RU2723517C1 - Method for determining degree of periodontitis - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely dentistry, and can be used for determining the degree of periodontitis in patients of all age groups. Method comprises determining the depth of pathological periodontal pockets of the examined teeth from the medial, distal, external and internal surfaces of the tooth by means of a dental periodontal probe with subsequent determination of the maximum value of their depth, and if the obtained maximum value is less than 4 mm, I is determined, i.e. mild degree of periodontitis, if value is 4–5.9 mm – II, i.e. average degree of periodontitis, if values of 6 and more mm, III is determined, i.e. severe degree of periodontitis. Depth of pathological periodontal pockets of the examined teeth is additionally determined along the entire width of above 4 sides of each examined tooth by means of a dental periodontal probe with division on the working part from 1 to 10 mm with pitch of 1 mm, and after its introduction into the pathological periodontal pocket, the periodontal probe is deflected at an acute angle from the tooth axis. After determining the depth of each pathological periodontal pocket of each surface of each tooth, the dental periodontal probe is withdrawn from the above pocket with subsequent insertion thereof into the same pocket, at that, departing from previous place of its introduction on width of working part of periodontal probe, wherein excretion of dental periodontal probe from above pocket with subsequent further introduction into same pocket is performed until complete inspection of each surface of each tooth; maximum depth of pathological periodontal pockets of the examined teeth is determined by selecting the maximum depth within each surface of each tooth to be examined.EFFECT: method enables increasing objectivity of determining the degree of periodontitis and providing the possibility of determining the depth of pathological periodontal pockets irrespective of the topographic anatomical features of the periodontium subject to examination, in the presence of fixed dental orthopedic structures, as well as in case of crowded teeth, teeth inclination along axis in different directions and overhanging of permanent dental orthopedic structures.1 cl, 28 tbl, 6 ex

Description

The invention relates to medicine, namely dentistry, and can be used to determine the degree of periodontitis in patients of all age groups.

Periodontitis is a chronic inflammation of periodontal tissues, accompanied by the development of destruction of the ligamentous apparatus and alveolar bone, and is not only a clinical, but also a social problem, in which dentists-therapists, dental surgeons, implant dentists, orthopedic dentists, pathophysiologists have joined forces. , histologists, microbiologists, general practitioners, psychologists.

Periodontal pathology in importance takes second place after dental caries: it is detected in 70% of the population. According to WHO epidemiological surveys in 45 countries of the world (2002), Russia is one of the most unfavorable countries in terms of the prevalence of periodontitis.

A known method for determining the degree of periodontitis, which consists in measuring the depth of pathological periodontal pockets of the examined teeth using a calibrated periodontal probe, placing it parallel to the long axis of the tooth, while tightly pressing it to the tooth surface, measuring the pocket from the edge of the gum to its bottom. On each side, vestibular and oral, the indicators obtained at three points are recorded: distally, midline, and medially.

Then, among the obtained values of the indicators, the maximum is chosen, and with a value of less than 4 mm, I, that is, a light degree of periodontitis, is determined, at 4-5.9 mm - II, that is, an average degree of periodontitis, - with 6 or more mm, III is determined, that is severe periodontitis. [Clinical recommendations for the diagnosis of periodontitis. The recommendations were approved by the Decision of the Council of the Association of public associations “Dental Association of Russia” on April 23, 2013 with amendments and additions on the basis of Decree No. 15 of the Council of the Association of public associations “Dental Association of Russia” dated September 30, 2014, updated 02 August 2018 (e-stomatology. ru)].

The disadvantages of this method include:

• To determine the depth of pathological periodontal pockets, use a bell-shaped periodontal meter, which is difficult to use to determine the depth of the medial and distal pockets, which is necessary to more accurately determine the degree of periodontitis, as well as in narrow gingival pockets without risk of injury to the patient’s oral mucosa.

• There is no description of the sounding technique, that is, the sequence of actions during sounding.

According to the closest technical essence, as a prototype we have chosen a method for determining the degree of periodontitis, which consists in measuring the depth of pathological gingival pockets.

