SERVICE CHARTER Operational Clinical Unit

DENTISTRY AND STOMATOLOGY CLINIC

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Operational Clinical Unit

DENTISTRY AND STOMATOLOGY CLINIC

Piazza dell’Ospitale 1– 34121 TRIESTE; Strada di Fiume 447 – 34149 TRIESTE

www.aots.sanita.fvg.it - www.odonto.units.it

INEGRATED ACTIVITY DEPARTMENT SPECIALISED SURGERY

Director: Prof. Emanuele Belgrano

Director: Prof. Roberto Di Lenarda

Tel: 040 – 399 2804; Fax: 040 – 399 2191 e-mail: r.dilenarda@fmc.units.it

Nursing coordinator: Marina Prelaz

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Tel: 040 – 399 2254; Fax: 040 – 399 2193 e-mail: marina.prelaz@aots.sanita.fvg.it

USEFUL NUMBERS TELEPHONE FAX SEDE

Ospedale Maggiore Piazza Ospitale entrance RECEPTION NURSING COORDINATOR

040 – 399 2563 040 – 399 2254

040 – 399 2193 040 – 399 2193

1° floor 1° floor

CONSERVATIVE D. CLIN. ENDODONTICS CLIN. PROSTETHIC CLINIC GNATHOLOGY CLINIC

040 – 399 2600 040 – 399 2600 040 – 399 2600 040 – 399 2600

1° floor

PREVENTIVE CARE CLINIC

040– 399 2600

1° floor

PAEDIADTRIC DENSITRY AND ORTHODONICS CLINIC

040 – 399 2600

1° floor

OPERATING ROOM

040 – 399 2346

1° floor

Ospedale Maggiore Via Slataper entrance

DAY – HOSPITAL

040 – 399 2564

SURGERY CLINIC ORAL MEDICINE AND PATHOLOGY CLINIC

040 – 399 2020 040 – 399 2102

1° floor 1° floor

DENTAL EMERGENCY ROOM

040 – 399 2020 1° floor

Ospedale Cattinara Palazzina Poliambulatori CATTINARA CLINIC

040 – 399 4787

040 – 399 4953

ground floor

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PRESENTATION The Dentistry and Stomatology Operational Clinical Unit of the Maggiore and Cattinara Hospitals provides for ordinary admissions, scheduled day hospital, emergency admissions and out-patient clinics. . The Dentistry and Stomatology Clinical Operational Unit is linked to a Specialised Degree Course in Dentistry and Dental Prosthesis and a Degree Course in Dental Hygiene, as well as Specialisation Schools in Oral Surgery and Orthognathodontics. Trainee dentists and trainee dental hygienists work in the clinics every day and assist interns and full-time dentists in their work by performing clinical tasks which, in order to complete the training process, must be carried out with the same technical and professional autonomy as any professional under the supervision of faculty members.

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Ordinary Admissions – Day Hospital:

Maxillo-facial trauma treatment Oral surgery Dental treatment for patients with severe systemic diseases or

suffering from serious odontogenic infections Outpatient services: available in both hospitals, with 41 dental chairs

Dental and maxillo-facial emergency room Conservative dentistry Endodontics Oral surgery Hygene and prevention Implantology and pre-prosthetic and pre-implant surgery Peridontology Mobile, removable, and fixed prostheses Oral medicine and pathology Paediatric dentistry Orthognathodontics Gnathology

STAFF Medical team: white coats Prof. Roberto di Lenarda

Prof. Daniele Angerame Dr. Lorenzo Bevilacqua Dr. Matteo Biasotto Prof. Milena Cadenaro Dr. Gaetano Castronovo Dr. Luca Contardo Dr. Fulvia Costantinides Prof. Michele Maglione Dr. Roberto Rizzo Dr. Gabriele Vidoni Dr. Erika Visintini

In addition to the medical team, the staff includes:

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Nursing coordinator: green uniform with dark green collar: Marina Prelaz

Professional nurses, green uniform Generic nurses, yellow uniform OTA/OSS (technical health care workers), blue uniform with white collar Social and healthcare auxiliary workers, blue uniform Dental technicians, light blue uniform Dental hygienists, light blue uniform Administrative staff, white uniform with orange collar and front pocket Dental students and interns, white uniform Dental hygiene students, white slacks and blue jersey

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HOW TO ACCESS THE DENTAL AND STOMATOLOGY CLINIC

Specialised examinations and the first examinations of adult patients are carried out at the Dental Emergency Room on the 1st floor of the Via Slataper arm of the Maggiore Hospital (entrance: central door, stair G). Examinations of patients under 18 years of age are carried out at the paediatric dentistry clinic, 1st floor, Piazza Ospitale 1 (entrance: central door, stair H). Appointments can be booked either through the Central Booking Office (CUP), by phone (+39 040 3992020), in person, or through authorized pharmacies. Access is direct, which means you will not need your GP’s referral. You will need your GP’s permission for orthodontic examinations, to be carried out at the Orthodontics clinic, 1st floor, Piazza Ospitale 1 (entrance: central door, stair H). The Dentistry Emergency Room is open Mondays to Fridays, from 8 a.m. to 6 p.m., Saturdays and days before a holiday from 8 a.m. to 2 p.m. In cases requiring urgent treatment, a general medicine physician can sign a referral by marking the boxes U, B or D in accordance with pre-defined criteria. In order to access the hospital clinics, patients will be requested their healthcare card, tax code number and exemption certificate, if any. Foreign patients will be requested valid international documents. . Dental services are provided after payment of the due medical charges, if any. Patients residing outside the Friuli Venezia Giulia Region or who are not holders of a healthcare card shall pay the full cost of the service (according to the regional price list). Patients are requested to cancel their scheduled appointments promptly (at least 24 hours in advance). In the event of two “no shows” without giving a 24-hour notice, the patient’s file will be closed. On the first appointment, urgent diseases are treated and a therapy plan is defined for implementation at the specialised clinics. For emergency room patients and patients with a referral for urgent treatment, only the pathologies requiring urgent treatment will be dealt with.

