Hypersensitivity of teeth: treatment. Hypersensitivity of the teeth (dental hyperesthesia)

Under the influence of temperature, chemical and mechanical irritants aggravated? This disease in dentistry is called hyperesthesia of the teeth. At the moments of exposure to certain stimuli, an intense and sharp pain, passing immediately after the termination of their action. Basically, sensitivity increases at the time of cleaning the oral cavity, with the use of salty, sour and sweet food as well as thermal shocks.

Hyperesthesia is manifested due to mechanical damage to the enamel. This may be erosion or thinning of the enamel coating. The disease is cured different methods. Which one the specialist will choose, depending on the initial cause of hyperesthesia. It could be: application special preparations containing potassium salts, deep fluoridation, filling. But anyway oral cavity The patient will need special care.

Hyperesthesia of the teeth is manifested by hypersensitivity, which entails discomfort or severe pain. This usually happens after eating different foods. temperature conditions as well as sweet, salty or sour foods.

On initial stages diseases, slight sensitivity can manifest itself only under the influence of chemical irritants. Later, the reaction occurs to temperature changes. In a neglected form, intense pain also appears with tactile contact. At this point, the patient experiences severe pain while eating and talking. Salivation may increase. The person tries to adopt a position that will help reduce the contact between the teeth and cheeks.

The process of brushing your teeth is very difficult. In some cases, it becomes impossible. For this reason, plaque begins to accumulate, provoking large-scale caries. Destructive and inflammatory changes occur in periodontal tissues. All this is enhanced by hyperesthesia and entails the formation of gingival hyperplasia, which provokes even more symptoms.

A kind of hyperesthesia

Hyperesthesia is one of the most common dental diseases. It is classified into a local and generalized form, as well as into several degrees of formation. Let's take a closer look.

Distribution

Sensitivity can manifest itself partially (individual dental units), and maybe throughout the entire arch of the dentition. Local hyperesthesia or its generalized form manifested itself in the patient will depend on this.

1. The local form is manifested by pain in one tooth (a variant with several dental units is possible). Most often, the cause is a carious lesion of the enamel, but it can also occur with other dental diseases associated with hard tissues tooth. Often provoked.
2. In the generalized form, hypersensitivity manifests itself throughout the entire arch of the dentition. Causes: damage to the necks of the tooth by periodontal disease, erosion, increased abrasion etc.

Due to the origin

Hyperesthesia can manifest itself after the loss or violation of hard tissues. The reason is the formation of carious cavities or increased abrasion of the tooth coating.

Hard tissues are not broken - the disease is most likely provoked by periodontal disease, metabolic disorders or.

By clinical course

1. Sensitivity is manifested under the influence of temperature stimuli.
2. Chemical irritants are added to temperature stimuli.
3. Sensitivity appears after exposure to all 3 types of stimuli (chemical, temperature, tactile). Pain can be felt with light touches to the tooth.

Taking into account all this classification, the doctor conducts differential diagnosis, followed by the selection of effective treatment.

What are the causes of hyperesthesia?

Half of the population turns to dental centers for help, complaining of high tooth sensitivity. Most often this is the age category of 30-55 years. Most of them are women. Why is that? Elderly people and children are less susceptible to manifestations of hyperesthesia. With age, the dentin becomes sclerotic and pain reactions are less pronounced, and in children it is not yet damaged. The main causes of hyperesthesia in middle-aged patients are as follows:

1. exposed neck of the tooth. Refers to pathologies of a non-carious nature. Causes: pathological abrasion, the presence of wedge-shaped defects, erosion. All these diseases are accompanied by a decrease in the enamel coating, and therefore exposure of the dentin.
2. The disease can form after an unprofessional, as well as if the rules for etching the tooth are not followed.
3. Sensitively manifested in traumatic injuries. This may be the formation of cracks, chips and breakage of some sections of the crown.
4. The presence of caries, which is localized in and causes demineralization of the enamel.
5. Unprofessional teeth whitening procedure. After such a procedure, micro and macro elements can come out of the enamel, and this increases its permeability. Also, the specialist may ignore the procedure for isolating the gums and thereby damage them, or polish the area of ​​​​the root and neck of the tooth too hard.

All of the above causes of the manifestation of the disease can occur: with mechanical injuries, periodontal diseases, with the installation of low-quality crowns and prostheses, with the use of too hard brushes and their aggressive use.

