RU2696061C1 - Method for determining the caries intensity level for further caries treatment and prevention in a patient - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to therapeutic dentistry and prevention of dental diseases, and aims at diagnosing the intensity of various forms of caries in patients of different age groups and planning further treatment. Universal caries intensity index (UCII) is calculated by calculating the formula UCII=∑CSR/x, where: C is the number of temporary and permanent teeth with caries, including those with initial forms (caries in stain); S is number of temporary and permanent sealed teeth; R – number of temporary and permanent teeth removed as a result of complicated caries; x is the number of teeth to be present in the patient of the given age minus the teeth absent due to primary partial adentia and/or physiological change, which is determined by the formula x=∑t.a.g.-∑t.p.a.-∑t.p.c., where: t.a.g. – number of teeth in given age group; t.p.a. – number of teeth with primary adentia; t.p.c. is number of teeth at stage of physiological change. Caries intensity (UCII) level is evaluated by the following criteria for all age groups: ≤0.14 – low; 0.15–0.30 – average; 0.31–0.60 – high; ≥0.61 – very high. Depending on the derived value of the UCII, certain medical measures are performed.

EFFECT: method enables determining a caries intensity level regardless of the patient's age, taking into account the further planning of the caries treatment and prevention.

1 cl, 5 ex

Description

The invention relates to medicine, in particular to therapeutic dentistry and the prevention of dental diseases, and is intended to diagnose the intensity of various forms of caries in patients of different age groups and plan further treatment.

Most often, to assess the intensity of caries in patients, the KPU caries intensity index is used, based on the calculation of the number of carious (K), filled (P) and removed (U) teeth. It is possible to measure the tooth CPU or CPU surfaces. When calculating the KPU of the surfaces, the extracted teeth are calculated differently by different authors and their data are ambiguous. The KPU index has been used since the eruption of permanent teeth [1]. The KPU index was first proposed by Klein in 1938 [3].

In 1960, the American scientist G. Nikiforuk developed a method for determining the individual activity of caries [4]. The method consists in determining individual caries prevalence by counting kpu indices (the sum of carious, filled and removed temporary teeth) and KPU (the sum of carious, filled and permanently removed teeth). According to the degree of already developed caries, resistance (predisposition) to the disease is determined and the further development of the carious process is predicted. The assessment of individual caries prevalence is carried out as follows: during a dental examination, individual caries intensity is determined using indices of kpu or KPU.

Individual indicators can be compared with the KPU or KPU indices of other people of this age using the table compiled by R.M. Grainder, G. Nikiforuk (1960), which reflects the distribution of KPU and KPU indices for populations of different age groups who consume non-fluoridated drinking water. The table allows the doctor to assign the subject according to the value of KPU and KPU to one of four groups: high, medium, low intensity (susceptibility) and the group resistant to caries. Evaluation of individual incidence of caries determines the choice of individual methods of prevention, as well as the multiplicity of preventive procedures.

The Nikiforuk method is much more informative than the Klein method, since it covers the entire diversity of the intensity level from very low to very high levels in different age groups of children and adults. Using the work of Nikiforuk, WHO recommended 5 levels of dental caries intensity in two age groups: in children 12 years old and in adults 35-44 years old. However, the above methods are limited in comparison and ambiguous. So, in these methods, the initial stages of caries are not taken into account, it is impossible to compare the intensity of caries between representatives of different age groups, and individual (congenital absence of teeth) and age (unformed bite) characteristics of patients are not taken into account.

Based on the WHO system, in 1990 Leus P.A. developed an index of the level of caries intensity (PEC), which can be used both at the individual and group levels for all age groups of the population [2].

Formula for determining the individual level of caries intensity (PEC) of adult teeth

PEC = KPU / N, where KPU - caries, seal, extracted tooth; N is the age of the subject in years.

The determination of PECs according to KPU data is the simplest arithmetic operation, but you can also use PEC tables which show the values of both individual KPUs and KPUs at different levels of tooth decay intensity.

The PEC index reflects the average annual increase in the intensity of caries of the patient’s teeth and can be used to predict the disease. Using PECs, one can determine at any time during the examination the level of caries in a given individual: low, medium, high or very high. Level tables are also grouped by age. However, this method also has drawbacks when comparing and interpreting indicators of the level of caries intensity.

