RU2755170C1 - Method for assessing the degree of oral halitosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to the field of medicine, namely dentistry, and is intended for assessing the condition of the oral cavity in halitosis. The oral cavity is visually examined using dental equipment and the medical history is collected. The condition of the oral cavity is assessed by the following criteria: oral odour, sensations in the mouth and a sense of taste or odour from the mucous membrane, a history of poor oral hygiene, gingival bleeding, inflammation, pain sensation from pressure or percussion on the teeth, after application of dental floss, presence of soft dental plaque, presence of dental calculus, frequency of hygienic oral care, presence of tongue plaque, area of tongue plaque, determination of oral odour depending on the distance from the source of this odour. The following assessment criteria are used: 0.0 to 11.0 - no halitosis events; 11.1 to 22.0 - a compensated condition, substantially undetectable oral odour; within 22.1 to 33.0 - a relatively compensated condition, weak but clearly defined oral odour; at an indicator of 33.1 to 44.0 - a severe condition; at an assessment of 44.1 to 55.0 - a very severe condition; extremely foul oral odour.

EFFECT: ensures diagnostics of the condition of the oral cavity in halitosis, excluding subjective interpretation of the results of visual inspection.

1 cl, 3 ex

Description

The proposed invention relates to the field of medicine, namely dentistry, and is intended for the clinical diagnostic assessment of bad breath in the population.

In dentistry, the problem of diagnosing bad breath is an urgent problem. One of the important signs of a person's dental health is the presence or absence of bad breath. In this regard, more attention has been paid to this symptom of many dental and somatic diseases. In order to understand how this feature is expressed, it is necessary to learn how to evaluate it, and for this to transfer its perception from the plane of subjective perception to the plane of objective one. Bad breath or halitosis is a common condition. In most individuals, it has a transient character, since it mainly occurs in the morning after sleep, when the level of saliva secretion in a person decreases, and this form of bad breath is easily eliminated as a result of adequate personal hygiene. Persistent halitosis is an indicator that there may be foci of inflammation in the oral cavity caused by pathogenic microorganisms or their accumulation in plaque at the root of the tongue. In addition, halitosis can be a consequence of common diseases such as diabetes, hiatal hernia, cirrhosis of the liver. Sociological studies in various countries of the world indicate an increase in the number of people who show anxiety about the appearance of their breath [1-4].

A known method for detecting halitosis using a gas sensor, which notifies of the detection of compounds indicating halitosis, exhaled through the mouth. Image sensor for capturing the condition of the teeth and / or tongue. A processor associated with the ability to communicate with the gas sensor and the image sensor, and also configured to process the sensor signal and images in order to determine, in the event that the sensor signal signals the presence of compounds indicative of halitosis, by determining the condition of the teeth and / or language in the image (RF patent for invention No. 2721939 C2, А61В 1/24, G01N 33/497).

The claimed method has the following disadvantages:

1. In a clinical setting, it does not allow assessing the dynamics of the pathological process in the early stages.

2. Dynamic observation is not provided.

3. Does not take into account the level of oral hygiene and the specifics of its implementation

4. Requires the use of complex, expensive equipment, reagents and special training of medical personnel.

A known method for diagnosing, predicting and monitoring inflammatory diseases of the oral cavity, such as gingivitis or periodontitis, and associated conditions, such as bad breath or bad breath. The method of the present invention can also be used to evaluate potential therapeutic agents for the treatment and / or amelioration of symptoms associated with oral inflammation. The methods of the present invention can be used to determine the presence, absence, or severity of inflammation in the oral cavity. The invention relates to the field of dentistry and discloses a method for determining the effectiveness of a treatment in a subject who has detected inflammation in the oral cavity. The method includes obtaining a test sample of material from the oral cavity, such as saliva, from a specified subject, determining the amount of polymorphonuclear neutrophils or an indicator substance of polymorphonuclear neutrophils in said analyzed sample, comparing the number of polymorphonuclear neutrophils or an indicator substance of polymorphonuclear neutrophils in said analysis sample with a control and control treatment (RF patent for invention No. 2702736, G01N 33/569). The disadvantages of the claimed method are:

1. Carrying out biochemical methods in the laboratory, which greatly complicates the registration process.

2. In clinical conditions, it is not possible to assess the dynamics of the pathological process in the early stages.

One of the serious disadvantages of most of the known methods is that in a clinical setting they do not allow assessing the dynamics of the pathological process. Functional and biochemical methods require the use of complex, expensive equipment, reagents and special training of medical personnel.

