis

IV COURSE – VIII TERM

1. TOOTH RESTORATION WITH POST SYSTEMS – INDICATIONS, CONTRAINDICATIONS, SEQUALE OF PROCEDURES FOR DYRECT AND UNDYRECT POSTS.

2. MISTAKES IN CAVTY PREPARATION AND OBTURATION LEADING TO SECONDARY CARIES DEVELOPMENT.

3. TREATMENT PLAN FOR THE MEANS OF CONSERVATIVE TGREATMENT. 4. CAST METAL INLAYS – INDICATIONS, CAVITY PREPARATION. INDIRECT

METHOD FOR PREPARATION V COURSE – IX TERM

1. VITAL PULP THERAPY – TYPES, INDICATIONS, CONTRAINDICATIONS, TECHNIQUE, CONTROL OF THE RESULTS

2. INSTRUMENTS FOR DIAGNOSIS AND TREATMENT IN ENDODONTICS – TECHNIQUES FOR SHAPING THE ROOT CANAL SYSTEM, OUTCOME EVALUATION, INFECTION CONTROL.

3. DIFFERENTIAL DIAGNOSIS OF INFLAMATORY DISEASES OF PULP AND PERIRADICULAR TISSUES.

V COURSE – X TERM

1. RETREATMENT IN ENDODONTICS 2. ENDODONTIC SURGERY – RADICOTOMY, HAEMISECTION,

BICUSPIDATION, REIMPLANTATION. 3. EMERGENCY ENDODONTICS – MANAGEMENT PRINCIPLES

MEDICAL UNIVERSITY - SOFIA

DEPARTEMENT OF PROSTODONTICS -

CURRICULUM

NAME OF DISCIPLINE – Dental materials, Educational degree-Master`s, Kind of discipline - binding

PROLONGATION OF THE COURSE- 2 semesters, Level of the course- Master`s

EDUCATIONAL FORMS OF ASSESSMENT:evaluations of seminars,tests,practical and theoretical exams

KIND OF FORMS AND METHODT FOR TRAINING USED IN COURSE - lectures,workshops,seminars,exercises

SEMESTRIAL EXAM -yes-to the end of the semester,

LECTURER OF DENTAL MATERIALS

Anastassov,Iv. DDS.,Ph.D.

DEPARTMENT – Department of Prostodontics,

ANNOTATION OF THE COURSE

The course provides an opportunity for acquiring knowledge about the origin,methods of manufacture,presentation,composition,properties,use and processing of materials used in dental materials.The course acquinted with the latest developments in dental materials.

DESCRIPTION OF THE COURSE

The course consists of 60 academical hours –representing various forms of load;

Lectures -30 hours

Practicals-26 hours

Workshops-4 academical hours

FORMATION EVALUATION

-assessing the students throughout the course,-evaluation of practical work during the semester

-a test of theory test,

-test results during the session

ASPECT IN THE FORMATION OF THE ASSESSMENT-

-the participation in discussions and seminars,-

-practical test

-theoretical test

TEACHING AIDS – charts, tests,samples of various materials,models for demonstration GOAL OF CURRICULUM - learning skills and methods of research composition,properties and processing technology of dental materials and their application in dentistry aid in accordance with European standart for healthcare. TASKS OF THE PROGRAM- Learning about the origin and mode of production of dental materials; -to establish knowledge of the purpose and manner of processing of dental materials; -to gain knowledge of the composition and properties of dental materials; To acquire practical skills for processing of dental materials.It is highly recommend from students Previously to have basic knowledgein chemistry,biology,physics

RESULT EXPECTATIONS After completion of the course,students must have a basic knowledge about the origin,composition,properties,and purpose of dental materials.The students have learned the methods of treatment of the main groups of dental materials.The students may properly consider The need of application of a given material in accordance with the requirements of the cours. RECOMMENDED LITERATURE ADDITIONAL LITERATURE TOPICS FOR INDEPENDENT WORK- 1.Basic materials 2.Clinical materials, CONSPECT FOR TRAINING- we send it to you

CHAPTERS FROM THE PROGRAM-

1.Auxiliary dental materials – gypsum products,dental waxes,casting investments

2.Restorative materials 3.Dental cements,adhesive materials 4.impression materials

MEDICAL UNIVERSITY –SOFIA-

DEPARTMENT OF PROSTHODONTICS

CURRICULUM OF DENTAL MATERIALS

LECTURES 1 course, 1 SEMESTER /WINTER/

15 WEEKS, 2 ACADEMICAL HOURS per every 2 WEEKS

1 WEEK HISTORY OF DENTAL MATERIALS

3 WEEK MECHANICAL PROPERTIES OF DENTAL MATERIALS

5 WEEK GYPSUM PRODUCTS

7 WEEK DENTAL WAXES CASTING INVESTMENT

9 WEEK METALS AND DENTAL ALLOYS

11 WEEK NOBEL DENTAL ALLOYS

13 WEEK BASE METAL ALLOYS

15 WEEK CORROSION RESISTANSE

LECTURES 1 course, 2 SEMESTER /SUMMER/

15 WEEKS, 2 ACADEMICAL HOURS per every 2 WEEKS

1 WEEK OPTICAL PROPERTIES OF DENTAL MATERIALS

3 WEEK DENTAL POLYMERS

5 WEEK DENTAL CERAMICS,METAL –CERAMIC PROSTHESIS

7 WEEK IMPRESSION MATERIALS

9 WEEK RESTORATIVE MATERIALS


13 WEEK RESIN-BASED COMPOSITES.DENTAL AMALGAMS

15 WEEK GLASS IONOMER CEMENT

MEDICAL UNIVERSITY --SOFIA

DEPARTMENT OF PROSTHODONTICS

CURRICULUM OF DENTAL MATERIALS

PRACTICAL EXERCISES 1 course, 1 SEMESTER /WINTER/

15 WEEKS, 2 ACADEMICAL HOURS per every TWO WEEKS

1 WEEK CLINICAL AND LABORATORY PROTOCOL

3 WEEK FINISHING AND POLISHING MATERIALS

5 WEEK MECHANICAL PROPERTIES OF DENTAL MATERIALS

7 WEEK GYPSUM PRODUCTS

9 WEEK DENTAL WAXES.CASTING INVESTMENTS

11 WEEK SEMINAR

13 WEEK DENTAL ALLOYS

15 WEEK CORROSION RESISTANCE

PRACTICAL EXERCISES 1 course, 2 SEMESTER /SUMMER/

15 WEEKS,2 ACADEMICAL HOURS per every TWO WEEKS

1 WEEK OPTICAL PROPERTIES OF DENTAL MATERIALS

3 WEEK DENTAL POLYMERS

5 WEEK DENTAL CERAMICS .METAL-CERAMICS .ARTIFICIAL TEETH


9 WEEK DENTAL CEMENTS

11 WEEK SEMINAR

13 WEEK RESIN-BASED COMPOSITE MATERIALS

15 WEEK PRACTICAL EXAMINATION

MEDICAL UNIVERSITY – SOFIA MEDICAL FACULTY

DEPARTMENT “SOCIAL MEDICINE AND HEALTH MANAGEMENT”

SECTION “BIOSTATISTICS AND MEDICAL INFORMATICS”

TRAINING PROGRAM

“INFORMATICS”

FOR DENTIST STUDENTS - Ist COURSE, IInd SEMESTER

Total-30 hours

Lectures — 0 hours Practical classes - 30 hours

Finish with examination at the end of the term

S o f i a

2011

T R A I N I N G P R O G R A M

Subject: Informatics

Degree: Master

Subject kind: Obligatory

Continuation: One semester (Second semester)

Level of the course: Level M (master level)

Types of evaluation: Continuous examination, Test, Exam

Methods and forms of training: Practical exercises

Term exam: Current examination

Leading teacher: Assoc. Prof. Gencho Genchev PhD

Department: Section Biostatistics and Informatics “Social Medicine

and Health Management”, Medical University, Sofia

2

Course Annotation: The course on Informatics provide the opportunity to obtain theoretical knowledge and practical experience to organize and use data bases and work in Internet, in the field of dental health and dental services. Course description: The course consists of 30 academic hours - practical exercises.

The training forms are:

- Practical exercises;

- Workshops;

- Tasks.

Control of knowledge and skills of the students is realized by:

- Current examination;

- Tests;

- Practical tasks;

- Colloquiums;

- Examination.

Supporting Tools: Computers

AIM of the program:

Obtain theoretical knowledge and practical experience to organize and use data bases and MSoff,

in organizing of dental health services according to contemporary European standards.

Objectives of the program:

The objectives of the course “Informatics” are:

1. Obtaining basic theoretical and problem based knowledge on Medical informatics, as well practical skills to use contemporary computer systems, software, and information transferring.

2. Acquiring obligatory minimum of knowledge about nature, principles and logics of statistical analysis, about cognitive possibilities and specific requirements in using basic statistical methods in biology, medicine and health care. Forming skills in applying computers for the most important statistical methods.

Preliminary requirements:

Before beginning the training on Informatics, it is preferable that students have basic Computer literacy.

Expected results: It is expected that students work with PPP, Windows, Word, Works, SPSS, after completing the course.

Recommendet literature:

1. VrabchevN., Genchev G. Medical Informatics. Sofia, Delphi 2002, 166. 2. G. Ranchov Biostatistics and biomathematics. Conceptions, methods, applications.

Sofia, Eko Print 2008, 388. 3

THEMATIC PROGRAM EXERCISES (by training weeks - summer term)

INFORMATICS

for dentist students

1. OS Windows. WinWORD. Basics of word-processing. Fonts, Pages, Paragraphs

and formatting, tabulation. Tables, Auto-corrections. 2. EXCEL. Basic characteristics. Organization of data entering and windows. Functions

and charts.

3. Data base. Creating and working with database in WORKS system. Forms - design. Field-defmition, and data entering in forms. Calculations with formulas.

4. Data base. Form reorganization. Updating. Data retrieving (QUERY command) and showing on the screen - LIST and FORM commands.

5. Data Base. Reporting. Components of the report. Sort and arrangement. Statistical elements in report.

6. Colloquium - practical task on database and theoretical test on medical informatics.

7. Structure, functions and working with statistical program package SPSS. Scales - nominal, ordinal, interval and ratio. Data entering and manipulation.

8. Empiric distributions. Tables and graphical presentation - polygons and histograms. Summary descriptive measures - mean, median, mode, variance, standard deviation, skewness and kurtosis.

9. Interval estimation - standard error, confidence interval. Analyzing of alternative (dichotomous) variables - proportion, confidence interval.

10. Estimating and testing of hypothesis of difference between two samples - related or independent; parametric tests.

11. Estimating and testing of hypothesis of difference between two samples - related or independent; nonparametric tests. Correspondence between empiric and theoretical distributions - Pearson's and Kolmogorov-Smimov's criteria.

12. Statistical analysis of relations between categorical variables. Chisquare test - coefficients of contingency.

13. One-Way ANOVA.

14. Colloquium - theoretical test and task on biostatistics.

15. Final evaluation.

4

1. Development of the computer technology. 2. Computer’s generations. 3. Information. Measurement units. Information flow. 4. Architecture and functioning of the microcomputers. 5. Computer characteristics - CPU, RAM. 6. Computer characteristics - peripheral devices. 7. Operating Systems. Purpose and functions. 8. Organization of information on discs - files and folders. 9. Operating System WINDOWS. General characteristics. 10. Databases. Main definitions. Kinds. 11. Medical information systems. 12. Systems for medical decision making (expert systems). 13. Transmission of information. Signals. Types. 14. Coding information. Redundancy. 15. Transmission of information in biological objects. 16. Local nets. Types. Characteristics. 17. Global nets - INTERNET. 18. WORLD WIDE WEB - client and server. Searching information in INTERNET. 19. Cell telephone network - common performance, ability to connection with INTERNET 20. Types of data. Scales of measurement. 21. Populations, samples, representative sample. Empirical distribution - analysis. Graphical

and table display of data. Crosstabulation. 22. SPSS - structure and functions. 23. Measures of central tendency - mean, median, mode. 24. Measures of dispersion - range, variance, standard deviation. Measures of skewness and kurtosis. 25. Assessment of statistical parameters - point and interval valuations. Confidence interval of the mean. 26. Statistical hypotheses - definition and types. Testing statistical hypotheses. Errors - type I and II. Significance level, critical area, test power. 27. Parametric tests for testing statistical hypotheses for difference of two dependent or independent samples. 28. Nonparametric tests for testing statistical hypotheses for difference of two dependent or independent samples - tests of Mann-Whitney and Wilcoxon. 29. Analysis of relations between categorical variables - method Chi-squire, coefficients of contingency. 30. One-Way ANOVA - main purpose and requirements, stages of the analysis.

Chief of the section Biostatistics and Medical Informatics: /Assoc. Prof. Genchev, PhD/

EXAMINATION SYNOPSES

OF COMPUTER TRAINING

FOR DENTIST STUDENTS OF MEDICAL UNIVERSITY, SOFIA,

5

LINGUA LATINA MEDICINALIS

TYPE OF THE SUBJECT: OBLIGATORY

COURSE OF TEACHING: FIRST YEAR

SEMESTERS OF TEACHING: TWO SEMESTERS

WEEKLY HOURS: 2 HOURS PER WEEK

HOURS IN TOTAL: 60 HOURS

EVALUATION: IN THE TIME OF COURSE, SEMESTER TEST AND

YEAR TEST AT THE END OF SECOND SEMESTER

CREDITS: 4.9 credits

“Latin in Medicine” tutorial will follow the course in Latin Language and medical

terminology taught at the Bulgarian course for students of dental medicine at the Medical

University of Sofia. Some extra Internet materials and texts will be used to adapt the material

for students in English course of dental medicine.

CURRICULUM 1. Fall semester – 30 hours /practical seminars

1. The Latin language in medical terminology. Latin spelling and pronunciation. Letters

and sounds, Vowels. Diphthongs. Consonants. Evolution consonants. Digraphs.

Peculiarities in the pronunciation. General rules for Latin accentuation.- 2 hours

2. Anatomic terminology. Parts of speech. Gender. Number. The idea of case and

declension in Latin - 2 hours

3. First declension – “a”-stems. Nouns and adjectives in the feminine gender – 2 hours

4. Second declension – “o”-stems. Nouns and adjectives in the masculine gender. Nouns

and adjectives in the neuter gender. - 2 hours

5. Declension of adjectives. Common suffixes. Concord of nouns and adjectives,

Attributive adjective. Word order. - 2 hours

6. Compendium. Self check. Oral and written exercises. – 2 hours

7. Third declension. First group – consonant stems. Suffixes used as clues. Concord of

nouns and adjectives.- 2 hours

8. Third declension. “-I- stems. Greek nouns. Suffixes. Concord of nouns and adjectives.

9. Third declension. Mixed stem. Concord of nouns and adjectives. - 2 hours

10. Declension of adjectives. Parasyllabic adjectives. Suffixes. Imparasyllabic adjectives.

Suffixes. Participle (Participium praesentis activi).- 2 hours

11. Compendium. Self check. Oral and written exercises – 2 hours.

12. Fourth declension. Concord of nouns and adjectives. 2 hours

13. Fifth declension. Concord of nouns and adjectives.- 2 hours

14. Degrees of comparison. Concord of nouns and adjectives. - 2 hours

15. Progress test – 2 hours

2. Spring semester - 30 hours /practical seminars

1. Clinical terminology. Word building. Term-elements. - 2 hours

2. Corpus humanum. Prefixes. Word-roots. Suffixes. - 2 hours

3. Colores. Term-elements. - 2 hours

4. Structura corporis. Prefixes. Word-roots. Suffixes. - 2 hours

5. Humores, secretiones et excretiones. Prefixes. Word-roots. Suffixes. 2 hours

6. Caput. Prefixes. Word-roots. Suffixes. - 2 hours

7. Cavum cranii. Prefixes. Word-roots. Suffixes. - 2 hours

8. Compendium. Self check. Oral and written exercises – 2 hours.

9. Cavitas oris. Prefixes. Word-roots. Suffixes. - 2 hours

10. Cavum thoracis Prefixes. Word-roots. Suffixes.- 2 hours

11. Cavum abdominis Prefixes. Word-roots. Suffixes.- 2 hours

12. Sexus Prefixes. Word-roots. Suffixes. - 2 hours

13. Aetates Prefixes. Word-roots. Suffixes.- 2 hours

14. Prescriptions. Parts. Structure. - 2 hours

15. Progress test – 2 hours

MEDICAL UNIVERSITY – SOFIA FACULTY OF DENTAL MEDICINE

DEPARTMENT OF MEDICAL CHEMISTRY AND

BIOCHEMISTRY

TEACHING PROGRAM

Name of the discipline: Medical Biochemistry


Discipline type: obligatory

Duration of the course: 2semesters - II and III semester

Level of the course: Level M (master level)

Forms of assessment: formative assessment, participation in seminars, colloquiums,

examination

What forms and educational methods are used in the course? -interactive problem-

solving oriented learning is introduced: multimedia lectures, seminars, written and computer

Web-based interactive tests, work with virtual patients - solving of Web-based interactive

simulations of clinical cases

Semestrial examination: yes - after the III semester

LEADING LECTURER: Professor Ganka Kossekova, PhD, Dr.Sc.

DEPARTMENT: Medical Chemistry and Biochemistry

COURSE ANNOTATION: The course on Medical Biochemistry for Dental Medicine students

gives them an opportunity to acquire knowledge and competence for the molecular organization of

living matter, enzymology, bioenergetics, metabolism, molecular biology, molecular pathology,

characteristic features of metabolism in different tissues and organs in norm and pathology,

necessary for their complete medical training dental help.

DESCRIPTION OF THE COURSE: The course consists of 120 academic hours, as follows:

Lectures - 60 hours

Practical exercises - 60 hours, including 4 colloquiums (seminars) announced at the beginning of the

course in the II semester and 3 colloquiums (seminars) in the III semester.

Formation of the rating - the assessment is comprehensive: formative assessment of the students

during the course on the topic for a fiven week program, assessment at the colloquiums on one or

more sections of the subject program, and result at the annual examination on the whole subject.

Aspects in formation of the rating: results from the formative assessment, check-up of self-

prepared schemes of metabolic pathways, results from the colloquiums, participation in discussions,

tests, solving of clinical cases (work with virtual patients) and result from the examination.

HELPFUL RESOURCES FOR TEACHING AND LEARNING: multimedia, schemes, cases for

interpretation.

OBJECTIVES OF THE TEACHING PROGRAM: the students should acquire knowledge and

competency for medical biochemistry to a level allowing them to understand the molecular bases of

diseases in man and be able to organize and carry out competently a modern dental help in

conformity with the contemporary European and World standards for healthcare: Global Standards

in Medical Education, accepted by the World Federation for Medical Education (WFME).

PROGRAM TASKS: The program should ensure that the students:

• understand the molecular organization of the living matter, the links between the structure and

function of proteins and nucleic acids, the intermolecular interactions;

• understand the principles of the enzyme action and the mechanisms, via which it is affected by

different environmental factors, as well as to explain the importance of the enzymes for

metabolism and regulation and application of enzymes in the medical practice;

• understand the principles of bioenergetics, explain the importance of environmental factors and

the mechanisms via which they influence the bioenergetical processes in the cell;

• understand the basic metabolic pathways, the links between them, their regulation and the

environmental factors

• acquire basic knowledge about how the genetic information is stored, preserved and passed on

to progeny, the effect of environmental factors on DNA replication, basic mechanisms for DNA

damage and repair;

• understand the principles of molecular pathology, build conceptual understanding for the

importance of genetic and other factors for the onset of pathology, importance of the molecular

genetic heterogenity for understanding of most common diseases nowadays in man and their

diagnostics and treatment;

• understand the characteristic features of metabolism and its disorders in liver, muscle, nerve

tissue, adipose tissue, blood, bones and teeth.

PRELIMINARY REQUIREMENTS: Before starting Biochemistry, the students should have

good basic knowledge in Biology and Chemistry and should have taken obligatory the examinations

in the disciplines mentioned above.

EXPECTED RESULTS: At the end of the course the students should know and can interpretate:

• the molecular organization of the living matter, the links between the structure and function of

proteins and nucleic acids, the intermolecular interactions;

• the principles of the enzyme action and the mechanisms, via which it is affected by different

environmental factors, as well as to explain the importance of the enzymes for metabolism and

regulation and application of enzymes in the medical practice;

• the principles of bioenergetics, explain the importance of environmental factors and the

mechanisms via which they influence the bioenergetical processes in the cell;

• the basic metabolic pathways, the links between them, their regulation and the environmental

factors which affect them;

• the mechanisms via which the genetic information is stored, preserved and passed on to

progeny, the effect of environmental factors on DNA replication, basic mechanisms for DNA

damage and repair;

• the principles of molecular pathology, build conceptual understanding for the importance of

genetic and other factors for the onset of pathology, importance of the molecular genetic

heterogenity for understanding of most common diseases nowadays in man and their diagnostics

and treatment;

• the characteristic features of metabolism and its disorders in liver, muscle, nerve tissue, adipose

tissue, blood, bones and teeth.

RECOMMENDED TEXTBOOKS: Textbooks in Bulgarian 1. Koceковa, Г . , B. Muтeв, A. Aлекceeв, T. Николов, Биохимия в Интернет, Лекции по

биохимия, 2010, второ допълнително и преработено издание (цветно), Централна

медицинска библиотека, София.

2. Ангелов, А., Е. Гачев, К. Даичева, А. Кръшкова, Т. Николов, Л. Сираков (1995),

Биохимия за медици и стоматолози, Университетско издателство „Св. Климент

Охридски“, София. Textbooks in English 1. Devlin, T. M. (ed.) (2006) Textbook of Biochemistry with Clinical Correlations, Wiley-Liss,

New York, 6th ed.

2. Murray, R., D. Bender, K. Botham, P. Kennely, V. Rodwell, P. Well (2009) Harper's Illustrated

Biochemistry, McGraw-Hill Medical, New York, 28th edn.

3. Harvey, A., R. Ferrier, 2011, Lippincott’s Illustrated Reviews. Biochemistry, 5th ed, Philadelhia.

Interactive resources 1. Косекова, Г. (1999) Биохимия в Интернет, Тестове по биохимия, Медицински

университет, София.

3. Koceковa, Г., „Тестове по биохимия” , 2004, CD, Централна медицинска библиотека,

София.

4. Koceковa, Г., peд. „Интерактивни учебни материали по медицинска биохимия” , 2011,

DVD, Централна медицинска библиотека, София.

Web-site

http://biochemistry.mu-sofia.bg

http://biochemistry.mu-sofia.bg/

PROGRAM OF THE LECTURES IN MEDICAL BIOCHEMISTRY

FOR THE STUDENTS IN DENTAL MEDICINE

SPRING SEMESTER: 15 weeks x 2 hours = 30 hours (All the lectures use multimedia and include animations and other interactive resources)

Lecture 1. Contemporary Biochemistry - basis for understanding metabolism in health and disease. Subject, objectives and scope of Biochemistry. Relationship between Biochemistry and other biomedical disciplines stimulates mutual advances. Biochemical investigations - necessary for diagnosis, prognosis and therapy. Examples: Galactosemia, Myocardial Infarction. Proteins: significance, amino acid composition, classification of amino acids based on the chemical structure and polarity of the side chains. Covalent bonds and noncovalent interactions in the protein molecule. Characteristic features of the polypeptide chains. Primary structure. Differences in the primary structure of hemoglobin A and S. Primary structure of insulin in different species. Charge properties of the amino acids and proteins. Electrophoresis. Electrophoretic profiles of serum proteins, role for diagnostics. Chomatographic techniques. Methods for determination of amino acid composition and primary structure. Phenylketonuria. Lecture 2 Secondary, tertiary and quaternary structure of proteins. Globular and fibrous proteins. Structure and function of hemoglobin. Glycated hemoglobin. Denaturation and renaturation. Sickle Cell Anemia. Prion Diseases. Relationship between protein structure and function. Structural similarities between a hemoglobin subunit and myoglobin, important for oxygen binding. Differences in the oxygen saturation curves of myoglobin and hemoglobin. Difference between HbA and HbF. Changes in collagen structure when vitamin C is deficient. Lecture 3 Nucleic acids - types and biologic role. Chemical composition, chemical bonds within nucleotides and between them. Free nucleotides with important biologic action. Characteristic features of the polynucleotide chains. Purine and pyrimidine analogs as anticancer and antimicrobial agents. Primary structure of nucleic acids. Sickle cell anemia and phenylketonuria - examples for molecular diseases. Conformation of DNA and different RNAs. Types of RNA and their biological significance. Lecture 4 Characteristics of the enzymes as biologic catalysts. Coenzymes and prosthetic groups. Nomenclature and classification of enzymes. Mechanism of enzyme catalysis. Enzyme-substrate complex. Active cite. Enzyme specificity. Enzyme kinetics. Michaelis-Menten equation - effect of the substrate concentration and the enzyme concentration on the velocity of the enzyme-catalyzed reaction. Enzyme units. Evaluation of the kinetic parameters Vmax and Km via the Lineweaver-Burk plot. Kinetic characteristics of phosphorybosyl pyrophosphate synthase in cases of gout. Increased sensitivity to ethanol due to increased Km of acetaldehyde dehydrogenase.

Lecture 4 Effect of pH and temperature on the velocity of enzyme-catalyzed reactions. Changes in the pH optimum of alcohol dehydrogenase. Competitive and noncompetitive inhibitors. Activators. Conversion of proenzymes into active enzymes. Antimetabolites - competitive inhibitors towards substrates and coenzymes. Examples: puromycin, acycloguanosine (acyclovir), 3’-azido-3’-deoxythymidine (AZT), sulfonamides, methotrexate, allopurinol. Lecture 5 Allosteric regulation. Case of gout due to mutation in an allosteric center. Orotic aciduria. Regulation of enzyme action via phosphorylation - dephosphorylation. Cascade for regulation of glycogen phosphorylase and glycogen synthase. Importance of enzymes for the clinical practice. Isozymes. Electrophoresis of lactate dehydrogenase isozymes. Increases in the levels of nonfunctional plasma enzymes (in myocardial infarction and hepatitis). Changes in functional plasma enzymes. Genetically determined enzymopathies (cases of gout, Lesch-Nyhan syndrome). Enzymes in therapy (in Myocardial Infarction). Lecture 6 Short data about the organization of animal cells. Compartmentalization of metabolic processes. Metabolic pathways - types, biomedical importance. Characteristics of living organisms as open chemical systems. Coupling of endergonic and exergonic processes via high-energy compounds. Types of high-energy compounds. Central role of the system ATP/ADP in energy transfer. Characteristics of biologic oxidation. Substrates of biologic oxidation and ultimate acceptors of hydrogen. Oxido-reductases, important redox-systems: NAD+/NADH, NADP+/NADPH, FMN/FMNH2, FAD/FADH2, K0Q/K0QH2, hemes of cytochromes, lipoate, ascorbate. Lecture 7 Oxidative phosphorylation at substrate level: synthesis of ATP in the oxidation of glyceraldehyde- 3-phosphate, enolase reaction, oxidative decarboxylation of a-keto acids (pyruvate dehydrogenase complex, role of the cofactors TPP, lipoate, CoA, FAD and NAD+). Beri-beri. Respiratory chain - localization, function and molecular structure. Sites for proton translocation. Coefficient of oxidative phosporylation (P/O). Respiratory control, phosphate potential. Inhibitors of electron transfer: barbiturates, antimycin A, KCN. Dangerous combination of barbiturates and alcohol. Lecture 8 Chemiosmotic theory for the mechanism of the oxidative phosphorylation in the respiratory chain. ATP synthase. Effect of uncouplers (2,4-dinitrophenol). Natural uncouplers. Inhibitors of oxidative phosphorylation (oligomycin). Uncoupled oxidation. Heat production. Role of thermogenin in mitochondria of brown adipose tissue. Electron transfer in the endoplasmic reticulum. Formation and detoxifying of reactive oxygen intermediates: superoxide, H202 and free hydroxyl radical. Citric acid cycle - importance for catabolism and anabolism. Chemical reactions. Metabolic and energy balance. Mechanisms of regulation. Pyruvate dehydrogenase deficiency. Lecture 9 Glycolysis - importance, chemical reactions, energy balance at anaerobic and aerobic conditions. Tissue specificity of glycolysis. Relationship between glycolysis and respiratory chains - shuttle mechanisms for transfer of hydrogen from the cytosol into mitochondria (malate and

glycerophosphate shuttles). Links with the citric acid cycle. Lactic acidosis. Gluconeogenesis. Importance. Circumvention of the three irreversible steps in glycolysis. Regulation of gluconeogenesis. Fructose-1,6-bisphosphatase deficiency. Lecture 10 The pentose phosphate pathway. Importance. Oxidative, isomerase and transferase reactions. Glucose-6-phospate dehydrogenase deficiency. Metabolism of galactose. Galactosemia. Metabolism of fructose. Fructose intolerance. Glycogenolysis and glycogenesis. Role of cAMP. Regulation. Glycogen storage diseases. Lecture 11 Lipids - classification. Oxidation of fatty acids with an even and odd number of carbon atoms. Energy balance. Biosynthesis of fatty acids. Role of acetyl-CoA carboxylase. Fatty acyl synthase - multifunctional enzyme. Synthesis of triacylglycerols. Obesity. Catabolism of triacylglycerols. Metabolism of glycerol. Lecture 12 Metabolism (synthesis and degradation) of phosphoglycerols. Biological role of phospholipases Ai, A2, C and D. Sphingolipids - types, structure and significance. Sphingolipidoses. Ketogenesis. Utilization and oxidation of ketone bodies in extrahepatal tissues. Ketonemia and ketonuria. Ketoacidosis in starvation and in Diabetes Mellitus. Lecture 13 Transport of lipids in the organism. Composition, origin and functions of lipoproteins (chylomicrons, VLDL, LDL, HDL. Receptors for lipoproteins. Familiar hypercholesterolemia. Metabolism of cholesterol. Chemical reactions in the synthesis of cholesterol. Excretion from the body. Regulation. Atherosclerosis. Lecture 14 Derivatives of cholesterol (steroid hormones, vitamin D, bile acids) - structure and biologic role. General reactions of amino acid catabolism: oxidative deamination, transamination, transdeamination. Clinical importance of aminotransferases. Decarboxilation of amino acids. Biological amines. Parkinson’s disease. Lecture 15 Detoxification of ammonia - synthesis of glutamine, urea cycle and ammoniogenesis. Catabolism of the carbon skeletons of amino acids. Glycogenic and ketogenic amino acids. Nutritionally essential and nonessential amino acids. One-carbon units - types, sources, importance. Role of S-adenosyl-L-methionine and folate derivatives. Metabolic disorders of amino acids catabolism (phenylketonuria, alkaptonuria, methylmalonic aciduria.

AUTUMN SEMESTER: 15 weeks x 2 hours = 30 hours All the lectures use multimedia and include animations and other interactive resources

Lecture 1 Biosynthesis and degradation of purine nucleotides. Regulatory enzymes in the biosynthesis. Hyperuricemia due to enzyme defects (gout, Lesch-Nyhan syndrome). Inhibition of xanthine oxidase. Biosynthesis and degradation of pyrimidine nucleotides. Regulatory enzymes in the biosynthesis. Allosteric modulation and orotic aciduria. Integration of metabolism. Links between metabolic pathways of carbohydrates, lipids, amino acids and nucleotides at molecular level. Role of common metabolites and key enzymes. Lecture 2 Biosynthesis of DNA. General characteristics. DNA polymerases in prokaryotes. DNA polymerase complex in eucaryotes. Steps of replication. Repair mechanisms. Biosynthesis of different types of RNA. General characteristics. RNA polymerases in prokaryotes and eukaryotes. Steps of transcription. Processing of RNA molecules. Structure of the prokaryotic and eukaryotic genes. Lecture 3 Genetic code. Biosynthesis of proteins. Role of different types of RNA. Steps of the protein synthesis. Postsynthetic modifications. Inhibitors of protein synthesis. Lecture 4 Regulation of gene expression in prokaryotes (operon model) and in eukaryotes: at the level of DNA, at the level of transcription, at the level of translation and posttranslational regulation. Lecture 5 Recombinant DNA techniques. Recombination of DNA. Role of restriction endonucleases, reverse transcriptase and chemical methods. Identifying of DNA sequences - electrophoresis, Southern blot. Dideoxynucleotide method of Sanger for DNA sequencing. Amplification of DNA: cloning, polymerase chain reaction (PCR). Use of recombinant DNA techniques in medicine. DNA polymorphisms. Detection of mutations by allele-specific probes and by PCR. Detection of a variable number of tandem repeats. Genetic consultations. Production of vaccines and therapeutic proteins. Gene therapy. Solving of cases in forensic medicine. Transgenic animals. DNA chips in diagnostics. Lecture 6 Signal transduction through membranes. Types of signal molecules. Classifications of hormones. Receptors. Molecular mechanisms of hormones which bind to intracellular receptors. Lecture 7 Molecular mechanisms of hormones which bind to receptors on the cell surface. Example - effect on glycogen phosphorylase and glycogen synthase. Role of cyclic SMP and other second messengers. Kinase cascades as second messengers. Diabetes mellitus - changes in metabolism in type I and type II. Type I as autoimmune disease. Mechanism of insulin action. Pathobiochemistry of diabetes mellitus type I and type II.

