RU2299015C2 - Method for diagnosing dentomaxillary system state - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves carrying out routine examination. Dentomaxillary system segments are consecutively estimated including following elements: dental hard tissues, pulp, extra- and intradental concrements, tissues adjoining to dental periodontium and parodentium, dental alveolus, jaw bone, and gingiva. Then, depending on injury, injury level is conditionally assigned to each element using 4-graded scale: 0 points - no injury, 1 - mild degree thereof, 2 - moderate degree, medium-heavy degree, 3 - reversible heavy degree, 4 - irreversible injury. Score value being equal to zero in a segment, given dentomaxillary system segment condition is considered to be in norm. The score value being equal to 1-10, the first tissue injury severity degree is considered to be the case in the segment. The value being equal to 11-20, the second injury severity degree takes place. The sum being equal to or greater than 21, the third injury severity degree is considered to take place. Periodontitis being additionally detected when estimating a dentomaxillary system segment, previous diagnoses like caries and pulpitis are to be taken into consideration, assigning 4 points to each of them.

EFFECT: enhanced effectiveness of medical treatment.

2 cl

Description

The present invention relates to medicine, namely to dentistry, and can be used in the diagnosis of dental status and treatment of the dentition.

An objective examination, in this case, an examination of the organs of the oral cavity, plays a major role in identifying dental pathology, making a diagnosis, choosing a treatment method and is an important part of the overall examination of the body.

New methods for routine examination of the organs of the dentition allow more correctly, accurately and objectively assess the state of each component with varying degrees of involvement in the pathological process, and identify the possible effect of one pathological focus on another.

A known method for the diagnosis of dentoalveolar system (Melekhov S.V. Card of a dental patient. - Krasnodar, 1988. - 43 p.), Which allows a sufficiently complete examination of each specific clinical case, to conduct dynamic monitoring at the appropriate agreed time after the initial examination and treatment. The method involves collecting symptoms in accordance with a standardized map. The map is a standardized medical history of a dental patient, giving the opportunity for automated processing using computer technology. Includes passport part, examination data, options for diagnoses and treatment methods, sequence of medical manipulations, etc.

Disadvantages:

1. The method provides isolated information about each specific clinical case (within the same tooth), not taking into account the possible influence of surrounding tissues.

2. To diagnose another clinical case, it is necessary to start a separate new card.

3. It does not provide the possibility of segmented and systemic diagnostics simultaneously.

For the closest analogue, we have adopted a method for an objective examination of the organs of the dentofacial system, proposed by E.V. Borovsky et al. (E.V. Borovsky et al. Therapeutic dentistry. - M., 1988. - P.67-103.) An objective examination includes examination, percussion, palpation and a number of additional methods. Inspection of the oral cavity suggest starting with the vestibule, examining the mucous membrane of the vestibule and lips, then the cheeks. Next, determine the ratio of the dentition - the bite. Following the oral cavity, the gum mucosa is examined. The condition of the pockets, subject to their presence, their depth, the presence of tartar. Then proceed to the examination of the oral cavity itself. First, pay attention to the mucous membrane, conduct an examination of the tongue, the bottom of the oral cavity. Then they proceed to the examination of the teeth, from right to left, starting with the teeth of the lower jaw. The teeth are examined using dental instruments: probe, mirror, tweezers. Percussion is carried out - to identify periodontal pathology. The presence of tooth mobility is determined, thermodiagnostics is carried out. For the convenience of recording the results of a dental examination, a graphic image of the dental formula is used. The data are entered in the survey map. For example, a diagram with the designation of tooth surfaces, where the incisors and fangs have 4, and premolars and molars - 5 surfaces. To determine the condition of the tooth, lettering is used: caries - C, pulpitis - P, periodontitis - Pt, etc. according to a known pattern. Other pathological changes are noted in the graphs located under the formula of the teeth.

Disadvantages:

1. The map does not fully reflect the situation in the oral cavity.

2. The map does not display indicators of many well-known routine examination methods.

3. Dynamic monitoring is not provided.

4. Diagnostics by segments is not provided.

5. Unreliability of diagnosis.

Objective: improving the quality of diagnosis of the pathology of the oral cavity, identifying the possible effects of one pathology on another in each (specific) segment, and as a result, making a more accurate, complete diagnosis, conducting complex treatment, thereby increasing the effectiveness of therapeutic measures.