According to the closest essence, as a prototype, we have chosen the method of index assessment of the severity of halitosis according to Ulitovsky (VSU index) is estimated by the severity of bad breath depending on its intensity and frequency (duration in time). The index is assessed according to the following formula: VSU Index = (IZ Index + ChZ Index) / 2, where IZ Index is the odor intensity index, FZ Index is the odor frequency (duration) index. The odor intensity index was assessed on a 5-point scale, assigned: 0 points - the absence of the slightest smell in close proximity (several cm); 1 point - a faint smell at a distance of no more than 20 cm, but not distinguishable at a distance of 0.5 meters; 2 points - smell, perceptible at a distance of up to 0.5 meters; 3 points - moderately pronounced, perceptible at a distance of 1 meter from the patient's mouth; 4 points - pronounced, perceptible at a distance of 1.5 meters; 5 points - very strong, perceptible at a distance of 2 meters or more. The odor frequency index was assessed on a 5-point scale, assigned: 0 points - there is no smell from the mouth (almost always); 1 point - weak, periodic odor from the mouth (rarely, but with a frequency of at least once a week); 2 points - weak regular breath odor, only in the morning, disappearing after brushing teeth and eating; 3 points - moderate breath on an empty stomach, disappearing after eating; 4 points - pronounced bad breath that disappears for a short period of time under the influence of personal oral hygiene products, food intake or the use of means for deodorizing the oral cavity; 5 points - unpleasant persistent odor from the mouth, which is not eliminated (even for a short time) by any means. When the value of the sum of the index assessment of the severity of halitosis according to Ulitovsky is 0 points - a good state of health of the oral cavity is what we mean by the concept of practically healthy (there is no smell from the mouth); 1 point - conditionally healthy; periodically appearing odor from the mouth or an extremely weak odor, which may be associated with the presence of cases of single dental caries, localized gingivitis or periodontitis, the phenomena of initial stomatitis, as well as the initial forms of gastritis; 2 points - the state of health is somewhat deteriorated, since there is a more pronounced odor from the mouth, but it is more associated with some strong single effects on the body (for example, with alcohol abuse on the eve of the study); 3 points - significant deterioration in health, locally associated with severe carious disease; chronic generalized periodontitis of moderate severity; lack of regular individual oral hygiene, especially cleaning of the interdental spaces; chronic sticking of food debris between the teeth, leading to its accumulation and decomposition, which provides a rather fetid odor from the mouth, but it is distinguished by a fairly quick elimination when removing the debris of decomposing food; beginning pathological changes in the gastrointestinal tract, lungs or other internal organs; 4 points - poor health; not sanitized oral cavity; against this background, personal oral hygiene is absent; more severe changes in internal organs; 5 points - a state of pronounced illness of the whole organism (for example, a bedridden patient who is not able to serve himself independently); the oral cavity is not sanitized: severe carious disease, severe chronic generalized periodontitis, severe general somatic changes in the body [5].

The disadvantages of the prototype method are:

• there is no practical difference between the presence of soft dental plaque and tartar;

• there is no assessment of the plaque area in the language;

• does not take into account the peculiarities of individual oral care.

The objective of the invention is:

• assess the state of oral respiration in dental patients as comprehensively and accurately as possible;

• to increase the availability of assessment of bad breath in a clinical setting at a dental appointment. The result of the invention is:

• exclusion of subjective interpretation by the researcher of the results of halitosis;

• the ability to determine bad breath in a dental patient;

• allows you to monitor changes in the state of odor from the mouth and its change under the influence of prophylactic agents;

• allows you to monitor the effectiveness of the treatment of halitosis, and, if necessary, to correct it.

