RU2406440C1 - Method of evaluating quality of life assessment in patients with dentition defects - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to dentistry. It involves questioning of the patients including the clinical characterisation of the dentition and symptoms, the assessment of the dentition defect (DD) related physical interference (physical functions), the assessment of DD related psychoemotional interference, the assessment of DD related social interference, the assessment of orthopedic result in the patient's life. Each block includes 5 questions, each answer is estimated on the five-grade scale. The points are summed up. If score is 25 and less, the patient's quality of life is considered to be normal, 26 to 50 shows satisfactory quality of life, 51 to 80 - low quality of life, over 80 points - very low quality of life.

EFFECT: method allows to derive a precise quality of life assessment from the offered criteria in the patients with dentition defects.

12 dwg, 4 ex

Description

The invention relates to medicine, namely to dentistry.

Assessing the quality of life as a prognostic factor can be useful in planning individual dental treatment in combination with psycho-emotional correction to improve its results and can be the basis of rehabilitation programs for monitoring the quality of medical care provided. However, special questionnaires that are directly related to the state of the chewing apparatus would be more indicative.

Using only well-known examination methods, such as, for example, a survey, a clinical examination of a patient, it is not always possible to determine the degree of change in the patient's daily activities, which are caused by violations of the maxillofacial system.

The known method of "self-assessment of the influence of inflammatory periodontal diseases on the quality of life" (Certificate of registration of an intellectual product registered by FSUE VNTITS dated March 15, 2004 No. 72200400023, author Ron G.I., Belova O.E.), the use of which is described in the article " The effect of periodontal information and wave therapy on the quality of life of patients ”(Problems of Dentistry, 2005, No. 1, p. 18-22, auth. Ron G.I., Belova O.E.), which reflects the possibility of evaluating the effectiveness of various treatment methods certain nosology in dentistry - inflammatory periodontal diseases. This method is taken as a prototype. However, according to the results of the study, it is clear that the patient’s psycho-emotional state (page 20) is definitely important, which was definitely determined by only five questions asked before and during treatment of the patient (poor mood, anxiety, increased irritability, disturbance of night sleep, feeling of depression), which is not accurate enough.

The objective of the invention was to more accurately determine the psychoemotional disorders that affect the quality of life and the results of orthopedic dental treatment of patients with defects in the dentition and their timely correction during rehabilitation.

The technical result - obtaining criteria for assessing the quality of life in patients with defects in the dentition.

The proposed method is as follows. The patient is questioned, including an assessment of the clinical condition of the dentoalveolar system, for this the patient determines the need to consult a dentist about the teeth, each answer is scored, namely: “no” is evaluated as 0 points, “I doubt” - 1 point, “probably” - 2 points, “rather yes” - 3 points, “yes” - 4 points, “immediately” - as 5 points; determines the food stuck between the teeth, evaluate the answer “no” as 0 points, “very little” - 1 point, “little” - 2 points, “medium” - 3 points, “often” - 4 points, “with each meal” - like 5 points; determines pain in the oral cavity, assess the answer “no” as 0 points, “very slightly” - 1 point, “little” - 2 points, “moderate” - 3 points, “very worried” - 4 points, “very much worries ”- as 5 points; determines the mobility of the teeth, the answer “no” is estimated as 0 points, “very slightly” - 1 point, “little” - 2 points, “moderate” - 3 points, “strong” - 4 points, “very strong” - as 5 points; determines whether the smile’s aesthetics are broken, the answer “no” is estimated as 0 points, “very slightly” - as 1 point, “little” - 2 points, “a little” - 3 points, “strong” - 4 points, “very strong” - like 5 points.

Then a questionnaire is conducted on a scale of physical functioning (FF) based on the judgment of the patient himself about the effect of a dentition defect or denture (if any) on his physical condition, for this the patient determines a mastication function due to lack of teeth, each response is evaluated in points, namely: “no” is estimated as 0 points, “very little” - 1 point, “little” - 2 points, “a little” - 3 points, “strong” - 4 points, “very strong” - as 5 points; determines the restrictions on food intake, the answer “no” is estimated as 0 points, “very slightly” - 1 point, “little” - 2 points, “a little” - 3 points, “strong” - 4 points, “very strong” - as 5 points; determines pain in the oral cavity due to prostheses, the answer “no” is estimated as 0 points, “very slightly” - 1 point, “little” - 2 points, “slightly” - 3 points, “strongly” - 4 points, “very strong "- as 5 points; determines the difficulty of chewing due to malocclusion (if there is a violation from the patient’s point of view), the answer “no” is estimated as 0 points, “very slightly” - 1 point, “little” - 2 points, “a little” - 3 points, “Strong” - 4 points, “very strong” - as 5 points; determines speech impairment due to the presence of dentures, the answer “no” is estimated as 0 points, “very slightly” - 1 point, “little” - 2 points, “moderate” - 3 points, “strong” - 4 points, “ very strong ”- as 5 points.

The questionnaire is also conducted on the psycho-emotional state (PS) scale and the effect of dentition defects on the patient’s psycho-emotional state is assessed, for this the patient determines how much his depressive feelings are worried, each answer is scored, namely: “no” is evaluated as 0 points, “Very weak” - 1 point, “relatively weak” - 2 points, “medium” - 3 points, “relatively strong” - 4 points, “extremely strong” - as 5 points; determines how often he feels irritable, the answer “never” is estimated as 0 points, “very rarely” - 1 point, “quite rarely” - 2 points, “neither often nor rarely” - 3 points, “quite often” - 4 point, "all the time" - as 5 points; determines how often there is a feeling of fear due to teeth, the answer “never” is rated as 0 points, “very rarely” - 1 point, “quite rarely” - 2 points, “neither often nor rarely” - 3 points, “pretty often "- 4 points," always "- as 5 points; defines a violation of night sleep, the answer “no” as 0 points, “very rarely” - 1 point, “quite rarely” - 2 points, “sometimes” - 3 points, “quite often” - 4 points, “very often” - as 5 points; determines the complexity due to ugly teeth (prostheses), the answer “never” is estimated as 0 points, “very rarely” - 1 point, “quite rarely” - 2 points, “sometimes” - 3 points, “quite often” - 4 points , "Always" - as 5 points.