The technical result of the proposal is to improve the quality of diagnosis of the state of the dentofacial system, due to a more thorough examination of the organs of the oral cavity and, as a result, the formulation of a joint systemic diagnosis, where the cause-effect relationships of the impact of one pathological focus on others and the system as a whole are traced. Dynamic observation allows you to record all installed changes.

The essence of the invention lies in the fact that they carry out a routine examination of the organs of the oral cavity, where the significant criteria for evaluating the dentition include segments consisting of: hard tooth tissues, pulp, extra-dental and intradental calculi adjacent to the tooth of the periodontal and periodontal tissues - periodontal proper, alveoli of the tooth, jaw bone, gums, then, depending on the lesion, each element on a 4-point scale is assigned a conditionally level of damage and when the value is equal to 0 points, it is determined as the condition of the segment of the dentition system in health; when the value of the total score from 1 to 10 as the first degree of tissue lesion of the segment; with a value of the sum of points from 11 to 20 - the second degree of defeat; and with an amount equal to 21 points or more, the third degree of defeat.

The method is as follows.

For the examination, the entire dentition is conditionally divided into separate segments (provided that there are 28 teeth in the oral cavity, 28 segments are distinguished, in the presence of 32, 32 respectively). The segment includes the following formations: hard tissues of the tooth, pulp, extra-dental and intradental calculi, adjacent to the tooth tissue of the periodontal and periodontal - periodontium proper, tooth alveolus, jaw bone, gum.

Cards showing the results of the system examination are made for each patient: tooth - hard tissues, pulp, extra-dental and intra-dental calculi, pulp; periodontal and periodontal tissues - periodontal proper; oral mucosa. In the map, all data for each specific tooth (segment) is positioned vertically one above the other, which allows, after filling in all points, to get an idea of the condition of each segment and dentition as a whole. The examination is carried out using dental instruments: a sharp probe, a mirror, tweezers, a periodontal probe.

Conduct a sequential examination of each segment of the dentition, following the recommendations of the WHO: 48, 47, 46, 45, 44, 43, 42, 41, 31, 32, 33, 34, 35, 36, 37, 38, 21, 22, 23, 24, 25, 26, 27, 28, 18, 17, 16, 15, 14, 13, 12, 11. The segment number corresponds to the tooth number. Survey all components of the segment. First, the state of the dentition is evaluated: each tooth is sequentially. To indicate the condition of each tooth, the following conventions are used: N - intact tooth, K - crown, X - removed, O - not cut, R - root, I - artificial tooth, W - pin design.

When examining directly tooth tissues, diagnostics are carried out on all surfaces, and the occlusal surface is divided into 4 parts (two proximal: distal, mesial and two lateral, according to the location of the tooth); surface conventions are used: p - palatine, m - medial, d - distal, o - occlusal, lg - lingual, l - labial, b - buccal, v - vestibular, c - cervical, s / I - blind fossa, cr - circular.

The presence of carious foci, fillings (including the reason for which the seal was placed), non-carious lesions, soft and mineralized plaque, their localization are noted, and symbols are also used to fix the diagnosis in the original examination map of the dental patient: C - caries (acute (1); chronic (2); pov. - superficial, cf. - medium, hl - deep), P-seal, G - hypoplasia, F - fluorosis, PS - pathological abrasion, CD - wedge-shaped defect, E - erosion, GP - hyperesthesia, T - injury.

Diagnosis of initial caries by staining with a solution of methylene blue, probing a carious lesion, percussion, thermal test (cold and hot water). The KPU index is calculated (by adding all the cavities, fillings and extracted teeth).

The OHI-S index is determined, which allows to separately assess the amount of plaque (DI-S) and tartar (CI-S). To determine the index, 6 teeth are examined: 16, 11, 26, 31 — vestibular surfaces, 36, 46 — lingual surfaces. Plaque assessment is carried out visually or using staining solutions. The index calculation is composed of the values obtained for each component of the index divided by the number of surfaces examined, followed by a summation of both values (OHI-S).

They diagnose complications of caries, provided it is present (Pt-periodontitis (acute (1); chronic (2); acute (3)) (fibrous, granulating, granulomatous), P - pulpitis (acute (1); hr. (2); exacerbation (3)); (simple, purulent, hypertrophy)).