This result is achieved by the fact that during a visual examination, the clinical picture is studied and, based on the results of the assessment of a dental patient, a digital assessment of bad breath is determined. The method is carried out as follows: the teeth are examined using dental instruments: probe, mirror, tweezers. During the examination, such criteria as halitosis are taken into account: absent - 1 point; bad breath occurs periodically - 2 points; weak breath, but persistent, does not bother - 3 points; bad breath is moderate, but constant, people around pay attention - 4 points; complaints of fetid odor from the mouth strong and constant, hostility of others - 5 points. Unpleasant sensations in the mouth and the sensation of unpleasant taste or odor from the mucous membrane in the mouth are assessed - 1 point; practically not determined - 2 points; weak - 3 points; expressed - 4 points; extremely pronounced - 5 points. A history of poor oral hygiene, bleeding gums, inflammation, pain when pressing on the teeth, or tapping on them is taken into account: absent - 1 point; single - 2 points; periodically noted - 3 points; pronounced manifestations - 4 points; extremely pronounced persistent and abundant manifestations - 5 points. During the conversation, the interlocutors are taken into account, they deviate or try to stand aside or away: do not react - 1 point; react rarely and without any special external manifestations - 2 points; the reaction is weak, but clearly visible - 3 points; a pronounced reaction causing significant visible manifestations - 4 points; extremely pronounced reaction, up to statements or manifestations - 5 points. Determined after the use of dental floss: there is no smell from it - 1 point; there is practically no unpleasant odor from dental floss - 2 points; weak, but clearly defined bad smell from dental floss - 3 points; pronounced unpleasant, causing a bad smell from the thread - 4 points; extremely offensive odor from dental floss - 5 points. The presence of soft dental plaque is assessed: absent - 1 point; almost undetectable soft plaque - 2 points; limited, but clearly defined soft plaque - 3 points; pronounced soft plaque covering most of the surfaces of the crowns of the teeth - 4 points; extremely abundant soft plaque covering almost the entire crown of the tooth - 5 points. The presence of dental calculus is taken into account: absent - 1 point; practically undetectable calculus - 2 points; limited, but clearly defined hard dental plaque, supra and / or subgingival - 3 points; pronounced hard plaque covering most of the surfaces of the crowns of teeth and / or roots - 4 points; extremely abundant hard plaque covering almost the entire tooth crown or root - 5 points. The frequency of hygienic oral care is determined: regular, after each meal - 1 point; twice a day, after breakfast and before bed - 2 points; once a day - 3 points; once a week - 4 points; less than once a week or before some important events - 5 points. The presence of plaque in the language is assessed: absent - 1 point; practically undetectable whitish-yellowish bloom - 2 points; limited, but clearly defined yellow-brown bloom - 3 points; pronounced dark plaque covering most of the dorsum (outer) surface of the tongue - 4 points; extremely abundant black plaque covering almost the entire outer (papillary) surface of the tongue - 5 points. The area of plaque in the language is taken into account: absent - 1 point; takes up to ¼ of the dorsum of the tongue - 2 points; plaque in the tongue from ¼ to ½ - 3 points; plaque in the tongue from ½ to ¾ - 4 points; plaque on the tongue more than ¾ or covers the entire dorsum - 5 points. Determination of bad breath depending on the distance from the source of this smell: halitosis at a distance of 10 cm - 1 point; halitosis at a distance of half a meter - 2 points; halitosis at a distance of 75 cm - 3 points; halitosis at a distance of 1 m - 4 points; halitosis at a distance of 1.5 m - 5 points.

Each of the above indicators is assessed using a simple point system from 1 to 5 points.

Assessment value = Σ (a ₁ +… + a _n ), where Σ is the sum of quantitative assessments of the criteria; a ₁ - the value of the score for the first criterion; a _n - the value of the score for the n-th criterion; n is the number of criteria used in the assessment; 5 - the number of evaluated parameters within each criterion. In our case, the number of criteria is 11, so the formula will look like this: score value = Σ (a ₁ +… + a ₅₅ ), this formula calculates the numerical value of the score.