For example, to determine an individual PEC for a child under 8 years old, the KP index is divided by his age. The level of intensity of caries in a child and adolescent (9-19 years) is calculated as the ratio of individual KPU to the age of the examinee minus five years (the age of the onset of eruption of permanent teeth). To calculate the PEC of an adult (20-65 years old), the KPI index of an individual’s teeth is divided by his age.

For a child under 8 years of age, PEC no more than 0.4 is low; from 0.5 to 0.8 - average; from 0.9 to 1.2 - high; 13 or more is very high. At the same time, for children and adolescents (9-19 years) PEC no more than 0.3 is low; from 0.4 to 0.6 - average; from 0.7 to 0.9 - high; 1.0 or more is very high. And for adults (20-65 years) PEC no more than 0.15 is low; from 0.15 to 0.30 - average; from 0.31 to 0.60 - high; 0.60 or more - very high.

All of the above methods have the following disadvantages:

1. It is impossible to compare the intensity of caries between different age groups, since the values of the intensity indicators in numerical form have different interpretations for different age groups.

2. Incorrect determination of the index in people with congenital tooth edentia.

3. The initial stages of caries are not taken into account.

4. The G.I. Nikiforuk index of caries intensity (kpu, KPU), in addition to the aforementioned drawbacks, also has one more thing - this is the inability to trace the dynamics of the intensity of the carious process during the transition observed from one age group to another.

To eliminate such shortcomings, we have developed a universal method for determining the universal index of caries intensity (UIIK).

The technical result of the invention is to increase the accuracy of determining the level of intensity of caries, regardless of the age of the patient, taking into account the further planning of treatment and prevention of caries.

The technical result is achieved by the fact that they determine the universal index of caries intensity (UIIK) by calculating the formula UIIK = ∑ KPU / x, where: K is the number of temporary and permanent teeth with caries, including the initial forms (caries in the spot stage) ; P - the number of temporary and permanent filled teeth; U - the number of temporary and permanent teeth removed, due to complicated caries; x is the number of teeth that a patient of a given age should have minus teeth missing due to primary partial adentia and / or physiological change, which is determined by the formula x = =з.в.г.- ∑з.ч.а.- ∑з.ф, s, where: З.в.г. - the number of teeth in this age group; h.a. - the number of teeth with primary adentia; z.s. - the number of teeth at the physiological shift stage.

The level of caries intensity (UIIK) is estimated by the following criteria for all age groups:

≤0.14 - low; 0.15-0.30 - average; 0.31-0.60 - high; ≥0.61 - very high.

The average intensity of dental caries according to the UIIK among the population is calculated as the ratio of the sum of the indices of individual UIIK indices to the total number examined.

UIIKn = ∑UIIK / N, _G de N - the number of examined patients.

This method of evaluating the intensity of caries allows you to evaluate the intensity of caries in any age group and compare them according to the same criteria regardless of the presence or absence of primary adentia and belonging to the age group of the tender, and also take into account the initial stages of caries.

The method is as follows. A dentist examines a patient’s dentition with a probe and a mirror, and also examines his orthopantomogram (if indicated) taking into account biological age, gender, physiological change of teeth, number and quality of teeth to determine the intensity of the carious process, taking into account further treatment planning and prevention of caries in a patient. The universal index of caries intensity (UIC) is determined by calculating the formula UIC = ∑ KPU / x, where: K is the number of temporary and permanent teeth with caries, including those with initial forms; P - the number of temporary and permanent filled teeth; U - the number of temporary and permanent teeth removed, due to complicated caries; x - the number of teeth that a patient of a given age should have minus teeth missing due to primary partial adentia and / or physiological change, which is determined by the formula x = ∑з.в.г.-∑з.ч.а.- Фз.ф.с, where: З.в.г. - the number of teeth in this age group; h.a. - the number of teeth with primary adentia; z.s. - the number of teeth at the physiological shift stage;

The method allows using unified criteria to evaluate the intensity of the development of the carious process in various groups of children and adults.