Pain response to local stimuli may be due to pathological condition the patient's body. Hyperesthesia of teeth of this type is called functional or systemic. Diseases become the cause: endocrinopathy, psychoneurosis, hormonal changes associated with the patient's age, metabolic disorders, as well as problems with the gastrointestinal tract.

How is hyperesthesia diagnosed?

Only a dentist can diagnose hyperesthesia. Usually, an instrumental and visual examination of the patient's oral cavity is enough for this. Teeth are examined for the presence of chips, cracks and other changes in the surface layer. The patient is interviewed and information is collected about the duration pain syndrome, as well as about the types of irritants (after which pain manifests itself).

How additional diagnostics a specialist can differential method research. The main task facing the doctor is not to confuse the symptoms of acute with hypersensitivity.

What are the treatments for hyperesthesia?

There are several methods of treating tooth sensitivity. Each of them is selected depending on the initial causes of occurrence. If enamel damage has occurred, remineralizing therapy can be performed. Dentinal exposure is cured by sealing the dentinal canals.

How is remineralization therapy performed?

All treatment with such therapy is aimed at improving the barrier properties of enamel and restoring its structure. For these purposes, applications are used that help to saturate the enamel with fluorine and calcium ions. The patient may be asked to undergo electrophoresis procedures using remineralizing solutions. The result of such procedures is less permeability of irritants into the enamel, which means reliable protection sensitive dentinal canals.

Indications for such therapy may include:

• hypersensitivity, which arose as a result of poor-quality teeth whitening;
• caries in the initial stage, which is manifested only by a white spot;
• superficial lesions of the tooth by fluorosis in a dashed or spotted form.

Remineralizing therapy will be less effective for thinning of the enamel that has formed in the cervical zone. This is due to the exposure of the root cementum. In such cases, experts recommend performing flap surgery. Its task is to restore the height of the gingival margins.

Such therapy will be ineffective:

• with necrosis and erosion of the surface layer;
• sensitivity that arose under the installed filling or orthopedic structure;
• when symptoms occur due to superficial caries;
• there is an aggressive form.

With a properly performed procedure for applying applications or gel, the teeth are thoroughly cleaned beforehand, and then dried and isolated from saliva. This is necessary so that the solutions have maximum contact with the tooth enamel and are not diluted with saliva when they enter the oral cavity.

Solutions are applied with gauze or cotton swabs. On top of the treated area, the specialist can apply a special varnish or put on a cap. The duration of the procedure will depend on the chosen method (3-5 minutes). At the end, the patient is warned to refrain from eating and smoking for an hour.

The number of procedures performed will directly depend on the form of the remineralizing agent, on the degree of the disease and the number of affected dental units.

Method for sealing dentine canals

This method uses a dentine sealant that has been designed to eliminate harmful effects filling materials for dentin. It was soon discovered that sealants could treat exposed areas of dentin, thereby eliminating sensitivity. The polymer resins that are part of the sealant contribute to this effect. Penetrating into the mouths of the channels, these resins are polymerized, due to which sealing occurs.

The indication for this procedure is:

• gum recession and enamel abrasion;
• sensitivity of the cult of the tooth, which appeared after its preparation for the installation of a crown;
• abnormal wear of tooth enamel;
• defects of the teeth that cannot be corrected with filling material.

The treatment procedure begins with the preparation of dental units. Dental deposits are removed from them, followed by drying and isolation from saliva. After applying the sealant, you need to wait some time for chemical polymerization to occur. Some experts use a special lamp designed for light-cured composites to speed up this process.

Existing methods of traditional medicine in the treatment of hyperesthesia

Traditional medicine offers its own ways to get rid of tooth sensitivity. Basically, these are infusions and decoctions made using medicinal plants which are used to treat many dental diseases and their prevention. The following recipes are considered the most effective:

Decoction of oak bark

Oak bark is used in many recipes in the fight against dental problems. Particularly well proven in the fight against tooth sensitivity. To make a decoction, you need to take a spoonful of bark (dry) and fill it with boiling water, boil for 15 minutes. It's better to do it on steam bath. Then the broth is cooled and filtered. Rinsing the mouth cavity is carried out 3 times / day. The procedures are repeated for about 14 days.