Complications. Lecture 8 Biochemistry of liver. Inactivation and detoxification of xenobiotics. Ethanol metabolism. Lecture 9 Biochemical characteristics and metabolism of red and white blood cells. Hemoglobinpathies. Biosynthesis of porphyrins. Types of porphyrias. Degradation of haemoglobin. Bile pigments. Enterohepatic urobilinogen cycle. Jaundices. Lecture 10 Water-soluble vitamins. Metabolic role. Lipid-soluble vitamins. Metabolic role. Biochemistry of food digestion. Chemical composition and enzymes of the digestive fluids - saliva, gastric, pancreatic, and intestinal fluid. Degradation of food and uptake of the digested food. Lecture 11 Nerve tissue - metabolism and function. Regulation. Changes with aging, degeneration of neurons. Drug dependence. Neuromediators. Lecture 12 Muscle tissue - metabolism and function. Molecular mechanisms of muscle contraction. Lecture 13 Biochemical processes in epithelial and connective tissue. Elastins, collagens, heteropolysacharides. Defects. Lecture 14 Metabolism of calcium and phosphorus. Regulation. Bone formation. Osteoporosis and hormone replacement therapy. Lecture 15 Biochemical mechanisms for formation and maintaining of the tooth enamel and dentin. Defects. Head of the Department of Medical Chemistry and Biochemistry: Prof. Dr. V. Mitev, PhD, DSc.

MEDICAL BIOCHEMISTRY

PROGRAM FOR THE PRACTICAL EXERCISES IN MEDICAL BIOCHEMISTRY

FOR STUDENTS IN DENTAL MEDICINE

I SEMESTER

Practical exercise 1 Proteins -aminoacid composition, properties. Protein conformation. Practice - Determination of the protein concentration by biuret assay. Web-based illustrations. Practical exercise 2 Proteins as polyelectrolytes. Structure and function of nucleic acids. Practice - Electrophoresis of serum proteins. Virtual patient “Sandra”. Practical exercise 3 BIOPOLYMERS (PROTEINS AND NUCLEIC ACIDS) SEMINAR WITH FINAL MARK (test, written problems and oral discussion) Practical exercise 4 Enzymes - structure, specificity and mechanism of action. Practice - Prove of absolute and group specificity of the enzymes urease and acidic phosphatase. Web-based illustrations. Practical exercise 5 Enzymes - kinetics. Michaelis constant. Inhibitors and activators. Regulation of enzymatic activity. Enzymatic units. Clinical importance of the enzymes. Practice -Determination of Michaelis constant of the enzyme urease in the presence and in the absence of inhibitor using a computer program. Virtual patient “Vassil”. Practical exercise 6 ENZYMES SEMINAR WITH FINAL MARK (test, written problems and oral discussion) Practical exercise 7 Principles of bioenergetics. Biological oxidation. High-energy compounds. Role of ATP. Practical exercise 8 Respiratory chain and oxidative phosphorylation. Citric acid cycle. Practice - oxidation and reduction of cytochrome c. Virtual models of electron transport and oxidative phosphorylation created by D.Norton, New Zeeland Practical exercise 9 BIOENERGETICS SEMINAR WITH FINAL MARK (test, written problems and oral discussion) Practical exercise 10 Glycolisis and gluconeogenesis. Pentosophosphate metabolic pathway.

Practical exercise 11 Metabolism of glycogen, metabolism of galactose and fructose Virtual patients “Rumen” and ‘Charly Practical exercise 12 Regulation of carbohydrate metabolism. Blood sugar. Sugar diabetis Bloodsugar curves Practical exercise 13 GENERAL REVIEW OF CARBOHYDRATE METABOLISM SEMINAR WITH FINAL MARK (test, written problems and oral discussion) Practical exercise 14 General review of lipid metabolism. Lipid transport in the blood. Practice - Determination of lipoproteins in blood serum. Practical exercise 15 Degradation of fatty acids. Ketogenesis and ketolysis. Ketonemia. Practice - Determination of total fats in blood serum. Legalization of the semester.

MEDICAL BIOCHEMISTRY

PROGRAM FOR THE PRACTICAL EXERCISES

IN MEDICAL BIOCHEMISTRY


II SEMESTER

Practical exercise 1

Metabolism of cholesterol and its derivatives

Practice - Determination of total cholesterol in blood serum.


Lipogenesis. General review of lipid metabolism. Virtual patient “Vassil 2”.


Atherosclerosis - molecular bases, heterogeneity, biochemical and molecular biological approaches

for evaluation of the risk.


LIPID METABOLISM AND ITS LINKS WITH CARBOHYDRATE METABOLISM.

SEMINAR WITH FINAL MARK.


General reactions in the metabolism of aminoacids.

Practice - deamination of alanine. Transamination of aminoacids - serum ASAT and ALAT.


End products of nitrogen metabolism. Biosynthesis of urea.

Practice - Determination of ammonia salts according to Malfaty. Virtual patients “Marina” and

“Dimiter”.


Metabolism of purine and pyrimidine nucleotides. Gout.

Practice - Determination of uric acid in blood serum. Virtual patient “Emil”.


METABOLISM OF CARBOHYDRATES, OF LIPIDS AND OF AMONOACIDS - GENERAL

REVIEW AND LINKS BETWEEN THE DIFFERENT METABOLISMS. REGULATION OF

THE PROCESSES.

SEMINAR WITH FINAL MARK.


Metabolism of nucleic acids and protein biosynthesis. Molecular diseases.

Virtual patient “Todor”.


Metabolism of porphyrines and bile pigments. Types of jaundice.

Practice - Determination of bilirubin in blood serum Virtual patient “Kiril”.


General regulation of metabolism at the level of the organism Hormones, growth factors, cytokines.

Chemical nature and molecular mechanisms of their action Hormonal receptors. Transducing

systems, oncogenesis:


Molecular mechanisms of diabetes - pathogenesis of type I and type II. Mechanism of action of

insuline. Pathobiochemistry of diabetes and its complications. Blood sugar curves in norme and

diabetes. Web-based simulations of clinical case “Rositsa”.


Biochemistry of the liver. Vitamines.


Biochemistry of connective and bone tissue.


Biochemistry of the muscular tissue. Determination of creatine in muscular tissue. Evaluation of the

average annual mark.

Legalization of the semester.

MEDICAL BIOCHEMISTRY SYLLABUS FOR STUDENTS IN DENTAL MEDICINE

1. Contemporary Biochemistry - basis for understanding metabolism in health and disease.

Subject, objectives and scope of Biochemistry. Relationship between Biochemistry and other biomedical disciplines stimulates mutual advances. Biochemical investigations - necessary for diagnosis, prognosis and therapy. Examples: Galactosemia, Myocardial Infarction.

2. Proteins: significance, amino acid composition, classification of amino acids based on the chemical structure and polarity of the side chains. Covalent bonds and noncovalent interactions in the protein molecule. Characteristic features of the polypeptide chains. Primary structure. Differences in the primary structure of hemoglobin A and S. Primary structure of insulin in different species.

3. Charge properties of the amino acids and proteins. Electrophoresis. Electrophoretic profiles of

serum proteins, role for diagnostics. Chomatographic techniques. Methods for determination of amino acid composition and primary structure. Phenylketonuria.

4. Secondary, tertiary and quaternary structure of proteins. Globular and fibrous proteins.

Structure and function of hemoglobin. Glycated hemoglobin. Denaturation and renaturation. Sickle Cell Anemia. Prion Diseases.

5. Relationship between protein structure and function. Structural similarities between a

hemoglobin subunit and myoglobin, important for oxygen binding. Differences in the oxygen saturation curves of myoglobin and hemoglobin. Difference between HbA and HbF. Changes in collagen structure when vitamin C is deficient.

6. Nucleic acids - types and biologic role. Chemical composition, chemical bonds within

nucleotides and between them. Free nucleotides with important biologic action. Characteristic features of the polynucleotide chains. Purine and pyrimidine analogs as anticancer and antimicrobial agents.

7. Primary structure of nucleic acids. Sickle cell anemia and phenylketonuria - examples for

molecular diseases. Conformation of DNA and different RNAs. Types of RNA and their biological significance.

8. Characteristics of the enzymes as biologic catalysts. Coenzymes and prosthetic groups.

Nomenclature and classification of enzymes. Mechanism of enzyme catalysis. Enzyme- substrate complex. Active cite. Enzyme specificity.

9. Enzyme kinetics. Michaelis-Menten equation - effect of the substrate concentration and the

enzyme concentration on the velocity of the enzyme-catalyzed reaction. Enzyme units. Evaluation of the kinetic parameters Vmax and Km via the Lineweaver-Burk plot. Kinetic characteristics of phosphorybosyl pyrophosphate synthase in cases of gout. Increased sensitivity to ethanol due to increased Km of acetaldehyde dehydrogenase.

10. Effect of pH and temperature on the velocity of enzyme-catalyzed reactions. Changes in the pH

optimum of alcohol dehydrogenase. Competitive and noncompetitive inhibitors. Activators. Conversion of proenzymes into active enzymes.

11. Antimetabolites - competitive inhibitors towards substrates and coenzymes. Examples:

puromycin, acycloguanosine (acyclovir), 3’-azido-3’-deoxythymidine (AZT), sulfonamides,

methotrexate, allopurinol. 12. Allosteric regulation. Case of gout due to mutation in an allosteric center. Orotic aciduria.

Regulation of enzyme action via phosphorylation - dephosphorylation. Cascade for regulation of glycogen phosphorylase and glycogen synthase.

13. Importance of enzymes for the clinical practice. Isozymes. Electrophoresis of lactate

dehydrogenase isozymes. Increases in the levels of nonfunctional plasma enzymes (in myocardial infarction and hepatitis). Changes in functional plasma enzymes. Genetically determined enzymopathies (cases of gout, Lesch-Nyhan syndrome). Enzymes in therapy (in Myocardial Infarction).

14. Short data about the organization of animal cells. Compartmentalization of metabolic processes.

Metabolic pathways - types, biomedical importance. 15. Characteristics of living organisms as open chemical systems. Coupling of endergonic and

exergonic processes via high-energy compounds. Types of high-energy compounds. Central role of the system ATP/ADP in energy transfer.

16. Characteristics of biologic oxidation. Substrates of biologic oxidation and ultimate acceptors of

hydrogen. Oxido-reductases, important redox-systems: NAD+/NADH, NADP+/NADPH, FMN/FMNH2, FAD/FADH2, K0Q/K0QH2, hemes of cytochromes, lipoate, ascorbate.

17. Oxidative phosphorylation at substrate level: synthesis of ATP in the oxidation of

glyceraldehyde-3-phosphate, enolase reaction, oxidative decarboxylation of a-keto acids (pyruvate dehydrogenase complex, role of the cofactors TPP, lipoate, CoA, FAD and NAD+). Beri-beri.

18. Respiratory chain - localization, function and molecular structure. Sites for proton

translocation. Coefficient of oxidative phosporylation (P/O). Respiratory control, phosphate potential. Inhibitors of electron transfer: barbiturates, antimycin A, KCN. Dangerous combination of barbiturates and alcohol.

19. Chemiosmotic theory for the mechanism of the oxidative phosphorylation in the respiratory

chain. ATP synthase. Effect of uncouplers (2,4-dinitrophenol). Natural uncouplers. Inhibitors of oxidative phosphorylation (oligomycin).

20. Uncoupled oxidation. Heat production. Role of thermogenin in mitochondria of brown adipose

tissue. Electron transfer in the endoplasmic reticulum. Formation and detoxifying of reactive oxygen intermediates: superoxide, H202 and free hydroxyl radical.

21. Citric acid cycle - importance for catabolism and anabolism. Chemical reactions. Metabolic and

energy balance. Mechanisms of regulation. Pyruvate dehydrogenase deficiency. 22. Glycolysis - importance, chemical reactions, energy balance at anaerobic and aerobic

conditions. Tissue specificity of glycolysis. Relationship between glycolysis and respiratory chains - shuttle mechanisms for transfer of hydrogen from the cytosol into mitochondria (malate and glycerophosphate shuttles). Links with the citric acid cycle. Lactic acidosis.

23. Gluconeogenesis. Importance. Circumvention of the three irreversible steps in glycolysis.

Regulation of gluconeogenesis. Fructose-1,6-bisphosphatase deficiency. 24. The pentose phosphate pathway. Importance. Oxidative, isomerase and transferase reactions.

Glucose-6-phospate dehydrogenase deficiency.

25. Metabolism of galactose. Galactosemia. Metabolism of fructose. Fructose intolerance. 26. Glycogenolysis and glycogenesis. Role of cAMP. Regulation. Glycogen storage diseases. 27. Lipids - classification. Oxidation of fatty acids with an even and odd number of carbon atoms.

Energy balance. 28. Biosynthesis of fatty acids. Role of acetyl-CoA carboxylase. Fatty acyl synthase -

multifunctional enzyme. Synthesis of triacylglycerols. Obesity. Catabolism of triacylglycerols. Metabolism of glycerol.

29. Metabolism (synthesis and degradation) of phosphoglycerols. Biological role of phospholipases

Ai, A2, C and D. Sphingolipids - types, structure and significance. Sphingolipidoses. 30. Ketogenesis. Utilization and oxidation of ketone bodies in extrahepatal tissues. Ketonemia and

ketonuria. Ketoacidosis in starvation and in Diabetes Mellitus. 31. Transport of lipids in the organism. Composition, origin and functions of lipoproteins

(chylomicrons, VLDL, LDL, HDL. Receptors for lipoproteins. Familiar hypercholesterolemia. 32. Metabolism of cholesterol. Chemical reactions in the synthesis of cholesterol. Excretion from

the body. Regulation. Atherosclerosis. 33. Derivatives of cholesterol (steroid hormones, vitamin D, bile acids) - structure and biologic

role. 34. General reactions of amino acid catabolism: oxidative deamination, transamination,

transdeamination. Clinical importance of aminotransferases. Decarboxilation of amino acids. Biological amines. Parkinson’s disease.

35. Detoxification of ammonia - synthesis of glutamine, urea cycle and ammoniogenesis. 36. Catabolism of the carbon skeletons of amino acids. Glycogenic and ketogenic amino acids.

Nutritionally essential and nonessential amino acids. One-carbon units - types, sources, importance. Role of S-adenosyl-L-methionine and folate derivatives.

37. Metabolic disorders of amino acids catabolism (phenylketonuria, alkaptonuria, methylmalonic

aciduria). 38. Biosynthesis and degradation of purine nucleotides. Regulatory enzymes in the biosynthesis.

Hyperuricemia due to enzyme defects (gout, Lesch-Nyhan syndrome). Inhibition of xanthine oxidase.

39. Biosynthesis and degradation of pyrimidine nucleotides. Regulatory enzymes in the

biosynthesis. Allosteric modulation and orotic aciduria. 40. Integration of metabolism. Links between metabolic pathways of carbohydrates, lipids, amino

acids and nucleotides at molecular level. Role of common metabolites and key enzymes. 41. Biosynthesis of DNA. General characteristics. DNA polymerases in prokaryotes. DNA

polymerase complex in eucaryotes. Steps of replication. Repair mechanisms. Biosynthesis of different types of RNA. General characteristics. RNA polymerases in prokaryotes and eukaryotes. Steps of transcription. Processing of RNA molecules.

42. Structure of the prokaryotic and eukaryotic genes.

43. Genetic code. Biosynthesis of proteins. Role of different types of RNA. Steps of the protein synthesis. Postsynthetic modifications. Inhibitors of protein synthesis.

44. Regulation of gene expression in prokaryotes (operon model) and in eukaryotes: at the level of DNA, at the level of transcription, at the level of translation and posttranslational regulation.

45. Recombinant DNA techniques. Recombination of DNA. Role of restriction endonucleases,

reverse transcriptase and chemical methods. Identifying of DNA sequences - electrophoresis, Southern blot. Dideoxynucleotide method of Sanger for DNA sequencing. Amplification of DNA: cloning, polymerase chain reaction (PCR).

46. Use of recombinant DNA techniques in medicine. DNA polymorphisms. Detection of

mutations by allele-specific probes and by PCR. Detection of a variable number of tandem repeats. Genetic consultations. Production of vaccines and therapeutic proteins. Gene therapy. Solving of cases in forensic medicine. Transgenic animals. DNA chips in diagnostics.

47. Signal transduction through membranes. Types of signal molecules. Classifications of

hormones. Receptors. 48. Molecular mechanisms of hormones which bind to intracellular receptors. 49. Molecular mechanisms of hormones wjiich bind to receptors on the cell surface. Example -

effect on glycogen phosphorylase and glycogen synthase. Role of cyclic SMP and other second messengers. Kinase cascades as second messengers.

50. Diabetes mellitus - changes in metabolism in type I and type II. Type I as autoimmune disease.

Mechanism of insulin action. Pathobiochemistry of diabetes mellitus type I and type II. Complications.

51. Biochemistry of liver. Inactivation and detoxification of xenobiotics. Ethanol metabolism. 52. Biochemical characteristics and metabolism of red and white blood cells. Hemoglobinpathies. 53. Biosynthesis of porphyrins. Types of porphyrias. Degradation of haemoglobin. Bile pigments.

Enterohepatic urobilinogen cycle. Jaundices. 54. Water-soluble vitamins. Metabolic role. Lipid-soluble vitamins. Metabolic role. 55. Biochemistry of food digestion. Chemical composition and enzymes of the digestive fluids

- saliva, gastric, pancreatic, and intestinal fluid. Degradation of food and uptake of the digested food.

56. Nerve tissue - metabolism and function. Regulation. Changes with aging, degeneration of

neurons. Drug dependence. Neuromediators. 57. Muscle tissue - metabolism and function. Molecular mechanisms of muscle contraction. 58. Biochemical processes in epithelial and connective tissue. Elastins, collagens,

heteropolysacharides. Defects. 59. Metabolism of calcium and phosphorus. Regulation. Bone formation. Osteoporosis and

hormone replacement therapy. 60. Biochemical mechanisms for formation and maintaining of the tooth enamel and dentin.

Destruction.

MEDICAL UNIVERSITY – SOFIA FACULTY OF DENTAL MEDECINE

CURRICULUM Name of the course: Medical Chemistry Education degree: Master Type of the course: Compulsory education (Compulsory, elective, facultative) Duration of the course: One semester, First semester Level of the course: Level М /master level/ Forms of evaluation: Current evaluations, seminars, tests, colloquium, practical exam Forms of education - Lectures, seminars, discussion Semestrial exam: Yes Lecturers: Assoc. prof. Ivan Ivanov Assoc. prof. Cyril Naidenov Department of Medical chemistry and biochemistry

1

ANNOTATION OF COURSE: The course in medical chemistry allows dental students to acquire basic knowledge and competence in the field of chemistry, necessary for their careers. The main directions are: 1. To acquire theoretical and practical knowledge of chemical methods of analysis; 2. To acquire knowledge necessary to solve issues related to dental practice such as: - Redox processes, redox potential and galvanic element in the oral cavity; - Nature of corrosion processes and methods to prevent them; - Selection of appropriate methods for analysis and proof of ions; - Preparation of solutions with known concentrations; - Calculation and experimental determination of the pH of solutions of acids and bases; pH measurements in biological materials; - Preparation of buffer solutions used in dental practice. 3. To acquire knowledge of basic chemical compounds involved in the biochemical processes of the living organisms as amino acids, carbohydrates, lipids, heterocyclic compounds, nucleic acids, vitamins, hormones, etc. 4. To analyze the relationship between chemical structure of organic compounds, drugs and their biological activity. DESCRIPTION OF THE COURSE: The course consists of 75 academic hours, including: • Lectures - 45 hours • Practical exercises - 30 hours (Laboratory exercises, seminars, colloquium). The evaluation of the students comprises: • Continuous assessment, by which the students are evaluated for their activity during the course; • Practical test; • Written exam. Aspects of formation of the evaluation: • Skills in solving the experimental tasks; • Tests; • Participation in discussions and colloquium; • Practical exam • Examination results during the session. AUXILIARY MEANS FOR TEACHING: schemes, molecular models, presentations, laboratory equipment and apparatuses. PURPOSE OF THE CURRICULUM: Asquisition of theoretical and practical skills in: • peparation of solutions with a known concentration; • determination of the pH of the solutions and in biological fluids; • preparation of buffer solutions with desired pH; • analysis of solutions containing different ions; • reactions associated with complex formation;

2

• processes associated with polymerization and polycondensation; • studying the properties of the main types of organic compounds in accordance with modern dental requirements. TASKS OF THE PROGRAMME: • Practical skills in analysis of biologically important substances using modern analytical and physicochemical methods of analysis; • Solving of practical problems associated with the preparation and use of various concentrations, pH, buffers, surfactants; • Analysis of various ions, biologically important organic compounds, vitamins, medicines, etc. Prerequisites: To start training of Medical Chemistry is necessary for the students to have basic knowledge of inorganic and organic chemistry, which is verified by the candidate student exam in chemistry. EXPECTED RESULTS: After completion of the course students should be able to: • analyze inorganic and organic substances used in dental practice; • know well the redox processes, and hence the processes associated with corrosion of dental materials and ways of preventing them; • solve experimental tasks related to preparation of solutions with specific concentrations and use the different concentrations by passing from one to another; • determine the pH in biological materials; • prepare buffers with defined pH; • know the properties of different types of surface-active substances and the use of non-ionic surfactant in the prevention of tartar; • make the connection between the structure of the used materials in dentistry and their biological action. Topics for independent work: Set up essays or presentations on certain topics. Literature: 1. Medical chemistry. Theoretical course for students. M. Nikolov, Iv. Ivanov, M.Matova, R.Tomova, Ts.Tsanova. Medical University, Sofia“, Publishing House, Pedagog 6”, Sofia, 2011. 2. Practical Course of Chemistry for English speaking students. The authors are from the Department of Medical Chemistry&Biochemistry, Faculty of Medicine, Medical University, Sofia, Published by “Reko”, Sofia 2009. Synopsis for the exam: see Annex

3

Medical University- Sofia F a c u l t y of M e d i c i n e

Department of Medical Chemistry and Biochemistry

SYNOPSIS

of Medical Chemistry

for English-Speaking Students from the Faculty of Dental Medicine I. GENERAL AND I N O R G A N I C C H E M I S T R Y Theoretical Bases of Medical Chemistry 1. Bonding. Ionic and covalent bonds 1.1. Nature of chemical bonding. Method of valence bonds. Types of covalent bonds: σ−, π− and δ−bonds. Properties of the covalent bond. Delocalization of the chemical bond. Hybridization of the atom orbitals. 1.2. Nature of hydrogen bond and biological significants. Intramolecular and inter-molecular hydrogen bonds. Role of hydrogen bond for the stability and formation of biological structures. Intermolecular (ion-dipole forces, dipole-dipole forces, London dispersion forces) and ionic forces of attraction and their biological role. Metal bond. 1.3. Chemical bonds in complex compounds. Donor-acceptor (coordinative) bond. Classification and nomenclature of the complex compounds. Isomerism, structure and stability of complex compounds. Chelates in living systems. Application of certain chelates in dental practice. 1.4. Chemical bonds and electronic effects in molecules of organic compounds. Inductive and resonance (mesomeric) effects. Relationship between electronic structure and chemical properties. 2. Dispersed systems: 2.1. Solutions and solubility. Saturated solutions of low soluble ionic compounds in water - solubility product constant. Units of concentration. 2.2. Weak electrolytes. Equilibrium in electrolyte solutions. Dissociation constant. Degree of dissociation. Ostwald’s dilution law. Theory of strong electrolytes – activity and ionic strength.

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2.3. Colligative properties of solutions: vapour pressure lowering, boiling point elevation, freezing point depression. Raoult's laws. Osmosis and osmotic pressure. Biological significance. 2.4. Acid-base systems. Protolysis processes: Broensted-Lowry’s conceptions of acids and bases. Conjugate acid-base pair. Acid-base strength – acid ionization constant (Ka) and base ionization constant (Kb). Lewis acids - bases. 2.5. Hydrolysis processes. The degree of hydrolysis and hydrolysis constant. Types of hydrolysis. Hydrolyses of organic compounds. Significance of hydrolysis processes. 2.6. Ionization of water. Ion product constant of water. The pH-scale. Physiological pH values. Methods for calculations and measuring the pH of solutions. 2.7. Buffer solutions-properties.The Henderson-Hesselbach equation. Buffer capacity. Blood’s buffers. Buffer solutions used in dental practice. 2.8. Colloid dispersed systems. Classification of colloid dispersed systems. Methods of obtaining. Dialysis. Structure of the hydrophobic colloid particles. Kinetic, optical and electric properties. Electrophoresis. Solutions of high–molecular compounds. Stability and coagulation of colloid solutions. Biological significance. Reversible and irreversible hydrocolloids (alginates) used as elastic impression materials in dentistry 3. Chemical kinetics and chemical equilibrium 3.1. Chemical reaction rate. Dependence of reaction rate on concentration of reactants. Rate law. Rate constant. Reaction order. Rate equations of different reaction order. 3.2. Effect of temperature on the rate of chemical reactions. A reaction energy diagram. Transition state. Activation energy and the Arrhenius equation. 3.2. Catalysis. Theory of catalytic processes in point of view of transitional state. Mechanism of homogeneous and heterogeneous catalysis. Role of the catalysts in vital processes - biocatalysis. 3.3. Criteria for determination of direction of chemical processes and principles thermodynamics quantities: enthalpy, entropy and free energy. Spontaneity of chemical reactions and free energy. Exergonic, endergonic and anergonic processes. Conjugated processes. Compounds with macroergic bonds. Anergonic processes in living organisms. 3.4. Chemical equilibrium. The concept of equilibrium: The forward and the reverse reaction. The equilibrium constant and change in free energy (reaction isotherm of van’t Hoff). Factors affecting equilibrium. Le Châtelier's principle and chemical equilibrium. 4. Processes of electron transfer 4.1. Valency and oxidation number. Reactions of oxidation and reduction. Electron exchange and types of redox processes. 4.2. Galvanic cell of Daniell. Galvanic cell in the oral cavity. Electrode half reactions. Electrode potential. Electromotive force of galvanic element. Nernst’s equation. Direction of redox processes. Relationship between redox - potential and equilibrium constant. Redox systems in living organisms. Characteristics of biological oxidation. 4.3. Corrosion. Types of corrosion. Biochemical corrosion. Nature of the electrochemical corrosion. Oral electrogalvanic element in cases of bimetallism and polymetallism. Methods for prevention of corrosion. 5. Surface phenomena Adsorption. Surface energy and surface tension. Adsorption on the surface: liquid/gas; liquid/liquid; liquid/solid substance. Adsorption equilibrium. Adsorption isotherm. The Langmuir equation. Ion exchange and selective adsorption. Lyotropic series. Surface-active substances and their use in dentistry. Chromatography - nature, types and application.

5

II. O R G A N I C C H E M I S T R Y 1.Hydrocarbons. 1.1 Saturated hydrocarbons. The reactivity of alkanes and cycloalkanes. Halogenation of alkanes - mechanism of reactions of free radical substitution (SR). Free radicals and cancerogenese. Cyclohexane – conformation “chair” and “boat”. 1.2. Unsaturated hydrocarbons. Alkenes and alkynes: structure and properties. Stereoisomerism: geometrical (cis - trans) isomerism. Acidity of alkynes. Mechanism of electrophilic addition to double bond (AE). Oxidation, reduction and polymerization of alkenes and alkynes. Mechanism of polymerization. Plastics as the most used dental materials. 1.3. Aromatic hydrocarbons. Hueckel’s rule of aromaticity. Mechanism of electrophilic aromatic substitution (SE). Activators and deactivators. Orientation in benzene ring. Fused aromatic hydrocarbons. Carcinogens.

2. Hydroxyl derivatives of hydrocarbons and thiols. Structures and chemical properties of alcohols and phenols. Alcohols as acids and bases. Acidity of phenols. Mechanism of esterification. Bio-oxidation of methanol, ethanol and glycol. Mercaptans (thioalcohols), thioethers: physical and chemical properties. Oxidation. Mercaptans (thioplastic materials) used as impression materials in dentistry. 3. Carbonyl compounds. Aldehydes and ketones. Reactivity and comparative review of chemical properties of aldehydes and ketones: nucleophilic addition (AN), oxidation and reduction. Important aldehydes and ketones. Reactions of polymerization and polycondenzation. Aldol condensation and its role in the biological processes. Cannizzaro

,s reaction. Use of some carbonyl compounds in dental

practice. Quinones-structure and properties. Phylloquinone (vitamin K1). 4. Carboxylic acids. 4.1. Saturated monocarboxylic fatty acids and aromatic monocarboxylic acids. Important representatives: formic acid, acetic acid, propionic acid, butyric acid, valeric acid (pentanoic acid) and benzoic acid. Chemical properties. Relationship between structure and acidity. 4.2.Unsaturated monocarboxylic fatty acids: chemical properties and representatives: acrylic acid, methacrylic acid and oleic acid. Polyunsaturated essential fatty acids: linoleic, linolenic and arachidonic, eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids (Vitamin F). Role of polyunsaturated ω–3 fatty acids for prevention of cardiovascular diseases. Concept of prostaglandins. 4.3.Dicarboxylic saturated acids - chemical properties. Representatives: oxalic acid, malonic acid, succinic acid, glutaric acid and adipic acid). Unsaturated dicarboxylic acids - fumaric and maleic acids. Aromatic dicarboxylic acids: phthalic acid, isophthalic acid and terephthalic acid. 4.4.Hydroxycarboxylic (fatty and aromatic) acids – structure and properties. Stereoisomerism of fatty hydroxycarboxylic acids. Representatives: lactic acid, β−hydroxybutyric acid, tartaric acid and citric acid. Optical activity. Enantiomers and racemates. Fischer’s projection formulae. Relative configuration to glycerolaldehyde. Molecules with more than one chiral centers Diastereomers. Derivatives of salicylic acid as medicines - methyl salicylate, aspirin, salol, paraaminosalicylic acid. 4.5.Aldehyde and ketocarboxylic acids - structure and properties. Representatives: glyoxalic acid, pyruvic acid, acetoacetic acid (tautomerism) and oxaloacetic acid. Acetoacetic ester (tautomerism). Acids involved in Kreb’s cycle. Ketone bodies.

6

4.6.Derivatives of carbonic acid: carbamic acid, urethanes, carbamide (urea), urethanes, ureides, biuret, guanidine, creatine, creatinine - structure and biological meaning. 4.7.Lipids. Saponifiable lipids - classification. Fats - structure and properties. β–Oxi-dation. Saponification of triglycerides. Types of phospholipids. Glycerophospho-lipids: cephalins and lecithins. Biological meaning. 5. Amines 5.1.Aliphatic and aromatic amines. Structure and basicity of amines. Physical and chemical properties of amines. Biogenic amines. Amides, Schiff’s bases, diazonium salts, and azo-compounds (azo-dyes). Amides with medical usage: phenacetin and paracetamol. 5.2.Aminoalkohols: aminoethanol (colamine), choline and sphingosine. Acetyl-choline. Catecholamines: dopamine, noradrenalin, adrenaline. 6. Amino acids and peptides 6.1. Amino acids (I). Classification of amino acids. Representatives. Essential aminoacids. Structure, configuration and optical activity of amino acids. Amino acids as dipolar ions. Isoelectric point. Amphoteric character of aminoacids. 6.2. Amino acids (II). Chemical properties: reactions of amino - and carboxylic- groups. Heat treatment of aminoacids and lactam - lactim tautomerism. Biological importantce of amino acids. 6.3. Aromatic aminoacidsn - p-aminobenzoic acid. Local anaesthetics: anaesthesin and novocain. Structural analogues of novocain − lidocain and baycain. Sulphanilic acid and some sulphonamides: sulphathiazole, sulphacetamide, sulphaguanidine. Concept of metabolites. 6.4. Peptides-structure and properties. Stereochemistry of peptide bond. Some important peptides: glutathione. Some important peptide hormones: vasopressin, oxytocin, insulin. Biological importance of peptides 7. Carbohydrates 7.1. Classification of carbohydrates. Monosaccharides (I). Important representatives: glucose, mannose, galactose, fructose, ribose and deoxyribose. Configuration and optical activity of monosaccharides. Anomers, epimers and mutarotation. Cyclization- hemiacetal (pyranose and furanose) formation. Haworth structures. Vitamin C − structure, properties and its role as antioxidant. 7.2. Monosaccharides (II). Chemical properties: oxidation and reduction reactions. Producing of aldonic acids, sugar acids, uronic acids and polyalcohols (sorbitol). Reactions of carbonyl and hydroxyl groups. Biologically important esters. Glycoside formation. O- and N-glycosides.