Evaluation criteria: 0.0-11.0 - there are no phenomena of halitosis (no smell). The health of the mouth is very good; 11.1-22.0 - a compensated state, almost undetectable odor from the mouth. Good condition; in the range of 22.1-33.0 - a relatively compensated state, weak, but clearly defined odor from the mouth. The condition is relatively satisfactory with indicators up to 27.6 points and unsatisfactory from 27.7 to 33.0 points; with a score equal to 33.1-44.0 - serious condition; pronounced halitosis. The condition is unsatisfactory; with an estimate of 44.1-55.0 - a very serious condition; extremely offensive odor from the mouth. The condition is very poor.

Essential distinguishing features of the proposed method and the causal relationship between them and the achieved technical result:

• Using an assessment of bad breath against the appropriate criteria: halitosis, discomfort in the mouth and feeling of bad taste or odor from the mucous membranes in the mouth, a history of poor oral hygiene, bleeding gums, inflammation, pain when pressing on the teeth, or tapping on them, while talking, the interlocutors deviate or try to stand to the side or away, after using dental floss, the presence of soft dental plaque, the presence of tartar, the frequency of hygienic oral care, the presence of plaque on the tongue, the area of plaque on the tongue, determination of bad breath depending on the distance from the source of this odor.

• Use of detailed evaluation criteria: 0.0-11.0 - there are no phenomena of halitosis; 11.1-22.0 - a compensated state, practically undetectable odor from the mouth; in the range of 22.1-33.0 - a relatively compensated state, weak, but clearly defined odor from the mouth; with an indicator equal to 33.1-44.0 - a serious condition; with an estimate of 44.1-55.0 - a very serious condition; extremely offensive odor from the mouth.

This significant distinguishing feature also eliminates inaccuracies in the interpretation of the valuation data.

The set of essential distinctive features is new and allows:

• To judge that the proposed method of assessment, according to the data of the conducted research, is distinguished by its simplicity, completeness of coverage of the assessment criteria, and the availability of conducting at a dental appointment.

• Reduce the time spent on determining dental health.

Examples from clinical practice:

Example 1. Patient B., 34 years old.

He complained of bad breath and bleeding when brushing his teeth. Anamnesis: complaints appeared about six months ago, associates with the onset of periodontal tissue disease and the peculiarities of the diet. Objectively: there is no facial asymmetry, regional lymph nodes are not changed, there are no signs of oncopathology.

The control examination revealed the presence of an unpleasant odor from the mouth, weak, but constant. Doesn't bother - it corresponds to 3 points, unpleasant sensations in the mouth and a feeling of unpleasant taste or odor from the mucous membrane in the mouth are practically not determined, which corresponds to 2 points, a history of poor oral hygiene, bleeding gums, pronounced manifestations of inflammation, which corresponds to 4 points, when talking, the interlocutors deviate or try to stand to the side or further away, the reaction is weak, but clearly visible, which corresponds to 3 points, after the use of dental floss, a weak but clearly defined bad smell from dental floss, which corresponds 3 points, limited but clearly defined soft plaque, which corresponds to 3 points, practically undetectable tartar, which corresponds to 2 points, the frequency of hygienic oral care once a day, which corresponds to 3 points, limited, but clearly defined yellow-brown plaque on the tongue, which corresponds to 3 points, plaque area on the tongue from ¼ to ½, which corresponds 3 points, halitosis at a distance of half a meter, which corresponds to 2 points.

Calculating the indicator according to the formula: the value of the assessment = Σ (a ₁ +… + a ₅₅ ), we get a value equal to 31, which is estimated as a relatively compensated state, weak but clearly detectable odor from the mouth, the state is unsatisfactory. Based on this assessment, we make a conclusion about the need for intensive treatment of halitosis.

Example 2. Patient S., 64 years old.