Tea tree oil

A couple of drops of oil diluted in a glass of water will help relieve a sudden pain syndrome. But to fix healing effect, it is desirable to repeat such rinsing 4 times / day (it is better if the procedure is carried out at the end of the meal).

Infusion of burdock and medicinal chamomile

For infusion, you need to take a spoon medicinal herbs by pouring a glass of boiling water over them. All this is infused for half an hour, after which it is filtered. Rinsing is repeated 2 times / day. The duration of the course is up to ten days.

Before independent application decoctions and infusions, a person should understand that hyperesthesia is treated for a long time and it is not always possible to do simple procedures mouth rinses. First of all, the cause of the problem and the stage of the manifested disease are established. It is likely that the patient will additionally need to observe special diet, which will contain a large number of trace elements, minerals and vitamins. And in cases with acute and chronic form hyperesthesia will have to resort to surgical intervention. In any case, without the advice of a specialist can not do.

Prevention

Measures for the prevention of hyperesthesia contain a whole range of various activities. All of them are aimed at preventing the development of the disease. Prophylactic agents are selected in the form medicinal decoctions, pastes, gels, etc. If the pain is manifested due to temperature irritants, the specialist selects special means capable of sealing dentinal canals.

The main rules of prevention include the following methods:

1. Systematic and proper conduct hygiene procedures.
2. Proper selection of hygiene products. Do not buy hard brushes. Use pastes with abrasive elements. Whitening pastes can only be used 2 times/week. Such pastes damage the enamel and contribute to the leaching of calcium. These rules will help to avoid destruction of tooth enamel.
3. Using the correct technique while brushing your teeth will help avoid injury to the soft tissues of the oral cavity.
4. Proper nutrition is the key to healthy teeth. It is worth increasing the intake of foods containing phosphorus and calcium, but it is better to reduce sweet and sour ones.

AND binding rule prevention of hyperesthesia of the teeth - systematically visit dental office. Any appointment begins with an examination of the oral cavity for existing injuries, which means that the patient has an increased chance of detecting the disease at the initial stage and curing it in time.

What is the prognosis of hyperesthesia

Hyperesthesia will be successfully treated if the disease was diagnosed on early stages and the patient adhered to all the rules prescribed by the dentist. In more severe cases the disease is also curable, but for this you will have to undergo a long course of treatment. And in some cases, undergo surgery, after which prosthetics may be needed.

Hyperesthesia is hypersensitivity. This term is called increased mental excitability and increased sensitivity of the skin.

Hyperesthesia is not an independent disease, but develops against the background of other conditions, for example, with depression or polyneuropathy.

Causes

The causes of mental hyperesthesia can be:

• withdrawal syndrome (or withdrawal syndrome) - a sharp refusal to drink alcohol, smoke or use drugs;
• asthenic syndrome;
• depression.

Skin hyperesthesia can develop under the following circumstances:

• with metabolic disorders (for example, with diabetes mellitus, uremia and other diseases);
• with salt poisoning heavy metals, medicines or organic solvents;
• at systemic diseases eg scleroderma, vasculitis;
• at mechanical damage skin (for example, with burns, skin injuries).

The cause of dental hyperesthesia may be thinning of the tooth enamel at the neck of the tooth.

Symptoms of hyperesthesia

With mental hyperesthesia, the patient has the following symptoms: increased irritability(overreaction to minor external stimuli, such as the ticking of a clock, the smell of certain substances). With mental hyperesthesia, emotional instability, easy temper and inability to control one's emotions are noted.

With skin hyperesthesia, there is an increased sensitivity of the skin when touched. Also isolated dental hyperesthesia, which is discomfort in the area of ​​​​the neck of the tooth, which occurs when drinking hot or cold drinks or when food is touched to the teeth.

Diagnostics

At the first stage, the patient's complaints are analyzed and an anamnesis of the disease is collected. On neurological examination, the skin sensitivity, as well as the state of the patient's vision and sense of smell. An examination by a psychologist or psychiatrist is carried out. Estimated emotional condition sick.

The patient needs a blood test: the concentration of glucose, the level of protein metabolism products and toxic substances that can cause symptoms of hyperesthesia are checked.

Among instrumental methods diagnosis is performed by electroneuromyography. The diagnostic method allows you to assess the speed of impulse conduction along nerve fibers, as well as determine the degree of nerve damage.