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WAITING TIMES

Emergency Room procedures and services and that PRIORITY CODE U are performed the same day; those with PRIORITY CODES B AND D are performed respectively within 10 and 30 days. Waiting times for general examinations, in the absence of priority codes, vary in accordance with demand (which is constantly increasing) and the amount of missed appointments due to unjustified absences. Waiting times are currently about 6 months. Non-urgent procedures prescribed during a general examination will be scheduled on the basis of the waiting lists for each specific discipline.

AVERAGE TIMES DAYS Surgery Cons. dentistry Endodontics Hygene and prevention Paediatric Dentistry Gnathology Orthodontics Implantology and pre-prosthetic

surgery Prostheses Oral Medicine and pathologies

30 - 60 180 – 240 90 – 120 60 – 90 90 – 120 150 – 180 210 – 270 30 – 60

3 years and 6 months

14 – 30

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MODALITIES FOR INFORMING USERS

Users will receive from the medical, nursing, and technical staff verbal information, written information, informed consent, clarifications and explanations regarding both the examination being performed and any follow-up visits or procedures. For foreign users, if necessary, a cultural mediator is available to help the patient understand the type of procedures and examinations which they will be subject to.

MODALITIES FOR REQUESTING CULTURAL MEDIATION SERVIC ES

For ordinary or urgent admissions, day-hospital admissions, general examinations, and Emergency Room admissions, a cultural mediator may be present in order to help foreign patients correctly understand health issues, the usefulness of clinical examinations and diagnostic procedures and their correct execution, and any indications to be followed upon discharge.

INFORMED CONSENT

Patients are asked to sign the following informed consent forms: Consent for the processing of personal data (adults /minors) Consent for photos and videos (adults/minors) Consent for local anaesthesia (adults/minors) Consent for anxiolysis and sedation Consent for nitrous oxide Surgical consent

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Consent for paediatric dentistry Consent for implantology

MODALITIES FOR REQUESTING HEALTH CARE DOCUMENTATION

Case histories Copies of case histories can be requested, using the appropriate form from the Central Booking Offices of the Maggiore and Cattinara hospitals by the patient in question or by an authorized third party bearing an identification document from the patient (or copy thereof) or self-certification using the appropriate form. Requests for copies of case histories can only be met upon payment of the required fee. In addition, please be advised that: Staff from the Case History Archive is on-duty from Monday- Friday from 7 a.m to 2 p.m. Staff can be contacted by telephone at 040 - 399 4031 for any information, especially regarding case histories from before 1977.

Copies of X-ray exams Copies of Orthopantomography X-rays and Endoral X-rays can be requested from the Central Booking Office using the appropriate form. The payment of medical charges is required in cases in which the exam was performed on hospitalized or Emergency Room patients Discharge report Patients can request a report of the clinical procedures performed by filling out the appropriate form available from the relevant clinic.

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SPECIFIC ACTIONS FOR PATIENT SAFETY

The Dentistry Clinic applies patient safety measures which require the correct identification of the patient him/herself:

Identification bracelet (ordinary admissions and DH) Double identification with first name, last name, and date of birth

(outpatients) The premises are constantly evaluated, and electromedical devices undergo periodical controls, safety checks, and maintenance. Particular care and attention is devoted to procedure to sanitize, disinfect, and sterilize premises, materials, and instruments.

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GENERAL INSTRUCTIONS FOR PATIENTS

Allergic patients must inform the relevant operator (Note: this includes patients who are allergic to LATEX because the gloves worn by medical staff and the dental dams are made of this material).

Pregnant patients must inform the relevant operator before proceeding with treatment

Possible bleeding caused by surgical procedures can generally be stopped with the help of topical medication. Some patients may require pre-surgery antibiotic treatment in order to reduce the risk of infective endocarditis.

TELEPHONES For safety reasons, mobile phones must be turned off, as they may interfere with medical equipment.

PRIVACY AND CONFIDENTIALITY

Every user has the right to keep their personal information confidential, including information regarding their health status and the possible diagnostic procedures and/or treatments they should be subject to. In addition, every user has the right to privacy during the performance of diagnostic examinations, specialized examinations, and health care treatment in general. The professional staff of the University Hospital undertakes to provide patients and their family members, except in cases of explicit dissent, with information both on hospitalisation and health conditions. All medical data is handled electronically, and access requires a personal password, in accordance with existing norms.

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COMPUTERIZATION The Hospital uses highly computerized systems for the archival, transmission, and the reporting of bio-images and medical documentation. Electronic communications make it possible to disseminate data in order to make it accessible to staff (access is available only to authorized staff) in order to consult the patient’s case history in other hospital and medical facilities as well.

PRIVATE PRACTICE

Some of the permanent medical staff also have private practices. Available services and their fees can be consulted on the University Hospital’s website (www.aots.sanita.fvg.it). Private consultations can be booked through the Central Booking Office or authorised pharmacies

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RESEARCH ACTIVITIES

The Trieste University Hospital is a highly-specialized hospital of national relevance, and it houses the Faculty of Medicine and Surgery of the University of Trieste.

The Dentistry and Stomatology Clinical Operational Unit is linked to a Specialised Degree Course in Dentistry and Dental Prosthesis and a Degree Course in Dental Hygiene, as well as Specialisation Schools in Oral Surgery and Orthognathodontics. Students undergoing training take part in all health care and research activities carried out in the Dentistry and Stomatology Clinical Operational Unit, under the supervision of full-time dentists. Experimental research, clinical, and laboratory activities are aimed at studying diagnostic procedures, surgical techniques, and treatment protocols – including innovative treatment procedures using pharmaceuticals – for the treatment of dental pathologies. Research in the field of dental biomaterials is particularly active, and avails itself of a laboratory that is on the cutting edge at the national and international levels. Research activities are carried out and funded within the framework of national and international research groups, and results are published in leading international journals.

