RU2676645C1 - Method for registration and determination of caries intensity - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, in particular to dentistry. Examine the oral cavity, record the state of hard tissue (HT) of each surface of all teeth present in the oral cavity and calculate the index of the intensity of carious lesions. Following criteria are used when registering the state of HT of teeth, each is assigned a numeric code reflecting the severity of the clinical lesion of caries: 0 – healthy surface, including intact sealant; 1 – soft dental deposits; 2 – visible focal demineralization; 3 – pigmented carious stain, pigmented fissures, caries within the enamel; 4 – pigmented halo from demineralized dentin; 5 – restoration; 6 – open carious cavity with exposed dentin; 7 – restoration complicated by caries; 8 – complicated caries, including a temporary filling; 9 – complicated caries with fistula; 10 – tooth extraction due to caries and its complications. If there are several signs of damage on the same tooth surface, the criterion with the highest digital code value is recorded. Calculate the intensity index of carious lesions by summing the number of detected digital codes, but not their values, according to the formula presented: KKPU=ΣI, where KKPU– the intensity of dental caries; ΣI– the number of tooth surfaces with indices from 1 to 10 inclusive.EFFECT: method allows to develop a method for recording and determining the intensity of dental caries, taking into account early and reversible forms of carious lesions, objectively reflecting the clinical situation in the oral cavity.1 cl, 2 ex

Description

The invention relates to medicine, namely to dentistry, and can be used to register and determine the intensity of caries, including when conducting epidemiological examinations of the dental health of the population.

A known method for determining the intensity of caries according to the WHO method, used including for conducting national epidemiological studies [1]. The essence of the method is to register the index of the CPU or the teeth of the teeth and surfaces. The index is calculated as the sum of the components (KPU (kpu) = K (k) + P (n) + Y (y)).

The method is easy to use, however, its disadvantages are registration of the carious process only in the presence of visible extensive tooth damage, thus, the index is not sensitive to the initial forms of caries, does not take into account caries of enamel, and does not register the activity of the carious process. Evaluation of the effectiveness of prevention programs according to the WHO methodology can be carried out no earlier than 5 years later.

A known method for assessing the severity of carious lesions using the ICDAS index I and II [2]. The method is an attempt to create a unified system for evaluating dental caries. The essence of the method is to register coronal caries, the presence of restorations, sealants. Codes for recording coronal caries are ranged from 0 to 6, determining the depth of the carious process before the pulp of the tooth is involved in the carious lesion. Codes for assessing restorations and sealing are recorded from 0 to 9. Before performing the technique, the surfaces of the teeth are cleaned and dried with compressed air for 5 seconds.

The method is sensitive to the initial forms of caries, but the disadvantages of this method are the difficulty of its use in epidemiological examinations, since the method takes a long time, in most cases there is no possibility of cleaning and drying the surfaces of the teeth. Examination of one child lasts about 10 minutes. The authors point out significant difficulties with the interpretation of the index, as well as a tendency to exaggerate the intensity of dental caries in the population [3]. Due to the complexity of registration, clinical calibration of specialists is necessary. It is not possible to compare the ICDAS index data with WHO criteria because they are not the same.

The prototype is a method for assessing tooth decay Caries Assesment Spectrum Treatment Index (CAST) [3]. The index is intended for epidemiological use. Assessment of each surface of the teeth present in the oral cavity occurs visually. The index consists of ten unique codes arranged in a hierarchical order. The disadvantage of the index is the possibility of its use only in epidemiological examinations, the index does not take into account the microsigns of developing carious lesions and local risk factors, which reduces the objectivity of the assessment of carious tooth damage. Its practical use is possible in countries with a low level of caries intensity.

The aim of the invention is to develop a method for recording and determining the intensity of dental caries, taking into account the early and reversible forms of carious lesions, objectively reflecting the clinical situation in the oral cavity. It is intended to use this method for early assessment of the effectiveness of individual and community-based caries prevention programs.