7

7.3. Disaccharides. Types of linkage of glycoside residues. Non reducing and reducing disaccharides - some important representatives (sucrose, maltose, cellobiose, lactose) - structure and properties. Galactoseaemia. 7.4. Homopolysaccharides. Structure and properties of starch (amylose and amylo-pectin), glycogen and cellulose. Derivatives of cellulose – cellulose nitrates and cellulose acetates. 7.5. Heteropolysaccharides: hyaluronic acid, chondroitinsulphuric acid and alginic acid - structure and properties. Heparin - biological meaning. 8. Hetererocyclic compounds. 8.1. Five-membered heterocycles with one heteroatom. Pyrrole - structure and properties. Biologically active derivatives of pyrrolidine: proline, hidroxyproline. Organic compounds containing porphin ring: protoporphirin and haem. Pyrrole pigments: haemoglobin, bilirubin. 8.2. Fused ring compounds with pyrrol ring. Indole – structure and properties. Important representatives with biological activity: tryptophane. Neurotransmitters and hormone derivatives of indole: tryptamine, serotonin and melatonin. 8.3. Five-membered heterocyclic compounds with two heteroatoms (diazoles) (I). Pyrazole- structure and properties. Derivatives of 5-pyrazolon: antipyrine, pyramidon (amidophene) and analgin. Ideas for antipyretics. 8.4. Five-membered heterocycles with two heteroatoms (diazoles) (II). Imidazole-structure and properties. Histidine and histamine. Antihistamine medicines. Biotin (vitamin B7). 8.5. Six-membered heterocycles with one heteroatom. Pyridine (azine)-structure and properties. Pyridine carboxylic acids and their derivatives: nicotinamide (vitamin PP, vitamin B3), coramine, tubazide, pyridoxine (vitamin B6). Biological meaning. 8.6. Six-membered heterocycles with two heteroatoms (diazines). Pyrimidine-structure and properties. Barbituric acid and some barbiturates - barbital (veronal), phenobarbital (luminal), evipan. Pyrimidine bases - cytosine, uracil and thymine. Antimetabolites with antitumor activity: 5 - fluorouracil. Thiamine (vitamin B1). 8.7. Fused ring compounds with pyrimidine ring (I). Pteridine-structure and derivatives: folic acid (vitamin B9 ) and riboflavin (vitamin B2). 8.8. Fused ring compounds with pyrimidine ring (II). Purine – structure and properties. Xanthine and hypoxanthine. Uric acid. Purine bases: adenine and guanine. 8.9. Nucleic acids: RNA and DNA. Hydrolysis of nucleic acids. Nucleosides and nucleotides. Pyrimidine nucleosides: uridine, cytidine and thymidine. Purine nucleosides: adenosine and guanosine. Primary and secondary structure of nucleic acids. Biological importance of nucleic acids. 8.10. Alkaloids. Characteristic of alkaloids. N-Methylxanthine derivatives: caffeine, theobromine, theophyline. Nicotine, atropine, cocaine, quinine and morphine. Derivatives of morphine - heroin and codeine. Physiological action.

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PRACTICAL COURS IN MEDICALCHEMISTRY FOR ENGLISH SPEAKING STUDENTS

From the Faculty of Dental Medicine First (Winter semester)

weeks Topics

1st 1. CONCENTRATION OF THE SOLUTIONS • Percent concentration (weight/weight percent, weight/ volume percent,

volume/volume percent). • Molarity. Molality. • Normality. Titer. • Connection between different types of concentrations. • Dilution of solutions.

2nd 2. AUTOPROTOLYSIS CONSTANT. ION PRODUCT CONSTANT OF WATER. pH. pH – MEASUREMENT AND CALCULATION • Autoprotolysis constant. • Ion product of constant of water. pH- concept. pH-scale. • Calculation of pH of strong and weak acids and bases. • Colorimetric and potentiometric methods for measurement of pH.

3th 3. BUFFER SOLUTIONS • Quantitative characteristic of the buffer solutions. Some important buffers. • The Henderson-Hesselbalch equation. • Calculation of pH of buffer solutions. • Buffer capacity. Determination of buffer capacity. • Acidosis and alkalosis.

4th 4. QUALITATIVE ANALYSIS OF BIOLOGICALLY ACTIVE IONS • Analysis of biologically active cations: K+, Ca2+, Ag+, Hg2

2+, Pb2+, Cu2+, Fe2+, Fe3+ and their biological role.

• Analysis of biologically active anions: CO32-, NO2

-, C2O42-, PO4

3- , urate anions and their biological role.

• Analysis of dental tartar.

5th 5. COLLOQUIUM: • Qualitative analysis of biologically active cations and anions and their

biological role; • Concentration of solutions: percent concentration, molarity, molality,

normality, titer. • Autoprotolysis constant. Ion product constant of water. pH. • Calculation of pH of strong and weak acids and bases. • Buffers; The Henderson-Hesselbalch equation. • Solve of some problems associated to the concentration, pH and buffers.

6. HYDROCARBONS

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6th

• Types of organic reactions: Substitution (SR, SE, SN), addition (AN, AE), elimination (E) and rearrangement reactions.

• Reaction of alkanes, alkenes, alkynes and aromatic hydrocarbons: Behavior of alkanes, alkenes and arenes towards bromine water. Electrophilic substitution reactions: brominating of benzene and toluene; nitration of benzene, toluene and naphthalene. • Oxidation of aliphatic and aromatic hydrocarbons.

Amines. • Basicity of amines. Basicity constant. • Reactions with nitrous acid. • Diazo reaction of Ehrlich and using of this reaction in clinical practice for

diagnosis. Diazonium salts. • Ring substitution in aromatic amines.

7th

7. ALCOHOL AND PHENOLS • Alcohols as acids and bases. Acidity of phenol. • Oxidation of alcohols and phenols. Catalytic dehydrogenation of methanol.

Oxidation of hydroquinone. • Esterification of alcohols. • Demonstration of neighbour hydroxyl groups in glycerol and other polyvalent

alcohols. • Electrophilic substitution of phenol (brominating and nitration). • Qualitative reaction of phenol with iron trichloride.

8th

8. ALDEHYDES AND KETONES • Oxidation of aldehydes and ketones. Fehling’s probe, silver mirror’s probe. • Reactions with phenylhydrazine and ammonia. Obtaining of phenylhydrazone. • Aldol condensation. Cannizzaro’s reaction (reaction of disproportionation). • Reaction of polymerization of formaldehyde. Reaction of polycondenzation of

formaldehyde with phenol and carbamide. • Legal’s probe for the detection of acetone in biological materials.

9th

. 9. CARBOXYLIC ACIDS • Acidity of carboxylic acids. • Oxidation of carboxylic acids. Formic acid as a reducer. • Saturated and unsaturated aliphatic carboxylic acids. High fatty acids.

Unsaturated Fatty acids. • Derivatives of carboxylic acids. Producing of soaps and esters. Acide amides. • Amides of the carbonic acid. • Basic properties of carbamide. Hydrolysis of urea in alkali medium. • Biuret reaction.

10th

10th

10. SUBSTITUTED CARBOXYLIC ACIDS • Hydroxycarboxylic acids: lactic acid, tartaric acid and salicylic acid. • Ufelmann’s probe for lactic acid. Diagnostic signifcance of the probe. • Reaction of potassium sodium tartarate with copper (II) hydroxide. • Reaction of salicylic acid: decarboxylation and colour reaction with FeCl3 • Keto carboxylic acids: pyruvic acid and acetoacetic acid.

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• Colour reaction of the enol form of the acetoacetic ester. Keto-enol tautomerism of the acetoacetic ester.

• Gerhard’s probe for acetoacetic acid. Ketone bodies. Amino acids. • Structure of natural amino acids. Amino acids as dipolar ions. • Amino acids as acids and bases. Buffer action of α–amino acids. Reactions of

amino acids. • Ninhydrin reaction. Biuret reaction for peptides. • Aromatic character of p-aminobenzoic acid.

11th

11. Carbohydrates. I. Monosaccharides • Monosaccharides – structure, α–inversion (epimerization). • Obtaining of osazones. • Demonstration of neighbour hydroxyl groups, oxidation of monosaccharides

by Fehling’s solution and by Tolens’ reagent. • Detecting pentoses according Tolens. Distinction of aldoses from ketoses by

the Selivanov’s reaction. II. Disaccharides and Polysaccharides. • Disaccharides of monocarbonyl and dicarbonyl type of bonding. • Reaction of disaccharides and polysaccharides. • Inversion of sucrose. Hydrolyse of sucrose and starch.

12th 12. Colloquium – structure and chemical properties of: • Hydrocarbons; • Alcohols and phenols; • Aldehydes and ketones; • Carboxylic acids, substituted carboxylic acids; • Amines, amides and aminoacids.

13th 13. HETEROCYCLIC COMPOUNDS I • Nitrogen-containing heterocyclic compounds with five membered ring:

pyrrole, indole, imidazole and pyrazole. • Colour reaction for pyrrole and indole. • Scheme of obtaining of some derivatives of 5-pyrazolon: antipyrin,

pyramidone and analgin. • Colour reactions of antipyrine and pyramidon with FeCl3 and HNO2.

14th 14. HETEROCYCLIC COMPOUNDS II • Nitrogen-containing heterocyclic compounds with six membered ring and

fused aromatic rings: pyridine, pyrimidine and purin. • Basic properties and colour reaction for pyridine. • Barbituric acid – lactam-lactim tautomerism. Qualitative reaction for detection

of barbituric acid. Solubility of veronal and sedimentary reaction of veronal. • Folin’s reaction for detection of uric acid and urates. • Analysis of alkaloids.

15th 15. PRACTICAL EXAM

11

Medical University- Sofia F a c u l t y of M e d i c i n e

Department of Medical Chemistry and Biochemistry

P r o g r a m

of Medical Chemistry

for English-Speaking Students from the Faculty of Dental Medicine I. GENERAL AND IN O R G A N I C C H E M I S T R Y Theoretical Bases of Medical Chemistry - 20 hours 3. Chemical bonding and structure of molecules - 4 hours 1.1. Nature of chemical bonding. Method of valence bonds. Types of covalent bonds: σ−, π− and δ−bonds. Properties of the covalent bond. Dipole moment. Polar and no polar molecules. Delocalization of the chemical bond. Hybridization. 1.2.Nature of hydrogen bond and biological significance. Intramolecular and inter-molecular hydrogen bonds. Role of hydrogen bond for the stability and formation of biological structures. Intermolecular (ion-dipole forces, dipole-dipole forces, London dispersion forces) and ionic forces of attraction and their biological role. Metal bond. 1.3.Chemical bonds in complex compounds. Donor-acceptor (coordinative) bond. Classification and nomenclature of the complex compounds. Isomerism, structure and stability of complex compounds. Chelates in living systems. Application of certain chelates in dental practice. 1.4. Chemical bonds and electronic effects in molecules of organic compounds. Inductive and resonance (mesomeric) effects. Relationship between electronic structure and chemical properties. 4. Dispersed systems - 6 hours 2.1. Solutions and solubility. Ideal and real solutions. Solubility product constant. Units of concentration. Colligative properties of solutions: vapour pressure lowering, boiling point elevation, freezing point depression. Osmosis and osmotic pressure. Isotonic solutions.

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Solutions of strong and weak electrolytes. Theory of strong electrolytes – activity and ionic strength. 2.2.Acid-base systems. Protolysis processes: Broensted-Lowry acids-bases. Conjugate acid-base pair. Acid - base strength – acid ionization constant (Ka) and base ionization constant (Kb). Lewis acids - bases. 2.3. Ionization of water. Ion product constant of water. The pH-scale. Physiological pH values. Methods for determination of pH. 2.4. Buffer solutions-properties.The Henderson-Hesselbach equation. Buffer capacity. Biological meaning of buffer solutions. Blood’s buffers. Buffer solutions used in dental practice. 2.5.Hydrolysis processes. Hydrolyses of salts and organic compounds. The degree of hydrolysis and hydrolysis constant. Relationship between hydrolysis and protolysis constants. Significance of hydrolysis processes. 2.6. Colloid dispersed systems - nature, types and methods of obtaining. Dialysis. Classification of colloid dispersed systems. Solutions of high–molecular compounds. Structure of the hydrophobic colloid particles. Kinetic, optical and electric properties. Electrophoresis. Stability and coagulation of colloid solutions. Biological meaning. Reversible and irreversible hydrocolloids (alginates) used as elastic impression materials in dentistry.

3. Chemical kinetics and chemical equilibrium - 4 hours 3.1. Chemical reaction rate. Dependence of reaction rate on concentration of reactants. Rate law. Rate constant. Reaction mechanisms and rate-determine step. Reaction order. Rate equations of different reaction order. Effect of temperature on the rate of chemical reactions. A reaction energy diagram. Transition state. Activation energy- Arrhenius equation. 3.2. Catalysis. Theory of catalytic processes in point of view of transitional state. Mechanism of homogeneous and heterogeneous catalysis. Role of the catalysts in vital processes - biocatalysis. 3.3. Criteria for determination of direction of chemical processes and principles thermodynamics quantities: enthalpy, entropy and free energy. Spontaneity of chemical reactions and free energy. Exergonic, endergonic and anergonic processes. Conjugated processes. Compounds with macroergic bonds. Anergonic processes in living organisms. Chemical equilibrium. The concept of equilibrium: the forward and the reverse reaction. The equilibrium constant and change in free energy (reaction isotherm of van’t Hoff). Factors affecting equilibrium. Le Châtelier's principle and chemical equilibrium.

4. Processes of electron transfer - 4 hours 4.1. Valency and oxidation number. Reactions of oxidation and reduction. Electron exchange and types of redox processes. Galvanic cell of Daniell. Galvanic cell in the oral cavity. Electrode potential. Electromotive force of galvanic element. Nernst’s equation. Direction of redox processes. Relationship between redox-potential and equilibrium constant. Redox systems in living organisms. Characteristics of biological oxidation. 4.3. Corrosion. Types of corrosion. Biochemical corrosion. Nature of the electrochemical corrosion. Oral electrogalvanic element in cases of bimetallism and polymetallism. Methods for prevention of corrosion.

5. Surface phenomena - 2 hours Adsorption. Surface energy and surface tension. Adsorption on the surface: liquid/gas; liquid/liquid; liquid/solid substance. Adsorption equilibrium. Adsorption isotherm. The Langmuir equation. Ionexchange and selective adsorption. Lyotropic series. Surface-active substances and their use in dentistry. Types of chromatography and application.

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II. O R G A N I C C H E M I S T R Y - 25 hours 1.Hydrocarbons - 4 hours 1.1. Saturated hydrocarbons. Alkanes - structure. Conformational isomerism. The reactivity of alkanes. Mechanism of reactions of free radical substitution (SR) (halogenation of alkanes). Free radicals and carcinogenesis. Cycloalkanes: cyclohexane - conformation. 1.2. Unsaturated hydrocarbons. Alkenes and alkynes: structure and properties. Stereoisomerism: geometrical (cis - trans) isomerism. Acidity of alkynes. Mechanism of electrophilic addition to double bond (AE). Oxidation, reduction and polymerization of alkenes and alkynes. Mechanism of polymerization. Plastics as the most used dental materials.

1.3. Aromatic hydrocarbons. Structure of benzene. Hueckel’s rule of aromaticity. Mechanism of electrophilic aromatic substitution (SE). Activators and deactivators. Orientation in benzene ring. Fused aromatic hydrocarbons. Carcinogens.

2. Alcohols, phenols and thiols -2 hours Structures and reactivity of alcohols and phenols. Alcohols as acids and bases. Acidity of phenols. Mechanism of esterification. Bio-oxidation of methanol, ethanol and glycol. Mercaptans (thioalcohols), thioethers: physical and chemical properties. Oxidation. Mercaptans (thioplastic materials) used as impression materials in dentistry. 3. Carbonyl compounds -2 hours Aldehydes and ketones. Reactivity and comparative review of chemical properties of aldehydes and ketones: nucleophilic addition (AN), oxidation and reduction. Important aldehydes and ketones. Reactions of polymerization and polycondenzation. Aldol condensation and its role in the biological processes. Cannizzaro

,s reaction. Use of some

carbonyl compounds in dental practice. Quinones-structure and properties. Phylloquinone (vitamin K1). Carboxylic acids - 4 hours 4.1. Saturated monocarboxylic fatty acids and aromatic monocarboxylic acids. Important representatives: formic acid, acetic acid, propionic acid, butyric acid, valeric acid (pentanoic acid) and benzoic acid. Chemical properties. Relationship between structure and acidity. 4.2.Unsaturated monocarboxylic fatty acids: chemical properties and representatives: acrylic acid, methacrylic acid and oleic acid. Polyunsaturated essential fatty acids: linoleic, linolenic, arachidonic, eicozapentaenoic and docozahexaenoic acids (Vitamin F). Role of polyunsaturated ω-3 fatty acids for prevention of cardiovascular diseases. Concept of prostaglandins. 4.3. Dicarboxylic saturated acids. Chemical properties. Representatives: oxalic acid, malonic acid, succinic acid, glutaric acid, adipic acid. Unsaturated dicarboxylic acids - fumaric and maleic acids. Aromatic dicarboxylic acids. 4.4. Substituted carboxylic acids. Hydroxycarboxylic (fatty and aromatic) acids -structure and properties. Representatives: lactic acid, β−hydroxybutyric acid, tartaric acid and citric acid. Optical activity. Enantiomers and racemates. Fischer’s projection formulae. Relative configuration to glycerolaldehyde. Molecules with more than one chiral centers Diastereomers. Derivatives of salicylic acid as medicines- methyl salicylate, aspirin, salol, paraaminosalicylic acid. Aldehyde and ketocarboxylic acids - structure and properties. Representatives: glyoxalic acid, pyruvic acid, acetoacetic acid. Acetoacetic ester (tautomerism). Acids involved in Kreb’s cycle. Ketone bodies.

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4.5. Derivatives of carbonic acid: carbamic acid, carbamide (urea), urethanes, ureides, burette, guanidine, creatine, creatinephosphate, creatinine- structure and biological meaning. 4.6. Derivatives of carboxylic acids: salts (soaps), esters, amides. Types of esters: waxes and fats. Fats- structure and properties. β– Oxidation. Saponification of triglycerides. Types of phospholipids. Glycerophospholipids: cephalins and lecithins. Biological significance. 5. Amines, amides and aminoalcoholes - 2 hours 5.1.Aliphatic and aromatic amines. Structure and basicity of amines. Physical and chemical properties of amines. Biogenic amines. Amides, Schiff’s bases, diazonium salts, and azo-compounds (azo-dyes). Amides with medical usage: phenacetin and paracetamol. Aminoalkohols: aminoethanol (colamine), choline and sphingosine. Acetylcholine. Catecholamine: dopamine, noradrenalin, adrenalin. 5.2.Sulphanilic acid and sulphonamides. Concept of metabolites. Some representatives: sulphathiazole, sulphacetamide, sulphaguanidine. 6. Amino acids and peptides - 2 hours 6.1. Amino acids. Classification of amino acids. Representatives. Essential amino acids. Structure, configuration and optical activity of amino acids. Amino acids as dipolar ions. Amphitricha character, pKa and pI constants. Chemical properties-reactions of amino- and carboxyl- groups. Heat treatment of aminoacids and lactam-lactim tautomerism. Biological importance of amino acids. Aromatic aminoacids - p-aminobenzoic acid. Local anaesthetics : anesthesin and novocain. Structural analogues of Novocain - lidocain and baycain and their use in dental practice. 6.2. Peptides-structure and properties. Stereochemistry of peptide bond. Some important peptides: glutathione. Some important peptide hormones: vasopressin, oxytocin, insulin. Biological significance of peptides 7. Carbohydrates - 4 hours 7.1. Classification of carbohydrates. Monosaccharides. Configuration and optical activity of monosaccharides. Anomers, epimers and mutarotation. Cyclization- hemiacetal (pyranose and furanose) formation. Haworth structures. Representatives: glucose, fructose, mannose, galactose, ribose and desoxyribose. Chemical properties of monosaccharides: oxidation and reduction. Reactions of carbonyl and hydroxyl groups. Biologically important esters. Glycoside formation. O- and N-glycosides. Vitamin C − structure, properties and its role as antioxidant. 7.2. Disaccharides. Types of linkage of glycoside residues. No reducing and reducing disaccharides - some important representatives (sucrose, maltose, cellobiose, lactose) - structure and properties. Galactoseaemia. 7.3. Homopolysaccharides. Structure and properties of starch (amylose and amylo-pectin), glycogen and cellulose. Derivatives of cellulose – cellulose nitrates and cellulose acetates. Heteropolysaccharides: hyaluronic acid, chondroitinsulphuric acid and alginic acid- structure and properties. Heparin - biological meaning. 8. Hetererocyclic compounds - 5 hours 8.1. Five-membered heterocycles with one heteroatom. Pyrrole - structure and properties. Biologically active derivatives of pyrrolidine: proline, hidroxyproline, pyramem. Organic compounds containing porphin ring: protoporphirin and haem. Pyrrole pigments: haemoglobin, bilirubin. Fused ring compounds with pyrrole ring. Indole-structure and properties. Important representatives with biological activity: tryptophane. Neurotransmitters and hormone derivatives of indole: tryptamine, serotonin and melatonin. 8.2. Five-membered heterocyclic with two heteroatoms (diazoles) (I). Pyrazole- structure and properties. Derivatives of 5-pyrazolon: antipyrine, pyramidon (amidophene) and analgine. Ideas for antipyretics.

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8.3. Five-member heterocycles with two heteroatoms (diazoles) (II). Imidazole-structure and properties. Histidine and histamine. Antihistamine medicines. Biotin (vitamin B7). 8.4.Six-membered heterocycles with one heteroatom (azine). Pyridine-structure and properties. Pyridine carboxylic acids and their derivatives: nicotinamide (vitamin PP, vitamin B3), coramine, tubazide, pyridoxine (vitamin B6). Pyrimidine salts - used as disinfection means in dental practice. 8.5.Six-membered heterocycles with two heteroatoms (diazines). Pyrimidine-structure and properties. Pyrimidine bases - cytosine, thymine and uracil. Barbituric acid and barbiturates. Antimetabolites with antitumor activity: 5- fluorouracil. thiamine (vitamin B1). 8.6.Fused ring compounds with pyrimidine ring. Pteridine - structure and derivatives: folic acid (vitamin B9 ) and riboflavin (vitamin B2). Purine– structure and properties. Xantine and hypoxanthine. N-methylxanthine derivatives: caffeine, theobromine, theophyline. Uric acid. Purine bases: adenine and guanine. 8.7. Nucleic acids: RNA and DNA. Hydrolyses of nucleic acids. Nucleosides and nucleotides. Pyrimidine nucleosides: uridine, cytidine and thymidine. Purine nucleosides: adenosine and guanosine. Primary and secondary structure of nucleic acids. Biological importance of nucleic acids. 8.8. Alkaloids. Characteristic of alkaloids. Nicotine, atropine, cocaine, quinine and morphine. Derivatives of morphine - heroin and codeine. Physiological effect. Literature: 1. Medical chemistry. Theoretical course for students. M. Nikolov, Iv. Ivanov, M.Matova, R.Tomova, Ts.Tsanova. Medical University, Sofia“, Publishing House, Pedagog 6”, Sofia, 2011. 2. Practical Course of Chemistry for English speaking students. The authors are from the Department of Medical Chemistry & Biochemistry, Faculty of Medicine, Medical University, Sofia, Published by “Reko”, Sofia 2009.

16



EDUCATIONAL PLAN

Name of the subject: MEDICAL MICROBIOLOGY


Type of the subject: Obligatory

Duration of the course: Two semesters (3rd & 4th), 106 academic hours

Course level: М (Master level)

Forms of assessment for the students’ knowledge: Marks during the course, colloquiums during the semesters, tests, final examination

What educational forms and methods are used in the course? Lectures, seminars, practical trainings

Examination after the semester: Yes

Leading lecturers: Prof. I. Mitov, Assoc. Prof. L. Sechanova and Assoc. Prof. L. Boyanova

CHAIR OF MEDICAL MICROBIOLOGY AT THE MEDICAL FACULTY – MEDICAL UNIVERSITY - SOFIA

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HIGHLIGHTS OF THE COURSE: The purpose of the course in medical microbiology for students in dental medicine is to give knowledge about microorganisms that are parasites in human organisms and cause infectious processes and the associated infectious diseases; the mechanisms of transmission; innate and acquired defensive reactions of the organism, as well as the methods for their diagnostics. The course is divided into 4 sections: general microbiology, infection and immunity, special microbiology and clinical microbiology. Every section pays specific attention to the processes, the normal flora and the specificities of the infections of teeth, periodontium and oral cavity. “General Microbiology” section concerns morphology and structure of microorganisms, their physiology (multiplication, culture methods, genetic structure and function); the impact of physical and chemical factors and the associated methods and means for sterilization and disinfection; and the antimicrobial chemotherapy. “Infection and Immunity” section deals with the interactions between the host and the pathogenic microorganisms, the specific features of the infectious diseases, microorganisms’ factors of pathogenicity and virulence, as well as the microorganisms’ defensive mechanisms in case of infections. This section provides some general knowledge about the nature of the infectious process which is necessary for the successive prophylactic and therapeutic activities. Special attention is paid to the means for specific prophylaxis and therapy of the infectious diseases (antibody containing preparations, vaccines) and the means for immunostimulation. “Special Microbiology” section provides information about the most significant pathogenic and opportunistic microorganisms – bacteria, viruses and fungi – their morphology and biology, their resistance in the environment and to physical and chemical factors; epidemiology, clinics and pathogenesis of the infections caused by them, mechanisms of protective immunity, means for specific prophylaxis and therapy, proper chemotherapy agents, methods for microbiological diagnosis, as well as methods for prevention and control of infections. “Clinical Microbiology” section reviews the normal microbial flora in the oral cavity and its participation in pathological processes there (caries, periodontitis, and infections developing in the mucosa and in the deep tissues). Diseases resulting from immunopathological (autoimmune and allergic) processes are also studied here. A review of the protective mechanisms in the oral cavity is included.

DESCRIPTION OF THE COURSE; The course includes 106 academic hours: lectures – 60 academic hours practical training – 46 academic hours

Formation of the final mark – complex; by assessing the students’ activity during the course (marks of the current checking of knowledge and tests, a colloquium in each of the two semesters, individual written works, marks from the test and the theoretical and practical examination during the session).

Considerations for the final mark: current checking of knowledge and tests, a colloquium in each of the two semesters, individual written works, final examination (a test, written and oral examination, practical examination).

ADDITIONAL EDUCATIONAL METHODS: computer PowerPoint presentations during the practical trainings; clinical cases for discussion; multimedia; overhead projectors; laboratory technical devices in the students microbiology labs.

2

AIM and TASKS OF THE EDUCATIONAL PLAN: To acquaint the dental medicine students with the pathogenic and opportunistic (normal flora and saprophytes) microorganisms and the infections caused by them. Special attention is paid to the infections in the oral cavity. The educational plan aims to provide the students with knowledge on the principles of infections origin and development and the host defensive reactions. The course provides knowledge about the principles, methods and measures for prophylaxis and treatment of the infectious processes and diseases: vaccines, antibody-containing preparations, immunostimulators, antibiotics and antiviral agents; methods and agents for sterilization and disinfection. A significant goal for the course is to educate on the algorithm and methods for microbiology diagnostics, incl. specimen collection and interpretation of the results. TASKS FOR THE PRACTICAL TRAINING:

Rules towards aseptic work in the microbiology lab, medical centers and hospitals. Rules and tools for collection, transportation and storage of specimens for microbiology testing. Operation with immersion oil microscope. Preparation of smears for microscoping. Simple staining methods. Complex staining methods. Stages of the microbiology testing – inoculation, isolation of pure cultures, identification. Preparation, reading, and interpretation of antibiograms. Performing basic immunological diagnostic reactions. Principles of preparation of disinfection solutions and rules towards the application of disinfectants and antiseptics. Principles of sterilization – preparation of instruments, execution, methods for quality control of the sterilization. Introduction to basic devices and methods for sterilization and disinfection. Introduction to the stages of the microbiology diagnostics for some of the major causative agents of infectious diseases. RECOMMENDED BIBLIOGRAPHY: Microbiology, a textbook edited by Prof. G. Mitov, 2000. Hиbook in microbiology – edited by G. Kaprelyan and Y. Docheva SYNOPSIS: attached

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LECTURES IN MEDICAL MICROBIOLOGY FOR STUDENTS IN DENTAL MEDICINE

Winter semester LECTION 1. Subject and objectives of microbiology. Essential stages in development of

microbiology. Significance of oral microbiology. Taxonomy of bacteria. LECTION 2. Morphology of bacteria. Bacterial cell structure – capsule, cell wall, cell

membrane. LECTION 3. Bacterial cell structure – flagella, fimbrae, cytoplasm and cytoplasm structures, ribosomes, nucleoid, spores. LECTION 4. Physiology of bacteria. Chemical composition of the bacterial cell. Nutrition.

Enzymes. Metabolism – catabolic and anabolic reactions. Growth and reproduction, culturing of bacteria.

LECTION 5. Viruses – nature and properties. Bacteriophages – structure and chemical composition. Basic types of interaction between the bacterial cell and the bacteriophage. Phage infection. Temperate phages, lysogenic cycle, phage conversion. Phage typing.

LECTION 6. Impact of physical factors on microorganisms: temperature, dehydration, liophylisation, osmotic pressure, UV rays, ionizing radiation, ultrasound. Impact of chemical agents on microorganisms – mechanisms of action. Disinfection, sterilization.

LECTION 7. Bacterial and phage genetics. Genotypes and phenotypes in bacteria and phages – the bacterial chromosome as a genetic system, extrachromosomal genetic elements (plasmids, temperate phages), transponible elements. Bacterial changeability. Mutations and mechanisms of genetic transmissions (transformation, conjugation, transduction). Genetic engineering.

LECTION 8. Antimicrobial chemotherapy: definition, principles of antimicrobial chemotherapy, requirements for antimicrobial agents, generic and trade names, spectrum of activity. Antibacterial chemotherapy products and mechanisms of their action.

LECTION 9. Antifungal chemotherapy products. Antiviral chemotherapy products. Adverse effects of antimicrobial treatment – toxic, immunologic, dysbacteriosis. Mechanisms of resistance of microorganisms to antimicrobial agents.

LECTION 10. Infection, infection process and infection disease. Characteristics of microorganisms’ properties, factors of pathogenicity. Impact of the environment, and social factors.

LECTION 11. Immunity. Types. Natural resistance. Acquired immunity. Antigens. Antigenic structure of microorganisms.

LECTION 12. Immune system. Essential stages in immunopoiesis. Immunity response. Humoral immunity. Immunoglobulines (antibodies) – structure and biological significance. Monoclonial antibodies and their application in medicine.

LECTION 13. Cell-mediated immunity. Mediators of cell immunity (lymphokines and cytokines). Local (secretory) immunity and immunosecretory system. Immunity (protective mechanisms) against bacterial infections (caused by toxigenic, exocellular and intracellular bacteria), viral and fungal infections. Protective mechanisms in the oral cavity.

LECTION 14. Immunopathology. Innate and acquired immunity deficiency. Medicine (antibiotics, etc) and bioproducts (serums, vaccines) induced allergy.

LECTION 15. Immunoprophylaxis and immunotherapy of infectious diseases. Types of vaccines and serums. Immunization schedule of the Republic of Bulgaria. Immunomodulation - immunostimulation and immunostimulators, immunosuppression.

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LECTURES IN MEDICAL MICROBIOLOGY


Summer semester

LECTION 1 . Genus Staphylococcus. Genus Streptococcus – S. pyogenes. LECTION 2 . Genus Streptococcus - S. pneumoniae, S. mutans. Family Neisseriaceae -

meningococci. Epidemic meningitis. Gonococci – gonorrhoea. Family Peptococcaceae - anaerobic cocci. Diseases.

LECTION 3. Family Enterobacteriaceae. Genus Escherichia. Genera : Klebsiella,

Enterobacter,Serratia, Proteus, Morganella, Providencia. Significance as opportunistic bacteria.

LECTION 4. Genus Salmonella – salmonellae, typhoid fever and causative agents food

intoxications. Genus Shigella – dysentery causative agents . LECTION 5. Genus Yersinia.Genus Vibrio – cholera causative agents. Genus Pseudomonas. LECTION 6. Genus Haemophilus. Genus Bordetella. Genus Fransisella. LECTION 7. Genus Corynebacterium. Genus Mycobacterium. Genus Listeria. LECTION 8. Genus Bacillus - B. anthracis. Genus Clostridium - С. tetani, gas gangrene causing

clostridia. LECTION 9. Genus Clostridium - С. botulinum, С. difficilae. Non spore-forming obligatory

anaerobic bacteria. Fusospirillary gingivitis. LECTION 10. Family Spirohaetaceae. Treponema palidum – syphilitic lesions in the oral

cavity.. Spirochetes in the oral cavity. Genus Borrelia - Borrelia burgdorferi, Borrelia recurentis. Pathogenic actinomycetes , actinomyceters in the oral cavity.