Then, a questionnaire is conducted on a scale of social functioning and the impact of a dentition defect on the social functioning of the patient is assessed, for which the patient determines whether his relationship with others and family members is affected due to bad teeth (prostheses), each response is scored, namely: “No” is estimated as 0 points, “very little” - 1 point, “slightly” - 2 points, “medium” - 3 points, “relatively strong” - 4 points, “very strong” - as 5 points; determines whether it is difficult to bite off food and chew it in the company of others, the answer “no” is estimated as 0 points, “very rarely” - 1 point, “sometimes” - 2 points, “quite often” - 3 points, “often” - 4 points, “always” - as 5 points; determines the decrease in working capacity due to bad teeth or dentures, the answer is “never” is estimated as 0 points, “very slightly” - 1 point, “little” - 2 points, “medium” - 3 points, “quite pronounced” - 4 points, “Very strong” - as 5 points; determines the difficulties with traveling on business trips, on vacation, the answer “no” is estimated as 0 points, “very slightly” - 1 point, “little” - 2 points, “moderate” - 3 points, “fairly pronounced” - 4 points, "Great difficulties" - as 5 points; defines violation of family relations, the answer “no” is estimated as 0 points, “insignificantly” - 1 point, “little” - 2 points, “medium” - 3 points, “quite pronounced” - 4 points, “very strong” - as 5 points.

Then, a questionnaire is conducted on the scale of the impact on the life of the respondent of the result of orthopedic treatment (the scores are reduced when responding from negative to positive), for this the patient determines how much the condition of his teeth makes him feel happy with life, each answer is scored, namely: “Never” is estimated as 5 points, “very rarely” - 4 points, “quite rarely” - 3 points, “medium” - 2 points, “quite often” - 1 point, “always” - as 0 points; determines how satisfied he is with his ability to fulfill his functional duties, the answer “very dissatisfied” is assessed as 5 points, “mostly unsatisfied” - 4 points, “neither yes nor no” - 3 points, “mostly satisfied” - 2 points, “Satisfied” - 1 point; “completely satisfied” - as 0 points; determines how satisfied with his health in general, the answer is “very dissatisfied” is estimated as 5 points, “mostly unsatisfied” - 4 points, “neither yes nor no” - 3 points, “mostly satisfied” - 2 points, “quite satisfied ”- 1 point,“ very satisfied ”- as 0 points; determines how satisfied he is that he was able to carry out the optimal variant of orthopedic treatment (dental prosthetics), the answer “very unsatisfied” is estimated as 5 points, “mostly unsatisfied” - 4 points, “neither yes nor no” - 3 points, “ mostly satisfied ”- 2 points,“ completely satisfied ”- 1 point,“ very satisfied ”- as 0 points; determines how satisfied with the quality of his life, the answer “very dissatisfied” is estimated as 5 points, “mostly unsatisfied” - 4 points, “neither yes nor no” - 3 points, “mostly satisfied” - 2 points, “completely satisfied "- 1 point," very satisfied "- as 0 points. Points on all issues are summarized. With an amount of 25 or less points, the patient’s quality of life is assessed as normal with the absence of clinical signs of the disease, impaired physical functioning associated with the dentofacial system, the psycho-emotional sphere, the presence of social activity, and high vitality.

With an amount of 26 to 50 points, the level of quality of life is assessed as satisfactory. The patient needs dental treatment, but most often without pronounced deviations from the normal indicators of the psycho-emotional sphere, without restrictions on social activity, physical functioning.

With an amount of 51 to 80 points inclusive, they assess the quality of life as low. Existing disorders of the maxillofacial system lead to a violation of physical function, a psycho-emotional imbalance, a pronounced increase in the level of anxiety, and sometimes clinically severe depression, and, as a result, a violation of social activity and a decrease in the vitality scale.

With an amount of more than 80 points, the quality of life is assessed as very low, limited to dental pathology. The existing pathology has clearly expressed clinical manifestations that provoke persistent changes in the psychoemotional sphere, characterized by clinically pronounced anxiety and depression, persistent violations of social activity.

The questionnaire is filled before the start of treatment, 1 month after the end of treatment, 2 and 3 months after the end of treatment. The patient is asked to evaluate his life over the past 4 weeks.

The invention is illustrated by the following figures:

Figure 1. Photo of the oral cavity of patient B., 46 years old, before treatment: a - photo in front, b - lateral area of the dentition on the left.

Figure 2. Photo of the oral cavity of patient B., 46 years old, after treatment: a - photo in front, b - lateral area of the dentition on the left.

Figure 3. Photo of the oral cavity of the patient K., 35 years old, before treatment: a, c - lateral sections of the dentition, b - photo in front.

Figure 4. Orthopantomogram of patient K., 35 years old.

Figure 5. Photo of the oral cavity of patient K., 35 years old, after treatment: a - photo in front, b - lateral area of the dentition on the left.

6. A photograph of the oral cavity of patient A., 24 years old, with a defect in the dentition of the upper jaw, replaced by an unsatisfactory plastic prosthesis.

7. Photos of the oral cavity of patient A., 24 years old, after treatment: a, c - lateral sections of the dentition, b - photo in front.

Fig. 8. Photograph of the oral cavity of patient T., 55 years old, before treatment: a, c - lateral sections of the dentition, b - photo in front.

Fig.9. Orthopantomogram of patient T., 55 years old.

Figure 10. Photograph of the oral cavity of patient T., 55 years old: a - with a treatment plate in profile, b - in front.

11. A photograph of the oral cavity of patient T., 55 years old, after removing the apparatus at the same level of isolation without muscle tension.

Fig. 12. Photo of the oral cavity of patient T., 55 years old: a, b - permanent denture on the upper jaw, c - temporary denture on the lower jaw.

The standardized indicators of the scales of the method of assessing the quality of life (QOL) will differ in different populations, and also depend on the gender and age of the respondents, therefore, prior to research, it is necessary to create a reference base of population values for standardized indicators of this method of assessing QOL.

The evaluation method can be used in the form of a screening study of violations of the main functions and symptoms, identifying the need for dental treatment and rehabilitation measures after them, used to compare the QOL of patients with defects in the dentition in accordance with the age and gender of the patients, as well as to evaluate the effectiveness of therapy during scientific research.