This goal is achieved by the fact that when registering the state of hard tooth tissues, the following criteria are used, each of which is assigned a digital code that reflects the severity of the clinical caries lesion: 0 - healthy surface, including intact sealant; 1 - soft dental deposits; 2 - visible focal demineralization; 3 - pigmented carious spot, pigmented fissures, caries within the enamel; 4 - pigmented halo from demineralized dentin; 5 - restoration; 6 - open carious cavity with exposed dentin; 7 - restoration, complicated by caries; 8 - complicated caries, including a temporary filling; 9 - complicated caries with fistula; 10 - tooth extraction due to caries and its complications; if there are several signs of damage on the same tooth surface, the sign with the highest code value is recorded; calculate the intensity indices of carious lesions by summing the number of detected codes, but not their digital values, according to the formulas presented:

To ₀ KPU _surfaces = ΣI _{1-10 surfaces} , where

K ₀ CPU _surfaces - the intensity of caries surfaces;

ΣI _{1-10 surfaces} - the number of tooth surfaces with codes from 1 to 10 inclusive;

To ₀ KPU of _teeth = ΣI _{1-10 teeth} , where

To ₀ KPU of _teeth - the intensity of dental caries;

ΣI _{1-10 surfaces} - the number of teeth with indices from 1 to 10 inclusive.

The criteria proposed for assessing the degree of caries severity include those already known and used to calculate the widespread caries intensity indices KPU and PUFA, as well as micro signs of the carious process that were not previously included in the caries assessment system (for example, criteria 1, 2, 3 ) Thus, the proposed caries registration system supports the most common caries registration system - KPU - and allows you to calculate the intensity of tooth decay and surfaces according to the KPU index.

The proposed method for recording and determining the intensity of caries is simple to implement, takes into account the early, including reversible, forms of the carious process, is sensitive and can be used to evaluate the effectiveness of both individual and community-based caries prevention programs. The time required to fill out the dental formula with the proposed method is comparable to the most common method of caries registration - CPU. However, the inclusion of early forms of caries in the criteria for evaluating the carious process makes the proposed caries intensity index more sensitive in comparison with the CPU. This allows us to recommend its use for assessing the intensity of caries at the individual and community level, including for early assessment of the effectiveness of implemented prevention programs.

Examination of the patient's oral cavity is carried out with a standard set of instruments for dental examination (probe, mirror), while the state of hard tissues of each surface of all the teeth present in the oral cavity is recorded. To register the state of hard tooth tissues, criteria are used, each of which is assigned a digital code that reflects the severity of the clinical caries lesion: 0 - healthy surface, including intact sealant; 1 - soft dental deposits; 2 - visible focal demineralization; 3 - pigmented carious spot, pigmented fissures, caries within the enamel; 4 - pigmented halo from demineralized dentin; 5 - restoration; 6 - open carious cavity with exposed dentin; 7 - restoration, complicated by caries; 8 - complicated caries, including a temporary filling; 9 - complicated caries with fistula; 10 - tooth extraction due to caries and its complications; if there are several signs of damage on the same tooth surface, the sign with the highest code value is recorded, the intensity indices of the carious lesion are calculated by summing the number of detected codes, but not their digital values, according to the formulas presented:

To ₀ KPU _surfaces = ΣI _{l-10 surfaces} , where

K ₀ CPU _surfaces - the intensity of caries surfaces;

ΣI _{1-10 surfaces} - the number of tooth surfaces with codes from 1 to 10 inclusive;

To ₀ KPU of _teeth = ΣI _{1-10 teeth} , where

To ₀ KPU of _teeth - the intensity of dental caries;

ΣI _{1-10 surfaces} - the number of teeth with indices from 1 to 10 inclusive.

The method is illustrated by clinical examples.

Example 1

Patient I., 28 years old, medical record No. 5642

An initial examination of the patient’s oral cavity revealed 15 surfaces of teeth covered with soft dental deposits, 3 surfaces with a pigmented halo, 7 surfaces with restorations and 2 surfaces with restorations complicated by caries. At the same time, 6 teeth had a sign - soft dental deposits, 3 teeth - a pigmented halo, in 4 teeth the most severe sign of caries damage was restoration, and 2 teeth had restoration, complicated by caries.

To ₀ KPU _surfaces = ΣI _{1-10 surfaces} = 15 + 3 + 7 + 2 = 27

To _{0 tooth} CPU = ΣI 1-10 _teeth = 6 + 3 + 4 + 2 = 15

Also, the following indexes of tooth tooth and tooth surface index were traditionally used to determine the intensity of caries:

CPU of _surfaces = ΣI _{5-10 surfaces} = 9

_Tooth CPU = ΣI _{5-10 teeth} = 6

Comparing intensity values of the indices caries K ₀ KPU KPU _teeth and _tooth shows a substantial difference in the evaluation of the severity of carious process - 15 and 6 respectively. The patient compiled an individual program for the prevention of major dental diseases, prescribed basic and additional means of oral hygiene, conducted controlled oral hygiene, motivation.