LECTION 11. Family Mycoplasmatacaeae. Family Rickettiaceae. Family Chlamidiaceae.

Pathogenic fungi. Genus Cиida. Cryptococcus neoformans . LECTION 12. Family Picornaviridae – poliomyelitis virus , ECHO and coxackie viruses. Family

Ortomyxoviridae – Genus Influenzavirus. Family Paramyxoviridae – parotitis and measles viruses. Family Adenoviridae. Family Reoviridae - rotaviruses.

LECTION 13 . Family Rhabdoviridae – rabies virus. Family Herpesviridae – common herpes,

shingles, chicken pox, cytomegalovirus, infectious mononucleosis virus. Family Togaviridae - Rubella virus.

LECTION 14. Family Hepadnaviridae - hepatitis А, В, С, D, F. Family Retroviridae – HIV,

AIDS causative agents. LECTION 15. Normal microflora of the human body. Oral microflora. Microbiological

aspects of pathological processes in the oral cavity: caries, infections of pulp, periapical tissues, periodontium, soft tissues.

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http://en.wikipedia.org/w/index.php?title=Fusospirillary_gingivitis&redirect=no

PRACTICAL TRAINING IN MEDICAL MICROBIOLOGY


Winter semester

Excercise 1 Microbiology laboratory. Bacterial morphology and structure. Microscopic

methods of examination. Pfeifer and Löffler stains. Microscopic methods of examination. Gram stain.

Excercise 2 Bacterial Morphology. Microbiological methods of examination. Ziehl-Neelson,

Peshkov and Neisser stains. Excercise 3 Test examination: Morphology and structure of bacteria. Physiology of bacteria.

Nutrition of bacteria. Cultivation of bacteria. Metabolism of bacteria. Bacterial enzymes. Biochemical methods of testing and examination of pure cultures.

Excercise 4 Physiology of bacteria. Growth and reproduction. Distribution of bacteria in the

environment. Impact of physical and chemical agents on microorganisms.

Excercise 5 Test examination: Physiology of bacteria.

Antimicrobial chemotherapy. Laboratory methods for accessing the susceptibility of bacteria to antimicrobial agents.

Excercise 6 COLLOQUIUM Exercise 7 Infection, infection process, infectious disease. Natural resistance against

infections. Immune reactions and their usage in diagnostics. Reaction of agglutination. Precipitation.

Exercise 8 Immunity. Immune reactions and their usage in diagnostics. Immune reactions

with involvement of the complement, immune reactions with marked antibodies. Immunoprophylaxis and immunotherapy of infectious diseases. Vaccines, antibody-containing products, immunomodulators.

SUMMER SEMESTER

Excercise 1 Basic principles of microbiological diagnostics. Microbiological diagnosis of

Staphylococcal infections. Excercise 2 Microbiological diagnosis of Streptococcal infections. Microbiological diagnosis of

diseases, caused by Neisseria. Excercise 3 Test examination: cocci. Family Enterobacteriaceae. Microbiological diagnosis of diseases, caused by bacteria from

Genera Escherichia and Klebsiella. Excercise 4 Microbiological diagnosis of diseases caused by bacteria from Genus Salmonella of

Family Enterobacteriaceae. Excercise 5 Microbiological diagnosis of bacterial dysentery. Microbiological diagnosis of

diseases, caused by bacteria from Genus Proteus and Genus Yersinia.

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http://www.google.com/url?sa=t&source=web&cd=4&ved=0CDMQFjAD&url=http%3A%2F%2Fwww.loeffler.at%2F&rct=j&q=loffler&ei=YxZlTdidK8GSOunDgO8F&usg=AFQjCNGMXef_8gw1UatNj0Atcm3mThIt5A&sig2=xC3uMuSnyAZyybRSsJpzcQ&cad=rja

Excercise 6 Microbiological diagnosis of cholera. Microbiological diagnosis of diseases, caused

by bacteria from Family Pseudomonadaceae. Microflora in the environment. Excercise 7 Microbiological diagnosis of diphtheria. Microbiological diagnosis of pertussis and

parapertussis. Excercise 8 Microbiological diagnosis of tuberculosis. Microbiological diagnosis of

actinomycosis. Microbiological diagnosis of candidiasis. Excercise 9 Microbiological diagnosis of anthrax. Microbiological diagnosis of anaerobic

infections, caused by Genus Clostridium. Excercise 10 COLLOQUIUM Exercise 11 Family Rickettsiaceae. Family Chlamydiaceae. Viruses – basic characteristics,

taxonomy, principles of virology diagnostics, taxonomy, principles of virology diagnostics.

Excercise 12 Family Picornaviridae. Family Reoviridae. Excercise 13 Family Ortomyxoviridae. Family Paramyxoviridae. Family Togaviridae. Excercise 14 Family Adenoviridae. Family Herpesviridae. Family Hepadnaviridae. Family

Retroviridae. Excercise 15 Normal microbial flora of the oral cavity and its significance for development of dental diseases. Microbiological examinations in cases of dental diseases.

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ЕXAMINATION SYNOPSIS IN MEDICAL MICROBIOLOGY


I. GENERAL MICROBIOLOGY 1. Subject and goals of microbiology. Essential stages in development of microbiology.

Taxonomy of bacteria. 2. Classification and nomenclature of viruses. 3. Morphology of bacteria. 4. Bacterial ultrastructure - flagella, axial filaments, pili. 5. Bacterial ultrastructure – capsule, glycocalyx. 6. Bacterial ultrastructure – cell wall in Gram-positive and Gram-negative bacteria. 7. Bacterial ultrastructure – cytoplasm, cytoplasm membrane and cytoplasm organelles. 8. Bacterial ultrastructure – nucleoid and chromosome. 9. Bacterial ultrastructure - spores. 10. Morphology and structure of fungi. 11. Physiology of microorganisms – chemical composition. Nourishment and cultivation of

bacteria. Growth factors. Bacterial enzymes. 12. Physiology of microorganisms – bacterial metabolism. 13. Physiology of microorganisms - growth and reproduction of bacteria. Productivity of

microorganisms. 14. Viruses – general characteristics and structure, culturing methods for viruses. Principles

of virology diagnostics. 15. Impact of chemical factors on microorganisms. Disinfection, disinfectants and antiseptic

agents; mechanism of action and usage. 16. Impact and mechanism of action of different physical factors on microorganisms. 17. Impact of physical factors on microorganisms – sterilization, methods of sterilization

and usage. 18. Bacterial genetics. Carriers of genetic information in bacteria – Structure, replication,

function. 19. Bacterial genetics. Mutations, mechanisms of recombination and DNA exchange. 20. Bacterial genetics. Genetic engineering: DNA cloning, DNA hybridization, PCR –

general characteristics and use. 21. Antimicrobial chemotherapy. Principle of selective toxicity, definition of terms,

requirements, names. Action of antibacterial agents. 22. Antimicrobial chemotherapy. Antibacterial agents – groups according their spectrum,

activity and molecular mechanisms. 23. Antimicrobial chemotherapy. Tuberculostartics. Antimycotic and antiviral agents. 24. Antimicrobial chemotherapy. Resistance of microorganisms to antimicrobial agents –

genetic and biochemical mechanisms of resistance.

II. INFECTION AND IMMUNITY 25. Infection. Interactions between microorganisms and host. Infection and infectious

disease. 26. Infection. The role of microorganisms in infection. Infectivity, pathogenicity, virulence

and contagiousness. 27. Infection. Pathogenicity and virulence factors of microorganisms. 28. Infection. Role of host, environment and social factors in infection. Reservoirs and

sources of infections; mechanisms of transmission.

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29. Infection. Pathogenesis of infection – infectious count, portals of exit and portals of entry, dissemination and localization of microorganisms in the host. Forms of infections and infectious diseases.

30. Immunity – definition, general characteristics, and types of immunity. 31. Natural resistance against infection. Physical barriers, normal human flora. 32. Natural resistance against infection. Humoral (chemical) defenses and factors.

Phagocytosis and inflammation. 33. Acquired immunity. Types and forms of acquired immunity. 34. Antigens – definition and general characteristics. Antigen structure of bacteria. 35. Antibodies (immunoglobulins). Structure and biological properties of

immunoglobulins. 36. Immune system – organs and cells of immune system. 37. Immune response. General characteristics. Immune response dynamics. Humoral

immune response (systemic and localized). Cell-mediated immunity. The role of Major Histocompatibility Complex in immune response.

38. Protective mechanisms against bacterial, fungal and viral infections. 39. Antigen-antibody reaction – mechanism and general characteristics. 40. Agglutination. 41. Precipitation. Toxin neutralization reaction. 42. Complementary-dependent reactions. 43. Immune reactions with labeled antibodies. 44. Immunopathology. Hypersensitivity reactions (allergies). 45. Immunopathology. Autoimmune diseases. Role of hypersensitivity reactions in

autoimmune diseases. Innate and acquired immunodefficiencies. 46. Immunoprophylaxis and immunotherapy. Vaccines. 47. Immunoprophylaxis and immunotherapy. Immune sera and antibody-containing

preparations. Immunostimulators and immunomodulators.

III. SPECIAL MICROBIOLOGY 48. Genus Staphylococcus. 49. Genus Streptococcus. Group A streptococci (Streptococcus pyogenes). 50. Streptococcus pneumoniae. 51. Streptococci part of the normal human flora. Streptococcus mutans etc. Genus

Enterococcus. 52. Neisseria meningitidis. 53. Neisseria gonorrhoeae. 54. Family Enterobacteriaceae. Genus Escherichia, E. coli . 55. Genus Salmonella. 56. Genus Shigella. 57. Genera Proteus, Providencia, Morganella; Klebsiella, Enterobacter and Serratia (K-E-

S group). 58. Genus Yersinia. Y. pestis. Y. enterocolitica. 59. Vibrio cholerae. 60. Haemophilus influenzae. 61. Bordetella pertussis. 62. Fransisella tularensis. 63. Family Legionellaceae. 64. Genus Pseudomonas. 65. Genus Corynebacterium. C. diphteriae. 66. Genus Listeria. L. monocytogenes. 67. Genus Mycobacterium. M.tuberculosis. 68. Anaerobic non-spore forming bacteria. 69. Genus Actinomyces. 9

70. Genus Bacillus. B. anthracis. 71. Genus Clostridium. C. tetani. 72. Anaerobic spore-forming clostridia causing gas gangrene. 73. Genus Clostridium. Clostridium botulinum. Clostridium difficile . 74. Family Spirochaetaceae. Genus Treponema. Treponema pallidum. 75. Genus Borrelia. Causative agents of Lyme disease (Borrelia burgdorferi etc.). 76. Genus Leptospira. 77. Genus Campylobacter. Genus Helicobacter. 78. Genus Mycoplasma. M. pneumoniae. M. hominis. 79. Genus Chlamydia. C. trachomatis. C. psittaci. C. pneumomiae. 80. Genus Rickettsia, Genus Coxiella). 81. Pathogenic fungi . 82. Picornaviruses (Family Picornaviridae). Human polioviruses. Coxackie- and

ECHOviruses. 83. Orthomyxoviruses (Family Ortomyxoviridae). Influenzavirus. 84. Paramyxoviruses (Family Paramyxoviridae). Parainfluenza viruses. Virus of parotitis

(Virus parotitidis). Virus of measles (Morbillivirus morbillorum). 85. Reoviruses (Family Reoviridae). Rotaviruses (Genus Rotavirus). 86. Rubella virus. 87. Rhabdoviruses (Family Rhabdoviridae). Rabies virus. 88. Retroviruses (Family Retroviridae). HIV-1 and HIV-2. 89. Herpesviruses (Family Herpesviridae). Human herpesvirus 1, 2; (Virus herpes simplex).

Varicella-zoster (Human herpesvirus 3, Herpesvirus varicellae). 90. Hepatites viruses (Human hepatitis A, B, C, D, E and G viruses). 91. Prions. 92. Microorganisms in the environment. 93. Microbial flora of human body in health and disease. 94. Microbial flora in the oral cavity. 95. Ethiological factors and pathogenesis mechanisms in pathological processes in oral

cavity and teeth. 96. Pathological processes in the oral cavity caused by microorganisms. Caries. 97. Pathological processes in the oral cavity caused by microorganisms. Diseases of dental

pulp and periapical tissues. 98. Pathological processes in the oral cavity caused by microorganisms. Periodontal

diseases. 99. Pathological processes in the oral cavity caused by microorganisms. Infections of

устната лигавица and дълбоките тъкани. 100. Pathological processes in the oral cavity caused by microorganisms. Focal infection.

Hypersensitivity and its clinical significance in dental medicine. 101. Protective mechanisms in the oral cavity. Specificities of the natural resistance and

acquired immunity in the oral cavity.

10

PRACTICAL EXAMINATION

1. Gram stain - preparation, observation and interpretation. 2. Smear preparation and staining by Ziehl – Neelsen method. Technique, observation and

examination of the preparations. 3. Neisser stain – preparation, observation and interpretation. 4. Smear preparation and staining by Peshkov method. Technique, observation and

examination of the preparations. 5. Simple nutrient media. Types, composition and application. Observation (characteristic) of

bacterial growth in broth and agar media. 6. Special (enriched) nutrient media. Types, composition and application. Observation

(characteristic) of bacterial growth in broth and agar media. 7. Elective, selective and differentiation nutrient media. Types, composition and application.

Observation (characteristic) of bacterial growth in broth and agar media. 8. Methods and nutrient media for cultivation of aerobe bacteria. Preparation of pure culture. 9. Methods and nutrient media for cultivation of anaerobe and microaerophile bacteria.

Reading of the growth of anaerobe bacteria. 10. Biochemical tests for the identification of bacteria. Tests for determination of carbolytic,

proteolytic enzymes and oxidoreductases. Kligler’s polytrope medium (Triple Sugar Iron Agar): composition, inoculation and reading.

11. Quantitative methods for the determination of bacterial growth: enumeration with optical standard and determination of microbial count on a solid medium.

12. Antibiotics and chemotherapeutics – characteristics and usage. 13. Serial Dilution Method for Antimicrobial Susceptibility Testing. 14. Disk Diffusion Method for Antimicrobial Susceptibility Testing (NCCLS method). 15. Methods of sterilization. Use of the particular methods in medical practice. 16. Disinfectants. Use of the particular disinfectants in medical practice. 17. Slide agglutination (direct agglutination): principle, technique and reading of the results. 18. Widal’s serodiagnosis (tube agglutination method). Principle, technique and reading of the

results. 19. Passive hemagglutination, coagglutination, latex agglutination. Principle, technique and

reading of the results. 20. Ring precipitation test (thermoprecipitation ). Principle, technique and reading of the

results. 21. Ouchterlony double immunodiffusion (DID). Radial single immunodiffusion.

Immunoelectrophoresis. Principle, application, reading of the results. 22. Titration of hemolytic serum – application, principle, technique and reading of the results. 23. Complement fixation reaction for diagnosis of syphilis: Wassermann’s reaction.

Application, principle, reading of the results. 24. ELISA (Enzyme-linked immunosorbent assay) – basic principle, reading and

interpretation of results, application. Immunofluorescence – direct and indirect immunofluorescence, application.

25. Virus hemagglutination and hemagglutination inhibition (HAI) reactions - application, principle, technique and reading of the results.

26. Neutralization test of viral infectivity - basic principle, reading and interpretation of results, application.

27. Antibacterial vaccines - characterization, application. 28. Antiviral vaccines – characterization, application. 29. Immune sera - characterization, application. Immunoglobilin preparations.

Immunomodulators. 30. Microbiological testing of microbial flora – specimens collection and transportation,

stages of the examination, reading the results.

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31. Tests for detection and pathogenicity of Staphylococcus spp. – reading and interpretation of results.

32. Tests for identification of Streptococcus spp. and Enterococcus spp. 33. Biochemical identification of the organisms of Family Enterobacteriaceae. Tests for

identification. 34. Sanitary-microbiological examination of potable water, soil, air, and food. 35. Specimen collection from teeth and oral cavity for microbiological examination. Principle

of the examination and reading the results.

12


CURRICULUM Name of the discipline: MEDICAL PHYSICS


Type of the discipline: obligatory

Course duration: one semester

Course degree: M degree (Master’s)

Evaluation methods: During the practical exercises the students are subjected to

continuous assessment; at the end of the semester an exam on the practical

exercises is carried out in form of a test; the final exam on the whole course

(covering the learning material from the lectures and practicum) contains written

answers and discussion on them.

Training methods used during the course: Lectures – 45 hours, practical (

laboratory) exercises – 30 hours; before coming to the laboratory exercises the

students have to prepare themselves on a given topic from recommended

reference sources (textbook, laboratory guide); during the practicum the basic

training form is the discussion; after finishing the laboratory practice the students

have to write an individual standard protocol concerning the experimental work,

the obtained results and their discussion – working out this protocol is important

part of the training.

Final exam at the end of semester: YES

Leading instructor: Associated professor DIMITAR MIHOV, PhD.

Home department: DEPARTMENT OF MEDICAL PHYSICS AND

BIOPHYSICS

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ANNOTATION OF THE COURSE: The Course of Medical Physics gives opportunity of the student of Dental Medicine to get fundamental knowledges and competence in the field of Physics and its applications in Dental Medicine. Physics is of general educational value for all medical universities students. The teaching in PHYSICS has a purpose the students: 1. To get important theoretical and practical knowledges. 2. To learn some topics concerning to their future dental practice like: - Structure of solids, kinds of deformations, Robert Hooke law. - Hardness and how to measure it. - Bernoulli’s equation, applications in dental practice. - Temperature and Heat. Linear thermal expansion. Volume thermal expansion. Transfer of heat. - Electric conductivity. Zone theory of electric conductivity. Electric resistivity of biological objects. - AC current. Electrical safety. - Electrography. Electric stimulation, electric pulses of different shape, applications. - Therapy with direct electric current. Therapy with pulse electric current having low frequency. - Defibrillators. Pacemakers. Electric therapy with alternating current having high frequency. - Total internal reflection, fiber optics, endoscopy. - UV rays, properties. Sources and detectors. Medical applications. - Optical lenses, centered optical systems, optical devices, applications. - Light microscope. Different microscope methods. - Electron microscope. Transmission and Scanning electron microscopes. - Outer and inner photoelectric effect. - Photodiode. Charge-coupled device. Devices using CCD with application in dental medicine. - Laser. Principle of working. Different kinds of Lasers. Some applications in dental practice. - NMR. Nuclear magnetic resonance imaging. - X-rays. X-ray tube. Principles of Roentgen diagnosis. X-rays protection. - Radionuclide investigations. COURSE OUTLINE: The course duration is 75 academic hours divided as follows: Lectures - 45 hours Practical exercises: 30 hours Formation of the overall mark for the course:

- Final examination – the mark for written answers on two theoretical questions from the lecture course material and discussion on them; eventually additional questions – 75 %

- Final mark for the practicum (25%) – formatted on the basis of: o Average mark from the continuous assessment o The mark from the final test on the practicum

ASPECTS OF THE STUDENT’S EVALUATION:

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During the practical exercises: - Assessment of the students ability to obtain knowledge working individually with the

reference sources. - Evaluation of the students participation in the discussion on the keywords given. - Assessment of the students experimental work in the laboratory. - Evaluation of the students skills to process statistically the obtained results (by using

computer programs and to represent them in tables, graph and to discuss them in the context of the aim of the study.

During the final examination: - Assessment of the ability of the students to give written answers on the questions. - Evaluation of the students skill to react on additional questions concerning his written

answers and on other additional questions.

RESOURCES USED DURING THE COURSE:

Lectures: - computer based multimedia presentation Laboratory practice: experimental set-ups, calculations, computers Course objectives: The students should gain knowledge and skills for introduction of physical methods (theoretical, experimental, and instrumental) in the organization of dental medicine care in accordance with the modern European standards in Health service. Course goals:

1. Students have to gain the basic knowledge from the Lecture course. 2. Students should learn the experimental methods introduced in the laboratory exercises. 3. Students have to learn to process statistically (calculate mean values and standard

deviations, do linear and non-linear regressions using statistical programs as Excel and Prism) the obtained experimental results and to represent them in tables, graph and to discuss them in the context of the aim of the study.

4. After finishing the laboratory practice the students have to be able to work up the experimental results and to write a standard protocol concerning to the final results.

REQUIREMENTS:

Successful finished courses in high school: physics, mathematics, chemistry and biology. A PURPOSE OF A TRAINING COURSE The purpose of the training on Medical Physics is to get knowledge and practical skills concerning to:

• Determining of physical quantities only with units from SI (International System of Units) which is the world's most widely used system of measurement, both in everyday commerce and in science

• How to measure the dynamic coefficient of viscosity; • Measuring the spectral characteristic of the ear; • Determining by lensmeter a refraction of optical lenses and prisms;

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• Determining of the Young's modulus of elasticity of compact bone; • Observing and analysis of atomic and molecular spectra; • Determining of the natural background ionizing radiation; • How to measure monochromaticity, coherence and directionality of laser light generated

by He-Ne Laser; • How to measure the coefficient of refraction of liquids by refractometer; • Determining of the total linear attenuation coefficient for gamma-rays;

LEARNING OUTCOMES: After ending of the lecture course the students

• have to understand all processes connected with the application of ultrasound in dental practice;

• have to understand all processes connected with the work of a suction pump in relation with the Bernoulli’s equation;

• have to understand that the repeated X-ray investigations increase the risk for the patient in connection with harmful influence of ionizing radiation;

• have to look for modern technical devices using lasers and CCD ( charge – couple- device) in theirs future dental practice;

• have to estimate the importance of hardness of different materials for dental practice; • have to estimate the importance of thermal conductivity and volume thermal

expansion for dental practice; • have to work with different UV devices realizing how to protect themselves from UV

harmful effect; • have to understand all usable methods for electric therapy; • have to understand all usable methods for electric diagnostics; • have to work with different electric devices in conditions of electric safety only; • have to understand the importance of fibre optic devices using for quality image of

the treated object; The practical skills offered to the students aim to familiarize them with basic knowledge about methods used in research and clinical laboratories.

In the practice the students learn:

- to formulate concrete aims and problems for experimental study; - based on the knowledge offered in these materials, the students must be able to propose and

discuss ideas about how the aims of the experiments have to be realized; - to process statistically the obtained experimental data and represent them in tables and graphs; - to comment the importance and application of the obtained information about the particular

object investigated in physical and medical context; - to document precisely the discussion, the experimental work and results in a protocol, which is

close in form and structure to a scientific paper. LITERATURE FOR PREPARATION: 1. Lectures – reprints of each one given to the students. 2. D. Ewen, R. Nelson, N. Schurter, E. Gundersen. Applied Physics, 2004, 768pp. 3. D. Halliday , R. Resnick, J. Walker. Fundamentals of Physics Extended, 2007, 1328 pp. TOPICS FOR INDIVIDUAL PREPARATION: Themes connected to the laboratory exercises.

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http://www.amazon.com/Jearl-Walker/e/B001H6OBVK/ref=ntt_athr_dp_pel_3


Department of Medical Physics and Biophysics

PROGRAM OF THE MEDICAL PHYSICS COURSE

FOR STUDENTS OF DENTAL MEDICINE

Lectures - 45 hours, Course Duration: one semester, the first semester

(Odd weeks - 2 hours, even weeks - 4 hours)

I. MECHANICS - 5 hours Theme 1. Basic principles and quantities of mechanics – 2 hours Velocity, acceleration, forces, impulse, laws of motion, linear motion, Newton’s laws, work, kinetic energy, potential energy, conservation of energy, different kind of movement, pressure, density. Atmospheric pressure, dependence of atmospheric pressure from the altitude, influence of atmospheric pressure upon human organism. Circular motion. Angular momentum, uniform circular motion, non-uniform circular motion, centripetal acceleration, centripetal force, angular velocity, moment of inertia, angular momentum. Influence of inertia forces upon human organism. Theme 2. Motion of ideal fluids – 2 hours Basic concepts and laws – continuity of the flow, Bernoulli’s equation. Medical applications. Laminar and turbulent motion. Blood pressure measurement. Motion of real fluids. Newton’s law for inner friction. Poeuaseu’s law, viscosimetry. Non-Newton’s behavior and micro rheological processes. Theme 3. Separation of the phases in liquid heterogeneous systems – 1 hour Sedimentation and centrifugation. Velocity of sedimentation force of centrifugation, Centrifuges – device, different types. Inertial forces effect upon human organism.

II. AQUSTICS - 3 hours Theme 4. Sound. Psychophysical characteristic of sound. Ultrasound - 3 hours Mechanical oscillations and waves – basic quantities and equations. Principles of Extracorporeal lithotripsy. Velocity of the sound, Doppler’s effect, physical characteristics of the sound. Field of hearing. Psychophysical parameters of sound. Vocal apparatus of human. Noise protection. Acoustic methods for diagnostics. Infrasound. Producing, general characteristics and effect of the ultrasound. Principles of ultrasound diagnostics, Doppler sonography. Medical application of ultrasound, drug ultraphonophorhesis.

III. MOLECULAR PHYSICS. THERMODYNAMICS - 6 hours Theme 5. Structure of liquids and Structure of solids - 2 hours Surface tension. Molecular pressure. Phenomenon on boundary between two different phases – menisci, capillarity. Gas embolisms. Trickling. Amorphous solids, crystalline solids, liquid crystals. Robert Hooke law. Strength and hardness. Theme 6. Thermodynamics - 4 hours Temperature and heat. Zeroth Law of Thermodynamics. Temperature Scales. Linear Thermal Expansion. Volume Thermal Expansion. Phase Change of Water. Specific Heat Capacity. Calorimetry. The first law of thermodynamics, statements of the First Law. Macroscopic state of a system. Some common

5

thermodynamic processes: isochoric process (isovolumetric process), isobaric process, isothermal process, adiabatic process. quasi-static process, thermodynamic equilibrium, cyclic process, reversible process and irreversible process. Second law of thermodynamics, a statement of the Second Law. Heat Engines and the Carnot Cycle. the efficiency. Refrigerators, Air Conditioners. Order, Disorder, and Entropy. The third law of thermodynamics. Thermal exchange by radiation and absorption Basic conceptions and quantities of thermal radiation. Kirchoff’s law, Stefan Boltzman’s law, Wien’s law. Thermostats, thermo regulators, sterilizers.

IV. ELECTRICITY AND MAGNETISM - 8 hours Theme 7. Electricity - 3 hours Electric field. Magnitude of electric field. Еlectric potential. Dipolar molecules in electric pole. Parallel plate capacitor. Electric capacity of conductors. Electric conductivity of solids. Zone theory of electric conductivity. Electric conductivity of metals. Conductivity of intrinsic semiconductors; conductivity of semiconductors with impurities. Thermistors and bolometers. Electric Current. Resistance and Ohm’s Law. Resistors in Series and Parallel. Ammeters and Voltmeters. Alternating Current. Capacitors in AC Circuits. RC Circuits. Inductors in AC Circuits. RLC Circuits. Resonance in Electrical Circuits. Electrical Safety. Theme 8. Magnetism - 2 hours Magnetic field. Magnitude of magnetic field, magnetic field lines. Motion of a Charged Particle in a Uniform Magnetic Field. Lorentz force. Mass Spectrometer. Cyclotron Magnetic properties of a matter. Dia-magnetics, para-magnetics and ferro-magnetics. Hysteresis. Mechanical moment and magnetic moment of an electron as well of an atom. Electron paramagnetic resonance, applications. Theme 9. Electric diagnostics and electric therapy - 2 hours Physical base of electric diagnostics. Electrography, heart as an electric dipole. Electric stimulation – electric stimulation of tissues, diagnostic parameters, pulses of different shape, applications. Transducers of non-electrical quantities. Physical base of electric therapy. Therapy with direct electric current. Therapy with pulse electric current with low frequency. Defibrillators. Pacemakers. Electric therapy with alternating current having high frequency. Electromagnetic field and its effect on a man, critical organs. Theme 10. Electromagnetic field - 1 hour Magnetic flux. Electromagnetic induction, mutual inductance, self-inductance. Electromagnetic(EM) waves, Maxwell’s equations. Speed of EM waves. EM spectrum.

V. OPTICS - 8 hours Theme 11. Light, geometrical optics, laws - 5 hours Photometric quantities and units. Spectral sensitivity of human eye. Reflection and refraction of light, laws. Ophthalmoscope. Total internal reflection, fiber optics, endoscopy. Refractometry. Dispersion and absorption of light. Normal and abnormal dispersion. Absorption of light, Lambert-Beer’s law. Colorimetry and photometry of cells. Scattering of light. Scattering in a turbid medium, Tyndall effect, Rayleigh law, nephelometry. Molecular scattering, Raman spectroscopy. Polarization of light. Unpolarized and polarized light. Malus’ law. Fully polarized light, Brewster’s law, birefringence, polarizers. Optical activity. Ultraviolet and infrared radiation. Sun radiation. Fields and zones. Properties. Sources and detectors. Medical application. Thermography. Ozone hole. “Greenhouse effect”. Theme 12. Lenses, Human eye - 2 hours Lenses. Type of lenses, optical systems. Basic elements of lens, lens aberrations, astigmatism. Cylindrical lenses, optical prisms. Human eye. Human eye as an optical system. Defects in the optical system of the eye, corrections. Theme 13. Light microscope - 1 hour Microscope device. Magnifying power. Resolution of a microscope. Immersion objectives. Different microscope methods.

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VI. QUANTUM PHYSICS - 5 hours

Theme 14. Electron microscope - 1 hour Basic principles, De Broglie’s wave, resolution of electron microscope. Transmission electron microscope. Scanning electron microscope. Theme 15. Outer and inner photoelectric effect - 1 hour Photoelectric emission, laws. Einstein’s equation. Photo conductivity and photo electromotive force. Photoelectric transducers, applications. Theme 16. Optical atomic and molecular spectra - 1 hour Energy levels of atoms and quantum numbers. Different types of transitions in atoms. Atomic spectral analysis – spectral apparatusеs, emission spectroscopy, absorption spectroscopy and fluorescence analysis. Energy levels and transitions in molecules. Spectrophotometry. Theme 17. Luminescence - 1 hour Types of luminescence, laws of photoluminescence. Photoluminescence transitions in diatomic molecules . Molecular fluorescence analysis. Theme 18. Lasers - 1 hour Normal energy level population and inverted population. The elements of a Laser. Principle of working. Different kinds of Lasers. Laser light. Some applications.

VII. ATOMIC AND NUCLEAR PHYSICS - 10 hours Theme 19. Nuclear Physics - 5 hours Nuclear magnetic resonance. Content, charge, mass and spin of a nucleus. Magnetic momentums of nucleons and nuclei. Nuclear magnetic resonance. Nuclear magnetic resonance imaging. X-rays. Mechanism of X-ray tubes. Bremsstrahlung and characteristic X-rays. Intensity and spectra of Roentgen rays. Main properties. X-ray spectroscopy. Radioactivity. α-radioactive decay. β-radioactive decay. Electron capture (K-capture). Gamma-rays. Isomeric transition. Mössbauer effect. Radioactive decay. Radioactive decay’s law. Half lifetime. Neutron-activation analysis. Radiopharmaceuticals. Effective period of half clearance. Interaction of photon ionizing radiation with matter.Photoelectric absorption. Compton effect. Creation of electron-positron pair. Exponential absorption law. Theme 20. Ionizing radiation - 5 hours Interaction of charged particles with matter. Dosimetry quantities and units: absorbed dose , exposition, equivalent dose, effective dose. Dosimetry of ionizing radiation. Dosimeters and radiometers. Ionization chamber. Photographic emulsions. Proportional counters. Semiconductor detectors. Scintillation detector. Thermo luminescent dosimeters. X-rays diagnosis and therapy. Principles of Roentgen diagnosis, different kind of methods. X-rays image intensifier tube. Roentgen- rays therapy. X-rays protection. Radionuclide diagnosis. Scintilators as transducer. Linear scintillation diagnostic. Gamma camera. SPECT. PET. Protection from ionizing radiation. Natural and artificial sources of ionizing radiation. Biologic effects of ionizing radiation – outer and internal radiation, radiation injuries. Principles of radiation protections, different types of protection. LITERATURE FOR PREPARATION: 1. Lectures – reprints of each one given to the students.

2. D. Ewen, R. Nelson, N. Schurter, E. Gundersen. Applied Physics, 2004, 768pp.

3. D. Halliday , R. Resnick, J. Walker. Fundamentals of Physics Extended, 2007, 1328 pp.

7







THEMATIC CALENDAR SCHEDULE

of the LECTURES ON MEDICAL PHYSICS for students of dental medicine

during the first (winter) semester of the first academic year

Lectures - 45 hours, Course Duration: one semester, the first semester

(Odd weeks - 2 hours, even weeks - 4 hours)

Week No.