To clarify the diagnosis of periodontitis, an X-ray examination is performed. When examining periodontal and periodontal tissues, the PMA index is calculated, the presence of bleeding (3 degrees), mobility (according to Tosky) are examined, the presence of foci of destruction is determined, and the tissues surrounding the tooth are also conditionally divided into 4 zones. Determine the nature and amount of discharge from the pockets, their depth (in 4 zones, around the tooth: approximate, vestibular (buccal), palatine (lingual)), gum retraction. The data of the samples taken are recorded in a separate card: N. Kotzschke, N. Rotter, Kavetsky-Bazarnova, a study conducted using the method of V.I. Kulazhenko, periodontal index (PI). Determine the quantitative index of OKG, the index of tooth wear. Data for each examined parameter is entered in the original maps. When examining the mucosa, all pathological phenomena on the oral mucosa, which is part of a certain segment, are taken into account, data on the state of the mucosa not being in any of the segments, including the tongue and mucosa of the palatine arches, are recorded separately, the changes are recorded in a separate original map, including a schematic representation of the cavities.

Depending on the quantitative indicator of the volume of tissues involved in the pathological process, each tissue component is conditionally assigned points according to a 4-point system in increasing order (0 - no damage, 1 - light degree of damage, 2 - medium (moderate) degree, 3 - severe, but reversible, 4 is an irreversible lesion; moreover, when it comes to periodontitis, then all the diagnoses preceding it are summed up, i.e. caries - 4 points, pulpitis - 4 points), then they add up all points in one segment. When the value of the amount equal to 0 points, it is determined as the condition of the segment of the dentofacial system in normal when the value of the total score from 1 to 10 - as the first degree of tissue lesion of the segment; with a value of the sum of points from 11 to 20 - the second degree of defeat; and with an amount equal to 21 points or more, a third degree of damage. Then the data obtained are summarized in a mathematical table. Based on the analysis of this table, a joint, systemic diagnosis is formulated. This examination is carried out in dynamics: the day of the visit, then after 1, 2 and 4 weeks. The research data is recorded in a special original “map of dynamic observation of the status of the dentofacial system”

We carried out using this method an examination of 54 patients (women from 18 to 59 years old) with various diseases of the organs and oral cavity.

Examination of patients using the proposed method allowed to improve the quality of diagnosis of diseases of the oral cavity, made it possible to identify a causal relationship between diseases of hard tissues of the tooth, pulp, periodontal and periodontal disease, to identify the dynamics of changes in these tissues. Entering the data into the examination map made it possible to study the state of the oral organs by segments. The generalization of the data in the table made it possible to mathematically evaluate the magnitude of the pathological process, to formulate a joint, systemic diagnosis.

Example 1. Patient F., 35 years old. During the examination, aesthetic complaints were revealed regarding “carious defects on the front teeth”, periodic bleeding of the gums during brushing. According to the patient, the defects appeared about 5 months ago, bleeding worries about a year, he visits a dentist 2 times a year.

Objectively: external inspection data without features. The mucous membrane of the oral cavity is pale pink, moist, shiny, without pathological elements. Bite II class. (I) according to Engle. Examination of the oral cavity revealed (in the examples of 11 and 21 segments): tooth 11 — deep carious cavity, Black class IV, extending to the mesial contact surface and the cutting edge filled with softened dentin, after excavation of which a dense pigmented surface is found. Probing of the cavity is slightly painful in the bottom; positive thermal test for cold, discomfort passes immediately after the termination of the stimulus. There is a seal in the region of the blind fossa made of a composite material of chemical curing; the seal is functionally sound. A dark coating was found on the tooth, covering the crown with 1/3 of the palatine surface.

Tooth 21 is a medium sized carious cavity, class IV according to Black, extending to the mesial contact surface and the cutting edge, the bottom and walls of the cavity are dense, pigmented, sounding and thermal tests are negative. A dark coating was found on the tooth, covering the crown with 1/3 of the palatine surface. We enter the data in the card:

where: "+" - the presence of a symptom;

“-” - absence of a symptom;

- наглядное изображение исследуемого зуба, разделенного диагоналями на части (для графического изображения локализации патологического очага). Зоны, очерчивающие центральное изображение зуба, представляют собой (от центра к внешнему краю): экватор зуба, пришеечную область, цемент корня. Зоны делятся диагоналями на вестибулярную, лингвальную и две апроксимальные (мезиальную - правый треугольник для левых половин челюстей, левый треугольник для правых половин челюстей; дистальную - левый треугольник для правых половин челюстей, правый треугольник для левых половин челюстей) поверхности.