She complained of bleeding gums when brushing teeth and bad breath. Anamnesis: generalized periodontitis of moderate severity. Objectively: there is no facial asymmetry, regional lymph nodes are not changed, there are no signs of oncopathology. The corners of the mouth are lowered, the nasolabial and chin folds are pronounced. The mucous membrane of the gums is hyperemic in the area of all groups of teeth on the upper and lower jaws. The control examination revealed the presence of an unpleasant odor from the mouth, moderate, but constant. The surrounding people pay attention, which corresponds to 4 points, discomfort in the mouth and a feeling of unpleasant taste or odor from the mucous membrane in the mouth are pronounced, which corresponds to 4 points, a history of poor oral hygiene, bleeding gums, inflammation, pain with pressing on the teeth, or tapping on them pronounced manifestations, which corresponds to 4 points, when talking, the interlocutors deviate or try to stand to the side or away, the reaction is weak, but clearly visible, which corresponds to 3 points, an extremely fetid odor from dental floss , which corresponds to 5 points, limited but clearly defined soft plaque, which corresponds to 3 points, limited but clearly defined hard plaque, supra and / or subgingival, which corresponds to 3 points, the frequency of hygienic care mouth twice a day, after breakfast and before bedtime, which corresponds to 2 points, pronounced dark plaque covering most of the dorsal (outer) the surface of the tongue, which corresponds to 4 points, the plaque area on the tongue is from ½ to ¾, which corresponds to 4 points, halitosis at a distance of 75 cm, which corresponds to 3 points.

Calculating the indicator according to the formula: the value of the estimate = Σ (a ₁ +… + a ₅₅ ), we get a value equal to 39, which is estimated as a serious condition; pronounced halitosis. The condition is unsatisfactory. Based on the result obtained, it should be concluded that the patient needs serious treatment to eliminate halitosis.

Example 3. Patient D., 22 years old.

He complained of bleeding gums. Objectively: there is no facial asymmetry, regional lymph nodes are not changed, there are no signs of oncopathology. Palpation of the masticatory muscles is painless. The mucous membrane of the gums is hyperemic in the area of all groups of teeth on the upper and lower jaws. The control examination revealed the presence of bad breath occurs periodically (from time to time), which corresponds to 2 points, unpleasant sensations in the mouth and a feeling of unpleasant taste or odor from the mucous membrane in the mouth are weak, which corresponds to 2 points, a history of poor oral hygiene, bleeding gums, inflammation, pain when pressing on the teeth, or tapping on them periodically is noted, which corresponds to 3 points, when talking, the interlocutors deviate or try to stand to the side or away, do not react, which corresponds to the 1st point, there is practically no unpleasant odor from dental floss, which corresponds to 2 points, limited but clearly defined soft plaque, which corresponds to 3 points, there is no tartar, which corresponds to 1 point, the frequency of hygienic oral care is one once a day, which corresponds to 3 points, an almost undetectable whitish-yellowish coating on the tongue, which corresponds to 2 points, flat sparing of plaque on the tongue occupies up to ¼ of the dorsum of the tongue, which corresponds to 2 points, halitosis at a distance of 10 cm, which corresponds to 1 point. Calculating the indicator according to the formula: the value of the assessment = Σ (a ₁ +… + a ₅₅ ), we get a value equal to 22, which is estimated as a compensated state, almost undetectable odor from the mouth. Good condition. Based on the results obtained, it can be concluded that the phenomena of halitosis are absent and treatment is not required at the moment.

The inventive method for assessing bad breath has been tested on 124 patients.

Thus, the presented examples clearly demonstrate the effectiveness of the proposed method for determining bad breath, which greatly facilitates the diagnostic process and improves the quality of dental treatment.

The tests of the proposed method have confirmed its advantages over the prototype method: the result of the assessment of bad breath is achieved by using the assessment of halitosis according to the appropriate criteria, in contrast to the prototype method, where there is no practical difference between the presence of soft plaque and tartar, area assessment is not provided plaque on the tongue and does not take into account the peculiarities of individual oral care.

The simplicity of the method for determining the evaluation criteria, which does not require additional calculations, greatly facilitates the application of the proposed method in practical dentistry and in scientific research and reduces the time for its determination, which is of fundamental importance during outpatient reception of patients. Mathematical assessment of the amount of bad breath increases the accuracy of the diagnosis, determining the choice of treatment method.