Subject Hours

1st

Basic principles and quantities of mechanics Velocity, acceleration, forces, impulse, laws of motion, linear motion, Newton’s laws, work, kinetic energy, potential energy, conservation of energy, different kind of movement, pressure, density. Atmospheric pressure, dependence of atmospheric pressure from the altitude, influence of atmospheric pressure upon human organism. Circular motion Angular momentum, uniform circular motion, non-uniform circular motion, centripetal acceleration, centripetal force, angular velocity, moment of inertia, angular momentum. Influence of inertia forces upon human organism.

2 hours

2nd

Motion of ideal fluids Basic concepts and laws – continuity of the flow, Bernoulli’s equation. Medical applications. Laminar and turbulent motion. Blood pressure measurement. Motion of real fluids Newton’s law for inner friction. Poeuaseu’s law, viscosimetry. Non-Newton’s behavior and micro rheological processes. Separation of the phases in liquid heterogeneous systems Sedimentation and centrifugation. Velocity of sedimentation force of centrifugation, Centrifuges – device, different types. Inertial forces effect upon human organism. Sound Mechanical oscillations and waves – basic quantities and equations. Principles of Extracorporeal lithotripsy. Velocity of the sound, Doppler’s effect, physical characteristics of the sound.

2 hours

2 hours

3rd

Psychophysical characteristic of sound Field of hearing. Psychophysical parameters of sound. Vocal apparatus of human. Noise protection. Acoustic methods for diagnostics. Infrasound. Ultrasound Producing, general characteristics and effect of the ultrasound. Principles of ultrasound diagnostics, Doppler sonography. Medical application of ultrasound, drug ultraphonophorhesis.

2 hours

8

4th

Structure of liquids Surface tension. Molecular pressure. Phenomenon on boundary between two different phases – menisci, capillarity. Gas embolisms. Trickling. Structure of solids Amorphous solids, crystalline solids, liquid crystals. Robert Hooke law. Strength and hardness. Temperature and heat Zeroth Law of Thermodynamics. Temperature Scales. Linear Thermal Expansion. Volume Thermal Expansion. Phase Change of Water. Specific Heat Capacity. Calorimetry. The first law of thermodynamics Statements of the First Law. Macroscopic state of a system. Some common thermodynamic processes: isochoric process (isovolumetric process), isobaric process, isothermal process, adiabatic process. quasi-static process, thermodynamic equilibrium, cyclic process, reversible process and irreversible process.

2 hours

2 hours

5th

Second law of thermodynamics A statement of the Second Law. Heat Engines and the Carnot Cycle. the efficiency. Refrigerators, Air Conditioners. Order, Disorder, and Entropy. The third law of thermodynamics. Thermal exchange by radiation and absorption Basic conceptions and quantities of thermal radiation. Kirchoff’s law, Stefan Boltzman’s law, Wien’s law. Thermostats, thermo regulators, sterilizers.

2 hours

6th

Electric field Magnitude of electric field. Еlectric potential. Dipolar molecules in electric pole. Parallel plate capacitor. Electric capacity of conductors. Electric conductivity of solids Zone theory of electric conductivity. Electric conductivity of metals. Conductivity of intrinsic semiconductors; conductivity of semiconductors with impurities. Thermistors and bolometers. Electric current Electric Current. Resistance and Ohm’s Law. Resistors in Series and Parallel. Ammeters and Voltmeters. Alternating Current. Capacitors in AC Circuits. RC Circuits. Inductors in AC Circuits. RLC Circuits. Resonance in Electrical Circuits. Electrical Safety. Magnetic field Magnitude of magnetic field, magnetic field lines. Motion of a Charged Particle in a Uniform Magnetic Field. Lorentz force. Mass Spectrometer. Cyclotron

2 hours

2 hours

7th

Magnetic properties of a matter Dia-magnetics, para-magnetics and ferro-magnetics. Hysteresis. Mechanical moment and magnetic moment of an electron as well of an atom. Electron paramagnetic resonance, applications. Physical base of electric diagnostics Electrography, heart as an electric dipole. Electric stimulation – electric stimulation of tissues, diagnostic parameters, pulses of different shape, applications. Transducers of non-electrical quantities.

2 hours

Physical base of electric therapy

9











8th

Therapy with direct electric current. Therapy with pulse electric current with low frequency. Defibrillators. Pacemakers. Electric therapy with alternating current having high frequency. Electromagnetic field and its effect on a man, critical organs. Electromagnetic field Magnetic flux. Electromagnetic induction, mutual inductance, self-inductance. Electromagnetic(EM) waves, Maxwell’s equations. Speed of EM waves. EM spectrum. Reflection and refraction of light Photometric quantities and units. Spectral sensitivity of human eye. Reflection and refraction of light, laws. Ophthalmoscope. Total internal reflection, fiber optics, endoscopy. Refractometry. Dispersion and absorption of light Normal and abnormal dispersion. Absorption of light, Lambert-Beer’s law. Colorimetry and photometry of cells.

2 hours

2 hours

9th

Scattering of light Scattering in a turbid medium, Tyndall effect, Rayleigh law, nephelometry. Molecular scattering, Raman spectroscopy. Polarization of light Unpolarized and polarized light. Malus’ law. Fully polarized light, Brewster’s law, birefringence, polarizers. Optical activity.

2 hours

10th

Ultraviolet and infrared radiation Sun radiation. Fields and zones. Properties. Sources and detectors. Medical application. Thermography. Ozone hole. “Greenhouse effect”. Lenses Type of lenses, optical systems. Basic elements of lens, lens aberrations, astigmatism. Cylindrical lenses, optical prisms. Human eye Human eye as an optical system. Defects in the optical system of the eye, corrections. Light microscope Microscope device. Magnifying power. Resolution of a microscope. Immersion objectives. Different microscope methods.

2 hours

2 hours

11th

Electron microscope Basic principles, De Broglie’s wave, resolution of electron microscope. Transmission electron microscope. Scanning electron microscope. Outer and inner photoelectric effect Photoelectric emission, laws. Einstein’s equation. Photo conductivity and photo electromotive force. Photoelectric transducers, applications.

2 hours

Optical atomic and molecular spectra Energy levels of atoms and quantum numbers. Different types of transitions in atoms. Atomic spectral analysis – spectral apparatusеs, emission spectroscopy, absorption spectroscopy and fluorescence analysis. Energy levels and transitions in molecules.

10



12th

Spectrophotometry. Luminescence Types of luminescence, laws of photoluminescence. Photoluminescence transitions in diatomic molecules . Molecular fluorescence analysis. Lasers Normal energy level population and inverted population. The elements of a Laser. Principle of working. Different kinds of Lasers. Laser light. Some applications. Nuclear magnetic resonance Content, charge, mass and spin of a nucleus. Magnetic momentums of nucleons and nuclei. Nuclear magnetic resonance. Nuclear magnetic resonance imaging.

2 hours

2 hours

13th

X-rays Mechanism of X-ray tubes. Bremsstrahlung and characteristic X-rays. Intensity and spectra of Roentgen rays. Main properties. X-ray spectroscopy. Radioactivity α-radioactive decay. β-radioactive decay. Electron capture (K-capture). Gamma-rays. Isomeric transition. Mössbauer effect.

2 hours

14th

Radioactive decay Radioactive decay’s law. Half lifetime. Neutron-activation analysis. Radiopharmaceuticals. Effective period of half clearance. Interaction of photon ionizing radiation with matter Photoelectric absorption. Compton effect. Creation of electron-positron pair. Exponential absorption law. Interaction of charged particles with matter Dosimetry quantities and units: absorbed dose , exposition, equivalent dose, effective dose. Dosimetry of ionizing radiation Dosimeters and radiometers. Ionization chamber. Photographic emulsions. Proportional counters. Semiconductor detectors. Scintillation detector. Thermo luminescent dosimeters.

2 hours

2 hours

15th

X-rays diagnosis and therapy Principles of Roentgen diagnosis, different kind of methods. X-rays image intensifier tube. Roentgen- rays therapy. X-rays protection. Radionuclide diagnosis Scintilators as transducer. Linear scintillation diagnostic. Gamma camera. SPECT. PET. Protection from ionizing radiation Natural and artificial sources of ionizing radiation. Biologic effects of ionizing radiation – outer and internal radiation, radiation injuries. Principles of radiation protections, different types of protection.

3 hours

11



THEMATIC CALENDAR SCHEDULE

of the LABORATORY PRACTICE IN MEDICAL PHYSICS for students of dental medicine

during the first (winter) semester of the first academic year

LABORATORY PRATICE - 30 hours, Course Duration: one semester, the first semester

(Every week 2 hours)

Week No.

Subject Hours

1st Seminar: Measurements of physical quantities and introduction to the theory of errors in measurement. International system units SI. Base,derived and non SI units.

2 hours

2nd

Determination of dynamic viscosity of liquids. Seminar Part: Newton's law of internal friction. Poiseuille's Law. Viscosimetry. None Newton microrheological behavior and processes.

2 hours

3rd

Measurement of auditory acuity via an audiometer. Seminar Part: District of hearing, Psychophysics parameters and sound parameters of the hearing. Noise protection. Principles of acoustic diagnostics. Measurement of spectral characteristics of the ear in hearing threshold.

2 hours

4th

Determination of surface tension of liquids. Seminar Part: Surface tension, molecular pressure. Phenomena of phase Borders - meniscus, capillary. Gas embolism. Dropping method. thermodynamic equilibrium, cyclic process, reversible process and irreversible process.

2 hours

5th

Determination of modulus of elasticity of bone. Seminar Part: amorphous, crystalline and liquid crystal state. Mechanical deformation law of Hooke. Strength and hardness of materials, methods for determining, Identify the module of linear deformation of bone.

2 hours

6th

Photometric values and measurements. Seminar Part: Energetic and light photometric quantities and units. Spectral sensitivity of human eye. Lambert's Law. Comparing the intensities of light sources and determine the sensitivity of selenium photocell.

2 hours

7th

Determination of refractive index of liquids by refractometer. Seminar Part: Laws of reflection and refraction, ophthalmoscopy. Total internal reflection. Refractometers, wire optics endoscopy

2 hours

8th

Photocolorimetric determination of the concentration. Seminar Part: Normal and anomalous dispersion. Absorption of light – Law of Bouguer-Lambert-Beer. Photocolorimetry and citophotometry.

2 hours

9th

Determination of optical lenses and prisms using dioptrometer. Seminar Part: Types of optical lenses and systems. Main elements and disadvantages of

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spherical lenses. Cylindrical lenses and optical prisms. Eye as an optical system of optical correcting its shortcomings.

2 hours

10th

Observation and analysis of atomic and molecular spectra. Seminar Part: Energy states of atoms and quantum numbers. Types of transitions and atomic spectra. Atomic spectral analysis - spectral apparatus, emission, absorption and fluorescence analysis. Assignment: Observation and analysis of atomic and molecular spectra.

2 hours

11th

A relative method for determination of radioactivity. Seminar Part: Radioactivity, radionuclides. Alpha-and beta-nuclear transformations, energy spectra. Gamma radiation spectra, isomeric transition. Activity of radioactive source. Law of radioactive conversion half-life of radionuclide. Radiopharmaceutical species use. Radiometric and radio-immunoassay. Neutron-activation analysis.

2 hours

12th

Determination of the common linear coefficient for weakening of matter for gamma rays. Seminar Part: Photoelectric absorption, scattering komptanovo, formation of electron-positron pairs - mechanism and linear coefficients of the processes. Act to reduce the intensity. Determination of jacketed linear coefficient of attenuation of the substance of gamma rays.

2 hours

13th

Main quantities in medical radiology. Seminar Part: Transmitted energy, absorbed dose, kerma, exposure, equivalent and effective dose, power of exposure and dose. Determination of the equivalent dose received by the radioactive source and the natural radiation background in the power of exposure.

2 hours

14th

Laser. Investigation of the general properties of laser radiation. Seminar Part: Normal and inverse population of energy levels. Main parts and principle operation of laser. Types of lasers. Properties of laser radiation. Applications in dentistry. Determination of monochromaticity, divergence and coherence of laser radiation genegated by He-Ne laser.

2 hours

15th Test examination on practical exercises and a semester validation. 2 hours

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SYNOPSIS FOR THE FINAL EXAM IN MEDICAL PHYSICS

FOR STUDENTS OF DENTAL MEDICINE

I. MECHANICS 1. BASIC PRINCIPLES AND QUANTITIES OF MECHANICS Velocity, acceleration, forces, impulse, laws of motion, linear motion, Newton’s laws, work, kinetic energy, potential energy, conservation of energy, different kind of movement, pressure, density. Atmospheric pressure, dependence of atmospheric pressure from the altitude, influence of atmospheric pressure upon human organism. 2. CIRCULAR MOTION Angular momentum, uniform circular motion, non-uniform circular motion, centripetal acceleration, centripetal force, angular velocity, moment of inertia, angular momentum. Influence of inertia forces upon human organism.

3. MOTION OF IDEAL FLUIDS Basic concepts and laws – continuity of the flow, Bernoulli’s equation. Medical applications. Laminar and turbulent motion. Blood pressure measurement.

4. MOTION OF REAL FLUIDS Newton’s law for inner friction. Poeuaseu’s law, viscosimetry. Non-Newton’s behavior and micro rheological processes.

5. SEPARATION OF THE PHASES IN LIQUID HETEROGENEOUS SYSTEMS Sedimentation and centrifugation. Velocity of sedimentation force of centrifugation, Centrifuges – device, different types. Inertial forces effect upon human organism.

II. AQUSTICS 6. SOUND

Mechanical oscillations and waves – basic quantities and equations. Principles of Extracorporeal lithotripsy. Velocity of the sound, Doppler’s effect, physical characteristics of the sound.

7. PSYCHOPHYSICAL CHARACTERISTIC OF SOUND Field of hearing. Psychophysical parameters of sound. Vocal apparatus of human. Noise protection. Acoustic methods for diagnostics. Infrasound.

8. ULTRASOUND Producing, general characteristics and effect of the ultrasound. Principles of ultrasound diagnostics, Doppler sonography. Medical application of ultrasound, drug ultraphonophorhesis.

III. MOLECULAR PHYSICS. THERMODYNAMICS. 9. STRUCTURE OF LIQUIDS

Surface tension. Molecular pressure. Phenomenon on boundary between two different phases – menisci, capillarity. Gas embolisms. Trickling.

10. STRUCTURE OF SOLIDS Amorphous solids, crystalline solids, liquid crystals. Robert Hooke law. Strength and hardness.

11. TEMPERATURE AND HEAT Zeroth Law of Thermodynamics. Temperature Scales. Linear Thermal Expansion. Volume Thermal Expansion. Phase Change of Water. Specific Heat Capacity. Calorimetry.

12. THE FIRST LAW OF THERMODYNAMICS Statements of the First Law. Macroscopic state of a system. Some common thermodynamic processes: isochoric process (isovolumetric process), isobaric process, isothermal process, adiabatic process. quasi-static process, thermodynamic equilibrium, cyclic process, reversible process and irreversible process.

13. SECOND LAW OF THERMODYNAMICS A statement of the Second Law. Heat Engines and the Carnot Cycle. the efficiency. Refrigerators, Air Conditioners. Order, Disorder, and Entropy. The third law of thermodynamics.

14. THERMAL EXCHANGE BY RADIATION AND ABSORPTION Basic conceptions and quantities of thermal radiation. Kirchoff’s law, Stefan Boltzman’s law, Wien’s law. Thermostats, thermo regulators, sterilizers.

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IV. ELECTRICITY AND MAGNETISM.

15. ELECTRIC FIELD Magnitude of electric field. Еlectric potential. Dipolar molecules in electric pole. Parallel plate capacitor. Electric capacity of conductors.

16. ELECTRIC CONDUCTIVITY OF SOLIDS Zone theory of electric conductivity. Electric conductivity of metals. Conductivity of intrinsic semiconductors; conductivity of semiconductors with impurities. Thermistors and bolometers.

17. ELECTRIC CURRENT Electric Current. Resistance and Ohm’s Law. Resistors in Series and Parallel. Ammeters and Voltmeters. Alternating Current. Capacitors in AC Circuits. RC Circuits. Inductors in AC Circuits. RLC Circuits. Resonance in Electrical Circuits. Electrical Safety.

18. MAGNETIC FIELD Magnitude of magnetic field, magnetic field lines. Motion of a Charged Particle in a Uniform Magnetic Field. Lorentz force. Mass Spectrometer. Cyclotron 19. MAGNETIC PROPERTIES OF A MATTER Dia-magnetics, para-magnetics and ferro-magnetics. Hysteresis. Mechanical moment and magnetic moment of an electron as well of an atom. Electron paramagnetic resonance, applications.

20. PHYSICAL BASE OF ELECTRIC DIAGNOSTICS Electrography, heart as an electric dipole. Electric stimulation – electric stimulation of tissues, diagnostic parameters, pulses of different shape, applications. Transducers of non-electrical quantities. 21. PHYSICAL BASE OF ELECTRIC THERAPY Therapy with direct electric current. Therapy with pulse electric current with low frequency. Defibrillators. Pacemakers. Electric therapy with alternating current having high frequency. Electromagnetic field and its effect on a man, critical organs. 22. ELECTROMAGNETIC FIELD Magnetic flux. Electromagnetic induction, mutual inductance, self-inductance. Electromagnetic(EM) waves, Maxwell’s equations. Speed of EM waves. EM spectrum.

V. OPTICS 23. REFLECTION AND REFRACTION OF LIGHT

Photometric quantities and units. Spectral sensitivity of human eye. Reflection and refraction of light, laws. Ophthalmoscope. Total internal reflection, fiber optics, endoscopy. Refractometry. 24. DISPERSION AND ABSORPTION OF LIGHT Normal and abnormal dispersion. Absorption of light, Lambert-Beer’s law. Colorimetry and photometry of cells.

25. SCATTERING OF LIGHT Scattering in a turbid medium, Tyndall effect, Rayleigh law, nephelometry. Molecular scattering, Raman spectroscopy.

26. POLARIZATION OF LIGHT Unpolarized and polarized light. Malus’ law. Fully polarized light, Brewster’s law, birefringence, polarizers. Optical activity.

27. ULTRAVIOLET AND INFRARED RADIATION Sun radiation. Fields and zones. Properties. Sources and detectors. Medical application. Thermography. Ozone hole. “Greenhouse effect”. 28. LENSES Type of lenses, optical systems. Basic elements of lens, lens aberrations, astigmatism. Cylindrical lenses, optical prisms.

29. HUMAN EYE Human eye as an optical system. Defects in the optical system of the eye, corrections. 30. LIGHT MICROSCOPE Microscope device. Magnifying power. Resolution of a microscope. Immersion objectives. Different microscope methods.

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VI. QUANTUM PHYSICS 31. ELECTRON MICROSCOPE Basic principles, De Broglie’s wave, resolution of electron microscope. Transmission electron microscope. Scanning electron microscope.

32. OUTER AND INNER PHOTOELECTRIC EFFECT Photoelectric emission, laws. Einstein’s equation. Photo conductivity and photo electromotive force. Photoelectric transducers, applications. 33. OPTICAL ATOMIC AND MOLECULAR SPECTRA Energy levels of atoms and quantum numbers. Different types of transitions in atoms. Atomic spectral analysis – spectral apparatusеs, emission spectroscopy, absorption spectroscopy and fluorescence analysis. Energy levels and transitions in molecules. Spectrophotometry. 34. LUMINESCENCE Types of luminescence, laws of photoluminescence. Photoluminescence transitions in diatomic molecules . Molecular fluorescence analysis. 35. LASERS Normal energy level population and inverted population. The elements of a Laser. Principle of working. Different kinds of Lasers. Laser light. Some applications.

VII. ATOMIC AND NUCLEAR PHYSICS. 36. NUCLEAR MAGNETIC RESONANCE Content, charge, mass and spin of a nucleus. Magnetic momentums of nucleons and nuclei. Nuclear magnetic resonance. Nuclear magnetic resonance imaging. 37. X-RAYS Mechanism of X-ray tubes. Bremsstrahlung and characteristic X-rays. Intensity and spectra of Roentgen rays. Main properties. X-ray spectroscopy. 38. RADIOACTIVITY α-radioactive decay. β-radioactive decay. Electron capture (K-capture). Gamma-rays. Isomeric transition. Mössbauer effect.

39. RADIOACTIVE DECAY Radioactive decay’s law. Half lifetime. Neutron-activation analysis. Radiopharmaceuticals. Effective period of half clearance. 40.INTERACTION OF PHOTON IONIZING RADIATION WITH MATTER Photoelectric absorption. Compton effect. Creation of electron-positron pair. Exponential absorption law.

41. INTERACTION OF CHARGED PARTICLES WITH MATTER Dosimetry quantities and units: absorbed dose , exposition, equivalent dose, effective dose. 42. DOSIMETRY OF IONIZING RADIATION Dosimeters and radiometers. Ionization chamber. Photographic emulsions. Proportional counters. Semiconductor detectors. Scintillation detector. Thermo luminescent dosimeters.

43. X-RAYS DIAGNOSIS AND THERAPY Principles of Roentgen diagnosis, different kind of methods. X-rays image intensifier tube. Roentgen- rays therapy. X-rays protection. 44. RADIONUCLIDE DIAGNOSIS Scintilators as transducer. Linear scintillation diagnostic. Gamma camera. SPECT. PET.

45. PROTECTION FROM IONIZING RADIATION Natural and artificial sources of ionizing radiation. Biologic effects of ionizing radiation – outer and internal radiation, radiation injuries. Principles of radiation protections, different types of protection. LITERATURE FOR PREPARATION: 1. Lectures – reprints of each one given to the students. 2. D. Ewen, R. Nelson, N. Schurter, E. Gundersen. Applied Physics, 2004, 768pp. 3. D. Halliday , R. Resnick, J. Walker. Fundamentals of Physics Extended, 2007, 1328 pp.

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DEPARTMENT OF PSYCHIATRY

COURSE “MEDICAL PSYCHOLOGY”

for students of Dental Medicine

Medical Psychology is a discipline which introduces the biopsychological integrative models of health and disease. The medical psychology curriculum is designed to prepare students to understand the psychological factors and the personality styles of coping with the illness.

The goals of the course are to provide the students with psychological knowledge in addition to the specialized medical competence. It has to facilitate the development of an integrative approach to the patient and a long-lasting interest to the psychological and behavioral aspects of health and disease.

Method:

The course consists of 15 hours lectures and 15 hours seminars. It relies on students active participation in discussions of clinical cases.

Assessment is based an oral examination.

CURRICULUM (30 hours)

1. Biopsychosocial Model. Clinical application. Psychological factors affecting physical health. Psychosomatic relationship. Illness behavior. Adjustment to illness and handicap.

2. Doctor-patient Relationship and therapeutic Alliance. Models and characteristics of a good therapeutic relationship. Doctor-patient relationship as communication. Therapeutic behavior and skills.

3. Personality and Behavior in Health and Illness. Theories about personality and personality disorders. Psychological responses to illness (somatic and psychiatric diseases, chronic diseases).

4. Live Development. Psychological theories of normal and abnormal development. Development stages of the life cycle. Crises of development. Domestic violence, child abuse and neglect. Interventions with child behavior problems.

5. Psychological Treatment (Psychotherapy and Counseling). Basic goals and indications. Models of psychotherapy The therapeutic process, procedures and techniques. Therapeutic factors.

6. Drug Addiction. Dependent behavior, substance dependence, substance abuse. Psychosocial factors.

7. Theory of Stress and Coping. The processes where psychology meets psychology – emotional and body responses. Adaptive and abnormal coping responses. Consequences of chronic stress. Illness as a stress. Coping with illness.

MEDICAL UNIVERSITY - SOFIA MEDICAL FACULTY

Department “Social medicine and health management” Section “Medicine of disastrous situations”

Address: 8 Belo more st. Hospital “Queen Ioanna” Tel: 9432-456 , Fax : 944 23 88

APPROVE: Chief of Department: ……………………

STUDY PLAN - PROGRAM "MEDICINE OF DISASTROUS SITUATIONS"

FOR STUDENTS OF DENTAL MEDICINE SECOND COURSE

Total – 30 hours Lectures – 15 hours

Practical classes – 15 hours

Graduating with mark based on continuous assessment

Sofia 2011

І. AIM The students of dental medicine, as a result of the medicine of the disastrous situations study, should get knowledge about: The biological effects of the different striking factors in cases of disastrous situations; The diagnostics, sorting out, medical aid and treatment of traumatic and radiation damages as well as of intoxication with highly toxic poisonous substances (industrial, agricultural poisonous substances, military poisonous substances), the most common epidemic diseases in cases of catastrophes; The organization, planning and management of the health care system in case of disastrous situations, etc. The content and character of the theoretical and practical preparation of the students of dental medicine in the course of Medicine of disastrous situations are made accordingly to their professional preparation and to the tasks, which they have to do in the health-care system in extreme circumstances. The study is organized in 30 hours, from which 15 hours are lectures and 15 hours are practical exercises and seminars. The three main parts of the Medicine of the disastrous situations are presented: Organization and management of the medical provision of the population in disastrous situations. Organization and management of the medical provision of the population in radiation accidents. Organization and management of the medical provision of the population in cases of intoxication with highly toxic poisonous substances. II. METHODOLOGY FORMS OF THE STUDY: lectures, practical exercises, seminars. The specific character of the study content of the discipline „Medicine of the disastrous situations" requires paying special attention to the methods, which increase the cognitive activity of the students: solving problems (tasks); situation task, etc. Control and evaluation: The traditional methods of oral examining and tests on different cognitive levels are used. The study of Medicine of the disastrous situation ends with the forming of a mark, based on continuous assessment.

III. THEMATIC PLAN (lectures) 1. Common characteristic of the disastrous situations. Organization of the protection of the population - 2 hours. 2. Organization of the medical provision of the population in disastrous situations. Plan and management of the Medical provision of the population - 4 hours. 3. Organization and management of the medical provision of the population in case of radiation accidents:

Exposure of the population from the natural and man-made sources of ionizing radiation - 1 hour. Pathogenesis of the radiation injuries - 2 hours. Biological effects after internal contamination with radionuclides - 1 hour. Basic principles of the radiation protection and handling of exposed individuals with ionizing radiation - 1 hour. 4. Organization and management of the medical provision of the population in case of chemical contamination from high-impact poisonous substances: Toxicology as a science, studying the laws of interaction between the living organism and the poison. Toxic, suffocating and reflector poisonous substances - 4 hours.

PRACTICAL EXERCISES 1. Organization and management of the medical provision of the population in disastrous situations. Organization of the medical provision of the population in floods and in case of earthquakes-2 hours. Assessment of the medical situation in case of an accident in a big chemical object-2 hours. 2. Organization and management of the medical provision of the population in radiation accidents. Assessment of the radiation risk and basic principles of the radiation safety - 2 hours. Assessment of the radiation situation in case of major nuclear accident - 2 hours. Radiation injuries - 2 hours. 3. Organization and management of the medical provision of the population in case of chemical contamination from high-impact poisonous substances: Medical provision of the population in case of intoxication with chlorine and ammonia-2 hours. Medical provision of the population in case of intoxication with phospho-organic compounds, hydrocyanogen and with aromatic hydrocarbons-3 hours.

HEAD OF SECTION "Medicine of Disastrous Situations": Associate professor doctor Il. Mihailova, PhD

SYNOPSIS

"MEDICINE OF THE DISASTROUS SITUATIONS"

for students of dental medicine

1. General characteristic of the disastrous situations. Definition, criterions and

classification.

2. Earthquakes- general characteristic.

3. Characteristic of the major chemical accidents.

4. Floods - general characteristic.

5. Organization of protection of the population in disastrous situations. Civil defense in Republic of Bulgaria and European Union.

6. Organization of protection of the population in disastrous situations. Civil defense and

coordination on international level outside EU.

7. Medical provision of the population in case of disasters and accidents. Purpose, tasks and composition.

8. Medical forces and resources in case of disasters and accidents.

9. Medical triage - definition, main aims, principles, types.

10. Organization and scope of the first medical aid.

11. Organization of the sanitary-anti-epidemic provision.

12. Health control.

13. Main parameters and units in the dosimetry of the ionizing radiation and radiation

protection. Maximum acceptable doses and dose limits in case of irradiation from technological sources of ionizing radiation. Main principles of the normalizing.

14. Special features of the absorbed dose for the population from the natural background

radiation and human technical activities.

15. Radio-ecology. Migration of the technological radionuclides in the nature.

16. Pollution of the foods from vegetable and animal origin with radionuclides. Means and methods for their render harmless.

17. Assessment of the radiation situation in radiation accidents. Measures for protection and

prevention.

18. Principles of the biological impact of the ionizing radiation. Theories.

19. Special features of the biological impact of the ionizing radiation on molecular level and on cellular level.

20. Special features of the biological impact of the ionizing radiation on tissue level.

21. Deterministic and stoxastic radiobiological effects. Cancerous and genetic risk.

22. Special features of the biological impact of the incorporated radionuclides ( I – 131, Cs –

137, Sr – 90 ).

23. Acute radiation sickness - classification, clinical picture and treatment. Prevention and treatment of the radiation damages.

24. Basic concepts in toxicology. Principles of the treatment of the acute poisoning.

25. Phospho-organic compounds-toxicity and ways of penetrating in the organism.

Pathogenesis and pathomorphology of the poisoning.

26. Clinical picture, diagnosis and differential diagnosis of the poisoning with phospho-organic compounds. Prevention and treatment.

27. Hydrocyanogen. Clinical picture, diagnosis, prevention and treatment.

28. Toxicology of the carbon monoxide.

29. Toxicology of the chlorine.

30. Toxicology of the ammonia.

31. Toxicology of the phosgene. Special features in poisoning with nitric-oxides.

32. Toxicology of the lachrymose substances.

33. Toxicology of the sneezing substances.

34. Toxicology of the organic solvents.

LIST OF THE MAIN TEXTBOOKS Medicine of catastrophes - edited by reader (docent) doctor V. Popzaharieva, "Knowledge"OOD, St. Z.1995. Handbook of the acute poisoning - professor A. Monov, Medicine and physical culture, Sofia, 1987. Medicine catastrophe -edited by prof. V. Riabochkina, prof. G. Nazarenko, "INI" Ltd, Moscow 1996. New public health care system, edited by professor V. Borisov and collective, publisher Aquagraphycs OOD, Sofia, 1998. Pressing and urgent medical aid in case of acute poisoning- reader (docent) doctor A. Xubenova, Sofia-Moscow 2000. Guide on medicine of the disastrous situations (catastrophes), edited by reader (docent) V. Dragnev and collective, Sofia, 2004.

HEAD OF SECTION "Medicine of Disastrous Situations": Associate professor doctor Il. Mihailova, PhD

MEDICAL UNIVERSITY - SOFIA FACULTY OF DENTISTRY

PROGRAM FOR PHARMACOLOGY EDUCATION Academic degree: Magister

Discipline type: Mandatory

Course duration: Two semesters (IV and V semester)

Course level: Level M (Magister)

Type of evaluation: Oral examination, participation in seminars,

colloquiums, and tests

Educational forms: lectures, seminars, discussion, receipt

prescriptions, brief video-films, individual class-work (review), PC-

based programs, web-based education.

Semestrial exam: Yes (V semester)

MAIN PROFESSOR: Professor N. Boyadjieva, MD, DSci

DEPARTMENT: Pharmacology and Toxicology, Medical Faculty

COURSE ANOTATION: The pharmacology course gives the opportunity to students to gain knowledge on pharmacodynamics (drug effects and drug mechanism of action), pharmacokinetics (absorption, distribution, biotransformation, and drug excretion) as well as indications, application, drug interactions and side effects which are necessary for the relevant organization and conduction of dentistry treatment. COURSE DESCRIPTION: The course comprises of 105 academic hours which are distributed as follows: Lections – 45 hours Seminars – 60 hours How is the final evaluation comprised of? On the basis of the mean annual score, mean score from the tests, final exam What are the final evaluation aspects? Regular examination, colloquiums, tests, and final exam (test, practical and theoretical examination) SUPPLEMENTARY TOOLS: Multimedia lectures, figures and schemes, tests, drug samples, video-films, PC-based programs, web-based education OBJECTIVES: The education is aimed to give to student current theoretical and practical training in pharmacology, necessary to the relevant development of dentistry specialists. PROGRAM TASKS Main tasks: To introduce to students the main problems of general pharmacology (drug pharmacokinetics and pharmacodynamics, and factors affecting the drug kinetics and action). To give current information on drugs used in the dentistry daily practice such as non-opioid analgesics, non-steroid anti-inflammatory drugs, glucocorticosteroids, local anesthetics, fluorides, antiseptics, local anti-inflammatory drugs, antimicrobial drugs, systemic and local antifungal agents, immunosupressors, dental vaccines, pharmacotherapy of anaphylactic shock etc.). To give current information on drugs used in the treatment of the most common chronic diseases. To introduce the main drug forms (solid, liquid, semi-solid and aerosols) and their correct prescription. PREVIOUS REQUIREMENTS: In order to start the pharmacology education students need to have basic knowledge on physiology, biochemistry, pathophysiology EXPECTED RESULTS After the end of the course students have to: To know the main pharmacodynamics and pharmacokinetics drug features To be able to prescribe different drug formulations (solid, liquid, soft and aerosol) To be able to prescribe drugs used in the daily dentistry practice RECOMMENDED LITERATURE 1. Mycek, M. J., R. A. Harvey, P. C. Champe. Pharmacology Lippincott’s Illustrated Reviews. Lippincott Williams & Wilkins, 2009. 2. Rang, H.P., Dale, M.M., Ritt e r, J.M., Moore, P.K. Pharmacology. 6th Edition, Churchill Livingstone, London, 2007. 3. Katzung, B.G. Basic & Clinical Pharmacology. 11th Edition, McGraw Hill, New York, 2009. 4. Haveles, E.B. Delmar’s Dental Drug Reference. Delmar Thomson Learning, Toronto, 2000.