The depth of the pathological gingival pocket, the distance from the gingival margin to the deepest point of the pocket, is carried out from the medial, distal, outer and inner surfaces of the tooth using a periodontometer with a spherical tip of 0.5 mm and with notches on the instrument 3.5 mm, 5.5 mm 8.5 mm, 11.5 mm. Then, among the obtained values of the indicators, the maximum is chosen, and with a value of less than 4 mm, I, that is, a light degree of periodontitis, is determined, at 4-5.9 mm - II, that is, an average degree of periodontitis, - with 6 or more mm, III is determined, that is severe periodontitis. [National Guide to Periodontology. Edited by prof. L.A. Dmitrieva. Moscow, Geotar-Media, 2013, 94 C, p. 705].

The disadvantages of the method selected as a prototype are:

1) a periodontal probe with a spherical tip is difficult to use to determine the depth of the medial and distal pockets, which is necessary to more accurately determine the degree of periodontitis, as well as in narrow pathological gingival pockets without risk of injury to the patient’s oral mucosa, which can cause a spherical tip of the periodontal probe;

2) the inability to determine the depth of pathological periodontal pockets with complex topographic and anatomical features of the examined periodontium, as well as in the presence of fixed dental orthopedic structures, which is associated with the shape of the working part of the probe used;

3) the lack of information on the full extent of periodontal destruction leads to excessive manipulation, which is a risk of periodontal injury (bleeding and separation of the periodontal ligament);

4) the absence of divisions on the probe, selected as a prototype, corresponding to the classification of the depth of periodontal pockets with periodontitis, which adds subjectivity to the results;

5) the lack of a description of the methodology for determining the degree of periodontitis;

The objective of the invention is:

• increasing the objectivity of the method for determining the degree of periodontitis;

• the ability to determine the depth of pathological periodontal pockets regardless of the topographic and anatomical features of the examined periodontium, in the presence of fixed dental orthopedic structures, as well as in case of crowding of teeth, tilting of teeth along the axis in different directions and overhang of fixed dental orthopedic structures;

• reduced risk of periodontal injury (bleeding and separation of the periodontal ligament);

• simplification of the method.

The technical result achieved by the invention is:

• expanding information on the full extent of periodontal destruction;

• simplification of determining the depth of the medial and distal pathological periodontal pockets, as well as in the narrow above pockets without the risk of periodontal injury (bleeding and separation of the periodontal ligament);

• the ability to determine the depth of pathological periodontal pockets along the entire width of the lateral 4 sides of each examined tooth, which will expand information on the complete periodontal destruction and eliminate the excessive manipulations inherent in the prototype, as well as reduce the risk of periodontal injury (bleeding and separation of the periodontal ligament);

• the exclusion of the use of a periodontal probe with a spherical tip due to the selection of the probe design, which reduces the risk of periodontal injury and increases the objectivity of the method for determining the degree of periodontitis.

The technical result is achieved by the fact that the method for determining the degree of periodontitis consists in determining the depth of the pathological periodontal pockets of the examined teeth from the medial, distal, outer and inner surfaces of the tooth along the entire width of the above 4 sides of each examined tooth using a dental periodontometer with divisions on the working part from 1 to 10 mm in increments of 1 mm. In patients with fixed orthopedic structures, excluding implants, the depth of pathological periodontal pockets is determined only in the abutment teeth. After the introduction of the dental periodontometer into the pathological periodontal pocket, the aforementioned periodontometer is rejected at an acute angle from the axis of the tooth. After determining the depth of each pathological periodontal pocket of each surface of each tooth, the dental periodontometer is removed from the above pocket with its subsequent introduction into the same pocket, while departing from the previous place of its introduction by the width of the working part of the periodontometer. The removal of the dental periodontometer from the above pocket with its subsequent introduction into the same pocket is carried out until a complete examination of each surface of each tooth. Then, the maximum depth value of the pathological gingival pockets is determined by selecting the maximum value from the obtained maximum depth values in the area of each surface of each examined tooth. In the presence of the obtained maximum value of less than 4 mm, I, that is, a light degree of periodontitis, is determined, with a value of 4-5.9 mm - II, that is, an average degree of periodontitis, with values of 6 or more mm, III, that is, a severe degree of periodontitis, is determined.