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EMERGENCY ROOM The Dentistry Emergency Room is open from Monday to Friday from 8 a.m. to 6 p.m., and on Saturdays and the days before holidays from 8 a.m. to 2 p.m. Access to the Dentistry Emergency Room takes place through referrals from the First Aid Centre of Maggiore Hospital, the Emergency Room of Cattinara Hospital, or upon request on the part of the GP, who must follow pre-defined criteria to indicate on the referral form the suspected condition and mark box “U” (urgent CODE RED). Initial examinations are also performed at the Dentistry Emergency Room. Appointments can be made though the Central Booking Offices (CUPs) or through local pharmacies Access to the Dentistry Emergency Room, both for urgent patients and for first examinations is reserved to adult patients. Paediatric dentistry examinations (patients under the age of 18) are performed by appointment in the Paediatric Dentistry Clinic.

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Activities The following activities are performed in the Dentistry Emergency Room:

DIAGNOSIS AND TREATMENT of all urgent dental, stomatological, and maxillofacial conditions. More specifically:

Oral maxillofacial trauma Mandibular dislocation and subluxation Trismus Toothaches that cannot be sedates using common painkillers

(acute periodontitis or pulpitis) Spontaneous or post-surgical bleeding of the oral cavity Oral infections or bleeding in patients suffering from systemic

diseases such as immunosupression, tumors, valvular heart disease, complex or uncompensated heart disease, uncompensated diabetes, kidney or liver failure, psychophysical disabilities

Oral symptoms in patients undergoing chemotherapy or radiation therapy

Abscesses or pus in the cervicofacial area with systemic symptoms (dysphagia, odynophagia, bruising, fever, dyspnea)

Post-operative alveolitis Angioedema and emphysema of oral and peri-oral tissue.

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INITIAL DENTAL EXAMINATIONS to provide a general diagnosis of

the patient and the drafting of a treatment programme that will subsequently be followed in the various clinics of the Dentistry and Stomatology Operational Units in accordance with existing waiting lists

CONSULTATIONS for patients in other wards of the Trieste University

Hospital. In addition, the necessary radiology examinations (orthopantomography X-rays and endoral X-rays) are performed for treating urgent cases or planning dental care. Instructions for patients

Urgent care may be followed up by additional sessions until treatment is complete. All subsequent appointments are subject to medical charges, which patients must pay at the Central Booking Office before accessing the clinic. Patients who are not residents of Friuli Venezia Giulia or who do not have a health care card must pay the full cost of treatment in compliance with regional regulations

Patients referred by their GP as CODE RED must pay medical charges for all services (examinations, x-rays, endodontic therapy, tooth extractions, etc…)

Patients referred by the First Aid Centre must pay medical charges whenever their clinical conditions are not urgent.

CONSERVATIVE DENTISTRY CLINIC The Conservative Dentistry Clinic is open Monday to Friday from 8 a.m. to 2 p.m. Patients admitted to the clinic will have already undergone an initial General Examination at the Dentistry and Stomatology Clinic (direct access is not allowed) and will have been included on the relevant waiting list. The clinic is comprised of two units, each with four dental chairs, and is used for the morphological and functional recovery of dental elements subject to pathologies that affect their integrity, such as cavities, abrasion, and fractures, and conditions such as dentine hypersensitivity, which can cause serious discomfort in patients, along with certain types of oral pigmentation that can be treated without recourse to prostheses.

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The services provided by the clinic, which require a certain urgency, are established during the first visit on the basis of the patient’s clinical conditions and international guidelines, are scheduled by the operator and provided rapidly. Direct access to the Conservative Dentistry Clinic is allowed in cases of brief visits to patients who have developed complications or who require check-ups by specialists. Activities

Simple coronal restorations using composites and occasionally amalgams

Complex, pre-prosthetic restorations Pre- and post-endodonthic coronal reconstructions Provisional filling Direct and indirect pulp capping Dentin desensitizing Internal dental bleaching for simple discolorations Repair of certain types of coronal fractures Intraoral repair of fixed prostheses to solve conservative problems Selective grinding Removal of incongruous splints Polishing of new and old fillings

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Treatment is generally carried out under dental dams and in keeping with the most stringent hygiene, prevention, and protection norms. Instructions for patients Post-treatment precautions are necessary in the following cases:

PROVISIONAL FILLING: filling material should be allowed to harden for a couple of hours before chewing food, which should be rather soft; in cases of extensive coronal damage treated with such fillings, patients should adopt a soft-food diet and chew only on the side not affected by fillings. Provisional fillings should never be energetically brushed. Failure to abide by these norms may result in the failure of the restoration procedure.

COMPLEX PRE-PROSTHETIC RESTORATIONS: given the complexity of these cases, an attentive prosthetic restoration is necessary to avoid coronal-radicular fractures.

PRE-EDONDONTHIC RESTORATIONS: generally performed in part with composite material and in part with material for provisional fillings, their mechanical hesitance may be weak and they require prudent chewing in order to avoid irreparable fractures.

DENTIN DESENSITIZING: performed exclusively after the patient has been instructed and motivated to follow correct dental hygiene procedures at home, which must be sustained over time in order not to jeopardize the treatment.

EDONDONTICS CLINIC The Edondontics Clinic is open Monday to Friday from 8 a.m. to 2 p.m. Patients admitted to the clinic will have already undergone an initial General Examination at the Dentistry and Stomatology Clinic (direct access is not allowed). The clinic provides conservative treatment of acute and chronic pulpal pathologies, acute and chronic periapical pathologies (apical granuloma, radicular cysts) and the resumption of endodontic treatment associated with the re-emergence of signs and symptoms of pulpal periodontal disease. Activities

Endodontic treatment of monoradicular and pluriradicular teeth Resumption of endodontic treatment Root canal dressing

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Filling of cavities caused by caries or iatrogenic processes Apicoectomies Endoral X-rays

Endodontic treatment is provided in several clinical phases, each of which is indispensable for a successful final outcome:

Local anaesthesia (if necessary) Application of a dental dam: a sheet of latex is applied to the tooth to

isolate it and to proceed safely. Pulpectomy and preparation of the root canals Irrigation with disinfectant solution Obturation of the hollows with thermal techniques.