The passport part is located at the end of the questionnaire, which allows not focusing the patient on the possible connection of passport data with the process of obtaining information. This part includes the following information: age, gender, education, profession, first turned to dental prosthetics, repeated prosthetics, the nature of addiction to prostheses.

We give the following clinical examples.

Example 1

Extract from the medical history No. 34562, patient B., 46 years old.

She complained of poor chewing food on the left. Previously 2.7, 3.5, 3.6 repeatedly treated for complicated caries, later they were removed.

Objectively: the mucous membrane of the oral cavity is pale pink, shiny, smooth, moist.

Dental examination

The ratio of the jaws according to the orthognathic type.

Diagnosis: defects in the dentition of the upper and lower jaws - Kennedy class III. Chronic generalized periodontitis of moderate severity in remission (figure 1).

According to the results of psychological testing, indicators of anxiety and depression were normal.

When questioning the patient and assessing the clinical condition of the dentofacial system on the “symptoms” scale, the patient answered “yes” to the question about the need to see a dentist, which is estimated as 4 points; food stuck between the teeth - “little” - 2 points; estimated pain in the oral cavity as “no” - 0 points; tooth mobility as “no” - 0 points; whether the aesthetics of the smile is violated as "very slightly" - 1 point. The total score on the "symptoms" scale was 7.

On the scale of physical functioning (FF), the question of impaired chewing due to lack of teeth was rated as “a little” - 3 points; restrictions on the intake of habitual food as “a little” - 3 points; soreness in the oral cavity due to prostheses as “no” - 0 points; difficulty chewing due to malocclusion as “no” - 0 points; speech disorders due to the presence of dentures as "no" - 0 points. The total score on the scale of "physical functioning" was 6.

According to the scale of the psychoemotional state (PS), the patient rated how much your depressive feelings bother you, rated the patient as “no” - 0 points; how often do you feel irritable as "very rare" - 1 point; how often do you feel a sense of fear due to teeth as “neither often nor rarely” - 3 points; disturbances of night sleep as "very rare" - 1 point; insecurity due to ugly teeth like "never" - 0 points. The total score on the scale of "psychoemotional state" was 5.

On the scale of social functioning (SF), when asked whether your relationship with others and family members is affected by bad teeth, the patient answered “no”, which is rated as 0 points; Do you have difficulty biting off food and chewing it in the company of others, answered “no” - 0 points; the reduction in working capacity due to bad teeth was rated as "never" - 0 points; difficulties with traveling on business trips, on vacation rated as “no” - 0 points; violation of family relations was rated as “no” - 0 points. The total score on the scale of "social functioning" was 0.

On the scale of the impact on the life of the respondent of the result of orthopedic treatment to the question, how much the condition of your teeth makes it possible to feel generally happy with life, the patient answered as “quite often” - 1 point; how satisfied with his ability to fulfill his functional duties - “completely satisfied” - 0 points; how satisfied with his health in general - “completely satisfied” - 1 point; How satisfied are you that you were able to conduct the best option for orthopedic treatment - “neither yes nor no” - 3 points; how satisfied with the quality of his life - “mostly satisfied” - 2 points. The total score on the scale of the impact on the life of the respondent of the result of orthopedic treatment was 7.

The total score on the questionnaire was 25. The level of quality of life is defined as normal.

Made of ceramic-metal bridges on the upper and lower jaw on the left (figure 2).

When questioning the patient and assessing the clinical condition of the dentofacial system 1 month after the end of treatment on the “symptoms” scale, the patient answered “probably”, which is estimated as 2 points; food stuck between the teeth - “little” - 2 points; estimated pain in the oral cavity as “no” - 0 points; tooth mobility as “no” - 0 points; whether the aesthetics of the smile is violated as "very slightly" - 1 point. The total score on the "symptoms" scale was 5.

On the scale of physical functioning (FF), the question of impaired chewing due to lack of teeth was rated as “no” - 0 points; restrictions on the intake of habitual food as “no” - 0 points; soreness in the oral cavity due to prostheses as “no” - 0 points; difficulty chewing due to malocclusion as “no” - 0 points; speech disorders due to the presence of dentures as "no" - 0 points. The total score on the scale of "physical functioning" was 0.

According to the scale of the psychoemotional state (PS), the patient rated how much your depressive feelings bother you, rated the patient as “no” - 0 points; how often do you feel irritable as "very rare" - 1 point; how often do you feel a sense of fear due to teeth as “neither often nor rarely” - 3 points; disturbances of night sleep as "very rare" - 1 point; insecurity due to ugly teeth like "never" - 0 points. The total score on the scale of "psychoemotional state" was 5.

On the scale of social functioning (SF), when asked whether your relationship with others and family members is affected by bad teeth, the patient answered “no”, which is rated as 0 points; Do you have difficulty biting off food and chewing it in the company of others, answered “no” - 0 points; the reduction in working capacity due to bad teeth was rated as "never" - 0 points; difficulties with traveling on business trips, on vacation rated as “no” - 0 points; violation of family relations was rated as “no” - 0 points. The total score on the scale of "social functioning" was 0.

On the scale of the impact on the life of the respondent of the result of orthopedic treatment to the question, how much the condition of your teeth makes it possible to feel generally happy with life, the patient answered “always” - 0 points; how satisfied with his ability to fulfill his functional duties - “completely satisfied” - 0 points; how satisfied with his health in general - “completely satisfied” - 1 point; how satisfied you are that you were able to carry out the best option for orthopedic treatment - “completely satisfied” - 1 point; how satisfied with the quality of his life - “completely satisfied” - 1 point. The total score on the scale of the impact on the life of the respondent of the result of orthopedic treatment was 3.

The total score on the questionnaire was 13. There was an increase in the level of quality of life.

Example 2

Extract from the medical history No. 49682, patient K., 35 years old.

She complained of aesthetic dissatisfaction, the dark color of the teeth of the frontal group of the upper jaw. Previously, she was repeatedly treated for complicated caries.

Objectively: the mucous membrane of the oral cavity is pale pink, shiny, smooth, moist.

Dental examination

Deep bite.

