RU2546102C1 - Method for determining degree of severity of periodontal disease - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: clinical presentations of the disease and parodontium data obtained by self-questionnaire are studied. An integrative self-examining periodontal index (ISPI) is calculated by formula involving determining the parameters in points: dental mobility, gingival hemorrhage, gingival oedema and (or) redness, root exposure and dental deposits. The ISPI value shows the periodontal health or mild, moderate or severe abnormality.

EFFECT: method enables providing more objective assessment of the need of a patient or a group of patients in dental medical assistance for the periodontal disease by assessing the clinical presentations of the disease and the periodontal health.

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Description

The invention relates to medicine, in particular to therapeutic dentistry, and can be used in the clinical diagnosis of periodontal disease, as well as in conducting mass research.

There are various methods for assessing the severity of the inflammatory process in periodontal tissues. Most often it is assessed visually, determining prevalence (interdental papilla, marginal gum, alveolar gum), as well as on the basis of determining the number of migrated white blood cells, methods of functional diagnostics (reoparondontography, polarography, photoplethysmography, etc.) (Ivanov BC "Periodontal Diseases", M ., 1989; Prokhonchukov A.A., Loginova N.K., Zhizhina N.A. "Functional diagnostics in dental practice", M., 1980).

A known method for assessing the severity of pathological changes in periodontal tissues, based on the study of the activity of oral fluid enzymes (lysozyme, acid and alkaline phosphatase, catalase, protease, peroxydismutase, etc.) by biochemical methods (V. Yakovleva et al. "Diagnosis of dental diseases ", Mn., 1986; Ivanov BC" Periodontal disease ", M., 1989).

There is a method of assessing the severity of the inflammatory process in periodontal tissues by examining the oral fluid, in which the content of bound and free water is determined, the ratio of the first indicator to the second is calculated and, with its value of 0.060-0.069, gingivitis is determined, with 0.070-0.079 mild periodontitis, 0.080- 0,089 periodontitis of an average degree, more than 0,090 severe periodontitis (Patent for the invention No. 2089908, IPC G01N).

One of the serious drawbacks of most of the known methods is that in clinical conditions they do not allow to evaluate the dynamics of the pathological process in the early stages. Functional and biochemical methods require the use of complex, expensive equipment, reagents and special training of personnel.

Periodontium is a complex of tissues surrounding the tooth, ensuring its fixation in the jaw and functioning. The condition of periodontal tissues is taken for clarity to express in the form of indices.

Thus, the CPITN index, developed by the WHO expert team in 1982 to assess the severity of periodontal tissue lesions and determine the need for specialized periodontal treatment, is most widely used in mass studies of the incidence of periodontal diseases. To determine the CPITN index, the human dentition is conditionally divided into 6 parts (sextants) - three on the upper (17-14, 13-23, 24-27 teeth) and lower (37-44, 33-43, 44-47 teeth) the jaw. The study is carried out by a dentist using a dental mirror and a graduated periodontal probe. The force with which the probe is used must not exceed 25 g; during the study, the probe is placed between the tooth and gum and the depth of the groove or periodontal pocket is determined. Recommended areas for probing are the mesial, middle and distal areas on both the vestibular and lingual-palatal surfaces of the teeth (A. Grudyanov. Periodontal diseases. - M.: Medical Information Agency Publishing House, 2009. - P. 68- 69).

The data of such a medical study are recorded using the following codes: 0 - healthy gum, no signs of pathology; 1 - bleeding gums after sounding; 2 - a subgingival tartar is determined by a probe; 3 - a periodontal pocket 4-5 mm deep was detected; 4 - periodontal pocket with a depth of 6 mm or more. According to the results of the study, you can calculate the number of healthy sextants, as well as determine the number of sectarians with signs of pathology (bleeding, tartar, periodontal pockets). According to the CPITN index, the need of one person or group of people for treatment is determined (Artyushkevich A.S. Clinical periodontology: Practical guide / A.S. Artyushkevich, E.K. Trofimova, S.V. Latysheva; Edited by A.S. Artyushkevich. - Mn .: Urajay, 2002. - S. 76.).

Thus, for the study of periodontal tissues using the CPITN index, a sufficiently high qualification of the dentist and significant labor costs are required.