The method is as follows: The claimed method for determining the degree of periodontitis is carried out in the dental office on an outpatient basis or in a dental hospital.

Use the following equipment: a dental unit, a gun with a supply of water and air, a dental lamp.

Tools used: dental mirror, dental tweezers, periodontometer from 1 to 10 mm in increments of 1 mm.

The method is carried out by one dentist or with the help of an assistant dentist:

1. Determine the depth of pathological periodontal pockets of the examined teeth along the entire width of the medial, distal, external and internal surfaces of each examined tooth using a dental periodontometer with divisions on the working part from 1 to 10 mm in increments of 1 mm. The probe is placed parallel to the axis of the tooth. Sounding is carried out from the edge of the outer surface to the inner.

2. After the introduction of the dental periodontometer into the pathological periodontal pocket, the above periodontometer is deflected by an acute angle from the axis of the tooth by 2-4 degrees and produce a sliding movement downward when examining the teeth of the lower jaw or upward when examining the teeth of the upper jaw.

3. After determining the depth of each pathological periodontal pocket of each surface of each tooth, the dental periodontometer is removed from the above pocket with its subsequent introduction into the same pocket, while departing from the previous place of its introduction to the width of the working part of the periodontometer.

4. The removal of the dental periodontometer from the above pocket, followed by its next introduction into the same pocket, is carried out until a complete examination of each surface of each tooth.

5. Then, the maximum depth value of the pathological periodontal pockets of the examined teeth is determined by selecting the maximum value from the obtained maximum depth values in the area of each surface of each examined tooth.

6. Moreover, in patients with fixed orthopedic structures, excluding implants, the depth of pathological periodontal pockets is determined in the abutment teeth.

With the obtained maximum value of less than 4 mm, I, that is, a light degree of periodontitis, is determined, with a value of 4-5.9 mm, II, that is, an average degree of periodontitis, with values of 6 or more mm, III, that is, a severe degree of periodontitis, is determined.

Significant distinguishing features and a causal relationship between them and the achieved technical result:

• The depth of the pathological periodontal pockets of the examined teeth is additionally determined over the entire width of the above 4 surfaces of each examined tooth using a dental periodontometer with divisions on the working part from 1 to 10 mm in increments of 1 mm.

Determining the depth of pathological periodontal pockets of the examined teeth along the entire width of the above 4 sides of each examined tooth gives additional, unlike the prototype, information about the periodontal destruction volume.

The determination of the depth of the medial and distal pockets of the above 4 surfaces of each examined tooth along the entire width is possible with the help of a dental periodontometer, in contrast to the button probe used in the prototype method, which eliminates excessive manipulations that are a risk of injury to the patient, as well as examine narrow pathological periodontal pockets without risk of damage to the oral mucosa.

The divisions on the working part of the dental periodontometer (1 mm, 2 mm, 3 mm, 5 mm, 7 mm, 8 mm, 9 mm, 10 mm) correspond to the divisions of the accepted classification of periodontitis, which ensures the determination of the degree of periodontitis, namely: at 4 mm determine I, that is, a light degree of periodontitis, with 4-5.9 mm, - II, that is, an average degree of periodontitis, with 6 or more mm, III, that is, a severe degree of periodontitis, is determined.

• After the dental periodontometer is inserted into the pathological periodontal pocket, it is deflected at an acute angle from the axis of the tooth, which allows you to visually assess the pathological gingival pocket, determine the presence of subgingival tartar, or hear a cryptic sound, which corresponds to the absence of subgingival dental deposits.

• After determining the depth of each pathological periodontal pocket of each surface of each tooth, the dental periodontometer is removed from the above pocket with its subsequent introduction into the same pocket, while departing from the previous place of its introduction to the width of the working part of the periodontometer, and the removal of the dental periodontal probe from the above pocket with its subsequent next introduction into the same pocket is carried out until a complete examination of each surface of each tooth.