Diagnosis: defects in the dentition of the upper and lower jaws - Kennedy class III, distal slope 3.4, mesial slope 3.6. Chronic granulating periodontitis 2.4. Chronic generalized periodontitis of moderate severity (Fig.3, 4).

Based on the results of psychological testing, subclinical anxiety and depression were revealed on the HADS scale.

When questioning the patient and assessing the clinical condition of the dentofacial system on the “symptoms” scale, the patient answered “yes” to the question about the need to see a dentist, which is estimated as 4 points; food stuck between the teeth - “little” - 2 points; estimated pain in the oral cavity as "little" - 2 points; tooth mobility as “no” - 0 points; whether the aesthetics of the smile is broken as “strongly” - 4 points. The total score on the "symptoms" scale was 12.

On the scale of physical functioning (FF), the question of impaired chewing due to lack of teeth was rated as “a little” - 3 points; restrictions on the intake of habitual food as "very slightly" - 1 point; soreness in the oral cavity due to prostheses as “no” - 0 points; difficulty chewing due to malocclusion as “no” - 0 points; speech disorders due to the presence of dentures as "no" - 0 points. The total score on the scale of "physical functioning" was 4.

According to the scale of the psychoemotional state (PS), the patient rated how depressing feelings really bother you, the patient rated it as “very weak” - 1 point; how often you feel irritable as “neither often nor rarely” - 3 points; how often do you feel a sense of fear due to teeth as “quite often” - 4 points; disturbances of night sleep as "very rare" - 1 point; insecurity due to ugly teeth as “quite often” - 4 points. The total score on the scale of "psychoemotional state" was 13.

On the scale of social functioning (SF), when asked whether your relationship with others and family members is affected by bad teeth, the patient answered “relatively strong”, which is estimated as 4 points; Do you have difficulty biting off food and chewing it in the company of others, answered “very rarely” - 1 point; the reduction in working capacity due to bad teeth was rated as "very slightly" - 1 point; He assessed difficulties with traveling on business trips and on vacation as “very slightly” - 1 point; violation of family relations was rated as “no” - 0 points. The total score on the scale of "social functioning" was 7.

On the scale of the impact on the life of the respondent of the result of orthopedic treatment, the patient answered as “quite rare” - 3 points to the question of how much the condition of your teeth gives you the opportunity to feel generally satisfied with your life; how satisfied with his ability to fulfill his functional duties - “satisfied” - 1 point; how satisfied with his health in general - “completely satisfied” - 1 point; How satisfied are you that you were able to conduct the best option for orthopedic treatment - “neither yes nor no” - 3 points; how satisfied with the quality of his life - “mostly satisfied” - 2 points. The total score on the scale of the impact on the life of the respondent of the result of orthopedic treatment was 10.

The total score on the questionnaire was 46. The level of quality of life was determined to be satisfactory.

Ceramic-metal crowns and a bridge for the upper jaw were made (Fig. 5).

2 months after the end of treatment, the indicators of anxiety and depression returned to normal.

When questioning the patient and assessing the clinical condition of the dentofacial system on the “symptoms” scale, the patient answered “no” to the question about the need to see a dentist, which is estimated as 0 points; food stuck between the teeth - “no” - 0 points; estimated pain in the oral cavity as “no” - 0 points; tooth mobility as “no” - 0 points; whether the aesthetics of the smile is violated as “no” - 0 points. The total score on the "symptoms" scale was 0.

On the scale of physical functioning (FF), the question of impaired chewing due to lack of teeth was rated as “no” - 0 points; restrictions on the intake of habitual food as "very slightly" - 1 point; soreness in the oral cavity due to prostheses as “no” - 0 points; difficulty chewing due to malocclusion as “no” - 0 points; speech disorders due to the presence of dentures as "no" - 0 points. The total score on the scale of "physical functioning" was 1.

According to the scale of the psychoemotional state (PS), the patient rated how much your depressive feelings bother you, rated the patient as “no” - 0 points; how often do you feel irritable as "quite rare" - 2 points; how often do you feel a sense of fear due to teeth as “quite often” - 4 points; disturbances of night sleep as "very rare" - 1 point; insecurity due to ugly teeth like "never" - 0 points. The total score on the scale of "psychoemotional state" was 7.

On the scale of social functioning (SF), when asked whether your relationship with others and family members is affected by bad teeth, the patient answered “no”, which is rated as 0 points; Do you have difficulty biting off food and chewing it in the company of others, answered “no” - 0 points; the reduction in working capacity due to bad teeth was rated as "never" - 0 points; difficulties with traveling on business trips, on vacation rated as “no” - 0 points; violation of family relations was rated as “no” - 0 points. The total score on the scale of "social functioning" was 0.

On the scale of the impact on the life of the respondent of the result of orthopedic treatment to the question of how much the condition of your teeth gives you the opportunity to feel generally happy with life, the patient answered as “quite often” - 1 point; how satisfied with his ability to fulfill his functional duties - “satisfied” - 1 point; how satisfied with his health in general - “completely satisfied” - 1 point; how satisfied with himself that he was able to conduct the best option for orthopedic treatment - “very satisfied” - 0 points; how satisfied with the quality of his life - “completely satisfied” - 1 point. The total score on the scale of the impact on the life of the respondent of the result of orthopedic treatment was 4.

The total score on the questionnaire was 12. The level of quality of life is defined as normal.

Example 3. Extract from the medical history No. 67552. B. A., 27 years old. He applied after making temporary prostheses in the community clinic to the department clinic complaining of aesthetic dissatisfaction due to the lack of upper front teeth and the prosthesis design of the prosthesis design planned by the doctor's clinic. He used a bridge made of steel, which also did not meet the requirements. I got used to them very long and hard. It was an inconvenience when pronouncing sounds, and when chewing. There was a click in the joint, a crunch on the right. According to the patient, the doctor was at a loss in choosing a treatment plan and design. Temporarily made a removable denture and plastic crowns.

Objectively: examination of the mucous membrane is pale pink, shiny, smooth, moist.

Dental examination

Bite - cross, right-handed. The degree of opening of the mouth is within normal limits. The projection of the head of the movement is asymmetric, there is a crunch and click. When opening the mouth, the lower jaw makes zigzag movements, when closing it is slightly shifted to the right.