Useful information The clinical phases are either performed during a single session, or they may require more than one appointment. If necessary, root canal dressings and provisional fillings are applied between one session and the next. IN CASE OF PERIAPICAL ABSCESS with draining of pus from the root canal, it may be necessary to apply medication to allow for the draining of exudate while preventing food debris from accumulating inside the tooth. IN CASE OF APICAL LESIONS that do not heal in spite of treatment, an apicoectomy may be called for. This is a surgical procedure that involves a small incision in the gums next to the apex or apices, the removal of granular or cyst tissue, and the resection of the last 2-3 mm of the root(s). Stitches are removed 7-10 days after the operation. Some teeth which had initially been deemed treatable with endodontic therapy may prove to be untreatable. In this case, the patient will be informed and sent to the Oral Surgery Clinic for tooth extraction. Instructions for patients

During the first day after treatment, some discomfort may arise due to apical inflammation. Treatment with anti-inflammatory drugs for 2-3 days is generally sufficient to make the symptoms disappear.

In case of persistent pain in the treated area, and in case of swollen gums or facial swelling, the patient may contact the clinic’s admissions office (Tel. 040 – 399 2600) to book a follow-up examination, which normally takes place on the same day, since it may be necessary to initiate treatment with antibiotics, which require a medical prescription.

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The conclusion of endodontic treatment is generally followed by referral to the Conservative Dentistry Clinic for definitive tooth reconstruction.

PREVENTION CLINIC The Prevention clinic is open Monday to Friday from 8 a.m. to 2 p.m. Patients admitted to the clinic will have already undergone an initial General Examination at the Dentistry and Stomatology Clinic (direct access is not allowed).. Periodontal disease is a chronic inflammatory disease of the tooth-supporting structure which affects about 60% of the population, of which 10% is affected by an aggressive variety of the disease that can lead to premature tooth loss unless diagnosed in a timely manner and adequately treated.

The many factors that can cause periodontal disease require the presence of a subgingival biofilm of bacteria in genetically predisposed subjects. Additionally, the rapidity of the onset and spread of the disease is highly influenced by a number of risk factors which must be kept under control (smoking, diabetes, etc…)

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Initially, each patient is subject to rapid, non-invasive screening (Periodontal Screening end Recording) to assess the health of periodontal tissue, and depending on the severity of the condition, the initial screening may be followed by a full periodontal examination including: periodontal chart, initial photos, and radiographic status. Non-surgical (causal) periodontal treatment includes:

Informing, instructing, and motivating the patient to adopt correct oral hygiene practices at home

Controlling the factors that influence the onset of the disease, such as smoking and diabetes

Removing bacterial place and tartar both above and below the gumline using manual or mechanical instruments

Eliminating the factors that cause plaque build-ups, such as misplaced fillings or jutting prosthetic margins

Shining and removal of extrinsic pigments from tooth surfaces

Upon completion of causal treatment, a periodontal re-assessment will be carried out, with the following expected results:

Improved collaboration and participation on the part of the patient Reduction of plaque and tartar Elimination or reduction of clinical signs of inflammation

If treatment achieves the expected results, patients suffering from severe periodontal disease will, upon request, take part in a support programme. The priority objectives of the prevention clinic include maintaining periodontal health in patients with particularly vulnerable systemic conditions, such as patients subject to organ transplants, disabled patients, and patients suffering from systemic pathologies. The same procedures that have been proven efficient in preventing periodontal diseases are also fundamental in preventing cavities and other pathologies of the oral cavity.

PAEDIATRIC DENTISTRY CLINIC

The Clinic is open Monday to Friday from 8 a.m. to 2 p.m.. Patients can access the clinic directly by booking a General Paediatric Dentistry Examination with the Central Booking Office (CUP) or authorized pharmacies.

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The Paediatric Dentistry Clinic is where initial paediatric dentistry visits and follow-up treatment are performed for patients up to the age of 18. Urgent visits certified by a paediatrician (code U red on the referral), are performed within 24 hours after making an appointment with the clinic’s admissions office (tel. 040 – 399 2600). . Activities

General examinations Urgent visits for dental trauma or toothaches that cannot be sedated

using ordinary painkillers (red U code on the paediatrician’s referral) Conservative cavity treatment (dental restoration) Endodontic treatment of deciduous and permanent teeth Extraction of deciduous and permanent teeth Minor oral surgery Oral hygiene and cavity prevention (tartar removal, oral hygiene

education, dental sealants, fluoride treatment) Children who are afraid of dentists or non-collaborative can be subject

to dental care under conscious sedation using nitrous oxide.

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Sedation using nitrous oxide Thanks to this clinical practice, based on the inhalation of a mixture of nitrous oxide and oxygen, the child will be calm and feel less pain, while remaining conscious.

Our Clinic uses modern, latest-generation equipment, guaranteeing maximum safety. If the precautions listed above are followed, ANY SPORADIC COLLATERAL EFFECTS are generally limited to slight nausea and the temporary impairment of vigilance and reflexes. For a few hours after sedation, the child should not play or engage in activities that require attention (running in the street or riding a bicycle). Advice for patents The aim of our Clinic is to help your child become a good patient and undergo dental care without problems. In order to achieve this goal, it is indispensable for the parents to behave properly even before the examination and treatment.

Some advice: Dental care is a normal part of medical

care: children must not be frightened by telling them a visit to the dentist hurts.