Upon repeated examination of the oral cavity of patient I. six months later, 4 surfaces of teeth covered with soft dental deposits, 3 surfaces with a pigmented halo, 7 surfaces with restorations and 2 surfaces with restorations complicated by caries were found. At the same time, 2 teeth had a sign - soft dental deposits, 3 teeth - a pigmented halo, in 4 teeth, the most severe sign of caries damage was restoration and 2 teeth had restoration, complicated by caries. Re-determination of caries intensity indices:

K ₀ CPU of _surfaces = ΣI _{1-10 surfaces} = 4 + 3 + 7 + 2 = 16

To _{0 tooth} CPU = ΣI 1-10 _teeth = 2 + 3 + 4 + 2 = 11

Indices of tooth CPU and CPU surface remained unchanged:

CPU of _{surfaces =} ΣI _{5-10 surfaces} = 9

_Tooth CPU = ΣI _{5-10 teeth} = 6

The values of the indices K ₀ KPU of _surfaces and K ₀ KPU of _teeth decreased in comparison with the first visit (by 11 and 4, respectively), which indicates the effectiveness of the proposed prevention program and a favorable prognosis for the patient regarding the risk of new carious lesions. At the same time, the values of the traditionally used caries intensity indices of KPU _surfaces and KPU of _teeth remained unchanged from the moment of the first examination (9 and 6, respectively), which does not allow judging the effectiveness of the proposed prevention program and makes it difficult to predict the course of carious disease in this patient.

The proposed index of the intensity of caries K ₀ KPU of _{teeth is} much more sensitive than the traditionally used index of KPU of _teeth due to the inclusion of early and reversible forms of caries in the calculation.

Example 2

A dental examination of 28 students of the 2nd grade of a comprehensive school was carried out at the beginning and end of the school year. Registration of carious lesions was carried out according to the proposed method. The average age of the children at the time of the initial examination was 8.2 years. The initial average indices of caries intensity indices were equal to K ₀ KPU of _surfaces = 4.8 and K ₀ KPU of _teeth = 2.4. A secondary examination at the end of the school year showed the average intensity of caries on the indices K ₀ KPU _surfaces = 7.4 and K ₀ KPU _teeth = 3.2. The dynamics of the average values of the indices K ₀ KPU _surfaces and K ₀ KPU _teeth had a pronounced negative direction - the increase in the number of caries affected surfaces averaged 2.6 per child, the increase in the number of caries affected teeth averaged 0.8 per child, which says about the need to develop and implement a comprehensive program for the prevention of major dental diseases among students.

Thus, the proposed method for recording and determining the intensity of caries is simple to implement, takes into account the early, including reversible, forms of the carious process, is sensitive and can be used to assess the intensity of caries at an individual level and in epidemiological surveys of the population. The sensitivity of the index allows us to recommend its use for early assessment of the effectiveness of dental disease prevention programs. Clear and understandable criteria used in the proposed method increase the reproducibility of the index and do not require preliminary calibration of specialists.

INFORMATION SOURCES

1. Klein N., Palmer C. Studies on dental caries vs. familial resemblance in the caries experience of siblings // Public Health Report. 1983 N. 53 P. 1353-1364.

2. International Caries Detection and Assessment System Coordinating Committee: Criteria Manual. International Caries Detection and Assessment System (ICDAS II). Baltimore - Maryland USA, 2005. H. 43.

3. Frencken J.E., Amorim R.G., Faber J., Leal S.C. The Caries Assesment Spectrum and Treatment (CAST) index: rational and development // International Dental Journal. 2011. N. 61. P. 117-123.

Claims (4)

The method of recording and determining the intensity of caries, including examination of the oral cavity, registration of the state of hard tissues of each surface of all teeth in the oral cavity and calculation of the index of intensity of carious lesions, characterized in that when registering the state of hard tissues of the teeth, the following criteria are used, each of which is assigned a digital code reflecting the severity of the clinical caries lesion: 0 - healthy surface, including intact sealant; 1 - soft dental deposits; 2 - visible focal demineralization; 3 - pigmented carious spot, pigmented fissures, caries within the enamel; 4 - pigmented halo from demineralized dentin; 5 - restoration; 6 - open carious cavity with exposed dentin; 7 - restoration, complicated by caries; 8 - complicated caries, including a temporary filling; 9 - complicated caries with fistula; 10 - tooth extraction due to caries and its complications; if there are several signs of damage on the same tooth surface, record the criterion with the highest value of the digital code, calculate the intensity index of the carious lesion by summing the number of detected digital codes, but not their values, according to the presented formula:

- the intensity of dental caries;

- the number of tooth surfaces with indices from 1 to 10 inclusive.