Diagnosis: defects of the dentition of the upper jaw class IV, replaced by a temporary denture, lower jaw - class III, complicated by horizontal deformation with displacement and inclination towards the tooth defect 4.7 and 3.7, right-sided cross occlusion, complicated by dysfunction of the temporomandibular joint. Palatine position of the tooth 1.2, the vestibular inclination of the tooth 1.3 (Fig.6).

As a result of a comprehensive examination, a significant violation of aesthetics, the function of speech, and chewing was determined. When questioning on the proposed method, specific indicators were determined that depended on the psycho-emotional state and experiences due to difficulties in aesthetic prosthetics and, possibly, due to doubts by the doctor in the success of treatment in aesthetic results.

When questioning the patient and assessing the clinical condition of the dentofacial system on the “symptoms” scale, the patient answered “yes” to the question about the need to see a dentist, which is estimated as 4 points; food stuck between the teeth - “at every meal” - 5 points; estimated pain in the oral cavity as "very slightly" - 1 point; tooth mobility as “no” - 0 points; whether the aesthetics of the smile is violated as "very strong" - 5 points. The total score on the "symptoms" scale was 15.

On the scale of physical functioning (FF), the issue of violation of the chewing function due to lack of teeth was rated as "very little" - 1 point; restrictions on the intake of habitual food as “a little” - 3 points; soreness in the oral cavity due to prostheses as "very slightly" - 1 point; difficulty chewing due to malocclusion as “very slightly” - 1 point; speech disorders due to the presence of dentures as "moderate" - 3 points. The total score on the scale of "physical functioning" was 9.

According to the scale of the psychoemotional state (PS), the patient rated how depressing feelings really bother you, the patient rated it as “very weak” - 1 point; how often you feel irritable as “neither often nor rarely” - 3 points; how often do you feel a sense of fear due to teeth as "quite rare" - 2 points; disturbances of night sleep as "sometimes" - 3 points; insecurity due to ugly teeth as “always” - 5 points. The total score on the scale of "psycho-emotional state" was 14.

According to the scale of social functioning (SF), the patient answered “very strongly”, which is estimated as 5 points, to the question whether your relationship with others and family members is affected due to bad teeth; Do you have difficulty biting off food and chewing it in the company of others, answered “always” - 5 points; the reduction in working capacity due to bad teeth was rated as "little" - 2 points; difficulties with traveling on business trips, on vacation rated as “small” - 2 points; rated violation of family relations as “insignificant” - 1 point. The total score on the scale of "social functioning" was 15.

On the scale of the impact on the life of the respondent of the result of orthopedic treatment, the patient answered as “quite rare” - 3 points to the question of how much the condition of your teeth gives you the opportunity to feel generally satisfied with your life; how satisfied with his ability to fulfill his functional duties - “satisfied” - 1 point; how satisfied with his health in general - “completely satisfied” - 1 point; how satisfied you are that you were able to carry out the best option for orthopedic treatment - “very dissatisfied” - 5 points; how satisfied with the quality of his life - “mostly satisfied” - 2 points. The total score on the scale of the impact on the life of the respondent of the result of orthopedic treatment was 11.

The total score on the questionnaire was 64. The level of quality of life is defined as low.

Based on the data obtained in a comprehensive study, a comprehensive rehabilitation plan was compiled.

The treatment was carried out according to plan. The manufacture and fixation of a temporary bridge made of plastic led to the patient's confidence in success even at the stage of treatment, the aesthetic form of which satisfied him. The results after treatment are shown in Fig.7.

2 months after the end of treatment, the indicators of anxiety and depression returned to normal, the indicators of the QL assessment questionnaire increased.

When questioning the patient and assessing the clinical condition of the dentofacial system on the “symptoms” scale, the patient answered “no” to the question about the need to see a dentist, which is estimated as 0 points; stuck food between the teeth - "very little" - 1 point; estimated pain in the oral cavity as “no” - 0 points; tooth mobility as “no” - 0 points; whether the aesthetics of the smile is violated as “no” - 0 points. The total score on the "symptoms" scale was 1.

On the scale of physical functioning (FF), the question of impaired chewing due to lack of teeth was rated as “no” - 0 points; restrictions on the intake of habitual food as "very slightly" - 1 point; soreness in the oral cavity due to prostheses as “no” - 0 points; difficulty chewing due to malocclusion as “no” - 0 points; speech disorders due to the presence of dentures as "no" - 0 points. The total score on the scale of "physical functioning" was 1.

According to the scale of the psychoemotional state (PS), the patient rated how much your depressive feelings bother you, rated the patient as “no” - 0 points; how often do you feel irritable as "very rare" - 1 point; how often do you feel a sense of fear due to teeth as "quite rare" - 2 points; disturbances of night sleep as "very rare" - 1 point; insecurity due to ugly teeth like "never" - 0 points. The total score on the scale of "psycho-emotional state" was 4.

On the scale of social functioning (SF), when asked whether your relationship with others and family members is affected by bad teeth, the patient answered “no”, which is rated as 0 points; Do you have difficulty biting off food and chewing it in the company of others, answered “very rarely” - 1 point; the reduction in working capacity due to bad teeth was rated as "never" - 0 points; He assessed difficulties with traveling on business trips and on vacation as “very slightly” - 1 point; rated violation of family relations as “insignificant” - 1 point. The total score on the scale of "social functioning" was 3.

On the scale of the impact on the life of the respondent of the result of orthopedic treatment to the question of how much the condition of your teeth gives you the opportunity to feel generally happy with life, the patient answered as “quite often” - 1 point; how satisfied with his ability to fulfill his functional duties - “satisfied” - 1 point; how satisfied with his health in general - “completely satisfied” - 1 point; how satisfied with himself that he was able to conduct the best option for orthopedic treatment - “completely satisfied” - 1 point; how satisfied with the quality of his life - “completely satisfied” - 1 point. The total score on the scale of the impact on the life of the respondent of the result of orthopedic treatment was 5.

The total score on the questionnaire was 14.

Thus, the indicators of quality of life gradually increased, and there was no need for special measures.