It is better for the child to be aware that a dental visit is coming up for some time before the visit itself.

If the child asks for information, he or she should be told that the dentist will “heal” his or her teeth to make sure they are all healthy. Never tell the child that the dentist will extract an unhealthy tooth; instead, say the tooth will be healed .

A child should never be told that he or she will be taken to the dentist if they misbehave, nor should a child be told that they will be given a shot or an injection.

During the first visit, we will try to help the child feel at ease in this new environment, by always explaining and showing him or her what we are about to do.

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IT IS DESIRABLE FOR THE CHILD TO GET USED TO ENTERING THE CLINIC ON HIS OR HER OWN WHEN CALLED BY THE OPERATOR. Parents may be present in the clinic during treatment only in cases of very young children, or with the dentist’s consent. PARENTS ARE ASKED NOT TO INTERFERE WITH DENTAL CARE, so that the dentist may be able to establish a direct relationship with the child We are certain that by following this simple advice you will greatly help your child; failure to follow this advice will hinder our efforts and make dental care more difficult. We believe that an approach focusing on prevention is essential for young patients; for this reason, our staff places great emphasis on oral hygiene, fluoride treatment, the sealing of permanent teeth, nutritional education to avoid harmful food, and the pre-emptive treatment of cavities: please help us in our task! THIS IS THE WAY TO ENSURE YOUR CHILD WILL BECOME A GOOD PATIENT, WITH HEALTHY TEETH AND A RADIANT SMILE.

ORTHODONTICS CLINIC The Orthodontics Clinic is open on Tuesdays and Thursdays from 8 a.m to 6 p.m. In order to access the clinic, patients must book an initial orthodontic examination with a referral from their GP (specifying orthodontic examination) from the Central Booking Office of the Trieste Hospital or from authorized pharmacies. After the initial examination, should the need for orthodontic treatment be ascertained, the patient is added to the protocol for the diagnosis and treatment of malocclusions (orthodontic check-up and subsequent treatment). Access to the service is open to all patients.

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Orthodontic services are provided for a fee, because orthodontic therapy is not included in the institutional activities provided for a prescription charge, but is subject to medical fees or shared expenses as per the hospital’s deliberation. Partial or total exemption from fees (with the exception of the orthodontic check-up which is always subject to a fee) may be granted to patients with health or social vulnerabilities, upon production of a medical certificate and/or ISEE form (Equivalent Economic Situation Indicator) available at INPS or CAF offices. Activities The clinic provides mobile and/or fixed treatment for the following:

Correction of dental malocclusions in children and adolescents; Correction of skeletal malocclusions in children and adolescents; Treatment of bad habits and their consequences; Interceptive treatment of malocclusions at an early age; orthodontic treatment for adults; orthodontic and surgical treatment for adults; pre-prosthetic treatment

The most common risks associated with these treatme nts include

possible, albeit very rare, allergic reactions induced by the infiltration of local anaesthetics in sensitive patients, or by the use of nickel-based orthodontic alloys.

Ingestion or inhalation of orthodontic materials during the application phase or during treatment

Oral lesions from friction due to the application of orthodontic gear Detachment of certain parts of the orthodontic gear

Instructions for patients

ISEE certificates must be produced during the orthodontic check-up and must be renewed upon expiration; failure to do so will result in the forfeit of partial or total exemption from fees

Annual adjustments in treatment costs may be made even while the treatment is ongoing

Patients – including those wholly or partly exempt from fees – are responsible for costs arising out of lost or damaged orthodontic gear.

SURGERY CLINIC AND OPERATING ROOM

The Surgery Clinic is open Monday to Friday from 8 a.m. to 2 p.m. Surgery is performed in the Operating Room on Tuesdays and Thursdays.

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Activity Operations under local anaesthesia, local anaesthesia plus sedation,

and general anaesthesia

Extraction of permanent teeth, extraction of dental roots, surgical extraction of teeth, apicoectomy, cystectomy, excisions of neoformations from soft parts, maxilla operations for the excision of neoformation or pre-prosthetic surgery with the insertion of autologous or alloplastic grafts, reduction and containment of fractures in the maxillar and/or mandibular alveolar process, and dental dislocations and fractures

Tartar removal and conservative and endodontic treatment in disabled patients

Reduction and containment of facial skeleton fractures. Access to the Clinic’s services takes place after the initial examination or ordinary admission for dental and stomatological pathologies which require surgery and/or due to the presence of serious or urgent systemic diseases. In case of ordinary admissions for surgery in the operating room, the patient undergoes pre-emptive hematochemical, x-ray, and anasthesiology examinations on an outpatient basis. Inpatients are hospitalised in the Day-Surgery Clinic from Monday to Friday, and at the Ophthalmology Clinic on Saturdays and Sundays. The following procedures take place in preparation for outpatient surgery:

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General pre-surgery assessment, appropriate radiographic assessments usually carried out with orthopantomograph, endoral X-ray and if necessary computerized tomography, informed consent. Where necessary, antibiotic or anti-allergy treatment. Candidates for surgery under general anaesthesia, sedation, and anesthesiological monitoring must fast and abstain from smoking starting at midnight of the day of the operation. The hospital’s procedures for the correct identification of the patient, the surgical site, and the surgical procedure are carried out in the operating room. POST-SURGICAL MANAGEMENT OF ORAL SURGERY PATIENTS Pain and edema relief Application of ice packs on the skin for the first 12 hours after surgery, applying packs for 15-20 minutes at a time, allowing area to warm for another 15-20 minutes before resuming application. When pharmacological pain relief is necessary, the physician prescribes 400 g Ibuprofen capsules (800/1200 g a day) or 50 g Ketoprofen capsules (100 g a day) starting immediately after surgery and for 2-3 days thereafter or more, as needed. Control of post-surgical bleeding. The patient should lie on the side of the body opposite to that of surgery, with their head raised. The patient must not rinse the oral cavity for the first 12 hours after surgery. In case of bleeding, apply gauze bandages to the wound and maintain compression for at least 15 minutes. During that time, avoid removing the bandages to check if bleeding has been stemmed. Infection control Suspend oral hygiene for the first 12 hours after surgery and avoid rinsing. Normal tooth brushing can be resumed after 12 hours, taking care not to traumatize the surgical site, which can be cleaned by rinsing 2-3 times a day using a chlorexidine-based mouthwash at concentrations between 0.1% and 0.2%.