Types of disease

There are the following forms of hyperesthesia:

• Mental hyperesthesia - hyperexcitability psyche.
• Cutaneous hyperesthesia - hypersensitivity of the skin.
• Dental hyperesthesia- Increased tooth sensitivity.

Patient's actions

Frequent symptoms of hyperesthesia may indicate the presence of certain diseases. It is necessary to diagnose and treat causative diseases.

Treatment of hyperesthesia

With mental hyperesthesia, the patient needs the help of a psychotherapist. It is necessary to allow internal and interpersonal conflicts. In some cases, it is necessary to use drugs that improve emotional background: antidepressants, adaptogens and others. The patient is shown sufficient rest and spa treatment.

With skin hyperesthesia, the following therapeutic measures can be carried out:

• the use of external preparations for the healing of skin wounds and burns;
• blood glucose control (if available) diabetes);
• carrying out renal replacement therapy (hemodialysis, kidney transplantation) with uremia;
• avoiding contact with toxic substances that can cause symptoms of hyperesthesia.

With dental hyperesthesia, the use of special toothpastes that reduce tooth sensitivity is indicated, as well as avoiding the use of too hot and cold drinks and food.

Complications

There may be a violation in social and labor adaptation. In some cases depression develops extreme degree emotional depression (necessary psychotherapeutic treatment).

Prevention of hyperesthesia

Prevention of hyperesthesia is reduced to the following recommendations:

• timely resolution of conflict situations;
• timely psychological or psychotherapeutic treatment emotional disturbances;
• conducting healthy lifestyle life;
• adequate rest and healthy sleep(at least 7-8 hours);
• preventive examinations by doctors;
• control blood pressure;
• timely access to a doctor in case of health problems.

Hyperesthesia is an increased sensitivity of tooth tissues when exposed to various external influences (chemical, mechanical or temperature origin) on the enamel. A person suffering from hyperesthesia of the teeth has diseases such as caries or pulpitis. When eating salty, sweet, sour, cold or hot, a sharp pain appears, which at the same time passes quickly.

Hyperesthesia can also appear due to thinning of tooth enamel. No less frequent (about 60%) are cases when hyperesthesia becomes the result of stress, menopause, problems with gastrointestinal tract and may also be associated with metabolic disorders. Statistics show that hyperesthesia is more common in women due to emotional disorders. On examination, the doctor will try to find out what triggered the development this disease, and then assign necessary treatment. If you do not seek proper treatment from a dentist in time, severe sensitivity can lead to hypertension of the hard tissues of the tooth. Hyperesthesia has two options (forms) for the development of the disease: generalized (located immediately on all parts of the teeth) and local (occurring on one or more teeth).

Classification of hyperesthesia

There are many types of classification of hyperesthesia, taking into account the severity and location of the disease.

Origin

Having an incomplete loss of hard tissues of the teeth:

• in the area of ​​carious cavities;
• due to erosion;
• due to the preparation of teeth during the installation of crowns;
• pathological thinning of hard tissues.

Regardless of the loss of hard tissues of the teeth:

• with periodontal diseases, the consequence of which will be the opening of sections of the necks and roots of the teeth;
• because of chronic diseases person.

By location

• limited (that is, only one specific tooth brings pain, which most likely has thinned enamel due to caries or the establishment of crowns);
• generalized (all human teeth are very sensitive, most likely due to running form caries, dental erosion, periodontal disease, etc.).

By severity

• Level 1 - characterized by a response only to temperature influences, namely when drinking hot or vice versa cold drinks;
• Level 2 - the response of tooth tissues not only to temperature, but also to chemical stimuli when eating sweet or salty foods in the diet;
• Level 3 - characterized by a response to everything possible types stimuli (temperature, chemical, tactile).

Causes of dental hyperesthesia

Probably every second person came to the dentist for help with the problem of tooth sensitivity. The main causes are most often poor oral care or wrong treatment certain diseases of the oral cavity. Consider detailed reasons the appearance of hyperesthesia in people:

1. Very often, the cause of hyperesthesia is an incorrectly sealed tooth, which eventually begins to bring pain.
2. Running caries or its improper treatment can also serve as the beginning of a disease of tooth sensitivity.
3. Improper use of dental floss irritates the gums and causes them to bleed.
4. The wrong toothbrush. Toothbrush in a state of soreness of the gums, it should be with soft, natural fibers and even, without unnecessary bends.
5. the cause of hyperesthesia may be traumatic injuries tooth surfaces;
   When wearing crowns, the cause of hyperesthesia can be their breaks.
6. It is better to install dentures and crowns only in clinics that have proven themselves well.
7. Incorrect polishing of teeth thins tooth enamel, which increases the risk of hyperesthesia.
8. whitening procedure. With frequent or improper teeth whitening, tooth enamel is erased;
   fracture or damage to the tooth tissue may occur.