As for the medical examination, for example, of preschool children (4-6 years old), it should provide for the following: after the completion of the rehabilitation of the oral cavity, children are divided into three groups for repeated examinations after 6, 12 months and according to an individual program. At the same time, the first dispensary group should include healthy and practically healthy children who do not have dental caries, malocclusion, have a healthy periodontium and proper articulation of the oral organs during the formation of the main functions: biting, chewing, swallowing, breathing, speech, etc. These children are examined once a year. The first group also includes children who do not have caries and malocclusion, but have risk factors for malocclusion in the form of diseases of the ear, throat, nose, anomalies of the frenum of the tongue, lips, bad habits of incorrect posture, mouth breathing, sucking the tongue, fingers, lips and other permanent objects. These children are referred to specialists of the appropriate profile to eliminate risk factors and can also be examined by the dentist once a year. However, to monitor the implementation of the recommendations of the dentist, educators must invite parents every 3 months. The second dispensary group should be children with dental caries. The third dispensary group consists of preschool children, in whom a combination of malformations of tooth tissues and caries is noted, which is manifested by a symptom of mutual burden. This symptom, in turn, is often combined with frequent illnesses of the child, poor appetite, decreased body reactivity and increased nervous system excitability, therefore it is more advisable to treat such children in the clinic, according to indications, perform oral sanitation in conditions of general anesthesia, and expand indications for tooth extraction with chronic periodontitis, primarily provide prosthetics. The same group includes children who have pronounced changes in the dentofacial area, formed malocclusion. They often determine changes in the configuration of the face and pronounced violations of the functions of biting and chewing food, swallowing, breathing, speech. For such children, an individual rehabilitation plan should be selected taking into account the general and dental status, and parents should be involved to implement this plan.

The following examples will demonstrate the full implementation of the present invention.

Example 1. The child is 1 year old, female. Dental formula:

Teeth 5.1, 6.1, 6.2 superficial caries. Teeth 5.2, 7.2, 7.1, 8.1, 8.2 - caries in the stage of a white spot.

UIIK = KPU / x, where x = ∑з.в.г.-∑з.ч.а.-∑з.ф.с.

CPU = 8 + 0 + 0 = 8

x = 8-0-0 = 8

UIIK = 8/8 = 1 - very high

Diagnosis: UIIK = 1 (very high). Multiple caries.

Caries treatment and prevention plan: conduct professional oral hygiene of a child, educate parents on the rules and methods of caring for a child’s oral cavity, start active local remineralizing therapy with calcium preparations, conduct nutritional correction, send a consultation to a pediatrician to identify foci of chronic infection in the child and select vitamin-microelement complexes for oral administration. Fill teeth 5.1, 6.1, 6.2.

Ongoing activities.

Professional oral hygiene of the child.

Apply a solution to the teeth, to indicate plaque, use a circular brush and polishing paste to completely clean the teeth of dental plaque, if there is hard plaque, use hand tools to remove it, after cleaning the teeth are covered with remineralizing gel containing calcium, according to indications, the procedure is carried out sealing fissures.

Teaching parents the rules and methods of caring for the oral cavity of the child. They explained to parents that it is necessary to care for the oral cavity of the child from the moment the first tooth erupts. Teeth brushing is carried out by parents 2 times a day after meals. Toothbrush for children of this age group should be with a small working part, the bristles are very soft. Toothpaste should correspond to the age group from 0 to 3 years, it is necessary to draw the attention of parents to the fact that there should not be fluoride in the toothpaste.

Active local remineralizing therapy with calcium preparations.

It is carried out in accordance with the Clinical Recommendations (Treatment Protocol) for the management of sick children "Dental caries" [5] | [AAE1] using calcium and phosphate preparations (gels, solutions). Before treatment, in the presence of rough surfaces, they are ground. Begin the course of remineralizing therapy. Remineralizing agent is applied to the surface of all teeth after brushing your teeth in the morning and evening, as well as during the day. With an active course of caries, the application of drugs is carried out 3-4 times a day for a month. After the procedure, the child is recommended not to eat for 1-2 hours. One month after the start of remineralizing therapy, it is necessary to conduct a dental examination of the child to assess the achieved result. A criterion for the effectiveness of the course of remineralizing therapy is to reduce the size of the demineralization focus until it disappears, restore enamel gloss or less intensive staining of the demineralization focus (on a 10-point enamel staining scale) with dye, improve the performance of other additional diagnostic methods (fluorescence method, etc.).

Power Correction

Parents are educated about the rules of healthy eating, a child is weaned from eating from a bottle with a pacifier, they completely refuse night feedings.

Pay attention to compliance with several rules, such as - proteins, fats and carbohydrates must be present in the daily diet in a ratio optimal according to age and physical activity; fiber, vitamins and minerals should be present in food; concentrated fruit juices and sweet carbonated drinks should be abandoned in favor of drinking or mineral water, weak tea; increase the use of fermented milk products rich in calcium: cottage cheese, cheese; at least twice a week, you should eat fish and other seafood containing a large amount of phosphorus and vitamin D; sweet dessert is best replaced with fresh, solid fruits rich in vitamin C.