The closest analogue of the invention is a method for assessing the severity of periodontal tissue lesions and determining the need for specialized periodontal treatment by determining the CPITN index described in the source. - Ed. Artyushkevich A.S. Clinical periodontology. - Mn .: Urajay, 2002.

A disadvantage of the known methods is the complexity and low objectivity.

The purpose of the invention is to increase the objectivity of assessing the needs of a patient or group of people in the medical care of medical specialists in the field of periodontal diseases.

This goal is achieved by studying the clinical picture by the results of self-questioning of a patient or group of people, determining the integrative periodontal self-assessment index - ISPI (integrative self-examining periodontal index) by the formula

ISPI = (a + b + c + d + e): 5,

Where:

a - tooth mobility: none - 0 points, slight - 1 point, noticeable - 2, strong - 3 points;

b - bleeding gums: absent - 0 points, occasionally during brushing - 1 point, constantly during brushing - 2, while eating - 3 points;

c - edema and (or) redness of the gums: absent - 0 points, interdental papilla - 1 point, interdental papilla and gingival margin - 2 points, the entire gum - 3 points;

d - root exposure: none - 0 points, slight - 1 point, noticeable - 2 points, strong - 3 points;

e - the presence of dental plaque: none - 0 points, tongue feeling of roughness of the tooth surface - 1 point, dental deposits visible by the eye - plaque, tartar - 2 points, a large amount of tartar and plaque - 3 points);

and if the ISPI value is 0 points, the periodontal condition is assessed as healthy;

from 0 to 1 point inclusive mild periodontal disease is noted;

from 1.1 to 2 points inclusive - periodontal pathology of an average degree;

from 2.1 to 3 points inclusive - severe periodontal pathology.

The application of the proposed index allows us to study the periodontal status of the periodontal mass of the population, which is important for organizing the provision of dental care to the population. In clinical practice, the use of the proposed index promotes "feedback" between the patient and the dentist, helps to assess the dynamics of the state of periodontal tissues during treatment, motivates the patient to increase the level of oral hygiene.

The method is implemented as follows.

The patient in the questionnaire makes a self-assessment of his periodontal condition according to paragraphs A, B, C, D, E. Then the doctor calculates the integrative periodontal self-esteem index, based on which it is possible to draw a conclusion about the indications for treatment.

To illustrate, here are some clinical examples.

Example 1. Patient I., 40 years old, turned to the clinic of maxillofacial surgery and dentistry with complaints of pain in area 46, bleeding gums, halitosis. Considers himself ill for 10-12 years. Previously received conservative treatment, after which there was a short-term improvement. Concomitant diseases: chronic bilateral maxillary sinusitis, chronic hypoacid gastritis, chronic ulcerative colitis.

Periodontal Integrative Self-Assessment Index (ISPI):

a - tooth mobility: insignificant - 1 point;

b - bleeding gums: constantly during brushing - 2 points;

c - edema and (or) redness of the gums: interdental papilla and gingival margin - 2 points;

d - exposure of the roots: strong - 3 points;

e - the presence of dental plaque: a large number of tartar and plaque - 3 points;

ISPI = 2.2 points, which indicates a severe periodontal disease.

An objective examination: the face is symmetrical, opening the mouth is not difficult. Orthognathic bite. There are three in the frontal part of the upper jaw, gum recession in the area of 12, 11, 21, 22 teeth 3 mm.

Dental formula:

There are abundant supragingival and subgingival deposits of tartar. Mobility of 41, 42 teeth of the first degree is noted.

Depth of periodontal pockets (largest among tooth surfaces, mm):

The mucous membrane of the interdental papilla and gingival margin is swollen, hyperemic, bleeds with a light probe touch (positive Ainamo test). CPITN index - 4 points (periodontal pockets with a depth of 6 mm and more) in the area of five sextants, in the area of one sextant - 3 points (periodontal pockets with a depth of 5 mm), the patient needs complex treatment of generalized periodontitis.