Most common causes the appearance of hyperesthesia of the teeth, experts still call permanent teeth whitening and untimely cured caries. Also, tooth sensitivity is often provoked by periodontal disease.
In addition, hyperesthesia may be due to wrong exchange substances. Hormonal changes and frequent stress is also among the reasons that can lead to the disease of hyperesthesia of the teeth.

Diagnosis of hyperesthesia of the teeth

Only a dentist can diagnose hyperesthesia during an individual examination. The doctor studies the causes of this disease, its manifestations and distribution. The degree of response to temperature, chemical, tactile interactions is also determined.

To determine the methods of treatment, doctors often use electroodontodiagnostics, the essence of which is to connect an electric current to a diseased tooth (it does not pose a danger to a person) and show the threshold of tooth sensitivity. The average norm is the sensitivity threshold of 2-6 μA (microamps). At strong sensitivity human teeth indicators are reduced, which indicates a severe form of hyperesthesia.
Often the disease is confused with pulpitis, which is similar in its symptoms. An important difference between these diseases is the duration of toothache, which becomes more protracted during pulpitis and mainly manifests itself at night, while pain during hyperesthesia is instantaneous and quickly calms down. It is also important to know that the threshold of tooth sensitivity during pulpitis reaches 20 μA (microamperes).

Treatment of hyperesthesia of the teeth

Upon examination, the doctor determines the level of complexity of the above disease and prescribes the necessary treatment. To date, clinics know several options for curing hyperesthesia, namely:

Principles of dental care for hyperesthesia of the teeth

Such a disease as hyperesthesia of the teeth can occur at absolutely any age. Treatment depends on the stage of spread and the actual causes of the disease. The most important thing is to consult a doctor in time so that he can accurately diagnose and prescribe a treatment that will lead to a positive result.
Subject to all these rules and recommendations, pain can be reduced to a minimum and the occurrence of such a disease as hyperesthesia can be prevented.
Be healthy!

Despite the fact that hyperesthesia is not an independent disease, it external manifestations quite dangerous and annoying. Increased mental response to external stimuli, excessive sensitivity of teeth or skin is not only unpleasant, but also dangerous to the body. The difficulty of dealing with the disease lies in the fact that in order to eliminate its symptoms, it is imperative to find out the cause of their appearance.

Psychological reasons for the appearance

Hyperesthesia, that is, a pathological increase in the threshold of sensitivity, is often caused by psychological reasons. A person feels an excessive increase in the sharpness of perception of reality and reacts too violently to external stimuli (for example, the rustle of leaves or the chirping of a cricket).

In most cases, the described symptoms manifest themselves in the initial stages of certain types of clouding of consciousness (for example, sleepwalking), as well as other acute mental disorders.

Another reason for increased mental sensitivity is an abnormal reaction of the body or poisoning with drugs used in the treatment mental illness and psychoactive.

Symptoms

Mental hyperesthesia is characterized by such manifestations as increased irritability and emotional instability. The patient inadequately and overreacts to certain external factors. It does not matter which sense organs or receptors are irritated: auditory (clock ticking, rustle), olfactory (slight smell), tactile (light touch, prick).

A person becomes emotionally unstable, easily excitable, cannot adequately control his emotions. Sometimes patients complain of a lot of pointless unpleasant sensations that occur in various parts of the body and are not amenable to localization.

Too frequent manifestation of symptoms of hyperesthesia indicates additional pathologies that the patient has. Therefore, before starting treatment, it is necessary to confirm or deny their presence.

Diagnostics

As in any other case, establishing the causes of the appearance of a pathology begins with an analysis of the patient's complaints and the collection of anamnesis, that is, information about the history of the course of the disorder, living conditions, previous illnesses, and so on.