Intake of vitamin-microelement complexes. With a lack of vitamins and minerals in the diet, multivitamin and mineral complex preparations should be taken, selected in accordance with the age of the child. To fill in the deficiency of microelements and strengthen the mineralizing properties of saliva, which nourishes hard tissues of teeth and protects them from pathogenic microflora. As a preventive measure, it is recommended to take vitamin preparations for children (ALFAVIT Our baby).

Example 2. A child of 10 years, male, ectodermal dysplasia, congenital bilateral cleft of the upper lip, alveolar bone, hard and soft palate, congenital adentia. Dental formula:

Bite interchangeable, narrowing of the upper jaw. Teeth 1.6, 3.6, 4.6 on the occlusal surfaces and in the blind fossa - carious cavities within the dentin. Tooth 5.3 on the vestibular and contact surfaces of the carious cavity within the dentin. Teeth 6.3 and 7.5 - removed as a result of exacerbation of chronic granulating periodontitis. On teeth 5.5, 6.5, 2.6, 7.3, 8.3 - hermetic fillings.

On the orthopantomogram, there are no pathological changes in the apices of the roots and furcations; the degree of formation and resorption of the roots corresponds to age. The rudiments of teeth 1.4, 1.2, 2.2, 2.4, 3.4, 4.5 and 4.5 are absent. From the anamnesis - tooth 8.5 was not erupted, absent on the radiograph.

CPU = 4 + 5 + 2 = 11

x = 24-7-0 = 17

UIIK = 11/17 = 0.65 very high

Diagnosis: UIIK = 0.65 is very high. Multiple caries. Congenital adentia.

Caries treatment and prevention plan: conduct professional oral hygiene of a child, educate parents and child on the rules and methods of caring for the oral cavity, conduct an active course of remineralizing therapy with calcium and fluoride preparations, conduct nutritional corrections, send a consultation to a pediatrician to identify foci of chronic infection in child and the selection of vitamin-microelement complexes for oral administration. To carry out treatment (filling) of teeth 1.6, 3.6, 4.6, 5.3. Refer for consultation with an orthodontist.

Planned result of treatment: sanitation of the oral cavity. The child is being transferred to the V dispensary group, it is necessary to continue the full range of treatment and preventive measures, carry out sanitary and hygienic education of parents and the child on nutrition and oral care, eliminate the identified risk factors for the progression of carious disease, motivate parents to follow up with the doctor recommendations. Perform preventive examinations every 1-2 months and unscheduled during the eruption of the next tooth, while simultaneously sealing the fissures of these teeth.

Example 3. A 6-year-old female patient. Dental formula:

The physiological change of the upper central incisors and lower incisors corresponds to the first half of the replacement bite. The bite is physiological. Teeth 1.6, 3.6 on occlusal surfaces and in blind fossae - carious cavities within the enamel. Teeth 5.5 and 7.4 on occlusal surfaces - hermetic fillings. Tooth 6.4 - removed due to chronic granulating periodontitis. On the orthopantomogram - there are no pathological changes, the development and resorption of the roots corresponds to the biological and passport age of the child. There are all the rudiments of permanent teeth.

CPU = 2 + 2 + 1 = 5

x = 24-0-4 = 20

UIIK = 5/20 = 0.25 average

Diagnosis: UIIK = 0.25. Initial caries of enamel 1.6 and 3.6.

Treatment and prevention plan for caries: conduct professional oral hygiene of a child, educate parents and child on the rules and methods of caring for the oral cavity, and conduct a course of remineralizing therapy with calcium and fluorine preparations. To carry out treatment (filling) of teeth 1.6 and 3.6, as well as sealing fissures 2.6 and 4.6.

Estimated result of treatment: sanitation of the oral cavity. The child is transferred to the II dispensary group. Perform preventive examinations every 6 months, and unscheduled when teething the next group of teeth, at the same time carry out the sealing of the fissures of these teeth. Once a year, conduct a short course of preventive remineralizing therapy.

Example 4. The patient is 5 years old, male. Dental formula:

Tooth 5.5 on the occlusal surface of the carious cavity within the dentin. Teeth 5.3, 5.2 and 7.2 have cavities in the fissure area. On the intraoral contact radiograph, carious cavities are not communicated with the tooth cavity, there are no pathological changes in the apex of the roots. Tooth 8.4 - there is a sealed filling on the occlusal surface, there is no demineralization under restoration on the intraoral contact radiograph, there are no pathological changes in the apex of the roots.