On the orthopantomogram (Fig. 1) - pronounced uneven resorption of the edges of the alveolar arches of the jaws with deep bone pockets. In area 46, there is a bone pocket up to 7 mm deep. Foci of rarefaction of bone tissue of a rounded shape with clear boundaries with a diameter of 6 mm at the tops of the roots of 16, 36 teeth.

On the basis of complaints, medical history, objective clinical, as well as X-ray examination, the diagnosis was established: Severe chronic periodontitis. Concomitant disease: chronic granulomatous periodontitis 16, 36 teeth.

Thus, the indicator of the integrative periodontal self-esteem index (severe periodontal pathology) is consistent with the results of objective clinical and radiological studies.

Example 2. Patient Α., 44 years old, turned to the clinic of maxillofacial surgery and dentistry of the Military Medical Academy with complaints of bleeding gums, the periodic appearance of pain and swelling of the gums in the region of 18, 17 teeth, the mobility of these teeth. Considers himself ill for 5 years.

Periodontal Integrative Self-Assessment Index (ISPI):

a - tooth mobility: strong - 3 points;

b - bleeding gums: constantly during brushing - 2 points;

c - edema and (or) redness of the gums: interdental papilla and gingival margin - 2 points;

d - exposure of the roots: strong - 3 points;

e - the presence of dental plaque: a large number of tartar and plaque - 3 points;

ISPI = 2.6 points, which indicates a severe periodontal pathology.

An objective examination: the face is symmetrical, opening the mouth is not difficult. Orthognathic bite. There is a recession of the gums in the area of 18, 17, 16, 13, 43 teeth 2-3 mm.

Dental formula:

There are abundant supragingival and subgingival deposits of tartar. Motility 18, 17 teeth - III degree, 16, 26 teeth - II degree.

Depth of periodontal pockets (largest among tooth surfaces, mm):

The gum in the area of the interdental papilla and gingival margin is swollen, hyperemic, bleeds with a light probe touch (positive Ainamo test). CPITN index - 4 points (periodontal pockets with a depth of 6 mm and more) in all sextants, the patient needs a comprehensive treatment of chronic generalized periodontitis.

The orthopantomogram (Fig. 2) shows a pronounced uneven resorption of the edges of the alveolar arches of both jaws with deep bone pockets. Foci of rarefaction of bone tissue of a rounded shape with clear boundaries with a diameter of 6 mm at the apex of the roots of 47, 46 teeth.

On the basis of complaints, medical history, objective clinical, as well as X-ray examination, the diagnosis was established: Severe chronic periodontitis. Concomitant disease: chronic granulomatous periodontitis 46, 47 teeth.

Thus, the indicator of the integrative periodontal self-esteem index (severe periodontal pathology) is consistent with the results of objective clinical and radiological studies.

Example 3. Patient U., 37 years old, turned to the clinic of maxillofacial surgery and dentistry with complaints of periodic bleeding of the gums during brushing for several months.

Periodontal Integrative Self-Assessment Index (ISPI):

a - tooth mobility: absent - 0 points;

b - bleeding gums: occasionally during brushing - 1 point;

c - edema and (or) redness of the gums: interdental papilla - 1 point;

d - exposure of the roots: none - 0 points;

e - the presence of dental plaque: dental plaque visible by the eye - plaque, tartar - 2 points;

ISPI = 0.8 points, indicating a mild periodontal disease.

Objectively: the general condition is satisfactory. From the internal organs and systems, pathological changes were not detected. The submandibular, cervical lymph nodes are not palpable. Locally: the face is symmetrical. The opening of the mouth is free. Orthognathic bite. Dental formula:

There is no abnormal tooth mobility. The mucous membrane of the oral cavity is slightly hyperemic in the area of the gingival papillae, bleeds with a light probe, the Schiller-Pisarev test is positive. There are gingival pockets up to 3 mm deep in the lateral parts of the dentition.

Depth of periodontal pockets (largest among tooth surfaces, mm):

Tartar deposits are light yellow in small amounts. CPITN index - 2 points (the presence of subgingival tartar in four sextants and supragingival with bleeding gums with light probing in all sextants), the patient needs professional oral hygiene.

On the orthopantomogram (Fig. 3): the phenomena of bone resorption of the vertices of the interalveolar ridges in the region of 17, 16, 15, 26, 27, 36, 37, 46, 47 teeth.