In case of increased infection risk, the physician may prescribe antibiotic treatment. Diet

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Cold liquid diet starting at 7 p.m. on the day of the operation and for the following 48 hours. Subsequently, soft diet at room temperature, chewing from the side that was not operated on.

PERIODONTAL SURGERY

When causal treatment (carried out in the Preventive Clinic) is not sufficient to stabilize periodontal disease, surgical procedures are necessary in order to facilitate tartar removal, modify the sub-gingival microbiological environment, reducing sites with probing depths of over 4 mm, re-establishing the biological dimension of tissue, treating lesions in II and III class bi-trifurcations, or re-establishing the correct morphology of soft tissue.

Maxillo-facial surgery These operations are performed under general anaesthesia for fractures of the middle third of the face or of the jaw . The following activities are carried out prior to surgery:

General pre-surgery assessment, Radiographic assessment, Informed consent. Antibiotic preventive treatment when necessary.

Surgery can take place through intraoral access or cutaneous access, the latter through the eyelids, the internal canthus, the preauricular region, the submandibular region, or the retromandibular region.

Skeletonization of bone fragments involved in the fracture with isolation of the fracture point.

Reduction of the fracture with the alignment of bone fragments Containment of the fracture using plaques and titanium screws, Assessment of the status of dental elements, the dental occlusion, and

facial symmetry. Application of an intermaxilliary elastic for a period of two to four weeks. Haemostasis and if needed application of surgical aspiration drains. Layered sutures. If necessary application of a nasogastric probe.

Post-surgical management of maxillofacial surgery patients is the same as for oral surgery patients, with the following specific recommendations regarding diet.

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Cold liquid diet starting at 7 p.m. on the day of the operation and for the following 48 hours. Subsequently, soft diet at room temperature. For patients with a nasogastric probe, ensure the probe is patent and clean before and after meals, and lightly move the probe every day in order to prevent sores. If the patient is wearing an intermaxilliary elastic, always keep a pair of scissors at the patient’s bedside, and in case of vomit cut the elastic bands that keep the jaws shut. The patient should eat an adequate diet for the pathology in question even after returning home.

ORAL PATHOLOGY AND MEDICINE CLINIC The Oral Pathology and Medicine Clinic is open Monday to Friday from 8 a.m. to 2 p.m. Patients treated in the clinic have either already undergone an initial general examination at the Dental and Stomatology Clinic, or have been referred by their GP with a specific priority code (yellow B code), or have been referred for consultation by other wards of the “Ospedali Riuniti” University Hospital in Trieste.

The clinic focuses on the diagnosis and treatment of orofacial pathologies (teeth, soft tissue, and bone structures); clinic staff is also trained in the care and treatment of “special needs” patients.

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The clinic is a specialized dentistry centre for the monitoring of cancer patients, with particular attention paid to the prevention and dental and stomatological treatment of patients suffering from oral cavity and cervicofacial cancer, in collaboration with physicians from the Otolaryntology Clinic.

Over the last few years, the clinic has intensified its assistance and treatment of cancer patients with dental pathologies caused by oncohematological treatment, patients who must be subjected to specific therapeutical interventions, or patients suffering from complications caused by cancer treatment. The clinic has recently introduced a new treatment protocol for mucositis, based on the efficacy of laser therapy thanks to its anti-inflammatory, analgesis, bio-stimulant, and anti-microbial effects.

The clinic also provides local residents with screening services for oral cavity pathologies in HIV positive patients or pathologies correlated with antiretroviral treatment. Patients who have already undergone dental care at the Oral Pathology and Medicine Clinic will be subject to periodical follow-up visits.

Activities The Oral Pathology and Medicine Clinic treats the following pathologies:

Recurrent aphthous stomatitis Oral lichen planus Atypical oral ulcers Bacterial, viral and mycotic infections of the oral mucosa Treatment of oral lesions in sexually transmitted diseases Pemphigus vulgaris and pemphigoid Leukoplakia, dysplastic lesions, and oral cancer (diagnosis and

screening) Mucosite induced by chemotherapy and radiotherapy Burning mouth syndrome Atypical facial pain Iatrogenic xerostomia or as a consequence of systemic disease Orofacial granulomatosis Osteonecrosis of the mandible induced by chemotherapy and

radiotherapy Chronic GvHD (organ transplant patient)

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In its daily diagnoses and treatment of oral cavity pathologies, which may be caused by local trauma or by systemic disease, the Clinic collaborates with the following hospital divisions:

Hemathology, Oncology, and Radiotherapy for oral mucosite induced by medical or radiation therapy of the head/neck

Dermatology for muco-cutaneous diseases involving the oral cavity Otolaryngology, Plastic Surgery, Radiotherapy, and Oncology for

diagnosis, follow-up, and rehabilitation of oral cancer patients Infectivology for orofacial infections.

PROSTHETIC AND GNATHOLOGY CLINIC

The Prosthetic and Gnathology Clinic is open Monday to Friday from 8 a.m. to 2 p.m. Prosthetic activities The Clinic can be access:

1) following a generic dental visit 2) upon referral from another hospital ward 3) Upon referral from the Local Health Authority (Distretto Azienda per i Servizi Sanitari n°1) in accordance with the current agreement regarding disabled patients.

Services provided include:

Total mobile-bearing prostheses Partial resin mobile-bearing prostheses Repairs of resin mobile-bearing prostheses New bases for total and partial resin prostheses Maxillofacial prostheses and devices Oral devices for radiotherapy.