CPU = 4 + 7 + 0 = 7

x = 20-0-0 = 20

UIIK = 7/20 = 0.35 high

Diagnosis: UIIK = 0.35 high. Uncomplicated caries 5.5, 5.3, 5.2, 7.2

The plan of treatment and prevention of caries: conduct routine professional oral hygiene, transfer the patient to the III dispensary group, carry out a range of treatment and preventive measures, conduct sanitary and hygienic education and eliminate the identified risk factors for the progression of carious disease. To conduct treatment (filling) of teeth 5.5, 5.3, 5.2, 7.2

Estimated result of treatment: sanitation of the oral cavity.

CPU = 0 + 2 + 0 = 2

x = 20-0-0 = 20

UIIK = 2/20 = 0.1 low.

The child is transferred to the III dispensary group, preventive examinations are carried out every 6 months, and unscheduled during the eruption of the next group of teeth, at the same time to seal the fissures of these teeth. Once every 6 months, carry out a short course of preventive remineralizing therapy.

Example 5. The patient is 28 years old, female. Dental formula:

The bite is permanent, orthognathic.

On occlusal surfaces 1.6, 2.6, and 4.6 are sealed. On the orthopantomogram - pathological changes in the bone tissue and under the fillings are absent.

CPU = 0 + 3 + 0 = 3

x = 32-0-0 = 32

UIIK = 3/32 = 0.09 low.

Diagnosis: UIIK = 0.09 low, oral cavity sanitized.

Prevention and treatment plan: conduct routine professional oral hygiene. Scheduled inspection after 12 months.

Bibliography:

1. Children's therapeutic dentistry. National Leadership / Ed. VC. Leontiev, L.P. Kiselnikova. - M .: GEOTAR-Media, 2010 .-- 896 p.

2. Leus P.A. Dental health level: guidelines / P.A. Leus, S.A. Vasina, N.L. Gudkova. M., 1990 .-- 38 p.

3. Klein N., Palmer C. Studies on dental caries vs. familial resemblance in the caries experience of siblings / Public Health Report. 1938 N 53. P 1353-1364.

4. Nikiforuk G. Understanding Dental Caries. Vol. 2., Etiology and Mechanisms; Basic and Clinical Aspects. Basel, Karger. 1985 - pp. 24-59

5. Clinical recommendations (treatment protocol) for the management of sick children "Dental caries" was developed by Moscow State Medical and Dental University. A.I. Evdokimova, Department of Pediatric Dentistry (Project). http://www.e-stomatology.ru/detstom/kalendar/2016/clinic_recommend_karies/ The link is valid from 03/29/16.

Claims (11)

A method for determining the level of caries intensity for further treatment and prevention of caries in a patient, which consists in determining the universal index of caries intensity (UIIK) by calculating the formula UIIK = Σ KPU / x, where: K is the number of temporary and permanent teeth with caries, including those with initial forms; P - the number of temporary and permanent filled teeth; Y - the number of temporary and permanent teeth removed due to complicated caries; x is the number of teeth that a patient of a given age should have minus teeth missing due to primary partial adentia and / or physiological change, which is determined by the formula x = Σz.v.g.- Σz.ch.a. - Σз.ф.с, where: zvg - the number of teeth in a given age group; c.a. - the number of teeth with primary adentia; z.s. - the number of teeth at the physiological shift stage; when the condition UIIK ≤0.14 - the level of intensity of caries is assessed as low and conduct routine occupational oral hygiene; when the UIIK condition is met, 0.15-0.30 - the level of caries intensity is assessed as average and a routine professional oral hygiene and a course of remineralizing therapy with calcium and fluorine preparations are carried out; when the UIIK condition is met, 0.31-0.60 - the level of caries intensity is assessed as high and routine professional oral hygiene is carried out, the patient is transferred to the dispensary group, a complex of treatment and preventive measures is carried out, sanitary and hygienic education is carried out, and the identified risk factors for progression are eliminated carious disease; when the condition UIIK ≥0.61 is fulfilled, the level of caries intensity is assessed as very high and professional hygiene of the oral cavity is carried out, the rules and methods of oral care are taught, local remineralizing therapy with calcium preparations is carried out, nutrition correction is carried out, and they are referred for consultation to identify foci of chronic infections and select vitamin-microelement complexes for oral administration.