Thus, the proposed invention optimizes the diagnosis of bad breath by using a new assessment method, and simplifies the process of monitoring the health of the oral cavity, which allows you to dynamically monitor the state of oral respiration.

Bibliography:

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2. Hunter CM, Niles HP, Lenton PA, Majerus GJ, Vazquez J., Kloos C., Subramayan R., Williams MI, Cummins D. Evaluation of breath odor by the determination of volatile sulfur compounds and its correlation with the organoleptic method // Institute of Dentistry. - 2006. - No. 1 (30). - with. 124-126.

3. Firsova I.V., Fedotova Yu.M., Mikhalchenko V.F., Dimitrova M.S., Veremeenko T.V., Baklanova A.A. An integrated approach to eliminating halitosis // International Journal of Applied and Fundamental Research. - 2016. - No. 3 (1) - P. 100-102.

4. Reef I.Ye., Tsimbalistov A.V. Features of microbiocenosis of periodontal pockets and plaque from the back of the tongue in patients with halitosis on the background of combined dental and otorhinolaryngological pathology. Institute of Dentistry. - 2014. -No. 3 (64). - with. 83-85.

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Claims (1)

A method for assessing the degree of halitosis of the oral cavity, including a visual examination of the oral cavity, characterized in that the odor from the mouth is evaluated in points: absent - 1 point; occurs periodically - 2 points; constant, but does not bother - 3 points; constant and others pay attention - 4 points; persistent and fetid odor - 5 points; assess the presence of discomfort and taste in the mouth: absent - 1 point; practically not determined - 2 points; weak - 3 points; expressed - 4 points; extremely pronounced - 5 points; assess the presence of a history of bleeding gums, inflammation, pain when pressing or tapping on the teeth: absent - 1 point; single - 2 points; periodically noted - 3 points; pronounced manifestations - 4 points; pronounced persistent manifestations - 5 points; the odor after the use of dental floss is assessed: absent - 1 point; practically absent - 2 points; clearly defined smell - 3 points; pronounced smell - 4 points; fetid odor - 5 points; assess the presence of soft dental plaque: absent - 1 point; almost undetectable soft plaque - 2 points; limited, but clearly defined soft plaque - 3 points; soft plaque covering most of the surfaces of the crowns of the teeth - 4 points; soft plaque covering almost the entire crown of the tooth - 5 points; assess the presence of dental calculus: absent - 1 point; practically undetectable calculus - 2 points; limited, but clearly defined hard dental plaque, supra and / or subgingival - 3 points; pronounced hard plaque covering most of the surfaces of the crowns of teeth and / or roots - 4 points; extremely abundant hard plaque covering almost the entire tooth crown or root - 5 points; identify the frequency of hygienic oral care: regular, after each meal - 1 point; twice a day, after breakfast and before bed - 2 points; once a day - 3 points; once a week - 4 points; less than once a week - 5 points; reveals the presence of plaque in the language: absent - 1 point; practically undetectable whitish-yellowish bloom - 2 points; limited, but clearly defined yellow-brown bloom - 3 points; pronounced dark plaque covering most of the dorsum of the tongue - 4 points; extremely abundant black plaque covering almost the entire surface of the tongue - 5 points; assess the area of plaque in the language: absent - 1 point; takes up to ¼ of the dorsum of the tongue - 2 points; from ¼ to ½ - 3 points; from ½ to ¾ - 4 points; more than ¾ or covers the entire dorsum of the tongue - 5 points; odor from the mouth is determined depending on the distance from the source of this odor: odor from the mouth at a distance of 10 cm - 1 point; at a distance of half a meter - 2 points; at a distance of 75 cm - 3 points; at a distance of 1 m - 4 points; at a distance of 1.5 m - 5 points; then the received points are summed up and the degree of halitosis of the oral cavity is assessed: up to 11 points - there are no phenomena of halitosis, there is no smell from the mouth; from 11 to 22 points - a compensated state, almost undetectable odor from the mouth; from 22 to 33 points - a relatively compensated state, clearly defined odor from the mouth; from 33 to 44 points - unsatisfactory condition, pronounced odor from the mouth; 44 or more points - serious condition, fetid odor from the mouth.