TOPICS FOR INDIVIDUAL WORK: 1. Non-opioid analgesics (paracetamol, metamizole) and nonsteroidal anti-inflammatory drugs (NSAIDs) administered in dentistry practice. 2. Local anesthetics. 3. Antiseptics and disinfectants. Agents used in pulp devitalization. 4. Stomatoantiseptics. Drugs used for treatment of parodonthosis. Dental vaccines. 5. Local anti-inflammatory agents used in dental practice. Antifungal drugs used to treat thrush. Antibiotics as intracanal agents (neomycin, polymixin B, clindamycin, demeclocycline, oleandomycin). Metronidazole. 6. Agents for exogenous and endogenous prophylaxis of caries. Fluorides. 7. Antimicrobial agents – penicillins and cephalosporins. 8. Antimicrobial agents – inhibitors of bacterial protein synthesis (macrolides, aminoglycosides, tetracyclines, lincosamides chloramphenicol). 9. Immunomodulating and cytotoxic drugs used to treat diseases affecting oral mucosa. 10. Coagulants. EXAM CONSPECTUS:

SYLLABUS of the Pharmacology course for English speaking students of dental medicine,

Faculty of Medicine, Medical University of Sofia Course of studies – 2nd and 3rd year Semesters – 4th and 5th Exam – the end of the 5th semester Full course of lectures and seminars – 105 hours Timetable of the lectures and seminars Semesters Lectures Seminars IV (15 weeks) 30 часа (2 hrs/weekly) 30 hrs (2 hrs/weekly) V (15 weeks) 15 часа (1 hr/weekly) 30 hrs (2 ч/седм.)

Общо: 105 hrs 45 hrs 60 hrs

According to the plan in education of students of dental medicine the University of Sofia, for the pharmacology are allocated 165 hours, during the 5th and 6th semesters (45 hrs lectures and 60 hrs seminars). The examination is at the end of the 5th semester. During the 4th semester the students have 2 hours both lectures and seminars each week, whereas during the 5th semester the lectures are 1 hours and seminars 2 hours weekly.

The goal of the training is to offer the students contemporary theoretical and practical knowledge in pharmacology which is necessary for their complete forming as specialists in dental medicine. The schedule of lectures covers the full course of education in pharmacology whereas the practical exercises – 95% of it.

The lectures precede the practical exercises and start with basic issues of general pharmacology, regarding pharmacokinetics and pharmacodynamics of drugs. After the general pharmacology the students study special pharmacology for dental medicine, antimicrobial and anticancer chemotherapeutic agents, immunomodulating agents, and drugs

influencing internal diseases. A module about the most common emergency conditions arising during dental treatment is included in the lecture course. In this way the students in dental medicine can apply the knowledge acquired during the course of education in pharmacology in their direct theoretical and practical training.

During the weekly 2 hours practical exercises the students study the drug forms, develop the skills for their prescription, and learn the basic issues of general pharmacology and almost all the pharmacological groups of medicines. The basic elements of the practical exercises include: a) test with a score; b) seminar with a score; c) demonstration of therapeutic preparations and leaflets, videos, slides, schemes and other demonstrative materials in a specially equipped room; d) exercises on writing prescriptions from the conspectus on practical examination in pharmacology.

During the course there are four control tests in the end of four lectures and also four colloquia. The colloquia include: a) recipe of the drug forms; b) special pharmacology for dental students: anesthetics, analgesics, antiseptics and disinfectants, agents for oral hygiene and therapy; c) anti-infective agents and immunomodulators; d) cardiovascular drugs, and drugs influencing the haemopoiesis and blood coagulation.

The pharmacology exam consists of a written test, a practical exam with prescription of recipes and an oral theoretical exam. The final score of the exam on pharmacology is formed as a whole, by evaluation of the activity of the students during the training course (current scores, control tests, colloquia) and the exam result of the session (exam test, practical exam, theoretical exam). The selection of the test, of the examination tickets and of the examination commission is on a lottery principle. The examination commission consists of a habilitated and a non-habilitated lecturer. The examination commissions are also formed on a lottery principle immediately before the start of the exam.

This present pharmacology course program is in accordance with the programs of leading universities in a number of European countries. There are a specialized textbook and tests in Bulgarian language for students in dental medicine (indicated in the present program). They are published under the edition of, and with the active participation of habilitated lecturers from the Department of Pharmacology and Toxicology at the Faculty of Medicine– Sofia and the Department of Pharmacology at the Faculty of Medicine – Plovdiv, in collaboration with the Faculties of Dental Medicine in Sofia and Plovdiv. Furthermore, students are recommended to use additional pharmacology literature of Bulgarian and foreign authors, videos and computer module programs. Synopsis of the pharmacology lectures: A. GENERAL PRINCIPLES OF PHARMACOLOGY 1. Introduction to pharmacology (2 hrs): Object and tasks of pharmacology. Relationship with other sciences. Historical review. Division of medical pharmacology. Definition of drug. Drug cruds and preparations. Stages in development and regulations of new drugs. 2. General pharmacokinetics (2 hrs) 2.1. Absorption of drugs. Transport of drugs through biologic membranes after enteral and parenteral administration. 2.2. Drug distribution. Binding of drugs to plasma proteins. Barrier systems (blood-brain, placenta, blood-milk). Basic pharmacokinetic parameters: bioavailability, volume of distribution, first pass metabolism, binding capacity of albumin, plasma half-life of the drugs. 2.3. Biotransformation of drugs. Prodrugs. Sites of drug metabolism. Phase I and phase II reactions of drug metabolism. Inducers and inhibitors of the drug-metabolizing enzymes. 2.4. Excretion of drugs and their metabolites. Excretion of drugs via kidney, bile, intestine, lung, salivary glands, or milk in nursing mothers. 3. General pharmacodynamics (1 hr) 3.1. Drug action and drug effect.

3.2. Specific mechanisms of drug action (receptors, ion channels, enzymes, transport systems). Definition of receptor. Affinity and intrinsic activity of the drugs. Agonists and antagonists. Types of receptors. Second messengers (cyclic adenosine monophosphate, inositol-1,4,5-triphosphate, and diacylglycerol). 3.3. Non-specific mechanisms of drug action. 3.4. Types of drug effects. 3.5. Drug effects in the mouth. 4. Factors affecting the kinetics and action of the drugs (1 hr) 4.1. Drug properties affecting its kinetics and action. Physical characteristic, physico-chemical characteristic, and chemical structure of the drugs. Drug forms. Dose (types of dose, therapeutic index). Loading and maintenance dose. 4.2. The role of environment on the kinetics and action of the drugs. 4.3. Factors of human body affecting drugs action. A role of age, body weight and sex in both kinetics and action of the drugs. Genetic factors and pathological processes on the kinetics and action of the drugs. 5. Peculiarities of drugs action due their multiple applications (1 hr) 5.1. Tachyphylaxis. 5.2. Tolerance. 5.3. Drug dependence. 5.4. Resistance. 5.5. Allergic reactions. 5.6. Cumulation. 6. Unwanted drug reactions. Drug toxicology (2 hrs) 6.1. Adverse effects related to the main pharmacological action of the drug. 6.2. Adverse effects related to the pharmacokinetics of drug. 6.3. Allergic reactions. Idiosyncratic reactions. 6.4. Drug dependence: characteristic and types. 6.5. Drug toxicity: nephrotoxicity, hepatotoxicity, hematotoxicity, ototoxicity, ophthalmotoxicity, and neurotoxicity. 6.6. Drug-induced fetal damage. 6.7. Mutagenesis and carcinogenesis. 6.8. Dug intoxication. Antidotes. 7. Drug interactions (1 hr) 7.1. Pharmaceutical drug interactions. 7.2. Pharmacokinetics drugs interactions. 7.3. Pharmacodynamic drugs interactions: additive effects, synergism, antagonism. 7.4. Interaction of the drugs with alcohol, nicotine, and psychosomimetics. Drugs affecting clinical laboratory tests. B. SPECIAL PHARMACOLOGY I. SPECIAL PHARMACOLOGY FOR DENTISTS 1. Anesthetics. Antihistamines (2 hrs) 1.1. Local anesthetics: Techniques of local anesthesia. Pharmacodynamics, pharmacokinetics, drug interactions, and adverse drug reactions of local anesthetics. Esters. Amides. 1.2. General anesthetics: Inhalation anesthetics. Injectable anesthetics. 1.3. Antihistamines: Н1-receptor blockers. Н2-receptor antagonists. Mast cell stabilizers (ketotifen, cromolyn, nedocromil).

2. Analgesics (2 hrs) 2.1. Opioid analgesics: Pharmacodynamics – endogenous opioids, type of opioid receptors, pharmacological effects of opioids. Clinical uses of opioid analgesics. Adverse drug reactions of opioids. Opioid overdose. Opioid antagonists. 2.2. Non-opioid analgesics (paracetamol, metamizole). Nonsteroidal anti-inflammatory drugs (NSAIDs) – salicylic acid derivatives, acetic acid derivatives, propionic acid derivatives, enolic acid derivatives (oxicams). Pharmacodynamics – non-selective and selective COX inhibitors. Adverse effects of non-opioid analgesics and NSAIDs. 3. Antiseptics and disinfectants. Agents used in pulp devitalization and anti-caries agents. Drugs for treatment of parodonthosis (2 hrs) 3.1. Antiseptics and disinfectants. 3.2. Agents used in pulp devitalization. 3.3. Fluorides. 3.4. Drugs for treatment of parodonthosis.

II. ANTI-INFECTIVE DRUGS 1. Anti-infective drugs – part I: Antibiotics (2 hrs) 1.1. Penicillins. Carbapenems and monobactams. 1.2. Cephalosporins. 1.3. Inhibitors of bacterial protein synthesis: aminoglycosides, macrolides, tetracyclines, chloramphenicol, lincosamides. 1.4. Other antibiotics: polymixins, bacitracin,vancomycin, linezolid, tigecycline. 2. Anti-infective drugs – part II (1 hr) 2.1. Sulfonamides. 2.2. Quinolones. 2.3. Metronidazole. 3. Anti-infective drugs – part III (1 hr) 3.1. Antifungal drugs. 3.2. Antiviral agents. III. ANTICANCER DRUGS. IMMUNOPHARMACOLOGY. 1. Anticancer drugs (1 hr) 1.1. Alkylating agents (Chlorambucil, Busulfan, Cyclophosphamide, Carmustine). 1.2. Antimetabolites (Methotrexate, 5-Fluorouracil, Azathioprine, Cytarabine). 1.3. Microtubule inhibitors (Vincristine, Vinblastine, Paclitaxel, Docetaxel). 1.4. Anticancer antibiotics (Bleomycin, Dactinomycin, Doxorubicin) 1.5. Hormones used to treat cancer (Prednisone, Estrogens, Tamoxifen). 2. Immunopharmacology (1 hr) 2.1. Immunomodulators – immunostimulators and immunosuppressive drugs. 2.2. Immunomodulating and cytotoxic drugs used to treat diseases affecting oral mucosa. IV. NEUROTROPIC AND PSYCHOTROPIC DRUGS 1. Drugs affecting the autonomic nervous systems (4 hrs). 1.1. Cholinergic neurotransmission. 1.2. Direct and indirect-acting cholinomimetics. 1.3. М-cholinergic antagonists. 1.4. Neuromuscular blockers. 1.5. Adrenergic neurotransmission. 1.6. Adrenomimetics with direct and indirect action. 1.7. Adrenolytics. Alpha-blockers. Beta-blockers.

2. Drugs affecting the central nervous systems (4 hrs). 2.1. Sedative-Hypnotic drugs. 2.2. Anxiolytics. Benzodiazepine and non-benzodiazepine anxiolytics. 2.3. Anticonvulsants. 2.4. Neuroleptics. 2.5. Antidepressants. 2.6. Psychostimulants. Nootropic drugs. 2.7. Drugs used in treatment in neurodegenerative diseases. Antiparkinson’s drugs. Drugs used to treat Alzheimer’s disease. V. DRUGS USED IN TREATMENT OF INTERNAL DISEASES 1. Drugs affecting cardiovascular systems (5 hrs). 1.1. Drugs used in treatment of heart failure: cardiac glycosides, beta-receptor agonists, PDE III inhibitors, thiazide and loop diuretics, aldosterone antagonists, АCE-inhibitors, Angiotensin II-receptor blockers. 1.2. Antiarrhythmic drugs. 1.3. Antianginal drugs. 1.4. Antihypertensive drugs. 1.5. Peripheral vasodilators. 1.6. Drugs used in treatment of migraine. 1.7. Capillarotonic and venotonic drugs. 1.8. Antihyperlipidemic drugs. 1.9. Diuretics. 2. Drugs affecting haemopoiesis (1 hr). 2.1. Drugs containing iron. 2.2. Vitamins used to treat anemia: Cyanocomalamin (Vitamin В12), Folic acid. 2.3. Hematopoietic growth factors: erythropoietin, filgrastim, sargramostim, oprelvekin. 3. Drugs affecting haemostasis (2 hr). 3.1. Blood coagulation and fibrinolysis. 3.2. Antithrombotic drugs: platelet inhibitors, anticoagulants, fibrinolytics (thrombolytic agents). 3.3. Drug used in treatment of bleeding: antifibrinolytics, local acting coagulants, Vitamin К, plasma factors of blood coagulation. 4. Drugs affecting the respiratory system (1 hr). 4.1. Drugs used to treat asthma. 4.2. Drugs used to treat cough. 4.3. Pulmonary surfactants. 5. Drugs affecting the gastrointestinal system (2 hr). 5.1. Drugs used to treat peptic ulcer disease. 5.2. Drugs affecting appetite. 5.3. Antiemetic drugs. 5.4. Laxatives. 5.5. Hepatoprotectors. 5.6. Drugs affecting the biliary secretion. 5.7. Drugs containing pancreatic enzymes.

VI. HORMONAL AGENTS. DRUGS AFFECTING UTERINE MOTILITY 1. Hormonal agents (2 hrs). 1.1. Hypothalamic and pituitary hormones. 1.2. Glucocorticoids. Mineralcorticoids. 1.3. Drugs affecting the thyroid: Thyroid hormones. Drugs inhibit thyroid hormone synthesis. 1.4. Agents for diabetes. Insulins. Oral hypoglycemic drugs. 1.5. Sex hormones. Anabols. 2. Drugs affecting uterine motility (1 hr). 2.1. Uterokinetic drugs. 2.2. Uterotonic drugs. 2.3. Toxolytics. VII. BASIC PRINCIPLES IN PHARMACOTHERAPY OF THE EMERGENCY INCIDENCES IN DENTISTRY CARE (1 hr). 1. Treatment of anaphylactic shock 2. Treatment of angioedema (Quincke's edema) 3. Treatment of hereditary and acquired disorders of coagulation. 4. Treatment of exacerbation of cardiovascular diseases (hypertensive crisis, anginal attack, arrhythmia).

PHARMACOLOGY LECTURES AND SEMINARS

FOR DENTAL STUDENTS

4TH SEMESTER - 2ND YEAR

Week Seminars Lectures

I.

• Definition of drug. Drug sources. Pharmacopoeia. Prescription.

• Object and division of pharmacology. Relationships with other sciences. Historical review. Definition of drug. Stages in development and regulations of new drugs.

II.

• Solid dosage forms. • Transport of the drugs through biological membranes. General pharmacokinetics.

III.

• Liquid dosage forms. Dental systems for injection (eg Citoject, Uniject K).

• Pharmacodynamics. Factors affecting the kinetics and action of drugs.

IV.

• Semisolid dosage forms. Aerosols. Seminar and prescription Writing on dosage forms.

• Special Pharmacology for dentists (part I): Local and general anesthetics. Antihistamines.

V.

• Pharmacokinetics.

• Special Pharmacology for dentists (part II): Opioid analgesics. Non-opioid analgesics. NSAIDs (nonsteroidal anti-inflammatory drugs).

VI.

• Pharmacodynamics. Drug effects in the mouth.

• Special Pharmacology for dentists (part III): Antiseptics and disinfectants. Drugs used for treatment of parodonthosis. Agents used in pulp devitalization. Fluorides.

VII.

• Colloquium on prescription of drug forms and general pharmacology.

• Anti-infective agents (part I): Antibiotics (penicillins, cephalosporins, inhibitors of bacterial protein synthesis).

VIII. • Local and general anesthetics. • Anti-infective agents (part II): Sulfonamides.

Antihistamines. Quinolones. Antiviral agents. Аntifungul agents. Metronidazole.

IX.

• Opioid analgesics. Non-opioid analgesics. NSAIDs (nonsteroidal anti-inflammatory drugs).

• Anticancer drugs. Immunomodulators.

X.

• Antiseptics and disinfectants. Drugs used for treatment of parodonthosis. Dental vaccines. Agents used in pulp devitalization.

• Neurotropic and psychotropic drugs (part I): Cholinergic neurotransmission. Cholinomimetics. Anticholinergic agents (Muscarinic cholinolytics). Neuromuscular blockers.

XI.

• Vitamins and microelements. Fluorides. • Neurotropic and psychotropic drugs (part II): Adrenergic neurotransmission. Adrenomimetics. Adrenolytics.

XII.

• Colloquium on special pharmacology for dentists (part I, II и III).

• Neurotropic and psychotropic drugs (part III): Hypnotic and sedative drugs. Anxiolytics. Anticonvulsants.

XIII.

• Penicillins and cephalosporins. • Neurotropic and psychotropic drugs (part (част IV): Neuroleptics. Antidepressants. Psychostimulants. Nootropic drugs.

XIV.

• Inhibitors of bacterial protein synthesis (macrolides, tetracyclines, lincosamides, aminoglycosides, chloramphenicol and other inhibitors of protein synthesis).

• Cardiac glycosides. Antiarrythmic drugs. Antianginal drugs.

XV.

• Sulfonamides. Quinolones. Аntifungal agents. Antiviral agents.

• Antihypertensive drugs. Peripheral vasodilators. Drugs used in treatment of migraine. Capillarotonic and venotonic drugs.

PHARMACOLOGY LECTURES AND SEMINARS FOR DENTAL STUDENTS

5TH SEMESTER - 3RD YEAR Седмица Упражнения Лекции XVI.

• Seminar of anti-infective drugs. • Diuretics. Drugs affecting haemopoiesis.

XVII.

• Anticancer drugs. Immunomodulators.

XVIII.

• Colloquim on anti-infective dugs and immunomodulators.

• Drugs affecting haemostasis.

XIX.

• Cholinergic neurotransmission. Cholinomimetics. M-cholinolytics.

XX.

• Adrenergic neurotransmission. Adrenomimetics. Adrenolytics.

• Drugs affecting the respiratory system. Drugs affecting uterine motility.

XXI.

• Hypnotic and sedative drugs. Anxiolytics. Anticonvulsants.

XXII.

• Neuroleptics. Antidepressants. Psychostimulants. Nootropic drugs. Drugs used in treatment in neurodegenerative diseases.

• Drugs affecting the gastroinstestinal system.

XXIII.

• Cardiac glycosides. Antiarrhythmic drugs. Antianginal drugs.

XXIV.

• Antihypertensive drugs. Peripheral vasodilators. Drugs used in treatment

of migraine.

• Hormonal agents.

XXV.

• Diuretics. Drugs affecting haemopoiesis.

XXVI.

• Drugs affecting haemostasis. Drugs affecting uterine motility.

• Drug interactions. Particular events after multiple drug application.

XXVII. • Colloquium on cardiovascular

agents and drugs affecting

haemostasis. XXVIII.

• Drugs affecting respiratory function. • Unwanted (adverse) drug reactions. Drug toxicology. Antidotes.

XXIX.

• Drugs affecting gastroinstestinal function.

XXX.

• Hormonal agents. • Basic principles in pharmacotherapy of emergency incidences in dentistry care (1hr).

RECOMMENDED LITERATURE 1. Mycek, M. J., R. A. Harvey, P. C. Champe. Pharmacology Lippincott’s Illustrated Reviews. Lippincott Williams & Wilkins, 2009. 2. Rang, H.P., Dale, M.M., Ritt e r, J.M., Moore, P.K. Pharmacology. 6th Edition, Churchill Livingstone, London, 2007. 3. Katzung, B.G. Basic & Clinical Pharmacology. 11th Edition, McGraw Hill, New York, 2009. 4. Haveles, E.B. Delmar’s Dental Drug Reference. Delmar Thomson Learning, Toronto, 2000. 5.WEB-sites: www.medpharm-sofia.eu www.kft.medfac-sofia-eu pharmsupport.data.bg COMPUTING MODUL PROGRAMS Pharma-CAL-ogy Software (UK) 1. Cardiac Disаrhythmias 2. Central 5-HT Transmission 3. Coronary Circulation 4. Drug Dependance 5. Drug Metabolism 6. Drug Targets + Transduction Systems 7. Enzyme Induction and Inhibition 8. Epilepsy 9. Local anaesthetics 10. Movement Disorders 11. Pharmacology of asthma 12. Schizophrenia 13. Suxamethonium 14. Synaptic Transmition in the CNS 15. The Pharmacology of Inflammation 16. Thyrosine Kinase Receptors 17. Uptake & Transport VIDEO FILMS • Surgical hand disinfection • Understanding&Living with Angina • Interferon beta-1b • Alzheimer’s Disease & Congnitive Disorders • 5-HT Syndrome

http://www.medpharm-sofia.eu/

http://www.kft.medfac-sofia-eu/

http://www.pharmsupport.data.bg/

Medical University of Sofia, Faculty of Medicine Department of Pharmacology and Toxicology 2, Zdrave Str., 1431 Sofia, Bulgaria (02) 952 0539, phone/fax 9172 621

CONSPECTUS

OF THE THEORETICAL EXAMINATION IN PHARMACOLOGY

FOR DENTAL MEDICINE STUDENTS (5th semester)

I. General Pharmacology 1. Object of pharmacology. Historical review. Definition for drug, drug substance and drug product. The origin of drugs. Drug nomenclature. 2. Drug resources (crude drugs). Drug preparations. The process of drug development. 3. Drug absorption after various routes of administration. 4. Drugs distribution. 5. Drug metabolism. 6. Drug excretion. Drugs undergoing salivary excretion. Drugs affecting salivary gland secretion. 7. Drug action and drug effect. Types of drug effects in oral cavity. 8. Receptor mechanism of drug-action. Types of receptors. Non-receptor mechanisms of drug-action. 9. Drug properties affecting drugs action. 10. Factors of human body affecting drugs action. 11. Peculiarities of drugs action due to their multiple applications. 12. Drugs interactions. 13. Adverse effects of drugs. 14. Toxic effects of drugs. II. Special Pharmacology for Dentists 15. Local anaesthetics – pharmacodynamic, pharmacokinetic, drug intera ctions, adverse effects. 16. Local anaesthetics – esters and amides. 17. General anaesthetics. 18. Antihistaminic drugs. 19. Opioid (narcotic) analgesics – classification, pharmacodynamic and toxycodynamic. Competitive morphine antagonists. 20. Opioid (narcotic) analgesics – preparations, pharmacokinetical differences, clinical application. 21. Non-opioid analgesic drugs (Non-steroidal antiinflammatory drugs) - classification, pharmacodynamic. 22. Non-opioid analgesics with predominantly analgesic and antipyretic activity. 23. Non-steroidal antiinflammatory drugs: derivatives of salicylic, propionic, phenylacetic, indolacetic acids, pyrazolon- and aniline derivatives. 24. Antiseptics and Disinfectants – oxidants, chalogenous preparations. 25. Antiseptics and Disinfectants – phenols, etheric oils. 26. Antiseptics and Disinfectants – aldehydes, dyes. 27. Antiseptics and Disinfectants – alcohols, detergents, acids and salts of some metals.

28. Drugs for devitalization of pulp in tooth root. 29. Fluoride containing products. Tooth-channel filling materials. 30. Preparations for local oral hygiene and therapy. Drugs for treatment of parodontitis. 31. Watersoluble vitamins. 32. Lipidsoluble vitamins. 33. Antibiotics – classification, pharmacodynamic, drug interactions. 34. Penicillins. Carbapenems. Monobactams. Protected penicillins. 35. Cephalosporins. 36. Tetracyclines. 37. Aminoglycosides. 38. Macrolides. 39. Lincosamides (Lincosamines). Amphenicols. Polymixines. 40. Sulfonamides. Drugs used to treat tuberculosis. 41. Quinolones. Oxiquinolones. Nitrofurans. 42. Antifungal drugs. 43. Antiviral drugs 44. Anticancer drugs. 45. Immunomodulators. Dental vaccines. II. Special Pharmacology 46. Cholinergic neurotransmission. Cholinomimetics. 47. Muscarinic antagonists. 48. Peripheral neuromuscular blockers. 49. Adrenergic neurotransmission. Adrenomimetics. 50. Adrenolytic drugs (Adrenoblockers and praesynaptically actigs sympatholytics). 51. Sedative and hypnotic drugs. Anxiolytics. 52. Antiepileptic drugs. 53. Neuroleptics. 54. Antidepressant drugs. 55. Drugs for treatment of neurodegenerative disorders. Antiparkinsonic drugs. Drugs used in Alzheimer’s disease. 56. Cardiac glucosides. 57. Antiarrhytmic (antidysrrhytmic) drugs. 58. Antianginal drugs. 59. Antihypertensive drugs. 60. Periferal vasodilators. Drugs for treatment of migraine. 61. Antidyslipidemic drugs. Capillarotonic and venotonic drugs. 62. Diuretics. 63. Drugs affecting haemopoesis. 64. Hemostatic (antihemorrhagic) drugs. 65. Anticoagulants. 66. Thrombolytic agents (fibrinolytics).Platelet aggregation inhibitors. 67. Antiasthmatic drugs. Drugs depressing dry cough. Expectorants. 68. Drugs for treatment of peptic ulcer. 69. Appetite-stimulating and appetite-supressing drugs. Antiemetic drugs. 70. Hepatoprotectors. Drugs affecting bile secretion. Drugs containing pancreatic enzymes. 71. Hypothalamic and pituitary hormones. 72. Thyroid and antihyperthyroid drugs. 73. Antidiabetic drugs. 74. Glucocorticoids and mineralcorticosteroids. 75. Sex hormones. Hormonal contraceptives.

CONSPECTUS OF THE PRACTICAL EXAMINATION IN PHARMACOLOGY

FOR DENTAL MEDICINE STUDENTS (5th semester)

1. Prescription – parts, type of prescription and different prescription forms (orders). 2. Prescription – abbreviations, metric and other units. 3. Pharmacopoeia. 4. Tablets. Prescribe: a.) Nitroglycerin in sublingual tablets of 0.5 mg; b.) Ciprofloxacin in film- tablets of 250 mg. 5. Types of tablets. Prescribe: a.) Acetylsalicylic acid (Acidum acetylsalicylicum) in effervescent tablets of 324 mg; b.) Benalgin in tablets. 6. Dragees and capsules. Prescribe: a.) Allergosan in dragees of 25 mg; b.) Amoxicillin in capsules of 500 mg. 7. Powders. Types of powders. Prescribe as powder for oral application: a.) 50 g Sodium bicarbonate (Natrii hydrocarbonas); b) Caffeine (Coffeinum Natrii benzoas) 50 mg and Analgin 500 mg (20 powders). 8. Types of powders. Prescribe: a) magistral powder (powder made by the pharmacist) for oral application, containing 10 mg Codeine (Codeini phosphas); b) officinal powder (powder made in pharamceutical works) Nemybacin 5 g for external application. 9. Solutions. Prescribe: a.) 4% 150 ml Sodium citrate (Natrii citras) as a solution for oral application in both short and non-short form (Label: 1 soup spoon 3-4 times daily); b.) 5% 100 g alcoholic solution of Iodine (Solutio Iodi spirituosae) for an external use. 10. Mixtures. Prescribe: а.) Hartman solution (containing 5 g thymol, 4 g 95 % ethanol, and 8 g aether medicinalis); b.) 1 vial of 150 ml Hustagil (480 mg/5 ml). 11. Prescribe 225 g mixture, containing infusion from the root of primrose (Infusi radicis Primulae 6,0/180,0), Ephedrini hydrochloridum, Liquor Ammonii anisatus, Natrii benzoas and syrup from hollyhock (Sirupus Altheae). Each dose for separate reception of Ephedrine, Liquor Ammonii anisatus and Sodium benzoate is 20 mg, 200 mg and 200 mg. Label: 1 soup spoon 3 times daily. 12. Tinctures. Prescribe: a.) 20 g Tinctura Valerianae; b.) 20 g Tinctura Menthae. 13. Prescribe 0.1% Xylometazoline as nasal drops in vial of 10 ml. 14. Suspensions. Prescribe 1 vial Amoxicillin (30 g) in granules for preparing oral suspension (50 mg/ml) for a child with body weight 12 kg. 15. Infusion and decoction. Prescribe a.) infusion (10,0/200,0) from the herb of St. John’s wort (Hypericum perforatum); b.) infusion (10,0/200,0) from the leafs of smoke tree (Rhus Cotinus). Label: For wash of the mouth (10 drops in 100 g wather). 16. Liquid drug forms for injections. Prescribe: а.) 3 ampoules Xylodren ”blue” (2% 2 ml); b.) 20 dry vials Benzylpenicillin of 1 000 000 UI, using 0.9% sodium chloride as solvent (200 000 UI/1 ml solvent). 17. Liquid drug forms for injections. Prescribe: а.) 3 ampoules Fentanyl (0,005% 2 ml); b.) 0,5% bupivacaine (marcaine) as vials of 20 ml. 18. Ointment (unguentum). Prescribe: a.) 2.5 g Nemybacin in the form of officinal eye ointment (Label: Apply in the lower conjunctival sac of the affected eye twice daily); b.) 5 g Indextol as officinal gingival ointment. 19. Paste. Prescribe: a.) paste, containing 100 mg Thymol, 10 g Eugenol, and Zinc oxide in sufficient quantity. Label: For external use; b.) devitalizing paste Necronerve 5 g. 20. Cream and gel. Prescribe: a.) Troxevasin 2% 40 g as officinal gel; b.) 15 g Cortimicin as cream. 21. Suppositories. Prescribe as officinal rectal suppositories: a.) Paracetamol 150 mg; b.) Ultraproct.

22. Aerosol inhalers. Prescribe 1 vial Salbutamol (0.2 %10 ml) as aerosol for inhalation in the mouth. 23. Calculate Vd (volume of distribution) of Propranolol bearing of mind that after single oral dose of 40 mg its steady-state plasma concentration is 100 ng/ml. 24. Gentamicin has plasma half-life 2 hrs and the dosage interval is 8 hrs in patients with normal kidney function. Calculate adjusted dosage interval in a patient with renal failure same as and prolongation of drug plasma half-life to 15 hrs. 25. Prescribe a combined preparation, containing articaine and epinephrine, using for local anesthesia in dental practice. 26. Prescribe a combined preparation, containing lidocaine, and using in dental practice for a patient with cardiac arrythmias. 27. Prescribe as aerosol drug form (10% 38 g) a local anesthetic from amide group. 28. Prescribe in ampoules 1% 10 ml a synthetic local anaesthetic, used also in ventricular tachycardia (Lidocaine, Tetracaine, Amiodarone). 29. Prescribe a H1-receptor antagonist from second generation without sedative effect in tablets of 10 mg (Promethazine, Loratadine, Ketotifen). 30. Prescribe an opium alkaloid as phosphate salt, using in treatment of dry cough

(Butamirate, Pethidine, Codeine). 31. Prescribe a synthetic opioid analgesic with a spasmolytic activity in ampoules of 5% 2 ml (Morphine, Fentanyl, Pethidine). 32. Prescribe separately a synthetic opioid analgesic and a butirophenon neuroleptic in flacons of 0, 5 mg/10 ml and 25 mg/10 ml, respectively used for neuroleptanalgesia. Label: 2 ml i.m. 33. Prescribe analgesic drug from the group of pirasolon derivates in tables and drops for oral use. 34. Prescribe salicylic agent used as anti-platelet drug. 35. Prescribe a combined Bulgarian drug containing Paracetamol, Metamizol, Codeine and Caffeine. 36. Prescribe a combined drug containing Indometacin, Oleandomycin, and Dexamethasone used in the local treatment of periodontal disease and gingivitis (Benzydamine, Indextol, Fluocinolone) 37. Prescribe an antiseptic from the group of oxidizers (Desictor, Hexisept, Hydrogen peroxide). 38. Prescribe an antiseptic preparation containing a mixture of ortho-, meta- and para-cresol with formaldehyde. 39. Prescribe a drug containing para-Chlorphenol, Camphor, Timol and Dexamethasone. 40. Prescribe a drug with antibacterial origin and immunotherapeutic activity used under the form of lozenges for aphthous stomatitis, glositis and periodontal disease (Chlorhexidine, Isoprinosine, Immudon).