- a visual image of the examined tooth, divided by diagonals into parts (for a graphic image of the localization of the pathological focus). The zones outlining the central image of the tooth are (from the center to the outer edge): the equator of the tooth, the cervical region, and cement of the root. Zones are divided by diagonals into the vestibular, lingual and two proximal (mesial - right triangle for the left halves of the jaw, left triangle for the right halves of the jaw; distal - left triangle for the right halves of the jaw, right triangle for the left halves of the jaw) surface.

Further, periodontal tissues were examined. During the Schiller-Pisarev test (RMA index), the marginal gum was colored. No pathological gingival pockets were found. Data entered into the map:

Where:

periodontal tissues, separated by diagonals into the vestibular (lower triangle), oral (upper triangle) and approximate (mesial - right triangle for the left halves of the jaws, left triangle for the right halves of the jaws; distal - left triangle for the right halves of the jaws, right triangle for the left halves jaw) zone. The same principle is used to graphically depict foci of destruction (only if they are present with a “+” sign, the absence is not marked with marks) in the diagram:

where the inner square displays the bone resorption of more than 1/2 of the root length, the next - from 1/3 to 1/2 and the outer - less than 1/3 of the root length.

We performed a Rotter H test: after applying Tilmans drops on the dried surface of the tongue, discoloration occurred after 16 seconds. During the Kulazhenko test, a hematoma in the region of the anterior teeth formed within 50 seconds. The periodontal index was determined. Data entered into the map:

When filling in the column related to the items: “OHI-S Index”, “Mobility”, “Bleeding”, “RMA”, “Periodontal Index”, “+” is only noted for the presence of a symptom, the absence is not marked with a “-”.

Because pathology from the mucous membrane of the oral cavity was not detected, the map for this section was not filled.

Diagnosis: deep caries 11, IV class. according to Black, chronic course (3 points), average tooth decay 21, IV class. according to Black, chronic course (2 points), chronic generalized catarrhal gingivitis, moderate severity (2 points). Thus, the 11th segment has a total of 3 + 2 = 5 points, and the 21st segment 2 + 2 = 4 points, respectively, which is the first degree of tissue damage in both segments.

Example 2. Patient G., 26 years old. The examination revealed complaints of halitosis, itching, bleeding gums when brushing your teeth; the destruction of the crowns of the tooth 36, tooth 46 and pain in the tooth 46 when biting. According to the patient, tooth 36 collapsed about 1 year ago, there is no pain; tooth 46 worries about 4 months, collapsed about 3 years ago.

Objectively: orthognathic bite, close position of the front teeth of the upper and lower jaws. There are abundant dental deposits. The gingival mucosa is edematous, hyperemic, bleeds profusely when probed.

When examining the hard tissues of the teeth (for example, segment 46): the crown of tooth 46 is 3/4 destroyed, the medial contact wall is preserved, the cavity is filled with food debris, after excavation of which softened dentin was found. Sounding, thermal tests are negative, percussion is positive (vertical and horizontal). The patient is referred to an orthopantomogram. X-ray: at the apex of the distal root, a bone destruction center with fuzzy borders, about 3-4 mm in size, was found. Data entered in the map:

Further, periodontal tissues were examined. During the Schiller-Pisarev test (RMA index), the alveolar gum was colored. A periodontal pocket 4 mm deep was determined. Data entered into the map:

A Rotter H test was performed: after applying a Tilmans drop to the dried surface of the tongue, discoloration occurred after 16 seconds. During the Kulazhenko test, a hematoma in the area of the 46 tooth formed within 10 seconds. The periodontal index was determined. Data entered into the map:

Because pathology from the mucous membrane of the oral cavity was not detected, the map for this section was not filled.

Diagnosis: exacerbation of chronic granulating periodontitis of the tooth 46 (4 + 4 + 3 = 11), generalized periodontitis in the acute stage of moderate severity (4 + 2 = 6). Thus, the 46th segment has a total of 11 + 6 = 17 points, which is the second degree of tissue damage to the segment of the dentofacial system.