Example 4

Extract from the patient’s medical history No. 63134 of 10/15/2007, T. 55 years old. He complained about the impossibility of chewing quality writing, biting the lips and cheeks, aesthetic dissatisfaction. Previously, he sought advice, according to the patient, the doctor was difficult to choose a treatment plan and design.

Objectively: the lower part of the face is reduced, nasolabial, chin folds are pronounced. Increased abrasion of the maxillary incisors to the level of the gums, Bilateral dentoalveolar elongation of the region of the lateral groups of teeth of the upper jaw. The ratio of the jaws in the area of cuts as a direct bite. The degree of opening of the mouth is within normal limits. The projection of the head of the movement is asymmetric, there is a crunch and click. When opening the mouth, the lower jaw makes zigzag movements, when closing it is slightly shifted to the left (Figs. 8, 9).

The mucous membrane of the oral cavity is pale pink, moderately moist.

Diagnosis: defects in the dentition of the upper jaw grade III, lower jaw - grade I, complicated by vertical deformation (dentoalveolar elongation of the posterior teeth). Increased abrasion of the frontal group of teeth of the upper jaw 3 degrees, lower jaw 1 degree, decompensated horizontal shape. Decreasing occlusion, dysfunction of the temporomandibular joint (see Fig. 9). Complete absence of crowns and chronic periodontitis of teeth 1.4, 1.2, 1.1, 2.1, 2.2, 2.3, 3.4.

When questioning the patient and assessing the clinical condition of the dentofacial system on the “symptoms” scale, the patient answered “yes” to the question about the need to see a dentist, which is estimated as 4 points; stuck food between the teeth - "very little" - 1 point; estimated pain in the oral cavity as “no” - 0 points; tooth mobility as “no” - 0 points; whether the aesthetics of the smile is violated as "very strong" - 5 points. The total score on the "symptoms" scale was 10.

On the scale of physical functioning (FF), the issue of malfunction of chewing due to lack of teeth was rated as "very strong" - 5 points; restrictions on the intake of habitual food as “very strong” - 5 points; soreness in the oral cavity due to prostheses as “no” - 0 points; difficulty chewing due to malocclusion as "very strong" - 5 points; speech disorders due to the presence of dentures as "no" - 0 points. The total score on the scale of “physical functioning” was 15.

According to the scale of the psychoemotional state (PS), the patient rated how “depressing” you are very worried, “relatively strong” - 4 points; how often do you feel irritable as “quite often” - 4 points; how often do you feel a sense of fear due to your teeth as “neither often nor rarely” - 3 points; disturbances of night sleep as "quite often" - 4 points; insecurity due to ugly teeth as “always” - 5 points. The total score on the scale of "psycho-emotional state" was 20.

According to the scale of social functioning (SF), the patient answered “very strongly”, which is estimated as 5 points, to the question whether your relationship with others and family members is affected due to bad teeth; Do you have difficulty biting off food and chewing it in the company of others, answered “always” - 5 points; the reduction in working capacity due to bad teeth was rated as "average" - 3 points; difficulties with traveling on business trips, on vacation rated as “fairly pronounced” - 4 points; violation of family relations was rated as "average" - 3 points. The total score on the scale of "social functioning" was 20.

On the scale of the impact on the life of the respondent of the result of orthopedic treatment, the patient answered as “very rare” - 4 points to the question of how much the condition of your teeth gives you the opportunity to feel generally happy with life; how satisfied with his ability to fulfill his functional duties - “mostly satisfied” - 2 points; how satisfied with his health in general - “mostly satisfied” - 2 points; how satisfied with himself that he was able to carry out the optimal variant of orthopedic treatment - “very dissatisfied” - 5 points; how satisfied with the quality of his life - “mostly unsatisfied” - 4 points. The total score on the scale of the impact on the life of the respondent of the result of orthopedic treatment was 17.

The total score on the questionnaire was 82. The level of quality of life is defined as very low.

On the scale of symptoms (C), aesthetic shortcomings are emphasized, on the scale of physical functioning (FF), a decrease was reflected in impaired chewing function due to lack of teeth, a restriction in the intake of habitual food, its nibbling, which was also associated with anomalous occlusion, which was reflected in the psychoemotional sphere, worsened social functioning (eating in public places, biting off food is difficult), there was also a decrease in working capacity. Prior to treatment, he was dissatisfied with the quality of life, and this scale was 17 points out of 25 as negative as possible. On the mental health scale, all indicators had high negative values. The patient noted the presence of depressive feelings, irritability, disturbance of night sleep, and complexation due to severe wear of the front teeth, etc.

On the day of fixation of the removable medical plate - the prosthesis - repeated testing was carried out, which revealed the absence or even a slight deterioration in the indicators of situational anxiety due to the difficulty of getting used to medical devices of this kind (Fig. 10).

The onset of adaptation and restructuring of the myotatic reflex was judged by psychoemotional indicators (a decrease in indicators on the hospital scale of anxiety and depression and reactive anxiety), in the oral cavity - by holding the lower jaw in a certain position after removing the apparatus at the same level of separation without muscle tension (Fig. eleven).

Permanent restorative prostheses were made from a metal composite on the upper jaw, the frontal group of teeth of the lower jaw and a removable prosthesis on the lower jaw (Fig. 12).

During the monitoring of indicators of the psychoemotional sphere and after the conversation revealed a gradual improvement.

When questioning the patient and assessing the clinical condition of the dentofacial system on the “symptoms” scale, the patient answered “no” to the question about the need to see a dentist, which is estimated as 0 points; stuck food between the teeth - "very little" - 1 point; estimated pain in the oral cavity as “no” - 0 points; tooth mobility as “no” - 0 points; whether the aesthetics of the smile is violated as “no” - 0 points. The total score on the "symptoms" scale was 1.

According to the scale of physical functioning (FF), the issue of violation of the chewing function due to lack of teeth was rated as "very little" - 1 point; restrictions on the intake of habitual food as "very slightly" - 1 point; soreness in the oral cavity due to prostheses as “no” - 0 points; difficulty chewing due to malocclusion as “no” - 0 points; speech disorders due to the presence of dentures as "no" - 0 points. The total score on the scale of "physical functioning" was 2.