The movement of the dental periodontometer is necessary for the maximum examination of each surface of each tooth in order to determine the maximum depths of the pathological periodontal pockets.

The removal of the dental periodontometer from the above pocket with its subsequent introduction into the same pocket is necessary in order to prevent periodontal injury (bleeding and tearing of the periodontal ligament).

A deviation from the previous injection site of the dental periodontometer to the width of its working part, that is, 0.5 mm, is necessary for a complete examination of the bottom of each pathological periodontal pocket of each surface of each tooth.

The removal of the dental periodontometer from the above pocket with its subsequent introduction into the same pocket is carried out until a complete examination of each surface of each tooth.

• Then, the maximum depth value of the pathological periodontal pockets of the examined teeth is determined by selecting the maximum value from the obtained maximum depth values in the area of each surface of each examined tooth.

• In patients with fixed orthopedic constructions, excluding implants, the depth of pathological periodontal pockets is determined only in the abutment teeth, since these teeth may have pathological periodontal pockets.

Thus, the set of essential distinguishing features is new and ensures the achievement of a technical result and the implementation of the objectives of the invention.

We give examples from clinical practice:

Example 1

Patient A., 35 years old. I went to the dentist about bleeding gums with oral hygiene.

In the oral cavity, the gum bleeds when probed and plaque is determined. The number of teeth during the initial examination is 32, which is 128 surfaces for study. 61 surfaces with a depth of pathological periodontal pockets = 3.5 mm are determined.

Diagnosis: periodontitis of mild severity.

Example 2

Patient S., 40 years old. I went to the dentist about bleeding gums with oral hygiene.

In the oral cavity, the gum bleeds when probed and plaque is determined. The number of teeth during the initial examination is 31, which is 124 surfaces to study. A surface of 80 is determined with maximum depths of pathological periodontal pockets = 3.5 mm.

Diagnosis: periodontitis of mild severity.

Example 3

Patient B., 37 years old. I went to the dentist's doctor about bleeding gums with hygiene, odor from the oral cavity, periodic itching and pain in the gums. Previously, he consulted a dentist about gum disease, but the treatment brought little relief.

In the oral cavity, the gums bleed during probing, the presence of abundant soft plaque in the area of contact between the teeth is determined. The number of teeth during the initial examination is 28, which corresponds to 112 surfaces for examination. 72 surfaces with maximum depths of pathological periodontal pockets of 4-5.9 mm are determined. Of these, 23 surfaces with a maximum depth of pathological periodontal pockets of 4.5 mm, 45 surfaces with a maximum depth of pathological periodontal pockets of 5 mm and 4 surfaces with a maximum depth of pathological periodontal pockets of 5.5 mm.

Diagnosis: periodontitis of moderate severity

Example 4

Patient S., 42 years old. I went to the dentist's doctor about bleeding gums with hygiene, smell from the oral cavity and pain in the gums.

In the oral cavity, the gums bleed when probed. The number of teeth during the initial examination is 28, which is 112 surfaces for research. 83 surfaces with maximum depths of pathological periodontal pockets = 5 mm are determined.

Diagnosis: Periodontitis of moderate severity.

Example 5

Patient T., 50 years old. I went to the dentist for bleeding gums with oral hygiene, previously I have not been observed by a periodontist.

In the oral cavity, the gums bleed during sounding and plaque was determined. The number of teeth during the initial examination is 30, which corresponds to 120 surfaces for research. 61 surfaces with pathological periodontal pockets are determined, of which 3 surfaces with pathological periodontal pockets of a maximum depth of 4.5 mm, 34 surfaces with pathological periodontal pockets equal to a maximum depth of 5 mm and 24 surfaces with pathological periodontal pockets equal to a maximum depth of 5.5 mm.

The diagnosis is periodontitis of moderate severity.

Example 6

Patient N., 55 years old. I went to the dentist's doctor about bleeding gums with hygiene, odor from the oral cavity and tooth mobility.