41. Prescribe a 30% 50 g silver nitrate solution for treatment of dental cavity. 42. Prescribe a drug used for disinfection of small surgery instruments (Timol, Hibiscrub,

Desictor). 43. Prescribe a fluorine drug used in the prevention of caries in children aged at 5 years old. 44. Prescribe a devitalisation paste for the dental pulp containing diarsenic trioxide

(Cresofen, Foredent, Kaustinerv arsenical). 45. Prescribe a combined lozenges containing dequaline and ascorbic acid used as an

antiseptic in the dentistry care (Bensidamine, Efisol, Chlorhexidine).

46. Prescribe a drug containing Flumethasone and Neomycin for the local treatment of chronic aphthous

stomatitis (Lorinden, Prednisolone, Lorinden N).

47. Prescribe a septomixine paste for the treatment of pulpitis and periodontitis in a tube of 7.5 g. 48. Prescribe an infusum (10,0/200,0) from the leaves of sage tea for rinsing the mouth cavity. 49. Prescribe an infusum (10,0/200,0) from the leaves of lime for rinsing the mouth cavity. 50. Prescribe a phyto-preparation used in the local treatment of periodontal disease (Phytodent, Spiramycin, Chlorhexidine). 51. Prescribe a vitamin under the form of ready-to-use oil solution used in the rachitis prophylaxis in flacon 200 000 units/10 ml (Tocopherol, Retinol, Cholecalciferol). 52. Prescribe vitamin in capsules of 2500 UI which repairs the damaged layers of the epidermis. 53. Prescribe a vitamin used in the treatment of cheilitis in film-tablets of 1 mg (Riboflavin, Cholecalciferol, Ascorbic acid). 54. Prescribe vitamin used in the treatment scurvy in tablets of 100 mg.

55. Prescribe narrow-spectrum acid stable penicilin (Benzylpenicillin, Cefalexin , Phenoxymethylpenicilin). 56. Prescribe wide-spectrum aminopenicillin with high intestinal absorption (Ampicillin, Amoxicillin,

Azlocillin). 57. Prescribe amoxicillin protected with clavulanic acid in tablets of 375 mg (Augmentin, Tazocin, Piperacillin).

58. Prescribe cephalosporin from the second generation with high antistaphylococcus activity in tablets of

250 mg (Oxacillin, Vancomycin, Cefuroxime). 59. Prescribe macrolide antibiotic used in the treatment periodontal disease (Amoxicillin,

Cefoperazone, Spiramycin). 60. Prescribe combined preparation used in the treatment and prophylaxis of periodontal

disease (Cefepime, Rodogyl, Phenytoin).

61. Prescribe a rational antibiotic combination (ampicillin and doxycycline, gentamicin and tobramycin, ampicillin and oxacillin). 62. Prescribe a combined preparation, containing sulfamethoxazole and trimethoprim (co-trimoxazole, augmentin, rodogyl). 63. Prescribe an antimycotic antibiotic which is effective in oropharyngeal candidosis (aciclovir, zidovudine, nystatin). 64. Prescribe in ampoules of 0,5% 1 ml a bulgarian anticholinesterase preparation, derived from some species of snowdrops (carbachol, neostigmine, galantamine). 65. Prescribe in ampoules an alkaloid from the group of M-cholinolytics (tubocurarine, atropine, pilocarpine). 66. Prescribe a preparation which stimulates alpha-, beta1- and beta2-adrenergic receptors and is in ampoules for subcutaneous application (noradrenalin, adrenalin, orciprenaline). 67. Prescribe a nonselective beta-adrenergic blocker with membrane stabilizing activity in tablets of 25 mg (atenolol, labetalol, propranolol). 68. Prescribe a preparation with sedative effect in sublingual tablets of 60 mg, containing menthol and menthol ester of isovalerianic acid. 69. Prescribe a benzodiazepine anxiolytic with euhypnotic effect in tablets of 5 mg (zolpidem, nitrazepam, phenobarbital). 70. Prescribe a benzodiazepine anxiolytic in dragees of 5 mg (flumazenil, buspirone, diazepam). 71. Prescribe an antiepileptic preparation in tablets of 200 mg which is also effective in the condition of neuralgia of nervus trigeminus (paracetamol, carbamazepine, phenytoin).

72. Prescribe in ampoules of 5 mg/1 ml an antipsychotic preparation from the group of butyrophenones which is used overcome a psychomotor excitation. 73. Prescribe a preparation used in the case of an anginal attack (nebivolol, nifedipine, nitroglycerin). 74. Prescribe in the form of dragees of 25 mg an adenosine-preserving coronary dilator which also has anti-aggregating activity (ticlopidine, dipyridamol, pindolol). 75. Prescribe an antihypertensive drug in tablets of 5 mg, blocking angiotensine I-converting enzyme (enalapril, nitrendipine, prazosin). 76. Prescribe a combined antihypertensive preparation in tablets, containing chlophazolin and saluretin. 77. Prescribe calcium antagonist, improving brain circulation, in tablets of 30 mg (Naftidrofuryl, Pentoxyphyllin, Nimodipine). 78. Prescribe selective antagonist of 5-HT1D-receptors in film-coated tablets of 50 mg, used for treatment of migraine (sumatriptan, ergotamine, sodium valproate). 79. Prescribe an antianaemic drug in film-coated tablets of 325 mg (venofer, cyanocobalamine, hemofer prolongatum). 80. Prescribe a combined drug with capillary tonic activity (peflavit C, acenocoumarol, etamsilat). 81. Prescribe a drug in ampoules, containing factor IV in blood clotting. 82. Prescribe a haemostatic drug in ampoules of 1% 5 ml for the treatment of bleeding associated with activated fibrinolysis (PAMBA, heparin, alteplase). 83. Prescribe a drug for local treatment which has haemostatic and antiseptic activity (Gelaspon, Solutio Hydrogenium peroxydi diluta, Phytomenandion). 84. Prescribe antiasthmatic drug, which inhibits phosphodiesterase, in ampoules of 2,4% 10 ml for intravenous application (Salbutamol, Ketotifen, Aminophylline). 85. Prescribe in capsules of 20 mg antisecretory agent from the class of proton-pump inhibitors, used for the treatment of peptic ulcer (Omeprazole, Ranitidine, Misoprostol). 86. Prescribe in tablets of 8 mg an antiemetic drug, which is a selective antagonist of 5-HT3-receptors (Metoclopramide, Scopolamine, Ondansetron). 87. Prescribe a drug containing pancreatic enzymes with moderate lipolytic activity (acarbose, mesym forte 3500, pancytrate 25000). 88. Prescribe glucocorticoide drug in dry ampoules of 20 mg for treatment of anaphylactic shock (adrenaline, methylprednisolone, prednisone). 89. Prescribe a hormonal contraceptive drug for oral application (nonoxinol, cilest, sildenafil). 90. Prescribe insulin preparation, suitable for treatment of hyperglycemic coma (Humulin R, Humulin N, Humulin L). Head of Dept. Pharmacology and Toxicology:

Prof. N. Boyadjieva, MD, DSci

CURRICULUM

IN THE SUBJECT OF: PHYSIOLOGY INCLUDED IN THE LEARNING SYLLABUS OF SPECIALTY: „DENTAL MEDICINE" DEGREE OF STUDY: „MASTER" COURSE DURATION: TWO SEMESTERS EVALUATION FORMS: SEMESTER EXAMINATION, PRACTI -CAL EXAM, TESTS, ORAL EXAMINATIONS, PRACTICAL TOPIC EXAMINATIONS. SEMESTER EXAMINATION: YES FORMS AND METHODS OF EDUCATION: LECTURES, LABORATORY PRACTICAL TOPICS CREDITS (ECTS): 7.6 LEADING INSTRUCTOR: PROF. DOCTOR R. GIRCHEV, DSCI DEPARTMENT: PHYSIOLOGY

ANNOTATION: The learning plan in the course is constructed of 90 academic hours of

practical topics, and 60 academic hours of lectures, for the second and third semester of study.

The objectives of learning physiology are for students to acquire in detail basic knowledge about

the main physiological processes in the organism and their regulation. Students get acquainted

thoroughly with the functions of main organs and systems of the body during lectures. In

laboratories, students work independently and perform experimental practical tasks, using

modern devices. The results from experiments are being discussed and recorded in protocols.

DESCRIPTION OF THE COURSE: The course of learning consists of 150 academic hours,

distributed as follows: > Lectures: 60 hours; > Practical laboratory topics: 90 hours.

Student examination is performed according to the Law for Academic Education and the

interior regulations of the Medical University of Sofia. Students are being assessed in laboratory

practical topics throughout the academic year, and get an average score out of their scores in

laboratories and double the scores they get in 4 preliminary examinations throughout the year.

There are two preliminary examinations in the winter semester - one covering the unit on

"Excitable tissues, synapses and muscles", and the other - on "Cardiovascular system".

Preliminary examinations in the summer semester are also two - "Excretory system, body fluids

and acid-base balance" and on "Sensory systems". Preliminary examinations include a test in the

MCQs format and a practical task performance.

The year exam in physiology for students in dental medicine includes the following:

• A test containing 25 questions from different units of medical physiology, duration of the test: 30 minutes.

• Practical examination with two tasks: it is done in the department immediately after the test.

• Theoretical examination with three topics from different units, the third one being written by the examinee.

Forming the score is complex via:

> Assessment of student involvement throughout the course;

> Assessment of the knowledge and practical skills students demonstrate in the

preliminary examinations;

> Assessment in test examinations;

> Assessment of practical skills of students;

> Examination result in the exam session.

The exam is being conducted by a board of examiners who are being drawn lots for on the day of

the examination and the board of examiners consists of at least two instructors having academic

rank.

TEACHING RESOURCES: The department possesses a wide range of educational resources

to illustrate the material being taught:

> Slides;

> Teaching boards for illustration and visualizing;

> Multimedia slide projector;

> Computer programs for interactive learning;

> Educational films on digital media;

> Demonstration and simulation software;

> Materials for distance learning, presented on the website of the department of

physiology.

Various medical, laboratory and experimental technical devices are used during teaching

sessions to record and analyze basic body functions. Experiments and demonstrations are

conducted on laboratory animals and on volunteering persons. Records of basic vital functions

are analyzed and calculation tasks are worked on.

STUDY PLAN PURPOSE: The program has the purpose of making students thoroughly

acquainted with the basic physiological processes in the body and their physiological

regulation.

OBJECTIVES OF THE CURRICULUM:

To shape the essential for the dental medic:

> fundamental theoretical knowledge;

> practical skills;

> analytical capability;

> handiness

BACKGROUND REQUIREMENTS: In order for students to start this learning course in

physiology, it is necessary that they have basic knowledge in biology, chemistry, physics and

anatomy.

EXPECTED RESULTS: After completing the educational course in physiology, students are

expected to have gained detailed theoretical knowledge about body functioning and regulation of

basic vital processes in the organism, to be able to work with the most frequently used medical

devices, to analyze and interpret the received data, to be acquainted with basic clinical

parameters and biological constants, and their diagnostic significance.

Synopsis for the Final Exam in Physiology for Students in Dental Medicine

1. Major principles of control in the body: homeostasis. Cell membrane: structural and functional characteristics. 2. Transport across the cellular membrane. Passive transport: diffusion, osmosis. Active transport across the cellular membrane: primary and secondary active transport. Exocytosis and endocytosis. Transport across epithelial cell layers. 3. Mechanisms for intercellular communication: membrane and cellular receptors. G- proteins. Secondary messengers. Protein kinases. 4. Transmembrane potential. Electrochemical gradient, equilibrium potential. 5. Excitable cell membranes: voltage-gated and ligand-gated channels. Local response. Action potential: ion mechanisms. 6. Excitability. Refractory periods. Propagation of action potentials along the different types of nerve fibers. 7. Synapses. Chemical and electrical synapses. Neurotransmitter release by the presynaptic terminal. Postsynaptic potentials: types and chatacteristics. 8. Postsynaptic membrane receptors: ionotropic and metabotropic receptors. Mechanism of action. 9. Neuro transmitter s. Low molecular neurotransmitters and neuropeptides. 10. Functional morphology of skeletal muscle. Mechanism of muscle contraction. Excitationcontraction coupling in the skeletal muscle. 11. Types of muscle contraction. Motor unit. Regulation of the force of muscle contraction. Electromyography. Length-tension and force-velocity relationship in the skeletal muscle.Energy metabolism of muscle contraction. Muscle fatigue. 12. Smooth muscle: morphological and functional characteristics. Mechanism of smooth muscle contraction. 13. Blood: functions and properties. Blood plasma. Plasma proteins. 14. Red blood cells: number, production and functions. Hemoglobin. Iron metabolism. Hemopoiesis. Erythropoietin: secretion, mechanism of action and effects. Hemolysis. 15. White blood cells: number, types and leukocyte formula. Origin and site of production of leukocytes. Functions of the different types of leukocytes. Functions of the spleen. The lymph: composition and generation. 16. Hemostasis: phases. Platelets. Coagulation phase of hemostasis. Intrinsic and extrinsic pathway for prothrombin activator generation. Fibrinolytic system. Physiological inhibitors of blood coagulation. Anticoagulants. 17. Blood types. ABO-system. Agglutination. Rh-system. Blood typing. Hemotransfusion. 18. Immunity. Innate and acquired immunity. Types of acquired immunity: humoral and cell-mediated immunity. 19. Functional morphology of the cardiac muscle. Cardiac action potentials. Refractory periods. Cardiac automaticity. Conduction of the action potential in cardiac muscle. Premature beats. Excitationcontraction coupling in the cardiomyocytes: role of Ca2+Myocardial contractility . 20. Electrocardiography. Generation of ECG. Normal ECG. 21. Cardiac cycle. Functions of the cardiac valves. Heart sounds. Pressure-volume relationship in the ventricles during the cardiac cycle. Myocardial metabolism and oxygen consumption. 22. Heart sounds. Auscultation. Stroke volume and cardiac output. Factors, which determine stroke volume and cardiac output. 23. Intracardial regulation of cardiac performance. Autoregulation in response to changes in preload and afterload. Extracardial regulation of cardiac performance: neural and humoral

regulation. 24. Functional morphology of the circulation and blood distribution. Hemodynamic principles. Factors, which determine blood flow. Linear velocity and blood flow. 25. Blood pressure in the circulation. Factors, which determine arterial pressure. Arterial pressure. Pressure and blood flow in veins. 26. Microcirculation. Transport across the capillary wall. Control of microcirculation. 27. Regulation of circulation: medullary cardiovascular center. Arterial baroreceptor, volume receptor and chemoreceptor role in the reflex control of circulation. Supramedullary regulation. Regulation of vascular tone. 28. Short-term and long-term mechanisms of arterial pressure regulation. 29. Special circulations: pulmonal, cerebral, myocardial and splanchnic circulation. Typical characteristics of the circulation in the facial region and in the oral cavity. 30. Respiration. Structure and function of the respiratory system. Function of the airways. 31. Pulmonary ventilation. Mechanisms of inspiration and exhalation. Pulmonary volumes and capacities. Respiratory minute volume and alveolar ventilation. 32. Elastic and non-elastic resistance to breathing. Factors, which determine the resistance of breathing. Control of bronchial tone. Work of breathing. 33. Gas exchange in the body. Composition of the inspired, alveolar and exhaled air. Gas diffusion through the respiratory membrane. 34. Exchange and transport of oxygen. Oxyhemoglobin dissociation curve. Oxygen consumption. Exchange and transport of carbon dioxide. 35. Regulation of respiration. 36. Structure and functions of the digestive system. Regulation of digestion: typical characteristics; neural and humoral control mechanisms. 37. Chewing. Cycles and periods of mastication. Control of mastication. 38. Deglutition. Deglutition phases. Neural regulation. 39. Motor activity of the stomach, small intestine and colon. Regulation. Vomitus. Defecation. 40. Production, composition and functions of saliva. Control of salivary secretion. 41. Role of saliva in teeth mineralization. Salivary effect on the microflora in the oral cavity. 42. Gastric and pancreatic juice: volume, composition and regulation of the secretion. 43. Bile and intestinal secretion: volume, composition and regulation of the secretion. 44. Digestion and absorption of carbohydrates, lipids and proteins. 45. Absorption of electrolytes, water and vitamins in the gastrointestinal tract. Regulation of intestinal absorption 46. Liver functions. 47. Carbohydrate metabolism. Control of blood glucose level. 48. Protein metabolism. Regulation of protein metabolism. 49. Lipid metabolism. Regulation of lipid metabolism. 50. Energy metabolism. Basal metabolism and energy output in different physiological conditions. Physiological standards for nutrition and energy balance. Physiological standards for protein, carbohydrate and lipid intake. 51. Vitamins: physiological significance and sources. Minerals (macro- and micro-): physiological significance. 52. Thermal regulation. Body temperature and thermal balance. Mechanisms of thermal regulation. Fever. 53. Functional morphology. Glomerular filtration. Tubular function. Transport in the proximal tubule, in Henle’s loop, and in the distal and collecting tubules. 54. Concentration and dilution of urine. Volume and composition of urine. Excretion of exogenous substances. Regulation of renal functions: intrinsic renal control mechanisms, hormonal and neural regulation. 55. Physiology of the skin. 56. Volume and composition of body fluids. Water balance in the body. Major electrolytes in the body: physiological significance and balance. Regulation of fluid- electrolyte homeostasis. 57. Acid-base balance in the body: major mechanisms. 58. Hormones: classification and mechanism of action. General principles of regulation of

hormonal secretion. 59. Hypothalamo-hypophyseal system. Neurosecretion. Neurohypophyseal and adenohypophyseal hormones: physiological effects and regulation of the secretion. 60. Control of calcium-phosphate balance. 61. Calcium-phosphate balance in the teeth: typical characteristics. 62. Thyroid hormones: mechanism of action, physiological effects and control of their secretion. 63. Endocrine pancreas. Pancreatic hormones: physiological effects and control of their secretion. 64. Adrenal glands. Glucocorticoids, mineralcorticoids and adrenal androgens: physiological effects, mechanism of action and control of their secretion. Adrenal medullary hormones. Sympatho-adrenal system. Stress reactions. 65. Male reproductive function. Testicular hormonal function. Control of hormonal secretion. 66. Female reproductive function. Ovarian hormonal function. Menstrual cycle. 67. Body changes during pregnancy. Childbirth. Lactation. 68. General overview of the nervous system functions. Physiology of the neuron: types of neurons. Axonal transport. Amplitude and frequency encoding of information. Glia and glial role in nervous system functioning. 69. Reflex activity of the nervous system. Neural networks. Inhibition in the central nervous system. 70. Sensory systems. Receptors, receptor potentials. Receptive fields. Encoding of information in sensory systems. Cortical sensory system representation. 71. Somatosensory system. Mechanoreceptors. Thermoreceptors. Nociceptors. Afferent pathways and central processing of information. Physiology of pain. Primary and secondary pain. Visceral pain. Antinociceptive system. 72. Somatic sensations in the facial region and in the oral cavity: typical characteristics. Receptors in the periodontal ligaments and in the muscles of mastication. Tooth pain. 73. Auditory system. Outer and inner hair cells. Sound transduction. Central processing of auditory information. Encoding of frequency, loudness and localization of the sound. 74. Optic system of the eye. Image formation. Accommodation. Refraction abnormalities. Visual acuity. Visual receptors. Light transduction. 75. Organization of the retinal neural network. Light adaptation. Central processing of visual information. Color vision. Eye movements and binocular vision. 76. Olfactory sensory system. 77. Gustatory sensory system. 78. Control of movement: general overview. Spinal control of movement. Myotatic reflex. Inverse myotatic reflex. Flexor reflex. Upper and lower motor neuron. 79. Vestibulary apparatus. Functions of the maculae and semicircular canals. Brein stem control of movement. Regulation of muscle tone. Control of posture. Decerebration and decortication rigidity. 80. Motor functions of the cerebral cortex. Cerebellar and basal ganglia control of movement. 81. Bioelectrical brain activity. Origin and characteristics of the electroencephalogram. Reticular formation: descending and ascending effects. Reticular activating system. Sleep and awake state. Types of sleep. Physiology of sleep. Control of the sleep-wake cycle. Biological rhythms. 82. Autonomic nervous system. Characteristics of the sympathetic and parasympathetic division. 83. Autonomic effects on the activity of different organs and systems. 84. Centers, which control autonomic functions. Physiology of the hypothalamus. Autonomic reflexes. Limbic system. Physiological basis of emotions and motivations. 85. Cerebral cortex: physiological characteristics. Physiology of the frontal and parietal lobe. Cerebral cortical plasticity. Lateralization of cerebral functions. Neurophysiological basis of learning, memory, thinking and consciousness. Neurophysiological basis of language and human behavior. 86. Physiology of exercise. Changes in the cardiovascular system and in the respiratory

system during exercise. Oxygen debt. Changes in the volume and composition of body fluids, in thermal regulation and hormonal profile during exercise. 87. Changes in the body in response to hypobaric and hyperbaric conditions; to acceleration and weightlessness.

Synopsis

Practical exam in physiology for students of dental medicine

1. Blood type testing 2. Hemoglobin concentration measurement 3. Calculation of erythrocyte indices 4. Blood pressure measurement 5. Auscultation and analysis of a phonocardiogram 6. Left ventricular systole analysis by means of a simultaneous recording of a sphygmogram, phonocardiogram and electrocardiogram 7. Calculation of pulse wave conduction velocity 8. Recording and analysis of an electrocardiogram 9. Spirogram analysis: calculation of tidal volume, inspiratory reserve volume, expiratory reserve volume and vital capacity. Calculation of actual vital capacity as a % from its reference value 10. Spirogram analysis: calculation of tidal volume, tidal rate, minute lung volume and alveolar ventilation. Calculation of actual minute lung volume and alveolar ventilation as % from their reference values 11. Spirogram analysis: calculation of the Tiffeneau index 12. Calculation of metabolic rate on the basis of expiratory air composition and minute lung volume 13. Calculation of basal metabolic rate 14. Evaluation of a daily menu according to the principles of balanced nutrition 15. Reflex testing 16. Testing the pupillary reflex to light 17. Testing the pupillary reflex in accommodation. Convergence testing 18. Estimation of visual acuity 19. Perimetry 20. Color vision estimation 21. Audiometry 22. Esthesiometry 23. Calculation and clinical significance of the clearances of inulin, creatinine and urea 24. Calculation of renal plasma and blood flow 25. Calculation of renal transport maximum of glucose 26. Calculation of plasma and blood volume 27. Calculation of sodium balance 28. Problems from acid-base balance

NO TOPIC Hours

WINTER SEMESTER 1. The subject of physiology. The role of physiology in medicine. Homeostasis.

Feedback. Transmembrane transport. Ion channels. Resting transmembrane potential

2

2. Action potential. Conduction of excitation along the nervous fibres. Changes in excitability during excitation.

2

3. Synapses. Main neutrotransmitter substances. 2 4. Physiology of striated muscle. Functional morphology. Mechanism of muscle

contraction of smooth muscles and skeletal muscles. 2

5. The heart. Specialized excitatory and conductive system of the heart. Cardiac cycle

2

6. Regulation of cardiac performance. Hemodynamics. Pressure in the circulatory system.

2

7. Systemic circulation. Microcirculation. The lymph. Blood flow in the veins. Circulation characteristics in different regions of the body - oral cavity and dental pulp, myocardium, brain, alimentary tract, lungs.

2

8. Blood. Erythrocytes, hemoglobin, erythropoiesis. White blood cells. Immunity. Hemostasis. Blood types.

2

9. Respiration. Mechanics of respiration. Lung volumes and capacities. 2

10. Gas exchange Transport of 02 and C02. Regulation of respiration. 2

11. Digestion. Motor function of the alimentary tract. Secretion of saliva. Gastric secretion

2

12. Pancreatic secretion. Intestinal secretion. Digestion and absorption in the gastrointestinal tract.

2

13. Renal functions. Glomerular filtration rate. Tubular functions. Resorption and secretion of organic substances.

2

14. Electrolyte and water transport in renal tubules. Regulation of renal functions. Endocrine function of kidneys.

2

15. Acid-base balance. Body fluids. Regulation of electrolyte and water balance.

2

SUMMER SEMESTER

16. Physiology of the neuron. Neuronal networks Reflex activity of the nervous system. Sensory systems. Receptors. Sensory information processing.

2

17. Somatic sensory system. 2

18. Gustatory and olfactory system functions. 2

19. Audition. The vestibular system. 2

20. Visual system. 2

21. General characteristics of the system of regulation of motor activity. Spinal, brainstem, cerebellar and cortical mechanisms of motor control.

2

22. Specifications of sensory and motor functions in the facial, maxillary and mandibular region.

2

23. Reticular formation. Physiology of sleep. 2

24. Autonomic nervous system. Hypothalamus. Stress reactions. 2

25. Mechanisms of endocrine control. Pituitary gland. Hormones of the neurohypophysis. Adenohypophysis.

2

26. Adrenal cortex. Thyroid gland. 2

27. Endocrine function of the pancreas. 2

28. Regulation of calcium and phosphate exchange. 2

29. Reproductive system. 2

30. Energy balance and temperature regulation. 2

- PRACTICAL LABORATORY TOPICS: N9 TOPIC Number

of hours

1. Winter semester Introduction. Transport across cellular membranes.

3

2. Transmembrane potential. Electrochemical gradient. Excitable cells. Potential-gated and ligand-gated ion channels.

3

3. Physiology of the peripheral nerve. 3

4. Measurement of the conduction velocity of action potential propagation along the peripheral nerve in humans. Physiology of the synapse.

3

5. Types of contraction in striated (skeletal) muscle. 3

6. Muscle fatigue. Electromyography. Smooth muscle. Test with mcos on excitable cells 3

7. Cardiomechanogram. Conductive system of the heart. Premature beats. Regulation of cardiac performance.

3

8. Auscultation of the acoustic events, which are generated during the cardiac cycle. Measurement of arterial pressure.

3

9. Electrocardiography. 3

10. Phase analysis of left ventricular systole. Measurement of pulse wave velocity. 3

11. Functional tests for the cardiovascular system. 3

12. Seminar on cardiovascular system. 3

13. Preliminary examination on cardiovascular system . Oral examination and a mcqs test

3

14. Daily nutritional regimen. 3

15. Review of the practical topics during the winter semester 3

16. Summer semester. Blood cell count. Hematocrit. 3

17. Measurement of hemoglobin concentration. Erythrocyte indices. Blood types. Hemolysis. Blood coagulation.

3

18. Lung volumes and capacities. Spirometry. 3

19. Airway resistance in breathing. Flow/volume curves. Control of respiration. 3

20. Measurement of gas exchange and energy expenditure. Basal metabolic rate 3

21. Clearance methods for assessment of renal function 3

22. Body fluids. Renal regulation of the volume and composition of body fluids 3

23. Acid-basf, balance in the body. Preliminary examination oh renal physiology, body fluids and acid-base balance (written test)

3

24. Visual acuity. Pupillary reflexes. Eye movements. 3

25. Color vision. Visual field. Electroretinography. 3

26. Auditory system. Somatosensory system. 3

27. Preliminary examination oh sensory systems (written test and examination of practical skills).

3

28. Physiology of the nervous system. Electroencephalography.. 3

29. Physiology of the endocrine system. 3

30. Review of the practical topics during summer semester. 3

MEDICAL UNIVERSITY, SOFIA FACULTY OF DENTAL MEDICINE

DEPARTMENT OF PEDIATRIC DENTAL MEDICINE

SYLLABUS

Name of discipline: “Propaedeutics of pediatric dentistry” or “Oral

embryology, histology and biology”

Degree: Master Kind of discipline: Obligate Course Length: Two semesters – IV and V Course level – M Form of assessment: Continuous assessment, tests, colloquia, practical exam Forms and methods of training: Lectures, seminars, microscopic observation, drawing of observed elements. Terminal exam: Yes - V semester Prof: Yes Department: Pediatric dental medicine

1

Annotation:

Course in “Oral embryology, histology and biology” provides opportunity to acquire a basic knowledge about oral embryology, histology and biology, the development of teeth, eruption and shedding of the teeth, abnormalities in the morphology and physiology of the dental structures, oral physiology, oral ecosystem and oral defense mechanisms in childhood.

This knowledge are form the basis for the acquisition of competence to organize and implementation of prevention of oral diseases, and correct choice of treatment methods.

Course description: The course consists 60 academic hours:

- 30 hours of lectures; - 30 hours of exercises.

Evaluation of the knowledge: Formed by the average current rating, assessment of the colloquium, assessment of the practical test, and assessment of the theory exam. Aspects of assessment:

- Participation in discussions; - Tests; - Description of microscopic preparations; - Result of exam.

Aids in teaching: Multimedia presentation, schemes, tests, microscopic preparations.

Purpose of the curriculum: Adoption of detailed basic knowledge of embryology, morphology and physiology of the oral structures and oral physiological processes.

Tasks of the program:

1. To obtain basic knowledge in embryology of the oral structures; 2. To obtain basic knowledge in morphology of the oral structures; 3. To obtain basic knowledge in physiology of the oral structures; 4. To know the dynamics of development of the temporary and permanent teeth; 5. To know the anatomical and physiological differences between temporary and

permanent teeth; 6. Be aware of anomalies in tooth development; 7. To know the composition of oral liquid physiological content and its role in the oral

physiology; 8. To know the genesis of the oral ecosystem and dynamics of the childhood; 9. To know the basic oral defense mechanisms;

Prerequisites: Basic knowledge of anatomy, histology and physiology.

Expected results:

1. To know all the processes taking place in every stages of the oral embryology; 2. Be aware of the microscop slide and describe each stage of the oral embryology; 3. To have a detailed knowledge of the morphology of oral structures; 4. To have a detailed knowledge of the fisiology of oral structures;

2

5. To know the terms in the dynamics of the dentition 6. To know the causes and mechanisms for the occurrence of abnormal development of

teeth; 7. To know the composition and the role of the saliva and characteristics in childhood 8. To know the mechanisms and dynamics in the formation of the oral ecosystem; 9. To know the protective oral mechanisms and characteristics of child immunity.

3

SYLLABUS FOR THE EXAM

QUESTIONS FOR ORAL EXAMINATION

1. Development of the oral facial region – development of human tissues and neurulation.

2. Development of the oropharinx, pharengeal arches, face and palate.. 3. Dental germ – arising of the teeth. Stage of development and elements of dental germ. 4. Physiologycal stages in dental germ`s development.Characteristic. 5. Morphologycal stages in dental development. Characteristic. 6. Amelogenesis. Stages of development. 7. Enamel matrix deposition and content. Ameloblast`s functions. 8. Morphologycal features of enamel, chemical composition and permeability. 9. Dentinogenesis. 10. Morphologycal features of dentin. Dentin clasification. 11. Structural organization and histology of the pulp. 12. Functions and fisiologycal mechanisms of the pulp. 13. Chemical composition and function of cementum. Cemental repair and aging

characteristics. 14. Histogenesis of the periodontium, organizacion and functions of the periodontal

ligaments. 15. Histogenesis and structure of oral mucosa. 16. Histogenesis, structure and physiology of the gingiva. Periodont. Characteristics in

cildhood. 17. Physiologycal characteristics and function of the oral mucosa in cildhood. 18. Dinamics of dental development. Chronology and stages of development of the

primary and permanent dentition. 19. Eruption and sheding of the teeth. Phases of development and tissue changes. 20. Possible factors influencing the process of tooth eruption. 21. Resorptive process of primary teeth. Stages, organ of root resorption and pulp

degeneration. 22. Humann dental dentitions. Theories about the formation of various dental groups.