Based on complaints, medical history, objective and x-ray data, the patient was diagnosed with mild chronic periodontitis.

Thus, the indicator of the integrative periodontal self-esteem index (mild periodontal pathology) is consistent with the results of objective clinical and radiological studies.

Example 4. Patient B., 25 years old, turned to the clinic of maxillofacial surgery and dentistry of the Military Medical Academy for a routine examination. No complaints.

Periodontal Integrative Self-Assessment Index (ISPI):

a - tooth mobility: absent - 0 points;

b - bleeding gums: absent - 0 points;

c - edema and (or) redness of the gums: absent - 0 points;

d - exposure of the roots: none - 0 points;

e - the presence of dental plaque: none - 0 points.

ISPI = 0 points, indicating a healthy periodontal disease.

Objectively: the face is symmetrical. Opening the mouth is free. Orthognathic bite. The teeth are intact. Dental formula:

Tooth mobility is physiological. The mucous membrane of the gums is pale pink, dense, there is no bleeding with light probe. Periodontal pockets and deposits of tartar and plaque have not been identified.

CPITN index - 0 points - a healthy periodontium in all sextants, the patient does not need treatment and professional hygiene.

On the orthopantomogram (Fig. 4), no pathological changes were detected.

Diagnosis: healthy.

Thus, the indicator of the integrative periodontal self-esteem index (healthy periodontium) is consistent with the results of objective clinical and radiological studies.

A sample survey of a group of people

A survey of 223 people exposed to occupational hazards (general vibration) revealed, according to the integrative periodontal self-assessment index, periodontal pathology in 167 patients (74.9%), including 18 people (8.1%) - periodontal pathology of average degree, 149 people (66.8%) had mild periodontal disease.

During a clinical examination, 18 patients were diagnosed with "Chronic generalized periodontitis of moderate severity" they needed complex treatment (including surgical), which characterizes the high accuracy of assessing the pathology of moderate severity by using an integrative periodontal self-assessment index.

Of the 149 patients with mild periodontal disease with an objective examination, 89 patients were diagnosed with chronic generalized mild periodontitis and 60 patients with chronic generalized catarrhal gingivitis, all of whom needed professional controlled oral hygiene.

Thus, the results of the questionnaire using the integrative periodontal self-assessment index and objective periodontal examination clearly indicate a high prevalence of inflammatory periodontal diseases in this category of patients.

Differential diagnosis of chronic catarrhal gingivitis and mild chronic generalized periodontitis is possible only by means of a medical dental examination, as it is carried out on the basis of the presence of a periodontal pocket, determined by the dentist during the probe.

However, the basis of treatment in both cases is the same procedure - conducting professional oral hygiene, so that for planning treatment, calculating the need for medical personnel and working time, the integrative periodontal self-assessment index provides a dentist with a fairly complete and objective picture.

Claims (1)

A method for assessing the severity of periodontal disease by studying the clinical picture of the disease and information on the periodontal condition obtained by self-questioning, characterized in that they determine the integrative periodontal self-assessment index - ISPI (integrative self-examining periodontal index) by the formula
IISP = (a + b + c + d + e): 5,
Where:
a - tooth mobility: absent - 0 points, slight - 1 point, noticeable - 2 points, strong - 3 points;
b - bleeding gums: absent - 0 points, occasionally during brushing - 1 point, constantly during brushing - 2 points, while eating - 3 points;
c - edema and (or) redness of the gums: absent - 0 points, interdental papilla - 1 point, interdental papilla and gingival margin - 2 points, the entire gum - 3 points;
d - root exposure: none - 0 points, slight - 1 point, noticeable - 2 points, strong - 3 points;
e - the presence of dental plaque: none - 0 points, tongue feeling of roughness of the tooth surface - 1 point, visible dental deposits - plaque, tartar - 2 points, a large amount of tartar and plaque - 3 points;
and if the ISPI value is 0 points, the periodontal condition is assessed as healthy; from 0 to 1 point inclusive mild periodontal disease is noted;
from 1.1 to 2 points inclusive - periodontal pathology of an average degree;
from 2.1 to 3 points inclusive - severe periodontal pathology.

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