Gnathological services In order to access the clinic, patients must first visit the Dentistry Emergency Room on a general admissions or emergency basis, and if necessary they will be placed on a waiting list for a gnathology examination.

Gnathology examination Custom-made mouthguards (tooth impressions and facial arc) Occlusal balancing

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The Clinic performs examinations related to episodes of acute or chronic pain caused by occlusal problems or problems with the temporomandibular joint, such as bruxism, tooth clenching, mandibular clicking, acute and chronic reducible and irreducible dislocations of the articular disc, mandibular dislocations. Assessment of the chewing muscles and of facial and neck muscles, careful assessment of static and dynamic occlusal relationships in order to identify the presence of any premature contacts and/or dental interferences during normal chewing. Finally, an analysis of the overall dynamics of the temporomandibular joint is performed. If necessary, the visit is completed with a request for a nuclear MRI in order to have radiographic confirmation of the examination’s findings.

BRUXISM AND CLENCHING OF TEETH Nervous parafunctional activity which takes place subconsciously and involves an increase in the activity of chewing muscles, causing tooth gnashing especially at night (bruxism) or the closure of the jaw for excessive lengths of time (tooth clenching).

MANDIBULAR CLICKING All the audible noises – ranging from crackles to clicks – caused by the movements of the jaw.

REDUCIBLE AND IRREDUCIBLE DISLOCATIONS OF THE ARTICULAR DISK The most characteristic pathologies of the tempromandibular joint, which involve the loss of the normal position of the articular disk within the capsule, with (reducible dislocation) or without (irreducible dislocation) full recovery upon closure of the mouth .

MANDIBULAR DISLOCATION The loss of the normal relationship between the joints of the mandible and the temporal bones.

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If deemed necessary by the examination, the subsequent phase calls for fashioning a custom-made mouthguard that addresses the pathology in question.

CATTINARA HOSPITAL

(Palazzina Poliambulatori, Cattinara Hospital – open 2 days a week from 8 a.m. to 2 p.m.) only for patients hospitalized at the Cattinara Hospital.

CUSTOM-MADE MOUTHGUARDS: An impression of the upper and lower teeth is made in order to fashion chalk model and a facial arc is used to obtain the correct relationship between the upper and lower teeth during occlusion with reference to the patient’s s skeleton structure.

OCCLUSAL BALANCING: Once the mouthguard has been balanced, an analysis of occlusion is performed which involves the identification and treatment of any occlusal interferences evidenced by gnathological treatment and which can interfere with normal chewing .

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Oral hygiene and prevention Non-surgical periodontal equipment Oro-dental and periodontal surgery Conservative Dentistry and Endodontics

HOSPITAL STAYS

Patients hospitalised at the Dentistry and Stomatology Clinic are admitted to the Day Surgery Facility of the Maggiore Hospital; on Saturdays, Sundays and holidays to the Ophthalmology Clinic. Any information on hospital-stay rules shall be requested from the relevant ward. Information on the health of patients Information is provided to the relatives of patients, with the latter’s permission, everyday from 12.30 p.m to 1.30 p.m. by the physician in charge of the patient. Upon discharge The patient will receive a letter, to be handed to his/her GP, including the diagnosis, the recommended treatment, and the findings of the main tests carried out. Should the in-patient need a copy of his/her clinical records, he/she can request them upon discharge. If, upon discharge, the patient needs to be taken home by ambulance, the nursing staff will have to be informed in advance. Do you need anything else? The Reception, located on the first floor at Piazza Ospitale n°1, is open to the public from Monday to Friday from 8 a.m. to 2 p.m. The Director of the Operational Clinical Unit is at your disposal for further information and to receive ideas for improvements and suggestions: make an appointment in person with the coordinator or call 040 - 399 2254.

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As a patient

Of the “Ospedali Riuniti” University Hospital in Trieste

You have the right to:

TRUST Every hospital patient has the right to be treated as a trustworthy subject. QUALITY The University Hospital is a highly specialized hospital of national relevance It aims to carry out, in a unitary and coordinated manner its, assistance, teaching, and research functions, in order to better provide its public health services, improve the quality of training processes, develop bio-medical knowledge and technological innovation, placing equal value on the functions and activities of hospital and university staff. The Hospital provides health care services with continuity, professionalism, and care for each individual. It guarantees organizational and multi-disciplinary integration, with understanding and respect for hospital patients and their family members.

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SAFETY Every patient has the right to receive the services necessary to protect their health, without sustaining ulterior harm caused by the malfunctioning of the facilities or services. In order to guarantee this right, the Hospital undertakes to constantly monitor risk factors and to ensure the continuous maintenance of its facilities and medical equipment. Additionally, the Hospital undertakes to provide continuous training for health care and medical workers ( Law n. 338 of 23 December 2000). PROTECTION All patients whose health conditions place him or her at risk has the right to protection and assistance. This right to special protection extends to the children who require hospitalization in our Hospital. On an exceptional basis, the University Hospital provides facilities for storing the valuables of urgently hospitalized patients or patients who are unable to care for them. We recommend that patients avoid bringing valuable objects (cash, jewel, gold objects) with them during hospitalization. NORMALITY Every patient has the right to be treated in the University Hospital without altering their habits, social, and family life more than is necessary. CERTAINTY Every patient has the right to certainty in receiving health care, without falling victim to professional or organizational conflicts, or to favouritism arising from their economic condition or social position. The Hospital is bound to establish waiting times within which services must be provided, on the basis of specific standards and the degree of urgency of each case. Any patient who requests it has the right to consult waiting lists, within the constraints of privacy laws. PARTICIPATION Patients, their family members, civic and volunteer organizations can contribute to improving the quality of the health care services and activities of the University Hospital through:

Civic Audits Perceived quality surveys

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Mixed working groups focusing on specific issues Reports and complaints .