Example 3. Patient M., 44 years old. Complaints of bad breath, mobility of the teeth of the lower jaw. Pain in the tooth 36 when biting. According to the patient, an unpleasant odor appeared about 1 year ago, she did not go to the doctors for help, pains when biting in tooth 36 disturb about a week, appear periodically over the past 3-4 years, and pass spontaneously.

The patient was examined according to the above scheme. Data entered into the cards.

Objectively: external examination without pathology. Oral mucosa without pathological elements. The mucosa of the alveolar process of the lower and upper jaws is hyperemic, edematous, bleeds when probed. In the region of 36 segments: there is a periodontal pocket, the depth of sounding from the buccal side is 5 mm, from the lingual and approximate 4 mm. From the pocket there is a purulent discharge. Tooth 36 is movable, deviates by 2 mm transversally. A stamped coated crown on the tooth is non-functional. Percussion vertical and horizontal are positive, thermal tests are negative. Radiological: bone resorption of interdental septa (on both sides) by 1/3 of the root length. In the area of the apex of the distal root, a bone rarefaction site with fuzzy contours is observed, with a diameter of about 4 mm.

The diagnosis (on the example of segment 36): severe (generalized) periodontitis of a severe degree in the acute stage (3 points), III degree of TOSKY mobility (3 points): (4 + 3 + 3 = 10 points); chronic granulating periodontitis of tooth 36 in the acute stage (3 points): (4 + 4 + 3 = 11), non-functional stamped crown for 36 (3 points). Thus, the 36th segment has a total of 10 + 11 + 3 = 24 points, which is the third degree of tissue damage in the segment of the dentofacial system.

Example 4. Patient K., 43 years old. Similarly, after the diagnosis of the dentition, it was revealed that the total score (for the example of segment 34) is 1. Therefore, segment 34 represents the first degree of tissue damage.

Example 5. Patient O., 41 years old. Was examined according to a scheme similar to that described in examples 1, 2. After the diagnosis of segment 36, the total score was 10, which represents the first degree of tissue damage to the segment of the dentition.

Example 6. Patient D., 32 years old. Similarly, after examining the dentition, it was revealed that the total score (for the example of segment 44) was 11. Therefore, segment 44 represents the second degree of tissue damage.

Example 7. Patient J., 25 years old. The survey was conducted according to a scheme similar to that described in examples 1.2. After diagnosing segment 37, the total score was 20, which represents the second degree of tissue damage to the segment of the dentofacial system.

Thus, the practical application of the proposed method for diagnosing the state of the dentofacial system, allows us to identify at earlier stages of the development of diseases of the oral cavity, to more accurately predict their course. Such a detailed systematic approach to diagnosis makes it possible to conduct a more thorough diagnosis of the pathology of the oral cavity in each patient, identify the most affected segment, its effect on surrounding tissues, as well as the effect of surrounding tissues on it. This approach allows us to identify the root cause of the pathology, to more carefully develop the most appropriate, etiopathogenetic treatment plan in accordance with the entire pathology detected, to carry out the treatment comprehensively, which will subsequently reduce the likelihood of early and late complications, an earlier and more stable onset of well-being in each segment in separately, and, accordingly, in the entire dentition.

Claims (2)

1. A method for diagnosing the condition of the dentofacial system, including its routine examination, characterized in that a sequential assessment of the segments of the dentofacial system is carried out, including the following elements: hard tissue of the tooth, pulp, extradental and intradental calculi, adjacent to the tooth tissue of the periodontal and periodontal, the tooth alveolus , jaw bone, gum, then, depending on the lesion, each element on a 4-point scale is assigned a conditionally level of lesion: 0 points - no lesion, 1 - mild lesion, 2 - medium, medium severe, 3 - severe but reversible, 4 - irreversible damage; when the value of the total score in the segment equal to 0, it is determined as the state of this segment of the dentofacial system in normal, with the value of the total score from 1 to 10 as the first degree of tissue damage to the segment; with a value of the sum of points from 11 to 20 - the second degree of defeat, and with an amount equal to 21 points or more - the third degree of defeat. 2. The method according to claim 1, characterized in that in the presence of periodontitis, in addition to evaluating segments of the dentofacial system, previous diagnoses are taken into account, namely caries and pulpitis, assigning 4 points to each of them.