Evolution of the dentition. 23. Comparisons of the primary and permanent dentitions. 24. Morpfologic and physiologic differences between primary and permanent teeth. 25. Abnormalities in shape and size of teeth. Syndromes causing these anomalies. 26. Developmental disturbances in the structure of the teeth - dental dysplasia - risk

factors, types of structural abnormalities, pathogenesis, classification and distribution. 27. Oral biological system. Characterization and interaction between elements of oral

biological system. 28. Types and composition of saliva. 29. Physiology of the saliva - digestive function, buffering capacity, oral cleaning.

Relationships with oral microflora. 30. Physiology of the saliva - role of salivary proteins. Saliva and mineral homeostasis. 31. Oral ecology. Resident oral microflora - characteristics of oral microorganisms. 32. Planktonic organisms and oral biofilms - formation and importance in oral ecosystem. 33. Protective factors of macro-organisms to maintain oral eubioza 34. Bacterial and exogenous factors to maintain oral eubioza 35. Protective properties of saliva in the oral environment. Secretory immunity. 36. Oral immunity - relevance to oral pathology. Protective mechanisms in the mouth. 37. Protective mechanisms of dental caries, periodontal diseases and diseases of the oral

mucosa 38. Immunological reactions involved in the pathogenesis of oral diseases

4

QUESTIONS FOR WRITTEN EXAM

1. Ontogenetic development of the oral facial region, period and,stages of prenatal development.

2. Development of the nose, nasal cavity, palate and tongue. Ossification of the maxillofacial bones. Defects in development.

3. Characteristics of the enamel organ. Disintegration of gubernaculum dentis..

Formation of the cervical loop.

4. Determining the shape of the crown. Formation of enamel knot, enamel cord, and enamel niche

5. Mineralization of enamel matrix. Theories of mineralizationof enamel.

6. Permeability of dentin. Theoies of dentin sensitivity

7. Vascularity and nerve supply of the dental pulp.

8. Development of cementum. Types of cementum on the root dentin surface.

9. Alveolar process – alveolar bone proper and supporting bone. Development, structure,

remodeling and reorganization.

10. Types of oral mucosa.Location and characteristics of each type of mucosa. Specialized mucosa of the tongue.

11. Theories of tooth eruption. Regularities of tooth eruption.

12. Development of a tooth root. Stages of root development.

13. Liquid oral environment. Salivary secretory system - characteristic of the salivary glands. Secretory mechanism and control.

14. Gingival fluid – characteristics, role in physiology and pathology of periodontium.

15. Physico-chemical factors in maintaining of oral eubioza

16. Immunity and oral biological system. Nonspecific, specific immunity and immune

tolerance

17. Development of the immune system in childhood. Development of oral immunity. 5

LECTURE PROGRAM OF THE COURSE:

„ORAL EMBRYOLOGY, HISTOLOGY AND BIOLOGY”

SECOND COURSE, 4 SEMESTER Workload: 15 h lectures 6 lectures of 2 hours and 1 lecture of 3 hours

I lecture – 2 h Ontogenetic development of the maxillofacial region II lecture – 2 h Tooth germ - the tooth germ elements and stages of development III lecture – 2 h Amelogenesis , morphology and physiology of tooth enamel. Theories of mineralization. Specific characteristics for temporary and permanent teeth IV lecture – 2 h Dentinogenesis, morphology and physiology of dentin. Specifications for temporary and permanent teeth V lectures – 2 h Histogenesis, morphology and physiology of the dental pulp. Specifications for temporary and permanent teeth. VI lecture – 2 h Histogenesis, morphology and physiology of the cementum. Specifications for temporary and permanent teeth. VII lecture – 3 h Histogenesis, morphology and physiology of the periodontium. Specifications for temporary and permanent teeth. 6

LECTURE PROGRAM OF THE COURSE:

„ORAL EMBRYOLOGY, HISTOLOGY AND BIOLOGY”

III COURSE, 5 SEMESTER Workload: 15 h lectures 6 lectures of 2 hours and 1 lecture of 3 hours

I lecture – 2 h

Histogenesis, morphology and physiology of gingival and oral mucosa. Features in childhood.

II lecture – 2 h

Dinamics of the dental development of temporary and permanent dentition - milestones and deadlines. III lecture – 2 h

Anatomical and physiological characteristics of temporary and permanent teeth

IV lecture – 2 h

Dental dysplasia - etiology, pathogenesis and classification

V lecture – 2 h

Liquid oral environment – composition and role in the physiology of the mouth

VI lecture – 2 h

Oral ecosystem - origin and dynamics in childhood

VII lecture – 3 h

Characteristics in the children's immunity. Defance mechanisms in the mouth.

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EXERCISE PROGRAM II COURSE, IV SEMESTER

15 exercises 6 exercises of 2 h and 1 of 3 h I exercise – 2 h

Ontogenetic development of the maxillofacial region

I I exercise – 2 h

Tooth germ - the tooth germ elements and stages of development

III exercise – 2 h Amelogenesis and morphology of dental enamel. Physiology of tooth enamel. Theories of mineralization. Specific characteristics for temporary and permanent teeth.

IV exercise – 2 h Dentinogenesis, morphology and physiology of dentin. Specifications for temporary and permanent teeth V exercise – 2 h Histogenesis, morphology and physiology of the dental pulp. Specifications for temporary and permanent teeth. VI exercise – 2 h Histogenesis, morphology and physiology of the cementum. Specifications for temporary and permanent teeth. VII exercise – 3 h Histogenesis, morphology and physiology of the periodontium. Specifications for temporary and permanent teeth.

8

Recommended reading

Nanci A. Ten Cate`s Oral Histology, Development, structure, and Function. Sixth Edition, Mosby, 2003

Garant P.R. Oral Cells and Tissues, Quintessence Publishing Co, Inc, 2003

Avery J, D. Chiego, Wssential of Oral Histology and Embryology: A clinical Approach, Mosby, 3 Edition, 2005

- .Jenkins.H.N. The physiology and biochemistry of the mouth,

-Schroeder,H. Differentiation of human oral stratified epithelia,Basel -1981

-Squier,C.A.,J.Meyer,Current concepts of the histology of oral mucosa,1971

-Stack,M.V.,R.W.Feaenhead.Tooth enamel;its composition, properties and fundamental structure,1965,Bristol

-Symons,N.B.Dentin and pulp;Their structure and reaction,1968,Lindon

-Vincent,D.,Provenza et all.Oral histology;Inheritance and development,1964

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EXERCISE PROGRAM III KURS, V SEMESTER

15 exercises 6 exercises of 2 h and 1 of 3 h I exercise – 2 h

Histogenesis, morphology and physiology of oral mucosa.

II exercise – 2 h

Histogenesis, morphology and physiology of gingiva and periodontium.

III exercise – 2 h

Dinamics of the dental development of temporary and permanent dentition and periradicular structures.

IV exercise – 2 h

Anatomical and physiological characteristics of temporary and permanent teeth

V exercise – 2 h

Dental dysplasia - etiology, pathogenesis and classification

VI exercise – 2 h

Liquid oral environment – composition and role in the physiology of the mouth

VII exercise – 3 h

Oral ecosystem - origin and dynamics in childhood. Oral immunity.

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MEDICAL UNIVERSITY – SOFIA FACULTY OF DENTAL MEDICINE

CURRICULUM

Discipline denomination: Propaedeutics of Prosthetic Dental Medicine Educational degree: Master Discipline category: Mandatory Course duration: 4 /four/ semesters: I, II, III and IV Course level: Level M /master level/ Forms of evaluation: Current grades, grades from seminars, grades from practical and theoretical exam. What educational forms and methods are utilized in the course: Lectures, demonstrations, seminars, practical exercises Semester exams: Including both practical and theoretical exam at the end of the IV semester LEADING LECTURERS: Associate Professor Dr Julia Kamenova, DDM; Associate Professor Dr Bozhidar Jordanov, DDM DEPARTMENT: Prosthetic dental medicine

COURSE ANNOTATION: The course in Propaedeutics of Prosthetic Dental Medicine

presents opportunities for acquiring knowledge in regards to the morphological and

functional characteristics of the masticatoty apparatus, design and fabrication technology of

prosthetic dental appliances. The theoretical basis of the course is developed upon the most

contemporary achievements in the science of dental materials, and in fabrication

technologies of prosthetic dental appliances. In the course of the practical exercises students

individually fabricate the main types of prosthetic dental appliances and acquire

competence, necessary for conducting dental care in the field of prosthodontics in full value.

COURSE DESCRIPTION: The course consists in 315 academic hours, which represent

various types of workload:

• lectures - 75 hours

• practical exercises - 224 hours

• work-seminars – 16 hours

Grade formation:

- Evaluation of students’ activity during the entire course

- Evaluation of the practical work during the entire semester

- Theoretical exam test

- Exam result during the student session

Aspects in forming the grade:

- participation in seminars

- grade on the practical work

- grade on the practical exam

- grade on the theoretical exam – written and oral assignment

EDUCATIONAL ASSISTING MEANS: slide-projection materials, schemes,

demonstration models, study films.

AIM OF THE STUDY PROGRAM: Acquirement of knowledge in regards to the

morphology and physiology of the masticatory apparatus, to the design of prosthetic dental

appliances and their fabrication technology. Mastering practical skills in fabricating the main

types of fixed and removable prosthetic dental appliances.

TASKS OF THE STUDY PROGRAM: 1. Acquirement of theoretical knowledge about the morphology and physiology of the

masticatory apparatus.

2. Acquirement of theoretical knowledge about the classification, design and fabrication

technology of the prosthetic dental appliances.

3. Acquirement of practical skills in fabrication of artificial dental crowns, bridges,

removable partial dentures and complete dentures.

PRELIMINARY REQUIREMENTS

In order to start education in Propaedeutics of Prosthetic Dental Medicine, it is necessary that

students possess basic knowledge on: anatomy and physiology

EXPECTED RESULTS: Upon graduating the course, students should have obtained

knowledge about the anatomy and physiology of the masticatory apparatus. To know in

details the morphology and the occlusal relationships of the teeth. To know the main types of

prosthetic dental appliances, utilized in the treatment of partially and completely edentulous

patients. To master the basic principles of designing the prosthetic dental appliances and to

be able to fabricate them individually.

RECCOMENDED LITERATURE SOURCES: 1. Ralev. R., T. Peev, A. Filchev – “Propaedeutics of Prosthetic Stomatology” (Medical

Faculty, Sofia, 1995.)

2. Ralev. R., A. Filchev – “Propaedeutics of Prosthetic Stomatology” (Medical Faculty,

Sofia, 2008.)

3. Raychinova Ek.; Joncheva Ars. “Practical Manual of Propaedeutics of Prosthetic

Stomatology” (Medical Faculty, Sofia, 1990.)

4. Jordanov B.; Joncheva I. “Practical Manual of Propaedeutics of Prosthetic

Stomatology” (Medical Faculty, Sofia, 2000.)

SUBJECTS OF INDIVIDUAL STUDY: 1. Morphology, structure and functional characteristics of incisors and canines.

2. Morphology, structure and functional characteristics of premolars and molars.

3. Prosthetic treatment with artificial crowns.

4. Prosthetic treatment of partially edentulous arches with dental bridges.

5. Prosthetic treatment of partially edentulous arches with removable prosthetic dental

appliances – removable partial dentures.

6. Planning and designing of cast metal-framework removable partial dentures.

7. Combined reconstruction of partially edentulous cases utilizing fixed and removable

prosthetic appliances.

8. Prosthetic treatment of the completely edentulous patient.

EXAMINATION SYNOPSIS: contains 84 items. Attached copy will be sent to You.

Modules, forming the curriculum of the discipline “Propaedeutics of Prosthetic Dental

Medicine”:

1. Morphology and anatomy of the teeth.

2. Types of mandibular movements and devices for reproduction of these movements.

3. Technology of fixed metal dental appliances.

4. Technology of removable dental appliances.

5. Technology of complete dentures.

FACULTY OF DENTAL MEDICINE - SOFIA DEPARTMENT OF PROSTHETIC DENTAL MEDICINE

LECTURE CURRICILUM ON PROPAEDEUTICS OF PROSTHETIC DENTAL MEDICINE

1st UNIVERSITY YEAR, 1st SEMESTER 15 study weeks with 2 lecture hours on every other week

Week Lecture subjects

1 I. Teeth, plains and surfaces for teeth designation and orientation. Teeth functional groups and dental formulas. Teeth sizes. Markers for teeth identification. Teeth morphology – common features.

3 II. Morphology of permanent incisors and canines.

5 III. Phylogenetic evolution of the masticatory apparatus and the maxillofacial region. Morphology of premolars.

7 IV. Morphology of molars.

9 V. Dental wax modeling techniques. P. K. Thomas wax modeling technique. Anatomical and functional wax modeling of tooth crowns on dental plaster models.

11 VI. Ontogenetic development. Theories on tooth development and eruption. Morphology of deciduous teeth – markers for identification.

13 VII. Functional anatomy of the masticatory apparatus. Oral cavity. Bones of the masticatory apparatus: maxilla and mandibula. Innervation of the masticatory apparatus.

15 VIII. Functional anatomy of the masticatory apparatus. Temporomandibular joint. Function of the muscles of the masticatory apparatus: masticatory and mimic muscles. Salivary glands.

FACULTY OF DENTAL MEDICINE - SOFIA DEPARTMENT OF PROSTHETIC DENTAL MEDICINE

LECTURE CURRICILUM ON PROPAEDEUTICS OF PROSTHETIC DENTAL MEDICINE

1st UNIVERSITY YEAR, 2nd SEMESTER

Week Lecture subjects

1 I. Gnathology and Occlusodontics. Main positions of the mandible. Central occlusion (maximum intercuspation), centric relation, myocentric occlusion. Lateral and anterior occlusion. Occlusal anatomy. II. Waxing technique for modeling tooth crowns in real size.

3 III. Common classification of prosthetic dental appliances. Artificial crowns. Tooth preparation for a complete crown. Impressions and working casts for artificial crowns. Plaster bitelock. IV. Pouring of two-layered plaster master model with removable

dies. Technology of a metal cast crown utilizing polypropylene coping, known as “Adapta” system. Contouring, finishing and polishing of the metal prostheses.

5 VI. Functional-mechanical equilibrium of the parodontium. Muscle forces. Masticatory pressure. Parodontal pressure. VII. Techology of a metal cast crown utilizing wax coping.

7 VII. Biomechanics of the mandibular movements. Basic movements. Theories on mandubular movements. Types of articulators. VIII. Cast post-and-core build-up.

9 IX. Physiologic-functional changes of the masticatory apparatus. Dental attrition, abrasion and erosion. X. Technology of ceromeric and resin crown.

11 XI. Physiologic-functional changes of the masticatory apparatus. Changes in parodontium. Clinical radix and crown. Changes in the temporomandibular joint (TMJ) and the maxillofacial muscles in the course of partial and complete edentulous progression. XII. Combined crowns. Types of metal-acrylic and porcelain fused to metal (PFM) crowns. Technology of metal-acrylic crown with vestibular acrylic esthetic coverage.

13 XIII. Methods for determination of the functional condition of the masticatory apparatus.

XIV. Technology of complete ceramic and PFM crowns.

15 XV. Partial crowns – classification and technology.

FACULTY OF DENTAL MEDICINE – SOFIA DEPARTMENT OF PROSTHETIC DENTAL MEDICINE

PRACTICAL EXERCISES CURRICILUM ON PROPAEDEUTICS

OF PROSTHETIC DENTAL MEDICINE

1st UNIVERSITY YEAR, 1st SEMESTER

15 study weeks with 2 hours of practical exercises = 30 study hours

Week Subjects of practical exercises

1 I. Drawing teeth in triple size - 11/21, 12/22, 13/23, 31/41, 32/42, 33/43.

2 II. Drawing teeth in triple size - 14/24, 15/25, 34/44, 35/45. 3 III. Drawing teeth in triple size - 16/26, 17/27, 36/46, 37/47.

4 IV. Sculpturing of first maxillary permanent incisor. 5 V. Sculpturing of maxillary permanent canine. 6 VI. Sculpturing of mandibular permanent first premolar. 7 VII. Sculpturing of maxillary permanent first molar. 8 VIII. Modeling cone, arch and dash shape on a study plate with

relief templates, utilizing dental wax modeling technique.

9 IX. Recreation of maxillary first premolar on a study plate, utilizing 10

11 X. Preparation and mounting of study plaster models in articulator. Carving teeth 11, 15, 17 and 31, 34, 36 for their following recreation, utilizing dental wax modeling technique.

12 XI. First modeling of teeth 11, 15, 17 и 31, 34, 36, utilizing dental wax modeling technique.

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14 XII. Second modeling of teeth 11, 15, 17 и 31, 34, 36, utilizing dental wax modeling technique.

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PRACTICAL EXERCISES CURRICILUM ON PROPAEDEUTICS

OF PROSTHETIC DENTAL MEDICINE

1st UNIVERSITY YEAR, 2nd SEMESTER

15 study weeks with 4 hours of practical exercises = 60 study hours

Week Subjects of practical exercises 1 I. Prosthetic treatment of tooth crown destruction. Types of artificial

crowns. Mounting of the working models with removable dies in occludator (non-adjustable articulator).

2 II. Technology of cast metal-acrylic crown, utilizing the «Adapta» system on tooth 24.

3 4 III. Technology of cast metal crown, utilizing the «Adapta» system on

tooth 26. 5

6 IV. Technology of cast metal crown, utilizing the wax dipping 7

8 V. Technology of cast metal crown, utilizing the wax dipping 9

10 V. Technology of cast metal crown on tooth 26 and metal-acrylic crown on tooth 24 – contouring, applying the esthetic acrylic coverage, finishing and polishing.

11 VII. Technology of cast metal crowns on teeth 45 and 47 - contouring, finishing and polishing.

12 VIII. Post build-up of dental crowns with severe crown destruction. Cast post-and-core on tooth 21 – preparing, modeling.

13 IX. Post build-up of dental crowns with severe crown destruction. Cast post-and-core on tooth 21 – contouring and adjusting.

14 X. Technology of acrylic crown on tooth 21 - modeling, mold preparation, polymerization of acrylics.

15 XI. Technology of acrylic crown on tooth 21 - contouring, finishing and polishing. Presentation of the semestrial work to the leading lecturer.

DEPARTMENT OF PROSTHETIC DENTAL MEDICINE

LECTURE CURRICILUM ON PROPAEDEUTICS OF OF PROSTHETIC DENTAL MEDICINE

15 study weeks with 2 lecture hours on every weeks = 30 hours

Week Lecture themes

Prosthetic rehabilitation of partially edentulous dentitions by fixed partial dentures

1. I. Bridge prostheses – components, pontic and abutment retainers Technology of mandibular hygienic bridge prosthesis using the Adapta technique.

2. II. Bridge prostheses – classification. Technology of maxillary esthetic bridge with a modified ridge lap pontic using the Adapta technique

3. III. Bridge prostheses – basic principles of construction 4. IV. Types of bridge prostheses. Cantilever bridges. Immediate bridges.

Complex FDPs with non-rigid connectors . Resin retained bridges with selectively opened partial retainers and Maryland retainers. Bridges on implants. Model-cast bridges.

5. V. Technological characteristic and mistakes of bridges fabricated using different technologies

6. VI. Resin-based partial dentures. Components: clasps (wrought, cast and resin). Impression making for partial dentures and pouring of a working cast. Technology of bent clasps (single-arm, two-arm and Jackson clasp)

7. VII. Other components of removable partial dentures: precision attachments, telescope and bar attachments. Connecting elements – connectors. Technology of wire major connectors. Indirect retainers (minor connectors, occlusal rests, Кипмайдери). Mounting casts.

8. VIII. Basic principles of planning and construction of RPD. Construction principles of resin-based partial dentures with wrought clasps. Technology of resin-based RPD in the upper and lower jaw.

9. IX. Construction of the metal framework of RPD. Investing. 10. X. Technology of the metal framework RPD. 11. XI. Technology of immediate RPD. Fixing of broken or damaged RPD 12. XII. Processing errors in the partial denture technique. 13 XIII. Types of partial dentures. Combining RPDs and FDPs in the

prosthetic rehabilitation of the partially edentulous dentition. 14. XIV. Fundamentals of prosthetic splinting – basic principles 15. XV. Technology of fixed and removable splints.


LECTURE CURRICILUM ON PROPAEDEUTICS OF OF PROSTHETIC DENTAL MEDICINE

2nd UNIVERSITY YEAR, IV SEMESTER

15 study weeks with 2 lecture hours on every two weeks

Week Lecture themes:

Prosthetic rehabilitation of totally edentulous patients 1 I. Technology of complete dentures. Impression trays,

impressions and working casts II. Constructing an individual tray

3 III. Pouring of functional working casts, outlining the boundaries and placing reference marks of the complete dentures

IV. Constructing baseplates and occlusal rims. Determining the centric occlusal position of the mandible and placing landmarks?

5 V. Selection of artificial teeth and esthetic aspects of the dentition

VI. Orthognathic arrangement of artificial teeth according to Gysi 7 VII. Esthetic requirements for the arrangement of artificial teeth

for complete dentures. Crossbite, prognathic and progenic arrangement

VIII. Waxing, flasking, polymerization, cleaning and polishing of the complete dentures

9 IX. Types of complete dentures – comparative assessment X. Mistakes in the technology of complete dentures

11 XI. Gnathology – intraoral graphic registration according to

Gerber XII. Occlusal articulation of complete dentures in an adjustable

articulator 13 XIII. Retention and stabilization of complete dentures –

mechanical and biomechanical factors?/means? XIV. Retention and stabilization of complete dentures – physical

and biophysical factors/means 15 XV. Technology of maxillofacial prosthesis


PROGRAM FOR THE WORKSHOPS

IN PRE-CLINICAL PROSTHETIC DENTISTRY

II year, III semester (WINTER) 15 weeks, 6 hours every week = 90 academic hours

Week Lecture themes Fixed Dental Prosthesis (FDP)

1 I. Bridge prostheses. Technology of mandibular hygienic bridge prosthesis using the Adapta technique (34-37). Fabrication of working cast with removable dies, plastic copings, waxing.

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3 II. Bridge prostheses. Technology of maxillary esthetic bridge with a modified ridge lap pontic using the Adapta technique (13-16). Fabrication of working cast with removable dies, plastic copings, waxing.

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5 III. Bridge prostheses. Technology of mandibular hygienic bridge prosthesis using the Adapta technique (34-37). Finishing and polishing

6 IV. Bridge prostheses. Technology of maxillary esthetic bridge with a modified ridge lap pontic using the Adapta technique (13-16). Finishing and polishing

7 V. Bridge prostheses. Technology of maxillary esthetic bridge with a modified ridge lap pontic using the Adapta technique (13-16). Fabrication of resin esthetic veneer.

Removable partial dentures (RPD) 8 VI. Retention and bracing of the RPD’s. Clasps. Fabrication of single

arm wrought clasp. 9 VII. Fabrication of two-arm clasp and Jackson clasp. Fabrication of a

wrought major connector for mandibular RPD. 10 VIII. Technology of the RPD. Fabrication of a shellac record base and

occlusion wax rims. IX. Recording the maxillomandibular relationships. Mounting the casts.

11 X. Technology of the acrylic- based RPD. Selecting prosthetic teeth. Arranging the prosthetic teeth on the upper and lower prosthesis. XI. Waxing and flasking the dentures.

12 XII. Technology of the acrylic-based RPD. Processing acrylic resin. Finishing and polishing of the dentures.

13 XIII. Fabrication of master models by pouring stock tray alginate impression from upper and lower jaws.

14 XIV. Fixing a broken RPD 15 XVI. Planning the design of the metal framework of the RPD.

Combining RPD and FDP. Seminar.


PROGRAM FOR THE WORKSHOPS

IN PRE-CLINICAL PROSTHETIC DENTISTRY

II year, IV semester (summer) 15 weeks, 4 hours weekly = 60 academic hours for the IV semester

Week Lecture themes Prosthetic treatment of the edentulous patient – total prosthesis

1. I. Prosthetic treatment of edentulous patient. Tracing the boundaries. Fabrication of custom tray for upper and lower jaw.

2. II. Fabrication of the record base and occlusal rims for upper and lower jaw. Placing the reference marks on the casts and fixing the centric position. Mounting the casts on an articulator.

3. III. First arrangement of the prosthetic teeth according to Gysi. Arranging the anterior teeth, premolars and molars on the upper complete denture.

4. IV. First arrangement of the prosthetic teeth according to Gysi. Compensating curves and arrangement of the prosthetic teeth on the lower complete denture.

5. V. Second arrangement of the prosthetic teeth according to Gysi. Arranging the anterior teeth, premolars and molars on the upper jaw.

6. VI. Second arrangement of the prosthetic teeth according to Gysi. Compensating curves and arrangement of the prosthetic teeth on the lower complete denture.

7. VII. Third arrangement of the prosthetic teeth according to Gysi on the upper and lower comlete dentures.

8. VIII. Waxing upper and lower total dentures. 9. IX. Flasking the dentures. 10. X. Packing the mold and processing the acrylic resin. 11. XI. Retrieving the dentures from the mold, finishing and polishing of the

complete dentures. 12. XII. Pouring working casts based on an anatomical alginate impression

from one’s own mouth. Fabrication of full palatal acrylic baseplate – waxing and flasking.

13. XIII. Fabrication of a full palatal acrylic baseplate – packing and processing the resin, finishing, intraoral adjustments and polishing.

14. XIV. Adjusting the occlusion of the complete dentures – occlusal principles

15. XV. Presenting the complete dentures and the baseplates to the course director. Identifying natural teeth.

Partially edentulous dentitions/jaws

Fixed partial dentures

Wrought, wire, bent clasps – телени огънати куки

Glossary (according to MacEntee : The Complete Denture – A Clinical

Pathway)(Iwao Hayakawa – Principles and Practices of Complete Dentures):

Complete dentures

Impression trays – отпечатъчни лъжици

Impressions – отпечатъци,

construction of an individual tray

Study casts (working casts)

Master casts

Outlining the boundary

Reference markings

Wax rims (occlusion rims)

Shellac baseplate

Flasking- опаковане на протезите в кювети

Border molding – Кантиране на инд.лъжица



CURRICULUM

Name of the discipline: Social Medicine and Medical Ethics (SMME) Educational degree: Master Type of the discipline: Compulsory Duration of the course: one semester, IV semester Level of the course: Level M (master level) Forms of marking: current marking, assessment on a given task What forms and methods of education are used in the course? – lectures, seminars, discussions, solving casuses, implementation on a given task. Semester examination (yes, no): YES – IV semester LEADING LECTURER: Assoc. Prof. Dr. Kr. Yaneva, DM

Assoc. Prof. Dr. L. Katrova, DM

DEPARTMENT: Dental Public Health (DPH)

ANOTATION OF THE COURSE: SMME course gives an opportunity for gaining theoretical knowledge and competence about: - Public health specific features, its measuring and factors that influence it. - Methods of scientific research. - Moral principles that regulate professional activity of the dental doctor.

DESCRIPTION OF THE COURSE: The course consists of 45 academic hours: - lectures – 15 hours; - seminars and practical exercises – 30 hours; Forming of marks – complex, in two different ways: - giving marks for students’ activity during the course; - examination during the session; Aspects about forming the marks: - taking part in discussions; - assessment on a given task; - solving casuses; - examination result; SUBSIDIARY INSTRUMENTS FOR TEACHING: Multimedia, slides, problems for interpretation.

OBJECTIVE OF THE CURRICULUM: Creating basic knowledge about global problems of public health and their solving as well as abilities for solving ethical conflict situations in professional practice. CURRICULUM TASKS: 1. Creating basic knowledge about modern concept related to health and prevalence. 2. Creating basic knowledge about health social factors, measuring of Public health,

health risk groups, tendencies in development of health condition of particular public groups.

3. Introduction to methods of scientific research – collecting and analyzing literature data, formulating aim, analyzing the results.

4. Forming knowledge about basic principles in medical ethics, standards for good dental practice, requirements in ethical codex of Bulgarian Dental Association, ethical norms in dental medicine as a part of international documents.

5. Acquiring abilities for solving conflicts of moral essence in clinical practice. PRELIMINARY REQUIREMENTS: Not necessary. EXPECTED RESULTS: After completing the course students are supposed to know social aspects of Public health, methods of scientific research and moral principles in medical ethics.

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RECOMMENDED LITERATURE: 1. Социална медицина и Обществено стоматологично здраве. Учебник под ред.

на доц. Цв.Йолов, Мед.и физ.; София, 1999, 104 с. 2. Ново Обществено Здравеопазване. Учебник под ред. на проф.В.Борисов,

доц.Зл.Глутникова, проф.Ц.Воденичаров. АКВАГРАФИКС ООД, София, 1998, 542 с.

3. Воденичаров, Ц., С. Попова, Медицинска етика, Фалкор Консулт, С., 2006. 4. Шипковенска, Е., Какво трябва да знаем, преди да започнем работа върху

дисертационния труд. Здравен мениджмънт, 2004, 4(4). THEMES FOR INDIVIDUAL WORK: Conducting literature on a given topic. EXAMINATION CONSPECTUS:

WRITTEN EXAMINATION: 1. Methods of social medicine. 2. Health as a biosocial phenomenon. Definition, levels of health. 3. Demographic processes. Mechanical movement. 4. Morbidity as a public health index – terminology. 5. Methods of scientific research - defining aim, registration and analysis of data. 6. Methods of scientific research – analysis of the results, writing and presenting.

ORAL EXAMINATION: 1. Subject and tasks of social medicine. 2. Social factors of health. 3. Indexes for individual and public health. 4. Public health – social-health effects. 5. Socio-medical approach in clinical practice. Social history of the disease. 6. Demographic processes – statics of population. 7. Demographic processes – indexes for natural movement of population. 8. Indexes for physical development. Acceleration. 9. Morbidity as a public health index – methods and sources of studying. 10. Morbidity with temporary disability (MTD). Expertise in performance. 11. Socially significant diseases. 12. Medical ethics and bioethics. 13. Medical ethics – principle of informed consent.

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14. Medical ethics – principle of patient’s autonomy. 15. Medical confidentiality, principle of “golden rule”. 16. Medical responsibility, medical error.

SOCIAL MEDICINE AND MEDICAL ETHICS – 15/30

II COURSE – 1:2

LECTURES:

MODUL I: HEALTH AS A BIO-SOCIAL PHENOMENON.

1. Introduction to social medicine. 1. Short history of the discipline. 2. Subject of social medicine. 3. Tasks of social medicine. 4. Methods of social medicine. 5. Teaching aims in social medicine. II. Introduction to methods of scientific research. 1. Defining a problem. 2. Organization of the research. 3. Processing of obtained results. 4. Writing and presenting scientific results. III. Health as a bio-social phenomenon. 1. Definition of health. Three-dimensional nature of health. 2. Health categories. 3. Health social factors and influence mechanisms. IV. Public health indexes. 1. Demographic indexes. 2. Indexes for physical development of population. 3. Acceleration – nature, theories. V. Public health indexes. 1. Morbidity indexes – terminology, sources and methods of its studying. 2. Morbidity with temporary and permanent disability – meaning, indexes. 3. Socially significant diseases.

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MODUL II: MEDICAL ETHICS AND BIOETHICS. VI. Bases of medical ethics and bioethics. 1. Philosophy and sociology of morality - concepts. 2. Deontology. 3. Human rights, patient’s rights, physician’s rights. 4. Medical Ethics and Bioethics, ethical dilemmas. 5. Ethical system of the physician. VII. Basic ethical principles in clinical practice. 1. Principle of informed consent. 2. Principle of patient’s autonomy. 3. Medical confidentiality. 4. Principle of benefit and safety of medical activity. 5. Principle of impartiality, fairness and honesty. 6. Principle of continuous education and self-improvement. 7. “Golden rule” principle. 8. Principle about advertising in clinical practice.

VIII. Putting ethical standards into dental practice.

1. Medical responsibility, medical error and responsibility limits. 2. Informed consent.

SOCIAL MEDICINE AND MEDICAL ETHICS – 15/30 EXERCISES – II COURSE

1. Introduction to discipline Social Medicine. 2. Subject, tasks and methods of social medicine. 3. Library skills. Sources of information. A task for conducting literature. 4. Introduction to methods of scientific research. 5. Development of an indicative plan-program of scientific research.

Discussion of literary reference.

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6. Health social factors and influence mechanisms. Social history of the disease.

7. Demographic characteristics of population. Mechanical and natural movement. Indexes.

8. Indexes for physical development of population. Acceleration. 9. Morbidity – definitions, indexes, methods and sources of information. 10. Morbidity with temporary disability – rights of the dentist in the expertise

of disability. Socially significant diseases. 11. Bases of medical ethics and bioethics. 12. Ethical system of the physician. 13. Basic moral principles in dental practice. 14. Discussing ethical casuses in clinical practice. 15. Medical responsibility, medical error and responsibility limits. 16. Informed consent.

CHIEF OF DEPARTMENT DENTAL PUBLIC HEALTH:

Assoc.Prof. Dr. Kr.Yaneva, DM

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