Then a neurological examination is performed. The reaction of the skin is evaluated, the vision and olfactory functions of a person are checked. A visit to a psychologist or psychiatrist, who can assess the psycho-emotional state of the patient, will help diagnose the disease and establish the causes of its occurrence.

As for the tools, the most effective among them is electroneuromyography. Using this procedure, the speed of passage of a nerve impulse from external receptors to the brain is measured, and the degree of damage to the nervous tissue is determined.

Hyperesthesia can be caused great content glucose, the presence of toxic substances and products of protein metabolism. Therefore, there is a need for a general laboratory analysis urine and blood.

Treatment

Most often, the appearance or exacerbation of hyperesthesia is associated with a person receiving a physical injury or getting into situations that are stressful for him. The “trigger” factor may not even be the pain itself, but its expectation or an acute feeling about the suffering of other people.

Treatment is carried out by several medicines. First of all, painkillers. Anesthetics stop the pain syndrome, which is the cause of the appearance of signs of hyperesthesia. Can be used medical equipment. Sedative drugs used to normalize mental state the victim.

Increased tooth sensitivity

As in the previous case, hyperesthesia of the hard tissues of the tooth is not an independent pathology, but a consequence or reaction to other painful conditions, for example, carious lesions or external physical impact.

In most cases, the pain does not have a long-lasting character, and varies in intensity from barely noticeable to almost unbearable. Sometimes hyperesthesia of the teeth prevents even eating or brushing.

The exact mechanism of the occurrence of pathology is still unknown. However, all experts agree that hyperesthesia of the teeth appears due to:

• intensive carious processes in the dental cavity;
• increased fragility of tooth enamel;
• chips and other damage to the surfaces of the teeth;
• other processes that are not classified as carious by dentists;
• damage to the enamel located in the area of ​​​​the neck of the tooth;
• necrosis and erosion of teeth.

Symptoms

The main sign by which hyperesthesia of the teeth is diagnosed is the appearance of a short-term, but very intense pain. The duration of the pain syndrome is from 10 to 30 seconds. The area of ​​manifestation can be clearly defined or have a global character.

All symptoms of pathology are classified according to the following criteria:

sign	Characteristic
Localization	clearly defined - discomfort occurs in one or more specific teeth; systemic - pain appears in the mouth and the patient cannot specifically point to its source.
Origin	associated with the loss of hard tooth tissues - often this type of hyperesthesia appears when enamel is removed during the treatment of carious processes or necrosis; not associated with the loss of a layer of enamel.
Clinical picture	the appearance of pain when exposed to temperature (cold or heat); the presence of discomfort is associated not only with the influence of temperature, but also chemical substances(acid, sweetness); irritation is caused by all influences, including physical ones.

Treatment

The method of getting rid of the disease depends on the cause of the pathology. Most often, it is sufficient to use prophylactic agents, but in some cases, for example, exposure of the neck of the tooth or pathological lowering of the gums, without surgical intervention not enough.

If hyperesthesia of the teeth is recurrent due to fragility or increased abrasion of the enamel, orthodontic procedures may be prescribed.

Hypersensitivity of the skin

Another fairly common type of hypersensitivity is skin hyperesthesia. This condition is a consequence of a violation of the functioning of special nerve fibers passing through the thickness of the skin. As a result, nerve receptors interact incorrectly with internal organs, including the brain.

The causes of this pathology can be as significant external influences(burns, injuries, lichen, wounds), and internal factors. The latter include increased excitability of neurons in the brain. Skin hyperesthesia is often diagnosed in patients suffering from neurosis, mental disorders and other similar ailments.

Symptoms

The violation in question is characterized by unpleasant sensations of a pressing nature, as well as burning pains similar to burns. Moreover, the nature of their manifestation differs from the place of localization. Attempt to lift the part skin causes almost unbearable pain.

An additional sign of hyperesthesia is dermographism. If you run a fingernail or spatula over the skin healthy person, it leaves an inconspicuous pale pink trace, which quickly disappears. The presence of a pathology is evidenced by a pronounced dark red line, which does not disappear for a rather long period of time.

But with this method of diagnosing pathology, one should be careful. Dermographism may also indicate impaired functioning of the endocrine and nervous system, inflammation of the membranes of the head and spinal cord and so on. Therefore, to clarify the diagnosis, it is necessary to contact a medical institution.