In the oral cavity, the gum bleeds when probed, the presence of abundant soft plaque and multiple dental deposits and tooth mobility is determined. The number of teeth during the initial examination is 22, which is 88 surfaces for research. 67 surfaces with maximum depths of pathological periodontal pockets of 6 mm are determined, 5 surfaces with maximum depths of pathological periodontal pockets of 7 mm, 9 surfaces with maximum depths of pathological periodontal pockets of 8 mm and 2 surfaces with maximum depths of pathological periodontal pockets of 10 mm.

Diagnosis: severe periodontitis.

Example 7

Patient T., 68 years old. I went to the dentist about bleeding gums with hygiene, smell from the oral cavity.

The number of teeth during the initial examination is 18, which is 72 surfaces for research. 43 surfaces with maximum depths of pathological periodontal pockets of 6 mm are determined, 3 surfaces with maximum depths of pathological periodontal pockets of 7 mm, 10 surfaces with maximum depths of pathological periodontal pockets of 8 mm and 1 surface with a maximum depth of pathological periodontal pockets of 9 mm.

Diagnosis: severe periodontitis

A total of 160 patients (115 men and 45 women) were examined, of which a mild periodontitis was detected in 40 patients, an average in 50, and a severe periodontitis was found in 70 patients.

Thus, the claimed method for determining the degree of periodontitis allows you to:

• expand information on the full extent of periodontal destruction;

• simplify the determination of the depth of the medial and distal pathological periodontal pockets, as well as in the narrow above pockets without the risk of periodontal injury (bleeding and tearing of the periodontal ligament);

• determine the depths of pathological periodontal pockets along the entire width of the lateral 4 sides of each examined tooth, which expands the information on the full extent of periodontal destruction and eliminates the excessive manipulations inherent in the prototype, which will reduce the risk of periodontal injury (bleeding and separation of the periodontal ligament);

• to exclude the use of a periodontal probe with a spherical tip due to the selection of the probe design, which reduces the risk of periodontal injury and improves the objectivity of the method for determining the degree of periodontitis,

which provides:

• increasing the objectivity of the method for determining the degree of periodontitis;

• the ability to determine the depth of pathological periodontal pockets regardless of the topographic and anatomical features of the examined periodontium, in the presence of fixed dental orthopedic structures, as well as in case of crowding of teeth, inclination of teeth along the axis in different directions and overhang of fixed dental orthopedic structures;

• reduced risk of periodontal injury (bleeding and separation of the periodontal ligament);

• simplification of the method.

Claims (2)

1. A method for determining the degree of periodontitis, which consists in determining the depth of the pathological periodontal pockets of the examined teeth from the medial, distal, outer and inner surfaces of the tooth using a dental periodontometer, followed by determining the maximum value of their depth, and if the maximum value obtained is less than 4 mm, I, that is, a light degree of periodontitis, with a value of 4-5.9 mm - II, that is, an average degree of periodontitis, with values of 6 or more mm, III, that is, a severe degree of periodontitis, characterized in that the depth of the pathological periodontal pockets of the examined teeth is additionally determined over the entire width of the above 4 sides of each examined tooth using a dental periodontometer with divisions on the working part from 1 to 10 mm in increments of 1 mm, and after its introduction into the pathological periodontal pocket, the periodontometer is rejected by an acute angle from the axis of the tooth, and after determine the depth of each pa of the periodontal pocket of each surface of each tooth, the dental periodontometer is withdrawn from the above pocket with its subsequent introduction into the same pocket, while departing from the previous place of its introduction to the width of the working part of the periodontometer, and the removal of the dental periodontometer from the above pocket with its subsequent introduction into the the same pocket is carried out until a complete examination of each surface of each tooth; the maximum depth value of the pathological periodontal pockets of the examined teeth is determined by selecting the maximum depth in the area of each surface of each examined tooth. 2. A method for determining the degree of periodontitis according to claim 1, characterized in that in patients with fixed orthopedic structures, excluding implants, the depth of pathological periodontal pockets is determined only in the abutment teeth.