Participation in the treatment process includes the patient’s right to know the physician responsible for their treatment and the credentials of the health care staff taking part in the treatment process. DIFFERENTIAL TREATMENT Every patient has the right to receive differential treatment in accordance with their needs and their individuality, without discrimination based on age, gender, nationality, race, language, political opinions, religious beliefs, or culture. The Hospital undertakes to satisfy, to the extent possible, any requests for religious or spiritual assistance, by contacting the relevant pastors. TIME Every patient has the right to timely service. Should it prove impossible to provide the services in keeping with the agreed-upon schedule, the patient shall be informed of the reasons and duration of the delay. Should the Hospital not be able to provide the services by the established deadline, it must ensure the possibility of accessing alternative services of comparable quality. PRIVACY AND CONFIDENTIALITY Every patient has the right to keep their personal information confidential, including information regarding their health status and the possible diagnostic and/or treatment procedures which they shall be subject to. The patient also has the right to the protection of their privacy during the carrying out of diagnostic exams, specialized visits, and medical and surgical treatment in general.

The professional staff of the University Hospital undertake to provide patients and their family members, except in cases of explicit dissent, with information both on hospitalization and health conditions. Up-to-date information shall be provided throughout the treatment process and recorded in the patient’s case history. A copy of the case history can be requested by the patient in question or by an authorized third party bearing an identification document from the patient (or copy thereof) or self-certification. A request for a copy of the case history can be presented upon dismissal or in the days immediately following dismissal (before the case history is archived). The request should be filed with the Central Booking Office of the Maggiore and Cattinara Hospitals. Starting on 1/6/2005,

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requests for a copy of the case history filed with the Central Booking Object are subject to a minimum handling fee of € 5.00, which must be paid in advance. Any outstanding balance must be settled upon retrieval of the case history copy. Staff from the Case History Archive is on-duty from Monday- Friday from 7 a.m to 2 p.m. Staff can be contacted by telephone at 040 - 399 4031 for any information, especially regarding case histories from before 1977.

DIGNITY All patients, including terminally ill ones, have the right to their personal dignity, to suffer as little as possible, and to receive all necessary assistance. The Hospital acknowledges and respects the needs of terminally ill patients by treating primary and secondary symptoms, managing pain, and responding to the emotional, religious, and cultural needs of patients and their family members. THE RIGHT TO INFORMATION AND CONSENT Every patient has the right to timely, exhaustive information on their diagnosis, treatment, and prognosis, especially in the case of risky procedures which require the patient’s consent. Patients have the right to give or deny their consent to proposed treatment or analyses. During their stay in the Hospital, in compliance with existing norms, patients are asked for their generic consent and their specific consent for invasive and/or complex procedures. In the absence of signed informed content, physicians cannot provided any diagnosis or treatment, except in those cases provided for by the law, and in urgent cases in which the patient’s life is at imminent risk. Patients receive clear, comprehensive information on clinical trials, and can participate only after signing the relevant informed consent form. HEALTH CARE INFORMATION AND DOCUMENTATION Physicians and health care workers guarantee clear, simply, essential, complete, and understandable information to the patients they assist. The patient has the right to participate in the drafting of the treatment plan, to be informed on how the illness may affect his quality of life, and on the therapeutic remedies and assistance that can help eliminate or alleviate pain and suffering.

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Patients have the right to view their case histories and request a copy. The case history must be clear, legible, and contain all information regarding diagnoses, treatments, and procedures carried out. Patients have the right to receive a letter of discharge upon leaving the hospital. In cases in which a diagnosis is incomplete, the patient has the right to receive a letter of discharge containing the provisional conclusions. Each patient has the right to interrupt treatment at any time during the clinical and assistance process, or to refuse a given treatment. Health care staff are under the obligation to inform the patient of the possible consequences of this behaviour. REDRESS FOR DAMAGES Every patient can file a claim with the Public Relations Office regarding violations of their rights. The University Hospital is under the obligation to respond to such claims. Patients and their family members can exert this right through a personal meeting or telephone conversation during the Public Relations Office’s hours, or via letter, fax, or email, or via the special form available at information points and complaint boxes. For problems that can be easily solved, the Public Relations Office will try to respond in real-time or, at most, within 15 days. For more complicated cases, which require a preliminary inquiry, the office guarantees a response within 30 days. Nevertheless, patients retain the right to resort to legal measures to redress damages sustained. ORGAN DONATIONS Patients can express their desire to donate their organs through a declaration of intent, pursuant to Law 91/99, at the Information Point of the Public Relations Office of the Cattinara Hospital. Staff from the office are available for additional information and specifications on this topic.

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As a patient

Of the

“Ospedali Riuniti” University Hospital in Trieste

It is your duty to: Respect the work and professionalism of health care workers as an indispensable condition for establishing a suitable treatment and assistance programme. Behave responsibly and respectfully towards other users. Show regard for the Hospital’s facilities, equipment, furniture, and medical devices. Abide by the established schedules and deadlines in order to ensure the normal progress of activities. Smoking is not allowed anywhere on the Hospital grounds. The use of mobile telephones is forbidden, since they may interfere with the functioning of medical equipment (infusion pumps, medical ventilators, etc.) Animals are not allowed on the grounds of the University Hospital. In order to protect their health, it is advisable to limit the access of minors to hospital wards. Under particular circumstances, dispensations should be agreed upon with ward staff. NOTE This booklet contains information valid at time of printing and is periodically updated. Among the other issue, however, may intervene in the operation changes.

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Drafted by the Office of Communications in collaboration with the Public Relations Office on the basis of text and images supplied by the Dentistry and Stomatology Operational Clinical Units tel. 040 – 399 6300; 040 – 399 6301; fax 040 - 399 6298 e-mail: comunicazione@aots.sanita.fvg.it Strada di Fiume 447 – 34 149 Trieste

Revision 004 – July 2013