According to the scale of the psychoemotional state (PS), the patient rated how depressing feelings really bother you, the patient rated it as “very weak” - 1 point; how often do you feel irritable as "quite rare" - 2 points; how often do you feel a sense of fear due to teeth as “neither often nor rarely” - 3 points; disturbances of night sleep as "sometimes" - 3 points; insecurity due to ugly teeth like "never" - 0 points. The total score on the scale of "psychoemotional state" was 9.

On the scale of social functioning (SF), when asked whether your relationship with others and family members is affected by bad teeth, the patient answered “no”, which is rated as 0 points; Do you have difficulty biting off food and chewing it in the company of others, answered “very rarely” - 1 point; the reduction in working capacity due to bad teeth was rated as "very slightly" - 1 point; He assessed difficulties with traveling on business trips and on vacation as “very slightly” - 1 point; rated violation of family relations as “insignificant” - 1 point. The total score on the scale of "social functioning" was 4.

According to the scale of the impact on the life of the respondent of the result of orthopedic treatment, the patient answered as “average” - 2 points to the question of how much the condition of your teeth makes you feel generally happy with life; how satisfied with his ability to fulfill his functional duties - “satisfied” - 1 point; how satisfied with his health in general - “mostly satisfied” - 2 points; how satisfied with himself that he was able to conduct the best option for orthopedic treatment - “mostly satisfied” - 2 points; how satisfied with the quality of his life - “neither yes nor no” - 3 points. The total score on the scale of the impact on the life of the respondent of the result of orthopedic treatment was 10.

The total score on the questionnaire was 26, which corresponds to a satisfactory level of quality of life.

Questionnaire for assessing the quality of life of patients with dentition defects

Instruction: these questions relate to how you feel about the quality of your life, health and other areas. If you have any doubts about the answer, please select the one that seems most suitable. This may be your first reaction to the question. Please rate your life in the last 4 weeks.

I. Assessment of the clinical condition of the dentition - symptoms (C)

1. Do you consider it necessary to consult a dentist about teeth

no I doubt probably rather yes Yes without delay 0 one 2 3 four 5

2. Jam between the teeth

no very little few medium often at every meal 0 one 2 3 four 5

3. Pain in the oral cavity

no very slightly few moderate degree very worried very worried 0 one 2 3 four 5

4. Tooth mobility

no very slightly few moderate degree strong very much 0 one 2 3 four 5

5. Is the aesthetics of the smile broken?

no very slightly few Little strong very much 0 one 2 3 four 5

II. Judgment on the effect of a dentition defect (DZR) or prosthesis (if any) on the physical condition of the patient

6. Impaired mastication due to lack of teeth

no (in case of DZR absence) very little few Little strong very much 0 one 2 3 four 5

7. Restrictions on the intake of habitual food

no very slightly few Little strong very much 0 one 2 3 four 5

8. Oral soreness due to dentures

no very slightly few Little strong very much 0 one 2 3 four 5

9. Difficult chewing due to malocclusion (abnormality, deformation) (if malocclusion exists)

no very slightly few Little strong very much 0 one 2 3 four 5

10. Speech impairment due to dentures (if any)

no very slightly few moderate degree strong very much 0 one 2 3 four 5

III. The effect of DZR on the patient's psychoemotional state

11. How much do you feel depressed?

no very weak relatively weak medium relatively strong extremely strong 0 one 2 3 four 5

12. How often do you feel irritable?

never rarely quite rarely neither often nor rarely often all time 0 one 2 3 four 5

13. How often do you feel fear due to teeth?

never rarely quite rarely neither often nor rarely often always 0 one 2 3 four 5

14. Violations of night sleep

no rarely quite rarely sometimes often Often 0 one 2 3 four 5

15. Complexity due to ugly teeth (dentures)

never rarely quite rarely sometimes often always 0 one 2 3 four 5

IV. The influence of DZR (or prosthesis) on the social functioning of the respondent

16. Do your relationships with others and family members suffer from bad teeth (prostheses)?

no very little Little medium relatively strong very much 0 one 2 3 four 5

17. Having difficulty biting food and chewing it in the company of others?

no rarely sometimes often often always 0 one 2 3 four 5

18. Reduced ability to work due to bad teeth (dentures)

never very slightly few medium quite pronounced very much 0 one 2 3 four 5

19. Difficulties with traveling on business trips, on vacation

no very slightly few moderate degree quite pronounced great difficulties 0 one 2 3 four 5

20. Breaking family relationships

no slightly few medium quite pronounced very much 0 one 2 3 four 5

V. The impact on the life of the respondent of the result of orthopedic treatment (points when responding from negative to positive are reduced)

21. How much does the condition of your teeth give you the opportunity to feel generally happy life?

never rarely quite rarely medium often always 5 four 3 2 one 0

22. How satisfied are you with your ability to fulfill your responsibilities?

very dissatisfied mostly unsatisfied neither yes nor no mostly satisfied satisfied quite satisfied 5 four 3 2 one 0

23. How satisfied are you with your overall health?

very dissatisfied mostly unsatisfied neither yes nor no mostly satisfied quite satisfied very satisfied 5 four 3 2 one 0

24. How satisfied are you with yourself that you were able to conduct the best option for orthopedic treatment (dental prosthetics)?

very dissatisfied mostly unsatisfied neither yes nor no mostly satisfied quite satisfied very satisfied 5 four 3 2 one 0

25. How satisfied are you with the quality of your life?

very dissatisfied mostly unsatisfied neither yes nor no mostly satisfied quite satisfied very satisfied 5 four 3 2 one 0

Please indicate your

age -

gender -

education -

profession -

first contacted

to the orthopedist -

for repeated prosthetics -

addiction is easy -

difficult -

impossible -

Thank you for your work in filling out the questionnaire. We wish you good health!

Claims (1)

A method of assessing the quality of life in patients with defects in the dentition, characterized in that they conduct a questionnaire of the patient, including an assessment of the clinical condition of the dentofacial system, for this the patient determines the need to consult a dentist for teeth, evaluate each answer in points, namely: “no” rated as 0 points, “I doubt” - 1 point, “probably” - 2 points, “rather yes” - 3 points, “yes” - 4 points, “urgently” - as 5 points; determines the food stuck between the teeth, the answer “no” is estimated as 0 points, “very little” - 1 point, “little” - 2 points, “medium” - 3 points, “often” - 4 points, “with each meal” - like 5 points; determines pain in the oral cavity, the answer “no” is estimated as 0 points, “very slightly” - 1 point, “little” - 2 points, “moderate” - 3 points, “very worried” - 4 points, “very much worries ”- as 5 points; determines the mobility of the teeth, the answer “no” is estimated as 0 points, “very slightly” - 1 point, “little” - 2 points, “moderate” - 3 points, “strong” - 4 points, “very strong” - as 5 points; determines whether the aesthetics of the smile are broken, the answer “no” is estimated as 0 points, “very slightly” - as 1 point, “little” - 2 points, “slightly” - 3 points, “strong” - 4 points, “very strong” - like 5 points; assessment of the effect of a dentition defect or denture (if any) on its physical condition; for this, the patient determines a mastication function due to lack of teeth, each response is scored, namely: “no” is evaluated as 0 points, “very little” - 1 point, “little” - 2 points, “a little” - 3 points, “strong” - 4 points, “very strong” - as 5 points; determines the restrictions on food intake, the answer “no” is estimated as 0 points, “very slightly” - 1 point, “little” - 2 points, “a little” - 3 points, “strong” - 4 points, “very strong” - as 5 points; determines pain in the oral cavity due to prostheses, the answer “no” is estimated as 0 points, “very slightly” - 1 point, “little” - 2 points, “slightly” - 3 points, “strongly” - 4 points, “very strong "- as 5 points; determines the difficulty in chewing due to malocclusion, the answer “no” is estimated as 0 points, “very slightly” - 1 point, “little” - 2 points, “slightly” - 3 points, “strong” - 4 points, “very strong” "- as 5 points; determines speech impairment due to the presence of dentures, the answer “no” is estimated as 0 points, “very slightly” - 1 point, “little” - 2 points, “moderate” - 3 points, “strong” - 4 points, “ very strong ”- as 5 points; assessment of the effect of dentition defects on the patient’s psycho-emotional state, for this the patient determines how much his depressive feelings are worried, each answer is scored, namely: “no” is evaluated as 0 points, “very weak” - 1 point, “relatively weak” - 2 points, “medium” - 3 points, “relatively strong” - 4 points, “extremely strong” - as 5 points; determines how often he feels irritable, the answer “never” is rated as 0 points, “very rarely” - 1 point, “quite rarely” - 2 points, “neither often nor rarely” - 3 points, “quite often” - 4 points , "All the time" - as 5 points; determines how often there is a feeling of fear due to teeth, the answer “never” is rated as 0 points, “very rarely” - 1 point, “quite rarely” - 2 points, “neither often nor rarely” - 3 points, “quite often "- 4 points," always "- as 5 points; defines a violation of night sleep, the answer “no” as 0 points, “very rarely” - 1 point, “quite rarely” - 2 points, “sometimes” - 3 points, “quite often” - 4 points, “very often” - as 5 points; determines the complexity due to ugly teeth (prostheses), the answer “never” is estimated as 0 points, “very rarely” - 1 point, “quite rarely” - 2 points, “sometimes” - 3 points, “quite often” - 4 points , "Always" - as 5 points; assessment of the impact of a dentition defect on the social functioning of the patient, for which the patient determines whether his relationship with others and family members is affected due to bad teeth (prostheses), each answer is scored, namely: “no” is assessed as 0 points, “ very little "- 1 point," slightly "- 2 points," medium "- 3 points," relatively strong "- 4 points," very strong "- as 5 points; determines whether it is difficult to bite off food and chew it in the company of others, the answer “no” is estimated as 0 points, “very rarely” - 1 point, “sometimes” - 2 points, “quite often” - 3 points, “often” - 4 points, “always” - as 5 points; determines the decrease in working capacity due to bad teeth or dentures, the answer is “never” is estimated as 0 points, “very slightly” - 1 point, “little” - 2 points, “medium” - 3 points, “quite pronounced” - 4 points, “Very strong” - as 5 points; determines the difficulties with traveling on business trips, on vacation, the answer “no” is estimated as 0 points, “very slightly” - 1 point, “little” - 2 points, “moderate” - 3 points, “fairly pronounced” - 4 points, "Great difficulties" - as 5 points; defines violation of family relations, the answer “no” is estimated as 0 points, “insignificantly” - 1 point, “little” - 2 points, “medium” - 3 points, “quite pronounced” - 4 points, “very strong” - as 5 points; assessment of the impact on the patient’s life of the result of orthopedic treatment, for this the patient determines how much the condition of his teeth makes it possible to feel generally happy with life, each answer is scored, namely: “never” is rated as 5 points, “very rarely” - 4 points , “Fairly rare” - 3 points, “medium” - 2 points, “quite often” - 1 point, “always” - as 0 points; determines how satisfied he is with his ability to fulfill his functional duties, the answer “very dissatisfied” is estimated as 5 points, “mostly unsatisfied” - 4 points, “neither yes, no” - 3 points, “mostly satisfied” - 2 points, “ satisfied ”- 1 point;“ completely satisfied ”- as 0 points; determines how much he is satisfied with his health in general, the answer “very dissatisfied” is assessed as 5 points, “mostly unsatisfied” - 4 points, “neither yes nor no” - 3 points, “mostly satisfied” - 2 points, “completely satisfied "- 1 point," very satisfied "- as 0 points; determines how satisfied with himself that he was able to carry out the optimal variant of orthopedic treatment (dental prosthetics), the answer “very unsatisfied” is estimated as 5 points, “mostly unsatisfied” - 4 points, “neither yes nor no” - 3 points, “in mostly satisfied ”- 2 points,“ quite satisfied ”- 1 point,“ very satisfied ”- as 0 points; determines how satisfied with the quality of his life, the answer “very dissatisfied” is rated as 5 points, “mostly unsatisfied” - 4 points, “neither yes nor no” - 3 points, “mostly satisfied” - 2 points, “completely satisfied” - 1 point, “very satisfied” - as 0 points; the obtained points are summarized and, with an amount of 25 or less points, the patient’s quality of life is assessed as normal, 26 to 50 points are assessed as a satisfactory quality of life, 51 to 80 points are assessed as a low quality of life; life as very low.

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